Topical administration of regorafenib eye drops: phase I dose‐escalation study in healthy volunteers

• Published in: British journal of clinical pharmacology Vol. 84; no. 5; pp. 865 - 875
• Main Authors: Zimmermann, Torsten, Höchel, Joachim, Becka, Michael, Boettger, Michael K., Rohde, Beate, Schug, Barbara, Kunert, Kathleen S., Donath, Frank
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.05.2018
• Subjects: Administration, Ophthalmic; Administration, Oral; Adolescent; Adult; Clinical Trials; convenience; Dose-Response Relationship, Drug; Double-Blind Method; eye drops; Healthy Volunteers; Humans; Male; Middle Aged; neovascular age‐related macular degeneration; Ophthalmic Solutions - adverse effects; Ophthalmic Solutions - pharmacokinetics; pharmacokinetics; Phenylurea Compounds - administration & dosage; Phenylurea Compounds - adverse effects; Phenylurea Compounds - blood; Phenylurea Compounds - pharmacokinetics; Protein Kinase Inhibitors - administration & dosage; Protein Kinase Inhibitors - adverse effects; Protein Kinase Inhibitors - blood; Protein Kinase Inhibitors - pharmacokinetics; Pyridines - administration & dosage; Pyridines - adverse effects; Pyridines - blood; Pyridines - pharmacokinetics; regorafenib; safety; Young Adult; eye drops; neovascular age-related macular degeneration; pharmacokinetics; convenience; regorafenib; safety
• DOI: 10.1111/bcp.13502
• ISSN: 0306-5251; 1365-2125

Aim Regorafenib is a multikinase inhibitor under investigation for use in neovascular age‐related macular degeneration. In this phase I study, regorafenib eye drops were administered to healthy volunteers to provide information on safety, tolerability and systemic exposure. Methods This was a single‐centre, randomized, double‐masked, parallel‐group, dose‐escalation, placebo‐controlled study. Subjects received regorafenib eye drops (30 mg ml−1, 25 μl) as a 0.75 mg single dose (Cohort 1), 0.75 mg twice daily (bid) or thrice daily (tid) over 14 days (Cohorts 2 and 3, respectively), 1.5 mg tid unilaterally for 3 days, then bilaterally for up to 14 days (Cohort 4), or placebo. Plasma samples were taken to estimate systemic exposure. Safety and functional assessments were performed throughout the study. Results Thirty‐six subjects received regorafenib and 12 received placebo. Regorafenib was safe and well tolerated over the dose range. No pathological changes occurred in the anterior, vitreous or posterior eye compartments. Mild eyelid redness, oedema and conjunctival hyperaemia were observed across all regorafenib cohorts; these were comparable with the effects seen with placebo. Predominant symptoms were blurred vision in the active and placebo groups. Systemic safety evaluations showed no clinically relevant findings. Absolute systemic exposure after multiple administrations of regorafenib eye drops at a dose of 0.75 mg was 600–700‐fold lower than after multiple oral administration of 160 mg day−1, the dose approved in cancer indications. Conclusion These results indicate a favourable safety and tolerability profile of regorafenib eye drops up to 30 mg ml−1 tid for use in clinical studies.