Trovafloxacin

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Trovafloxacin
Trovafloxacin.svg
Clinical data
AHFS/Drugs.com Micromedex Detailed Consumer Information
MedlinePlus a605016
Routes of
administration
Oral, intravenous
ATC code
Legal status
Legal status
  • Withdrawn from market
Identifiers
  • 7-(6-Amino-3-azabicyclo[3.1.0]hex-3-yl)-1-(2,4-difluorophenyl)-6-fluoro-4-oxo-[1,8] naphthyridine-3-carboxylic acid
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
Formula C20H15F3N4O3
Molar mass 416.360 g·mol−1
3D model (JSmol)
  • O=C(O)C2=CN(c1nc(c(F)cc1C2=O)N3C[C@H]4[C@H](N)[C@H]4C3)c5ccc(F)cc5F
  • InChI=1S/C20H15F3N4O3/c21-8-1-2-15(13(22)3-8)27-7-12(20(29)30)17(28)9-4-14(23)19(25-18(9)27)26-5-10-11(6-26)16(10)24/h1-4,7,10-11,16H,5-6,24H2,(H,29,30)/t10-,11+,16+ Yes check.svgY
  • Key:WVPSKSLAZQPAKQ-CDMJZVDBSA-N Yes check.svgY
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Trovafloxacin (sold as Trovan by Pfizer and Turvel by Laboratorios Almirall) is a broad spectrum antibiotic that inhibits the uncoiling of supercoiled DNA in various bacteria by blocking the activity of DNA gyrase and topoisomerase IV. [1] It was withdrawn from the market due to the risk of hepatotoxicity. It had better Gram-positive bacterial coverage and less Gram-negative coverage than the previous fluoroquinolones.

Contents

Adverse reactions

Trovafloxacin use is significantly restricted due to its high potential for inducing serious and sometimes fatal liver damage. [2] Currently, the drug is not approved for use in the U.S. or the European Union due to association with cases of acute liver failure and death.

Manufacturing

Trovafloxacin synthesis: K. E. Brighty, U.S. Patent 5,164,402 (1992 to Pfizer). Trovafloxacin synthesis.svg
Trovafloxacin synthesis: K. E. Brighty, U.S. Patent 5,164,402 (1992 to Pfizer).

The key reaction in building the ring consists of 1,3-Dipolar cycloaddition of ethyl diazoacetate to N-Cbz-3-pyrroline to afford the pyrrazolidine (3). Pyrolysis results in loss of nitrogen and formation of the cyclopropylpyrrolidine ring. The stereochemistry of the ring simply reflects the thermodynamics, since cis ring fusion is by far the most stable arrangement, as is the cis configuration of the ester group. The ester is then saponified to the corresponding carboxylic acid (5). The acid undergoes a version of the Curtius rearrangement when treated with diphenylphosphoryl azide (DPPA) to afford the transient isocyanate (6). The reactive function adds t-BuOH from the reaction medium to afford the product as its tert-Butyloxycarbonyl protecting group derivative (7). Catalytic hydrogenation then removes the carbobenzyloxy protecting group to afford the secondary amine (8). In a standard quinoline reaction, this amine is then used to displace the more reactive fluorine at the 7-position in Ethyl 1-(2,4-difluorophenyl)-6,7-difluoro-4-oxo-1,4-dihydro-1,8-naphthyridine-3-carboxylate (9). [3]

Society and culture

The U.S. Food and Drug Administration approved trovafloxacin for therapeutic use in December 1997 for use in patients aged 18 years and older. [4] In June 1999, the agency advised doctors to limit the prescription of trovafloxacin due to adverse events associated with the drug (over 100 cases of acute liver injury reported to FDA). In May 2000, the FDA withdrew marketing authorisation for trovafloxacin.

Trovafloxacin received marketing authorisation in the European Union in October 1998. [5] In June 1999, in view of reported adverse events, the Committee for Proprietary Medicinal Products recommended suspension of the marketing authorisation for a year. [6] [7] The suspension took effect in August 1999 and was renewed in September 2000. [5] In October 2000, Pfizer notified the European Commission of its decision to voluntarily withdraw the marketing authorisation which was approved by EMA in March 2001. [5]

Economics

Trovan sales during its first full year on the market contributed US$160 million of Pfizer's total revenue of US$12.6 billion. Investors expected it to eventually bring in US$1 billion per year. [6]

Nigerian clinical trial controversy [8]

In 1996, during a meningitis epidemic in Kano, Nigeria, the drug was administered to approximately 200 [9] infected children. Eleven children died in the trial: five after taking Trovan and six after taking an older antibiotic used for comparison in the clinical trial. Others suffered blindness, deafness and brain damage, common consequences of meningitis that have not been seen in patients treated with trovafloxacin for other infection types. [10] [11] [12] An investigation by the Washington Post concluded that Pfizer had administered the drug as part of an illegal clinical trial without authorization from the Nigerian government or consent from the children's parents. [13] The case came to light in December 2000 as the result of an investigation by The Washington Post , and sparked significant public outcry. The most serious error was the falsification and backdating of an ethics approval letter by the lead investigator of the trial, Dr. Abdulhamid Isa Dutse. Dr. Dutse is now the chief medical officer of Aminu Kano Teaching Hospital. The result of the trial was that children treated with oral trovafloxacin had a 5% (5/100) mortality rate compared to a 6% (6/100) mortality rate with intramuscular ceftriaxone.

Between 2002 and 2005 the victims of the Trovan tests in Nigeria filed a series of unsuccessful lawsuits in the United States. However, in January 2009, the United States Court of Appeals for the Second Circuit ruled that the Nigerian victims and their families were entitled to bring suit against Pfizer in the United States under the Alien Tort Statute. A US$75 million settlement with the State of Kano was reached on July 30, 2009. [14] Additionally two lawsuits also remain pending in New York, United States. [14] According to Wikileaked US embassy cables, Pfizer's country manager admitted that "Pfizer had hired investigators to uncover corruption links to federal attorney general Michael Aondoakaa to expose him and put pressure on him to drop the federal cases." [15]

See also

Related Research Articles

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Pfizer American multinational pharmaceutical corporation

Pfizer Inc. is an American multinational pharmaceutical and biotechnology corporation headquartered on 42nd Street in Manhattan, New York City. The company was established in 1849 in New York by two German immigrants, Charles Pfizer (1824-1906) and his cousin Charles F. Erhart (1821-1891).

Levofloxacin antibiotic

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Ofloxacin Antibiotic to treat bacterial infections

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Nalidixic acid

Nalidixic acid is the first of the synthetic quinolone antibiotics.

Norfloxacin

Norfloxacin, sold under the brand name Noroxin among others, is an antibiotic that belongs to the class of fluoroquinolone antibiotics. It is used to treat urinary tract infections, gynecological infections, inflammation of the prostate gland, gonorrhea and bladder infection. Eye drops were approved for use in children older than one year of age.

Moxifloxacin Antibiotic

Moxifloxacin is an antibiotic used to treat a number of bacterial infections. This includes pneumonia, conjunctivitis, endocarditis, tuberculosis, and sinusitis. It is used by mouth, by injection into a vein, or as an eye drop.

Sparfloxacin Chemical to treat bacterial infections

Sparfloxacin is a fluoroquinolone antibiotic used in the treatment of bacterial infections. It has a controversial safety profile.

Topoisomerase inhibitors are chemical compounds that block the action of topoisomerases, which are broken into two broad subtypes: type I topoisomerases (TopI) and type II topoisomerases (TopII). Topoisomerase plays important roles in cellular reproduction and DNA organization, as they mediate the cleavage of single and double stranded DNA to relax supercoils, untangle catenanes, and condense chromosomes in eukaryotic cells. Topoisomerase inhibitors influence these essential cellular processes. Some topoisomerase inhibitors prevent topoisomerases from performing DNA strand breaks while others, deemed topoisomerase poisons, associate with topoisomerase-DNA complexes and prevent the re-ligation step of the topoisomerase mechanism. These topoisomerase-DNA-inhibitor complexes are cytotoxic agents, as the un-repaired single and double stranded DNA breaks that they cause can lead to apoptosis and cell death. Because of this ability to induce apoptosis, topoisomerase inhibitors have gained interest as therapeutics against infectious and cancerous cells.

The Kano trovafloxacin trial litigation arose out of a clinical trial conducted by the pharmaceutical company Pfizer in 1996 in Kano, Nigeria, during an epidemic of meningococcal meningitis. To test its new antibiotic, trovafloxacin (Trovan), Pfizer gave 100 children trovafloxacin, while another 100 received the gold-standard anti-meningitis treatment, ceftriaxone, a cephalosporin antibiotic. Pfizer gave the children a substantially reduced dose of the ceftriaxone relative to that described on the US FDA-approved prescribing information. The allegation is that this was done to skew the test in favor of its own drug. Pfizer claimed that the dose used was sufficient even though a clinical trial performed by Médecins Sans Frontières recommends a dose of 50-100mg/kg.

Aminocoumarin

Aminocoumarin is a class of antibiotics that act by an inhibition of the DNA gyrase enzyme involved in the cell division in bacteria. They are derived from Streptomyces species, whose best-known representative – Streptomyces coelicolor – was completely sequenced in 2002. The aminocoumarin antibiotics include:

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Flumequine

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Prulifloxacin

Prulifloxacin is an older synthetic antibiotic of the fluoroquinolone class undergoing clinical trials prior to a possible NDA submission to the U.S. Food and Drug Administration (FDA). It is a prodrug which is metabolized in the body to the active compound ulifloxacin. It was developed over two decades ago by Nippon Shinyaku Co. and was patented in Japan in 1987 and in the United States in 1989.

Pradofloxacin

Pradofloxacin is a 3rd generation enhanced spectrum veterinary antibiotic of the fluoroquinolone class. It was developed by Bayer HealthCare AG, Animal Health GmbH, and received approval from the European Commission in April 2011 for prescription-only use in veterinary medicine for the treatment of bacterial infections in dogs and cats.

Clinafloxacin

Clinafloxacin is an investigational fluoroquinolone antibiotic. Despite its promising antibiotic activity, the clinical development of clinafloxacin has been hampered by its risk for inducing serious side effects.

Besifloxacin

Besifloxacin (INN/USAN) is a fourth-generation fluoroquinolone antibiotic. The marketed compound is besifloxacin hydrochloride. It was developed by SSP Co. Ltd., Japan, and designated SS734. SSP licensed U.S. and European rights to SS734 for ophthalmic use to InSite Vision Incorporated in 2000. InSite Vision developed an eye drop formulation (ISV-403) and conducted preliminary clinical trials before selling the product and all rights to Bausch & Lomb in 2003.

African countries have been sites for clinical trials by large pharmaceutical companies, raising human rights concerns. Incidents of unethical experimentation, clinical trials lacking properly informed consent, and forced medical procedures have been claimed and prosecuted.

Quinolone antibiotic Class of antibacterial drugs, subgroup of quinolones

A quinolone antibiotic is a member of a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. They are used in human and veterinary medicine to treat bacterial infections, as well as in animal husbandry.

Finafloxacin

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References

  1. Gootz, TD; Zaniewski R; Haskell S; Schmieder B; Tankovic J; Girard D; Courvalin P; Polzer RJ (December 2006). "Activity of the new fluoroquinolone trovafloxacin (CP-99,219) against DNA gyrase and topoisomerase IV mutants of Streptococcus pneumoniae selected in vitro". Antimicrob Agents Chemother. 40 (12): 2691–7. doi:10.1128/AAC.40.12.2691. PMC   163605 . PMID   9124824.
  2. Pannu, H. K.; Gottlieb, L.; Fishman, E. K. (2001). "Acute liver failure due to trovafloxacin: CT findings". Emergency Radiology. 8 (2): 108–110. doi:10.1007/PL00011876. S2CID   43307678.
  3. D. Lednicer, The organic chemistry of Drug Synthesis, Vol. 5, p 123 (1995).
  4. "Trovafloxacin – Approval Letter & Printed Labelling" (PDF). Food and Drug Administration .
  5. 1 2 3 "Public statement on Trovan / Trovan IV / Turvel / Turvel IV: Withdrawal of the marketing authorisations" (PDF). European Medicines Agency .
  6. 1 2 Petersen, Melody (August 27, 2000). "Unforeseen Side Effects Ruined One Blockbuster". The New York Times . p. 3.11.
  7. "Suspension of Trovan Drug in Europe Is Urged". The New York Times . June 12, 1999. p. C.3.
  8. Oldani, Michael (2016), "Trovafloxacin (Trovan) Controversy", The SAGE Encyclopedia of Pharmacology and Society, SAGE Publications, Inc., pp. 1444–1447, doi:10.4135/9781483349985.n409, ISBN   9781483350004 , retrieved 2019-01-21
  9. Report of the Investigation Committee on the Clinical Trial of Trovafloxacin (Trovan) by Pfizer, Kano, 1996. (PDF), Federal Ministry of Health, Nigeria
  10. Williams D, Hopkins S (June 1998). "Safety of trovafloxacin in treatment of lower respiratory tract infections". Eur. J. Clin. Microbiol. Infect. Dis. 17 (6): 454–8. doi:10.1007/bf01691582. PMID   9758292. S2CID   1325773.
  11. Lipsky BA, Baker CA (February 1999). "Fluoroquinolone toxicity profiles: a review focusing on newer agents". Clin. Infect. Dis. 28 (2): 352–64. doi: 10.1086/515104 . PMID   10064255.
  12. Sabatini C, Bosis S, Semino M, Senatore L, Principi N, Esposito S (June 2012). "Clinical presentation of meningococcal disease in childhood". J Prev Med Hyg. 53 (2): 116–9. PMID   23240173.
  13. Stephens, Joe (May 7, 2006). "Panel Faults Pfizer in '96 Clinical Trial In Nigeria". The Washington Post . p. A01. Retrieved 2006-08-28.
  14. 1 2 Stephens, Joe (July 31, 2009). "Pfizer to Pay $75 Million to Settle Nigerian Trovan Drug-Testing Suit". The Washington Post. Retrieved May 26, 2010.
  15. Boseley, Sarah (9 December 2010). "WikiLeaks cables: Pfizer 'used dirty tricks to avoid clinical trial payout'". The Guardian.