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Lack of Clinical Pharmacodynamic and Pharmacokinetic Drug–Drug Interactions Between Warfarin and the Antisense Oligonucleotide Mipomersen

Li, Zhaoyang PhD*; Hard, Marjie L. PhD*; Grundy, John S. PhD; Singh, Tejdip MD*; von Moltke, Lisa L. MD*; Boltje, Ingrid MD, PhD*

Journal of Cardiovascular Pharmacology: August 2014 - Volume 64 - Issue 2 - p 164–171
doi: 10.1097/FJC.0000000000000101
Original Article

Abstract: Mipomersen is a second-generation antisense oligonucleotide indicated as an adjunct therapy for homozygous familial hypercholesterolemia (HoFH). Warfarin is commonly prescribed for a variety of cardiac disorders in homozygous familial hypercholesterolemia population, and concurrent use of warfarin and mipomersen is likely. This open-label, single-sequence 2-period phase 1 study in healthy subjects evaluated the potential drug–drug interactions between mipomersen and warfarin. The subjects received a single oral 25 mg dose of warfarin alone on day 1, and after a 7-day washout period, received 200 mg mipomersen alone subcutaneously every other day on days 8–12, and received both concurrently on day 14. Coadministration of mipomersen did not change the pharmacodynamics (international normalized ratio, prothrombin time, and activated partial thromboplastin time) and pharmacokinetics (PK) of warfarin. There were no clinically significant changes in the PK of mipomersen with concurrent administration of warfarin. There were no events indicative of an increase in bleeding tendency when warfarin was coadministered with mipomersen, and the adverse event profile of mipomersen did not appear to be altered in combination with warfarin, as compared with that of the respective reference treatment. The combination of these 2 medications appeared to be safe and well tolerated. These results suggest that the dosage adjustment of warfarin or mipomersen is not expected to be necessary with coadministration.

*Genzyme, A Sanofi Company, Cambridge, MA; and

Isis Pharmaceuticals, Carlsbad, CA.

Reprints: Zhaoyang Li, PhD, Clinical and Exploratory Pharmacology, Genzyme, A Sanofi Company, 500 Kendall St, Cambridge, MA 02142 (e-mail:

Z. Li, T. Singh, L. L. von Moltke, and I. Boltje (deceased) are employees of Genzyme, a Sanofi Company; M. L. Hard was an employee of Genzyme at the time of the conduct and completion of this clinical trial; J. S. Grundy is an employee of ISIS Pharmaceuticals, Inc. T. Singh report no conflicts of interest.

Supported by Genzyme, a Sanofi Company. Z. Li, M. L. Hard, T. Singh, L. L. von Moltke, and I. Boltje had support from Genzyme and J. S. Grundy had support from ISIS Pharmaceuticals for the submitted work.

Received January 22, 2014

Accepted March 23, 2014

© 2014 by Lippincott Williams & Wilkins.