Cofrogliptin

Cofrogliptin (HSK7653) is a long‐acting dipeptidyl peptidase‐4 inhibitor for the treatment of type 2 diabetes mellitus with a twice‐monthly dosing regimen. This study included 62 participants (48 without food effect, 14 with food effect) receiving single doses of HSK7653 (5, 10, 25, 50, 100, and 150 mg) or placebo. Pharmacokinetic samples were collected over 24 hours postdosing and sampling times are aligned with 12‐lead electrocardiograms (ECGs) which were derived from continuous ECG recordings. For the concentration‐QT interval corrected for heart rate (C‐QTc) analysis, we used linear mixed‐effects modeling to characterize the correlation between plasma concentrations of HSK7653 and the change from baseline in the QT interval which was corrected by Fridericia's formula (ΔQTcF). The result showed that a placebo‐corrected Fridericia corrected QT interval (ΔΔQTcF) prolongation higher than 10 milliseconds is unlikely at the mean maximum observed concentration (Cmax) (411 ng/mL) associated with the recommended therapeutic doses (25 mg twice‐monthly), even at the highest supratherapeutic concentration (2425 ng/mL). Thus, HSK7653 does not significantly affect QT prolongation at either recommended doses or the highest supratherapeutic concentration.

To investigate the metabolism and disposition characteristics of HSK7653 in healthy male Chinese participants.

A single oral dose of 80 μCi (25 mg) [14C]HSK7653 capsules was administered to six healthy participants, and blood, plasma, urine and faeces were collected. Quantitative and qualitative analysis was conducted to investigate the pharmacokinetics, blood‐to‐plasma ratio, mass balance and metabolism of HSK7653.

The drug was well absorbed and reached a maximum concentration at 1.25 h. The drug‐related components (HSK7653 and its metabolites) were eliminated slowly, with a half‐life (t1/2) of 111 h. Unchanged HSK7653 contributed to more than 97% of the total radioactivity in all plasma samples. The blood‐to‐plasma ratio (0.573‐0.845) indicated that HSK7653 did not tend to distribute into blood cells. At 504 h postdose, up to 95.9% of the dose was excreted, including 79.8% in urine and 16.1% in faeces. Most of the radioactivity (75.5% dose) in excreta was unchanged HSK7653. In addition, nine metabolites were detected in urine and faeces. The most abundant metabolite was M6‐2, a dioxidation product of HSK7653, which accounted for 4.73% and 2.63% of the dose in urine and faeces, respectively. The main metabolic pathways of HSK7653 in vivo included oxidation, pyrrole ring opening and sulphonamide hydrolysation.

HSK7653 was well absorbed, slightly metabolized and slowly excreted in humans. The high plasma exposure and long t1/2 of HSK7653 may contribute to its long‐lasting efficacy as a long‐acting dipeptidyl peptidase‐4 inhibitor.