Identification
- Summary
Vamorolone is a synthetic glucocorticoid used as an anti-inflammatory and immunosuppressant in the management of Duchenne muscular dystrophy (DMD).
- Brand Names
- Agamree
- Generic Name
- Vamorolone
- DrugBank Accession Number
- DB15114
- Background
Vamorolone is a novel and fully synthetic glucocorticoid developed by Santhera Pharmaceuticals. It is used to manage inflammation and immune dysregulation in patients with Duchenne muscular dystrophy (DMD), a neuromuscular disorder characterized by the insidious regression of neuromuscular function and the most common form of muscular dystrophy in the United States.5 Corticosteroid therapy is the current standard of care for DMD despite relatively high rates of adverse effects.5 Vamorolone is positioned as having a more tolerable adverse effect profile than other corticosteroids owing to its unique receptor binding profile,1 thus providing an additional treatment option in patients for whom corticosteroid adverse effects are intolerable or otherwise unacceptable.5
Vamorolone was approved by the FDA in October 2023 for the management of DMD in patients ≥2 years of age.4,5 In December 2023, it was approved in the EU for the treatment of patients ≥4 years of age.7
- Type
- Small Molecule
- Groups
- Approved, Investigational
- Structure
Structure for Vamorolone (DB15114)
- Weight
- Average: 356.462
Monoisotopic: 356.198759382 - Chemical Formula
- C22H28O4
- Synonyms
- Vamorolone
- External IDs
- VBP15
Pharmacology
- Indication
Vamorolone is indicated for the treatment of Duchenne muscular dystrophy (DMD) in patients ≥2 years of age in the US4 and in patients ≥4 years of age in the EU.6
Reduce drug development failure ratesBuild, train, & validate machine-learning modelswith evidence-based and structured datasets.Build, train, & validate predictive machine-learning models with structured datasets.- Associated Conditions
Indication Type Indication Combined Product Details Approval Level Age Group Patient Characteristics Dose Form Management of Duchenne muscular dystrophy (dmd) •••••••••••• •••••••••• Management of Duchenne muscular dystrophy (dmd) •••••••••••• •••••••••• - Contraindications & Blackbox Warnings
Prevent Adverse Drug Events TodayTap into our Clinical API for life-saving information on contraindications & blackbox warnings, population restrictions, harmful risks, & more.Avoid life-threatening adverse drug events with our Clinical API- Pharmacodynamics
In clinical studies, treatment with vamorolone induced a dose-dependent decrease in morning cortisol levels and a dose-dependent increase in leukocyte and lymphocyte counts.4
- Mechanism of action
Vamorolone is a synthetic corticosteroid that acts as an agonist at the glucocorticoid receptor4 to exert anti-inflammatory and immunosuppressive effects. It is also an antagonist of the mineralocorticoid receptor.1 The precise mechanism by which vamorolone exerts its therapeutic effects in patients with DMD is unclear.
Target Actions Organism UGlucocorticoid receptor agonistHumans UMineralocorticoid receptor antagonistHumans - Absorption
Following oral administration with food, the median Tmax of vamorolone is approximately 2 hours.4
The co-administration of vamorolone with a high-fat, high-calorie meal reduced Cmax by 18%, increased AUC by 13%, and delayed Tmax by one hour. The co-administration of vamorolone with a low-fat, low-calorie meal reduced Cmax by 4%, increased AUC by 14%, and delayed Tmax by one hour.4
- Volume of distribution
Based on population pharmacokinetic analysis, the apparent volume of distribution of vamorolone when administered with a meal to a 20 kg patient with DMD is 162 L.4
- Protein binding
The in vitro protein binding of vamorolone is 88.1%.4
- Metabolism
Vamorolone is subject to multiple metabolic pathways, including glucuronidation, hydroxylation, and reduction.4 Its metabolism is mediated through CYP3A4, CYP3A5, CYP2C8, UGT1A3, UGT2B7, and UGT2B17.4 Glucuronides - formed via direct glucuronidation and hydrogenation with subsequent glucuronidation - are the main metabolites in the plasma and urine.4
- Route of elimination
Approximately 30% of a given vamorolone dose is excreted in the feces (15.4% as unchanged parent drug) and 48% is excreted in the urine (<1% as unchanged parent drug).4
- Half-life
The terminal elimination half-life of vamorolone is approximately 2 hours. 4
- Clearance
Based on population pharmacokinetic analysis, the clearance of vamorolone when administered with a meal to a 20 kg patient with DMD is 58 L/h.4
- Adverse Effects
Improve decision support & research outcomesWith structured adverse effects data, including: blackbox warnings, adverse reactions, warning & precautions, & incidence rates. View sample adverse effects data in our new Data Library!Improve decision support & research outcomes with our structured adverse effects data.- Toxicity
Specific data regarding vamorolone overdosage are not readily available. Prescribing information recommends supportive and symptomatic treatment in the event of suspected vamorolone overdose, with consideration given to gastric lavage or emesis if clinically appropriate.4
- Pathways
- Not Available
- Pharmacogenomic Effects/ADRs
- Not Available
Interactions
- Drug Interactions
- This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction Integrate drug-drug
interactions in your softwareAbametapir The serum concentration of Vamorolone can be increased when it is combined with Abametapir. Acarbose The risk or severity of hyperglycemia can be increased when Vamorolone is combined with Acarbose. Aceclofenac The risk or severity of gastrointestinal irritation can be increased when Vamorolone is combined with Aceclofenac. Acemetacin The risk or severity of gastrointestinal irritation can be increased when Vamorolone is combined with Acemetacin. Acenocoumarol Vamorolone may increase the anticoagulant activities of Acenocoumarol. - Food Interactions
- Take with food. Prescribing information for vamorolone states that it should preferably be administered with food.
Products
Drug product information from 10+ global regionsOur datasets provide approved product information including:dosage, form, labeller, route of administration, and marketing period.Access drug product information from over 10 global regions.- Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Agamree Suspension 40 mg/1mL Oral Purna Pharmaceuticals Nv 2023-11-23 Not applicable US 
Agamree Kit 40 mg/1mL Oral Catalyst Pharmaceuticals, Inc. 2024-02-01 Not applicable US
Categories
- Drug Categories
- Adrenal Cortex Hormones
- Anti-Inflammatory Agents
- Corticosteroids
- Cytochrome P-450 CYP2C8 Substrates
- Cytochrome P-450 CYP3A Inducers
- Cytochrome P-450 CYP3A Substrates
- Cytochrome P-450 CYP3A4 Inducers
- Cytochrome P-450 CYP3A4 Inducers (strength unknown)
- Cytochrome P-450 CYP3A4 Substrates
- Cytochrome P-450 CYP3A5 Substrates
- Cytochrome P-450 Enzyme Inducers
- Cytochrome P-450 Substrates
- Fused-Ring Compounds
- Pregnadienes
- Pregnanes
- Steroids
- UGT1A3 substrates
- UGT2B17 substrates
- UGT2B7 substrates
- Chemical TaxonomyProvided by Classyfire
- Description
- This compound belongs to the class of organic compounds known as 21-hydroxysteroids. These are steroids carrying a hydroxyl group at the 21-position of the steroid backbone.
- Kingdom
- Organic compounds
- Super Class
- Lipids and lipid-like molecules
- Class
- Steroids and steroid derivatives
- Sub Class
- Hydroxysteroids
- Direct Parent
- 21-hydroxysteroids
- Alternative Parents
- Gluco/mineralocorticoids, progestogins and derivatives / 20-oxosteroids / 3-oxo delta-1,4-steroids / 17-hydroxysteroids / Delta-1,4-steroids / Tertiary alcohols / Alpha-hydroxy ketones / Cyclic ketones / Cyclic alcohols and derivatives / Primary alcohols show 2 more
- Substituents
- 17-hydroxysteroid / 20-oxosteroid / 21-hydroxysteroid / 3-oxo-delta-1,4-steroid / 3-oxosteroid / Alcohol / Aliphatic homopolycyclic compound / Alpha-hydroxy ketone / Carbonyl group / Cyclic alcohol show 12 more
- Molecular Framework
- Aliphatic homopolycyclic compounds
- External Descriptors
- Not Available
- Affected organisms
- Humans
Chemical Identifiers
- UNII
- 8XP29XMB43
- CAS number
- 13209-41-1
- InChI Key
- ZYTXTXAMMDTYDQ-DGEXFFLYSA-N
- InChI
- InChI=1S/C22H28O4/c1-13-10-18-16-5-4-14-11-15(24)6-8-20(14,2)17(16)7-9-21(18,3)22(13,26)19(25)12-23/h6-8,11,13,16,18,23,26H,4-5,9-10,12H2,1-3H3/t13-,16-,18+,20+,21+,22+/m1/s1
- IUPAC Name
- (1R,2R,3aS,3bS,9aS,11aS)-1-hydroxy-1-(2-hydroxyacetyl)-2,9a,11a-trimethyl-1H,2H,3H,3aH,3bH,4H,5H,7H,9aH,11H,11aH-cyclopenta[a]phenanthren-7-one
- SMILES
- C[C@@H]1C[C@H]2[C@@H]3CCC4=CC(=O)C=C[C@]4(C)C3=CC[C@]2(C)[C@@]1(O)C(=O)CO
References
- Synthesis Reference
Reeves EKM, Hoffman EP, Nagaraju K, Damsker JM, McCall JM: VBP15: preclinical characterization of a novel anti-inflammatory delta 9,11 steroid. Bioorg Med Chem. 2013 Apr 15;21(8):2241-2249. doi: 10.1016/j.bmc.2013.02.009. Epub 2013 Feb 18.
- General References
- Heier CR, Yu Q, Fiorillo AA, Tully CB, Tucker A, Mazala DA, Uaesoontrachoon K, Srinivassane S, Damsker JM, Hoffman EP, Nagaraju K, Spurney CF: Vamorolone targets dual nuclear receptors to treat inflammation and dystrophic cardiomyopathy. Life Sci Alliance. 2019 Feb 11;2(1):e201800186. doi: 10.26508/lsa.201800186. Print 2019 Feb. [Article]
- Mavroudis PD, van den Anker J, Conklin LS, Damsker JM, Hoffman EP, Nagaraju K, Clemens PR, Jusko WJ: Population Pharmacokinetics of Vamorolone (VBP15) in Healthy Men and Boys With Duchenne Muscular Dystrophy. J Clin Pharmacol. 2019 Jul;59(7):979-988. doi: 10.1002/jcph.1388. Epub 2019 Feb 11. [Article]
- Reeves EKM, Hoffman EP, Nagaraju K, Damsker JM, McCall JM: VBP15: preclinical characterization of a novel anti-inflammatory delta 9,11 steroid. Bioorg Med Chem. 2013 Apr 15;21(8):2241-2249. doi: 10.1016/j.bmc.2013.02.009. Epub 2013 Feb 18. [Article]
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
- American Journal of Managed Care: FDA Approves Vamorolone to Treat Duchenne Muscular Dystrophy [Link]
- EMA Summary of Product Characteristics: Agamree (vamorolone) suspension for oral administration [Link]
- EMA EPAR: Agamree (vamorolone) [Link]
- External Links
- ChemSpider
- 2299335
- BindingDB
- 50432396
- 2669799
- ChEMBL
- CHEMBL2348780
- ZINC
- ZINC000033650317
- Wikipedia
- Vamorolone
Clinical Trials
- Clinical Trials
Phase Status Purpose Conditions Count 2 Completed Treatment Duchenne Muscular Dystrophy (DMD) 4 2 Recruiting Treatment Becker's Muscular Dystrophy (BMD) 1 2 Recruiting Treatment Duchenne Muscular Dystrophy (DMD) 1 1 Completed Treatment Healthy Volunteers (HV) 1 1, 2 Withdrawn Treatment Ulcerative Colitis, Pediatric 1
Pharmacoeconomics
- Manufacturers
- Not Available
- Packagers
- Not Available
- Dosage Forms
Form Route Strength Kit Oral 40 mg/1mL Suspension Oral 40 mg/1mL - Prices
- Not Available
- Patents
Patent Number Pediatric Extension Approved Expires (estimated) Region US11690853 No 2016-06-29 2036-06-29 US US11471471 No 2020-03-17 2040-03-17 US US10857161 No 2009-05-28 2029-05-28 US US8334279 No 2009-05-28 2029-05-28 US US11382922 No 2020-07-16 2040-07-16 US US11833159 No 2009-05-28 2029-05-28 US
Properties
- State
- Solid
- Experimental Properties
- Not Available
- Predicted Properties
Property Value Source Water Solubility 0.0246 mg/mL ALOGPS logP 3.36 ALOGPS logP 2.54 Chemaxon logS -4.2 ALOGPS pKa (Strongest Acidic) 12.45 Chemaxon pKa (Strongest Basic) -3.3 Chemaxon Physiological Charge 0 Chemaxon Hydrogen Acceptor Count 4 Chemaxon Hydrogen Donor Count 2 Chemaxon Polar Surface Area 74.6 Å2 Chemaxon Rotatable Bond Count 2 Chemaxon Refractivity 102.22 m3·mol-1 Chemaxon Polarizability 39.26 Å3 Chemaxon Number of Rings 4 Chemaxon Bioavailability 1 Chemaxon Rule of Five Yes Chemaxon Ghose Filter Yes Chemaxon Veber's Rule No Chemaxon MDDR-like Rule No Chemaxon - Predicted ADMET Features
- Not Available
Spectra
- Mass Spec (NIST)
- Not Available
- Spectra
Spectrum Spectrum Type Splash Key Predicted MS/MS Spectrum - 10V, Positive (Annotated) Predicted LC-MS/MS splash10-0079-0129000000-b34dbb0ca596b9d266a6 Predicted MS/MS Spectrum - 10V, Negative (Annotated) Predicted LC-MS/MS splash10-004i-0009000000-1cf8956eb1952d19638a Predicted MS/MS Spectrum - 20V, Positive (Annotated) Predicted LC-MS/MS splash10-004r-0093000000-74fb262914c711f1c327 Predicted MS/MS Spectrum - 20V, Negative (Annotated) Predicted LC-MS/MS splash10-0a4m-9051000000-838f16d42f300ae44dce Predicted MS/MS Spectrum - 40V, Negative (Annotated) Predicted LC-MS/MS splash10-0a4i-0059000000-4d54dac892c0fe2eabd6 Predicted MS/MS Spectrum - 40V, Positive (Annotated) Predicted LC-MS/MS splash10-00xs-0930000000-5f4eb2cdfff89704a24c Predicted 1H NMR Spectrum 1D NMR Not Applicable Predicted 13C NMR Spectrum 1D NMR Not Applicable - Chromatographic Properties
Collision Cross Sections (CCS)
Not Available
Targets
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Agonist
- General Function
- Zinc ion binding
- Specific Function
- Receptor for glucocorticoids (GC). Has a dual mode of action: as a transcription factor that binds to glucocorticoid response elements (GRE), both for nuclear and mitochondrial DNA, and as a modula...
- Gene Name
- NR3C1
- Uniprot ID
- P04150
- Uniprot Name
- Glucocorticoid receptor
- Molecular Weight
- 85658.57 Da
References
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- Unknown
- Actions
- Antagonist
- General Function
- Zinc ion binding
- Specific Function
- Receptor for both mineralocorticoids (MC) such as aldosterone and glucocorticoids (GC) such as corticosterone or cortisol. Binds to mineralocorticoid response elements (MRE) and transactivates targ...
- Gene Name
- NR3C2
- Uniprot ID
- P08235
- Uniprot Name
- Mineralocorticoid receptor
- Molecular Weight
- 107066.575 Da
References
- Heier CR, Yu Q, Fiorillo AA, Tully CB, Tucker A, Mazala DA, Uaesoontrachoon K, Srinivassane S, Damsker JM, Hoffman EP, Nagaraju K, Spurney CF: Vamorolone targets dual nuclear receptors to treat inflammation and dystrophic cardiomyopathy. Life Sci Alliance. 2019 Feb 11;2(1):e201800186. doi: 10.26508/lsa.201800186. Print 2019 Feb. [Article]
Enzymes
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- SubstrateInducer
- General Function
- Vitamin d3 25-hydroxylase activity
- Specific Function
- Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
- Gene Name
- CYP3A4
- Uniprot ID
- P08684
- Uniprot Name
- Cytochrome P450 3A4
- Molecular Weight
- 57342.67 Da
References
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- General Function
- Oxygen binding
- Specific Function
- Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
- Gene Name
- CYP3A5
- Uniprot ID
- P20815
- Uniprot Name
- Cytochrome P450 3A5
- Molecular Weight
- 57108.065 Da
References
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- General Function
- Steroid hydroxylase activity
- Specific Function
- Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It oxidizes a variety of structurally un...
- Gene Name
- CYP2C8
- Uniprot ID
- P10632
- Uniprot Name
- Cytochrome P450 2C8
- Molecular Weight
- 55824.275 Da
References
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- General Function
- Retinoic acid binding
- Specific Function
- UDPGT is of major importance in the conjugation and subsequent elimination of potentially toxic xenobiotics and endogenous compounds. Isoform 2 lacks transferase activity but acts as a negative reg...
- Gene Name
- UGT1A3
- Uniprot ID
- P35503
- Uniprot Name
- UDP-glucuronosyltransferase 1-3
- Molecular Weight
- 60337.835 Da
References
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- General Function
- Glucuronosyltransferase activity
- Specific Function
- UDPGT is of major importance in the conjugation and subsequent elimination of potentially toxic xenobiotics and endogenous compounds.Its unique specificity for 3,4-catechol estrogens and estriol su...
- Gene Name
- UGT2B7
- Uniprot ID
- P16662
- Uniprot Name
- UDP-glucuronosyltransferase 2B7
- Molecular Weight
- 60694.12 Da
References
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
- Kind
- Protein
- Organism
- Humans
- Pharmacological action
- No
- Actions
- Substrate
- General Function
- Glucuronosyltransferase activity
- Specific Function
- UDPGT is of major importance in the conjugation and subsequent elimination of potentially toxic xenobiotics and endogenous compounds. The major substrates of this isozyme are eugenol > 4-methylumbe...
- Gene Name
- UGT2B17
- Uniprot ID
- O75795
- Uniprot Name
- UDP-glucuronosyltransferase 2B17
- Molecular Weight
- 61094.915 Da
References
- FDA Approved Drug Products: Agamree (vamorolone) suspension for oral administration [Link]
Drug created at May 20, 2019 14:51 / Updated at January 10, 2024 06:22