Details
Stereochemistry | ABSOLUTE |
Molecular Formula | C27H26ClF3N6O3.C9H9NO3 |
Molecular Weight | 754.155 |
Optical Activity | UNSPECIFIED |
Defined Stereocenters | 2 / 2 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
OC(=O)CNC(=O)C1=CC=CC=C1.CCOC(=O)[C@@H](N)CC2=CC=C(C=C2)C3=CC(O[C@H](C4=C(C=C(Cl)C=C4)N5C=CC(C)=N5)C(F)(F)F)=NC(N)=N3
InChI
InChIKey=XSFPZBUIBYMVEA-CELUQASASA-N
InChI=1S/C27H26ClF3N6O3.C9H9NO3/c1-3-39-25(38)20(32)12-16-4-6-17(7-5-16)21-14-23(35-26(33)34-21)40-24(27(29,30)31)19-9-8-18(28)13-22(19)37-11-10-15(2)36-37;11-8(12)6-10-9(13)7-4-2-1-3-5-7/h4-11,13-14,20,24H,3,12,32H2,1-2H3,(H2,33,34,35);1-5H,6H2,(H,10,13)(H,11,12)/t20-,24+;/m0./s1
DescriptionCurator's Comment: Description was created using several sources including:
http://www.lexpharma.com/media-center/news/525-fda-extends-pdufa-date-for-telotristat-etiprate-for-the-treatment-of-carcinoid-syndrome;
https://www.ncbi.nlm.nih.gov/pubmed/25012985
Curator's Comment: Description was created using several sources including:
http://www.lexpharma.com/media-center/news/525-fda-extends-pdufa-date-for-telotristat-etiprate-for-the-treatment-of-carcinoid-syndrome;
https://www.ncbi.nlm.nih.gov/pubmed/25012985
Telotristat (telotristat etiprate) is an ethyl ester prodrug which is hydrolyzed to its active moiety LP-778902 both in vivo
and in vitro. Telotristat etiprate is an orally bioavailable, small-molecule, tryptophan hydroxylase (TPH) inhibitor. It is the first investigational drug in clinical studies to target TPH, an enzyme that triggers the excess serotonin production within metastatic neuroendocrine tumor (mNET) cells leading to carcinoid syndrome. Unlike existing treatments of carcinoid syndrome which reduce the release of serotonin outside tumor cells, telotristat etiprate reduces serotonin production within the tumor cells. By specifically inhibiting serotonin production telotristat may provide patients with more control over their disease. Telotristat etiprate has received Fast Track and Orphan Drug designation from the U.S. Food and Drug Administration and has been granted priority review by the FDA with a Prescription Drug User Fee Act (PDUFA) target action date of February 28, 2017.
CNS Activity
Sources: https://www.ncbi.nlm.nih.gov/pubmed/25012985
Curator's Comment: The molecule was designed not to cross the blood-brain barrier at the intended dose, and preclinical studies suggested that telotristat etiprate acts primarily peripherally, with little, if any, activity observed in the central nervous system.
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: 121278.0 Gene Symbol: TPH2 |
1210.0 nM [IC50] | ||
Target ID: 7166.0 Gene Symbol: TPH1 |
800.0 nM [IC50] | ||
Target ID: 121278.0 Gene Symbol: TPH2 |
32.0 nM [IC50] | ||
Target ID: 7166.0 Gene Symbol: TPH1 |
28.0 nM [IC50] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Curative | XERMELO Approved UseXermelo is a tryptophan hydroxylase inhibitor indicated for the treatment of carcinoid syndrome diarrhea in combination with somatostatin analog (SSA) therapy in adults inadequately controlled by SSA therapy. Launch Date2017 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
610 ng/mL |
500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered: |
TELOTRISTAT plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: FASTED |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
2320 ng × h/mL |
500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered: |
TELOTRISTAT plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: FASTED |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
5 h |
500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered: |
TELOTRISTAT plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: FASTED |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
1% |
500 mg single, oral dose: 500 mg route of administration: Oral experiment type: SINGLE co-administered: |
TELOTRISTAT plasma | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: FASTED |
Doses
Dose | Population | Adverse events |
---|---|---|
500 mg 3 times / day steady, oral Highest studied dose Dose: 500 mg, 3 times / day Route: oral Route: steady Dose: 500 mg, 3 times / day Sources: |
unhealthy, adult n = 14 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 14 Sources: |
Disc. AE: Abdominal pain, Shortness of breath... AEs leading to discontinuation/dose reduction: Abdominal pain (1 patient) Sources: Shortness of breath (1 patient) |
500 mg 3 times / day steady, oral Highest studied dose Dose: 500 mg, 3 times / day Route: oral Route: steady Dose: 500 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Disc. AE: Gastrointestinal disorders, Skin and subcutaneous tissue disorders... AEs leading to discontinuation/dose reduction: Gastrointestinal disorders (7.1%) Sources: Skin and subcutaneous tissue disorders (1.4%) Cardiac disorders (1.4%) |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 140 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 140 Sources: |
Disc. AE: Abdominal pain, GGT increased... AEs leading to discontinuation/dose reduction: Abdominal pain (4.3%) Sources: GGT increased (2.1%) |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Disc. AE: Gastrointestinal disorders, Psychiatric disorders... AEs leading to discontinuation/dose reduction: Gastrointestinal disorders (10%) Sources: Psychiatric disorders (2.9%) Infections and infestations (2.9%) Skin and subcutaneous tissue disorders (1.4%) Hepatobiliary disorders (1.4%) Metabolism and nutrition disorders (1.4%) Renal and urinary disorders (1.4%) Respiratory, thoracic and mediastinal disorders (1.4%) Vascular disorders (1.4%) |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Abdominal pain | 1 patient Disc. AE |
500 mg 3 times / day steady, oral Highest studied dose Dose: 500 mg, 3 times / day Route: oral Route: steady Dose: 500 mg, 3 times / day Sources: |
unhealthy, adult n = 14 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 14 Sources: |
Shortness of breath | 1 patient Disc. AE |
500 mg 3 times / day steady, oral Highest studied dose Dose: 500 mg, 3 times / day Route: oral Route: steady Dose: 500 mg, 3 times / day Sources: |
unhealthy, adult n = 14 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 14 Sources: |
Cardiac disorders | 1.4% Disc. AE |
500 mg 3 times / day steady, oral Highest studied dose Dose: 500 mg, 3 times / day Route: oral Route: steady Dose: 500 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Skin and subcutaneous tissue disorders | 1.4% Disc. AE |
500 mg 3 times / day steady, oral Highest studied dose Dose: 500 mg, 3 times / day Route: oral Route: steady Dose: 500 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Gastrointestinal disorders | 7.1% Disc. AE |
500 mg 3 times / day steady, oral Highest studied dose Dose: 500 mg, 3 times / day Route: oral Route: steady Dose: 500 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
GGT increased | 2.1% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 140 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 140 Sources: |
Abdominal pain | 4.3% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 140 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 140 Sources: |
Hepatobiliary disorders | 1.4% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Metabolism and nutrition disorders | 1.4% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Renal and urinary disorders | 1.4% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Respiratory, thoracic and mediastinal disorders | 1.4% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Skin and subcutaneous tissue disorders | 1.4% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Vascular disorders | 1.4% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Gastrointestinal disorders | 10% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Infections and infestations | 2.9% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Psychiatric disorders | 2.9% Disc. AE |
250 mg 3 times / day steady, oral Recommended Dose: 250 mg, 3 times / day Route: oral Route: steady Dose: 250 mg, 3 times / day Sources: |
unhealthy, adult n = 70 Health Status: unhealthy Condition: carcinoid syndrome Age Group: adult Population Size: 70 Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000ClinPharmR.pdf#page=8 Page: 7.0 |
likely | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000ClinPharmR.pdf#page=8 Page: 7.0 |
likely | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000ClinPharmR.pdf#page=8 Page: 7.0 |
likely | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000ClinPharmR.pdf#page=8 Page: 7.0 |
likely | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000ClinPharmR.pdf#page=8 Page: 7, 38 |
likely | |||
likely | ||||
Page: 10.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
no | |||
Page: 10.0 |
no | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Page: 10.0 |
unlikely | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
weak | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
weak | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
weak | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
weak | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
weak | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
weak | |||
Page: 10.0 |
yes | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
yes | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36.0 |
yes | |||
yes | no (co-administration study) Comment: 79% inihibition at 1 mcM, 30 min incubation (cytochrome P450isozymes using specific fluorometric substrates or human liver microsomal samples w/LC-MS/MS analysis), When 3 mg midazolam was coadministered orally after 5 day treatment with telotristat ethyl 500 mg three times daily (twice the recommended dosage), the mean Cmax , and AUC0-inf for midazolam were decreased by 25%, and 48%, respectively, compared to administration of midazolam alone. The mean Cmax , and AUC0-inf for the active metabolite, 1’-hydroxymidazolam, were also decreased by 34%, and 48%, respectively. Page: 36, (ClinPharm) 28-30, 38 |
|||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000ClinPharmR.pdf#page=31 Page: 30-31, 39 |
yes | unlikely (co-administration study) Comment: Following co-administration with telotristat ethyl (500 mg TID x 5 days (twice the recommended dose)), mean Cmax, and AUC0-inf for fexofenadine (180 mg with the final dose of telotristat ethyl) were 15.6%, and 14.3% higher, respectively compared to administration alone. Telotristat ethyl exhibited a lower level of P-gp inhibition in humans (<1.25-fold) that not clinically meaningful. Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000ClinPharmR.pdf#page=31 Page: 30-31, 39 |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36-37 |
likely | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36-37 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36-37 |
no | |||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=43 Page: 36-37 |
no |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=32 Page: 25.0 |
||||
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208794Orig1s000PharmR.pdf#page=32 Page: 25.0 |
Sample Use Guides
In Vivo Use Guide
Sources: https://clinicaltrials.gov/ct2/show/NCT01677910
Two 250 mg telotristat etiprate tablets three times daily over 12 weeks
Route of Administration:
Oral
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Classification Tree | Code System | Code | ||
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NCI_THESAURUS |
C471
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EU-Orphan Drug |
EU/3/09/661
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FDA ORPHAN DRUG |
266308
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1872448
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3T25U84H4U
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WW-147
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100000168560
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ACTIVE MOIETY
PARENT (SALT/SOLVATE)
PARENT (SALT/SOLVATE)
SUBSTANCE RECORD