Quantitative analysis of T-wave morphology increases confidence in drug-induced cardiac repolarization abnormalities: evidence from the investigational IKr inhibitor Lu 35-138

J Clin Pharmacol. 2009 Nov;49(11):1331-42. doi: 10.1177/0091270009344853.

Abstract

This study investigates repolarization changes induced by a new candidate drug to determine whether a composite electrocardiographic (ECG) measure of T-wave morphology could be used as a reliable marker to support the evidence of abnormal repolarization, which is indicated by QT interval prolongation. Seventy-nine healthy subjects were included in this parallel study. After a baseline day during which no drug was given, 40 subjects received an I(Kr)-blocking antipsychotic compound (Lu 35-138) on 7 consecutive days while 39 subjects received placebo. Resting ECGs were recorded and used to determine a combined measure of repolarization morphology (morphology combination score [MCS]), based on asymmetry, flatness, and notching. Replicate measurements were used to determine reliable change and study power for both measures. Lu 35-138 increased the QTc interval with corresponding changes in T-wave morphology as determined by MCS. For subjects taking Lu 35-138, T-wave morphology was a more reliable indicator of I(Kr) inhibition than QTcF (chi(2) = 20.3, P = .001). At 80% study power for identifying a 5-millisecond placebo-adjusted change from baseline for QTcF, the corresponding study power for MCS was 93%. As a covariate to the assessment of QT interval liability, MCS offered important additive information to the effect of Lu 35-138 on cardiac repolarization.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Delayed Rectifier Potassium Channels / antagonists & inhibitors*
  • Dihydropyridines / adverse effects*
  • Drug Evaluation, Preclinical / methods
  • Electrocardiography / drug effects
  • Female
  • Heart Conduction System / drug effects
  • Humans
  • Indoles / adverse effects*
  • Male
  • Middle Aged
  • Models, Cardiovascular

Substances

  • 3-(1-(2-(1-acetyl-2,3-dihydro-1H-indol-3-yl)ethyl)-3,6-dihydro-2H-pyridin-4-yl)-6-chloro-1H-indole
  • Delayed Rectifier Potassium Channels
  • Dihydropyridines
  • Indoles