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INTRODUCTION
The theories of oral drug absorption have been actively investigated in the last three decades.1 Various concepts have been introduced to represent the oral absorption of drugs, for example,
the absorption potential (AP),2 the maximum absorbable dose
(MAD),3 the biopharmaceutics classification system (BCS),4 the
developability classification system (DCS),5 and in vitroin vivo
correlation (IVIVC).6 These concepts originate from the same
differential equations that describe the dissolution and intestinal membrane permeation of drugs. The aim of this article is to
Abbreviations used: AP, absorption potential; API, active pharmaceutical ingredient; AUC, area under the curve; AUC BE, bioequivalence of AUC; BCS, biopharmaceutics classification system; BCS-BWS, BCS-based biowaiver scheme;
BE, bioequivalence; COAS, computational oral absorption simulation; Cmax BE,
bioequivalence of Cmax ; Cdissolv , concentration of a dissolved drug; Cdissolv,ss ,
concentration of a dissolved drug at the steady state; DCS, developability classification system; DF, degree of flatness; DRL, dissolution rate limited; Deff ,
effective diffusion coefficient; Dn, dissolution number; Dncrit , critical dissolution
number; Do, dose number; Docrit , critical dose number; Dose, dose strength; EIE,
equivalent-in-effect; EIP, equivalence of independent parameter; Fa, fraction of
a dose absorbed; FaCS, Fa classification system; GI, gastrointestinal; IR, immediate release; IVIVC, in vitroin vivo correlation; MAD, maximum absorbable
dose; MDT, mean dissolution time; PBPK, physiologically based pharmacokinetics; PL, permeability limited; PL-E, epithelial membrane permeability limited;
PL-U, unstirred water layer permeability limited; Pncrit , critical permeation
number; PUWL , unstirred water layer permeability; Papp , apparent permeability; Peff , effective intestinal membrane permeability; Pep , epithelial membrane
permeability of unbound drug molecules; PKs, pharmacokinetics; Pn, permeation number; S1I7, GI compartment model with one stomach compartment
and seven intestinal compartments; SL, solubilitypermeability limited; SL-E,
solubilityepithelial membrane permeability limited; SL-U, solubilityunstirred
water layer permeability limited; SMF, safe margin factor; Sblank , solubility in a
blank buffer; Sdissolv , solubility in the GI tract (free and bile micelle bound drug
molecules); Sn, saturation number; Tabs , transit time through the absorption
site in the GI tract; UWL, unstirred water layer; V, fluid volume in the GI tract;
VE, villi expansion factor; Xdissolv , dissolved amount; fu , free fraction at the
surface of the intestinal epithelial membrane; in vitro T85% , time to reach 85%
dissolution in an in vitro dissolution test; kabs , absorption rate coefficient; kdiss ,
dissolution rate coefficient; kel , elimination rate coefficient; kperm , permeation
rate coefficient; rp , particle radius of a drug; T1/2 , elimination half-life.
Correspondence to: Kiyohiko Sugano (Telephone: +81-47-472-1494; Fax: +8147-472-1337; E-mail: kiyohiko.sugano@phar.toho-u.ac.jp)
Journal of Pharmaceutical Sciences
C 2015 Wiley Periodicals, Inc. and the American Pharmacists Association
(1)
dX abs
= kperm X dissolv
dt
(2)
kdiss =
3Deff Sdissolv
rp2 D
(3)
2DF
Peff
R
(4)
kperm =
where kdiss is the dissolution rate coefficient, kperm is the permeation rate coefficient, Dose is the dose strength, Xundissolv is
the undissolved amount, Xdissolv is the dissolved amount, Xabs
is the absorbed amount, Sdissolv is the solubility in the intestinal fluid (free and bile micelle bound drug molecules), Deff is
the effective diffusion coefficient, Peff is the effective intestinal membrane permeability (free and bile micelle bound drug
Sugano and Terada, JOURNAL OF PHARMACEUTICAL SCIENCES
REVIEW
Events
Reference
1897
1985
1986
1993
1995
1996
NoyesWhitney equation
Absorption potential
Mixed tank model
Plug-low model
Biopharmaceutics classification system
Maximum absorbable dose
Compartment absorption transit model
Absorption-limiting step classification
Biopharmaceutics drug disposition
classification system
Fa equation
Developablility classification system
7
2
8
9
4
3
10
11
12
1999
2005
2009
2010
Fa = 1 exp kperm Tabs = 1 exp (Pn)
13
5
Trivial Answers
Dissolution Rate-Limited Cases
In the case of dissolution rate-limited (DRL) absorption, Fa
can be calculated by integrating the dissolution equation. By
applying Xdissolv = 0 (perfect sink condition), we obtain
32
2
= 1 1 Dn
3
(5)
(6)
Fa = 1
kperm
exp (kdiss Tabs )
kperm kdiss
Pn
kdiss
exp (Dn)
exp kperm Tabs = 1
kdiss kperm
Pn Dn
Dn
exp (Pn)
Dn Pn
(8)
32
2
Fa = 1 1 kdiss Tabs
3
(7)
This equation is often used to correlate in vitro membrane permeability values with Fa, for example, the Caco-2
cell assay,16,17 the MadinDarby canine kidney cell assay,18
and the parallel artificial membrane permeation assay.1921 We
can also introduce a dimensionless parameter for permeation
(Pn = kperm Tabs ).
Fa =
MAD
Pn
kperm Sdissolv VTabs
=
=
Dose
Dose
Do
(9)
Dose
Sdissolv V
(10)
Do =
REVIEW
Pn
BCS I
BCS II
10
0.1
10
Do
BCS III
BCS IV
0.1
Figure 1. The BCS plane (PnDo plane) and DCS lines. The solid and
gray lines corresponds to Fa = Pn/Do = 0.3 and 0.7 for SL cases.
1
Fa = 1 exp 1 Do
+ Pn
Dn
1
1
+ Do
Dn
Pn
if Do < 1, set Do = 1.
(11)
(12)
DOI 10.1002/jps.24391
1
Cdissolv,ss
=
Pn
Sdissolv
1 + DnDo
(13)
The wide spread of personal computers after the late 1980s provided new research tools for many scientists. Computational
numerical integration of differential equations (computer simulation) can provide answers to more general cases compared
with analytical solutions. Computer simulation is now used in
various research areas such as astronomy, meteorology, engineering, economics, and so on. Pharmaceutical sciences have
been reaping many benefits from computer simulation as well.
Computational oral absorption simulations (COASs)13 have
been used since the mid-1980s. A simple mixed tank model
and a plug flow model were first employed to represent the
GI tract.8,9 The dissolution and permeation equations were numerically integrated with these models. The compartment absorption transit model was then introduced in 1996 to represent the distribution of a drug in the GI tract.10,11,24 The other
multicompartment models such as the gastrointestinal transit
absorption model25 and the advanced dissolution absorption
and metabolism model26 were later introduced. In most cases,
the stomach and the small intestine are expressed as one and
seven compartments, respectively [the GI compartment model
with one stomach compartment and seven intestinal compartments (S1I7) model]. In each GI compartment, the dissolution
and permeation processes of a drug are simulated. The GI transit of polydispersed particles between the compartments can be
simultaneously simulated.13 By using a S1I7 model, various
scenarios of oral drug absorption can be simulated, such as the
effects of pH change in the GI tract.27
One of the well-known disadvantages of computational simulation is that it might distract us from understanding the
deep and often abstracted nature.28 Therefore, even in this age
of massive computing power, analytical solutions will not lose
their importance. Computer simulation and analytical solution
are complementary to each other. Because of its complexity,
COAS is often used as a black box. However, commercial programs have not been sophisticated enough for nonexpert users.
Therefore, a simple analytical solution and/or a classification
system should be used alongside with COAS to understand the
essence of oral drug absorption. Commercial COAS programs
are often used side by side with a physiologically based pharmacokinetics (PBPK) model.29,30 Pharmacokinetic (PK) scientists sometimes use oral absorption and formulation modules in
software, whereas formulation scientists merely use the PBPK
module on its own. A good collaboration between the biopharmaceutics and PK scientists is vital for an appropriate use of
COAS. Even though the S1I7 models seem to provide significant advantages, a simple one compartment model is sufficient to predict Fa in many cases.31 The Fa equation and the
seven compartment model give similar Fa values for nonsupersaturable cases.22 To simulate the plasma concentrationtime
profile of a drug, kabs can be used with a one-compartment PK
model.
As COAS is a relatively new research tool for pharmaceutical
scientists, there is little consensus on how to write the method
section in a research paper. There are many indefinite factors
in in vivo GI physiology and there are significant discrepancies
between in vitro and in vivo conditions. The awareness of this
issue initiated an international project in Europe (OrBiTo).32
Therefore, an almost perfect prediction of PK profiles reported
so far in many articles is at least questionable (many of them
employ a commercial software). A good simulation practice13
Sugano and Terada, JOURNAL OF PHARMACEUTICAL SCIENCES
REVIEW
Figure 2. Fa classification system and its relationship with BCS, food effect (by bile micelles), API and formulation design, and biowaiver
strategy.
FA CLASSIFICATION SYSTEM
The Fa equation can provide a classification system for oral
drug absorption (referred as the Fa classification system (FaCS)
in this article). FaCS includes the concept of BCS, but it provides a more mutually exclusive and collectively exhaustive
classification system for oral drug absorption (Fig. 2; Table 2).
On the basis of the Fa equation, the limiting factors of oral drug
absorption can be classified as:
1
PUWL
PE
+ VEf1u Pep
(14)
Permeability limited
Solubilitypermeability limited
a
b
Yua
FaCS
Dn < 1.1
Pn > 5.7
Pn/Do >> 1
Dn > 4.4
Pn < 5.7
Pn/Do >> 1
Dn > 4.4
Pn > 5.7
Pn/Do << 1
Dn < Pn/Do
Fa = 1exp(Dn)
Pn < Dnb
Do < 1
Fa = 1exp(Pn)
Fa = Pn/Do
Fa Equation
DOI 10.1002/jps.24391
REVIEW
where PE is the plica expansion factor, VE is the villi expansion factor, fu is the free fraction at the surface of the intestinal
epithelial membrane, PUWL is the unstirred water layer permeability (free and bile micelle bound drug molecules), and
Pep is the epithelial membrane permeability of unbound drug
molecules. Taken together, FaCS classifies drug products into
the five classes as shown in Figure 2.23,37 FaCS explicitly includes the basic concept of BCS (classification by Pn and Do).
In addition, FaCS also explicitly includes the dissolution perspective as represented by the Dn in its classification scheme
(Fig. 2; Table 2). In contrast to commonly speculated interpretation, BCS cannot determine whether Fa becomes DRL
or not.5 For example, when the solubility of a drug is 0.001
mg/mL, the dose is 0.1 mg, the particle size is 20 :m, Deff
is 6.6 106 cm2 /s, and Peff is 6.6 104 cm/s (corresponding to BCS class I; Dn = 0.7, Pn = 18.9, Do = 0.8), Fa becomes DRL. The third discriminate point of FaCS is related
to the permeability criterion. Unlike BCS, the permeability
boundary in FaCS is based on the rate-limiting factors of intestinal membrane permeation, i.e., UWL or the epithelial
membrane.
DRL Cases
In the case of DRL, particle size reduction would be effective
to increase Fa. However, as the dissolution rate increases, the
absorption regime changes from DRL to SL. The critical particle radius to become DRL can be calculated based on the Fa
equation.23 The discriminate equation between DRL and SL is:
Dn <
Pn
Do
(15)
(16)
Sdissolv can be cancelled out from both sides of Eq. (16), suggesting that the discrimination boundary between DRL and SL
does not depend on the solubility of a drug (for Do > 1). Even
though it is counterintuitive, this can be interpreted as follows;
when Sdissolv is low, the dissolution rate becomes slow, and at the
same time, the ceiling of Cdissolv (i.e., Sdissolv ) becomes low. On
the contrary, when the solubility is high, the dissolution rate
becomes fast and the ceiling of Cdissolv becomes high. Therefore,
the tendency of Cdissolv to reach Sdissolv does not depend on Sdissolv
(cf. the Sn does not depend on Sdissolv as well). By solving this
equation for rp , we obtain23
rp >
3Deff DoseRSI
2DFPeff VSI
(17)
REVIEW
BIOEQUIVALENCE
Problem Statement
The equivalence of the PKs between two drug products containing the same drug molecule is called BE. Clinical BE is
defined as 20% acceptance range (80%125%) for the 90% confidence interval of the ratio between test and reference least
square means after log transformation of the PK parameters
of interest, Cmax , and AUC.69 If it is possible to allow waivers
of clinical BE studies based on the in vitro data (biowaiver),
it would be beneficial for both drug developers and patients.
However, an in vitro dissolution test is not an all-round tool
and only reflects a certain dimension of complicated in vivo
situations. Therefore, the problem statement for a biowaiver
scheme is when and under what conditions can waivers of
clinical studies be allowed?4
BCS-Based Biowaiver Scheme
The BCS-based biowaiver scheme (BCS-BWS) for oral
immediate-release (IR) dosage has been employed by US FDA,
EMA, WHO, and many other regulatory agents. There are
many excellent review articles regarding BCS-BWS.33 The rationale to allow biowaivers for BCS Class I drugs was described
as,
When the in vivo dissolution of an IR oral dosage form is
rapid in relation to gastric emptying, the rate and extent of
drug absorption is likely to be independent of drug dissolution. Therefore, similar to oral solutions, demonstration
of in vivo bioequivalence may not be necessary as long
as the inactive ingredients used in the dosage form do not
significantly affect the absorption of the active ingredient.
Thus, for BCS Class I (high solubility- high permeability)
drug substances, demonstration of rapid in vitro dissolution using the recommended test methods would provide
sufficient assurance of rapid in vivo dissolution, thereby
ensuring human in vivo bioequivalence.33
In BCS-BWS, the criterion for solubility is based on the solubility of an API in the plain buffers of the entire pH range in
the GI tract (e.g., pH 1.27.4). The criterion for permeability
is based on the permeability value for nearly complete absorption (e.g., Fa > 0.850.90) (there are some variations in each
regulatory guideline).
Discussion Based on FaCS
In this section, a biowaiver strategy is discussed based on FaCS.
As described above, the dissolution criteria in BCS-BWS is
based on the ratio of the dissolution rate and the gastric emptying rate. However, the gastric-emptying rate largely depends
on the phase of the migrating motor complexes, which are the
waves of the GI walls that sweep through the stomach and the
intestine in a regular cycle during a fasting state.70 In addition, the gastric emptying half time can be as short as 4 min
in a fasted state.71,72 Furthermore, the solubility of a drug in
Sugano and Terada, JOURNAL OF PHARMACEUTICAL SCIENCES
(18)
(19)
(20)
There are two types of conditions to satisfy these equations: the equivalence of independent parameter (EIP) and
equivalent-in-effect (EIE) conditions. When Dn, Do, and Pn of
two formulations are identical, it is obvious that Cmax and AUC
become equivalent (Fig. 3a).
Dn1 = Dn2 , Do1 = Do2 , Pn1 = Pn2
(21)
We can also define the EIE condition in which AUC and Cmax
become insensitive to the independent parameters. In a certain
range, even when the independent parameters differed (i.e.,
Dn1 Dn2 , Do1 Do2 , and/or Pn1 Pn2 ), it could result in
the bioequivalence of Cmax (Cmax BE) and AUC (AUC BE). For
example, when Dn >> Pn, Do <1, and Pn > 2, AUC becomes
insensitive to the differences of these parameters within this
range (Fig. 3b).
Dn1 , Dn2 > Dncrit ; Do1 , Do2 < Docrit ; Pn1 , Pn2 > Pncrit
(22)
REVIEW
(a)
Formulation 1
Fa
Formulation 2
Dn1
Pn1
Dn2
Do1
Pn2
Do2
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
(b)
Insensitive
Pn
Figure 3. An illustration of (a) EIP and (b) EIE conditions for biowaiver.
Dn1 and Dn2 are larger than Dncrit , the dissolution rate does
not affect the bioequivalence of AUC and Cmax even when
Dn1 Dn2 (Dn1 and Dn2 become EIE). When Dn1 and/or
Dn2 are smaller than Dncrit , AUC and/or Cmax become sensitive
to Dn. In this case, the EIP, that is, Dn1 = Dn2, has to be proved.
For the Cmax BE, Dncrit can be roughly calculated as:
Dncrit >
1
Do
Pn
T1/2
(23)
ln2 Tabs
(24)
where MDT is the mean dissolution time. The Tabs MDT term
suggests that MDT reduces the time available for drug absorption.
Numerical integration can be used to calculate Dncrit more
accurately. Figure 4a shows the relationship among Pn, elimination T1/2 , and Dncrit obtained by numerically solving three
first-order equations (with kdiss , kperm , and kel ) that are sequentially connected (simulated for Tabs = 3.5 h; Do < 1).
Figure 4a suggests that in the case of short half-life
drugs (<120 min.), the dissolution rate criteria for a highpermeability drug should be larger than that for a lowpermeability drug because of the sensitivity of Cmax to Dncrit .75,76
Figure 4b is the cross-section of Figure 4a at T1/2 = 60 min. The
Dncrit lines for Cmax and AUC show different trends. For Cmax
BE, as the permeability of a drug becomes higher, a faster dissolution is required (Table 3). This might be one of the reasons
for that some of the BCS class I drugs failed to show Cmax BE
even when they complied with the rapid dissolution criteria.77
Several low-permeability drugs show clinical BE even when
the dissolution profiles significantly differed among the formulations, for example, cimetidine,78 fexofenadine,79 and so on.
The Cmax of a high-permeability and short half-life drug can be
sensitive to the dissolution profile, for example, ibuprofen.80
In the Do > 1 cases, the Dncrit plane shifts lower, suggesting
that AUC and Cmax become less sensitive to the dissolution
DOI 10.1002/jps.24391
REVIEW
Figure 4. The relationship among Dncrit , Pn, and T1/2 . (a) Dncrit plane satisfying both AUC BE and Cmax BE. (b) Cross-section at T1/2 =
60 min. The AUC and Cmax lines satisfy the equivalence of AUC and Cmax , respectively. The Dcrit values for Pn > 2 (Fa > 0.850.90) and
T1/2 < 10 h become higher than that for the Pn < 2 cases.
Table 3. Dissolution Criteria for Biowaiver
T85% (min)a
Dncrit
Pn
T1/2
AUC
Cmax
BEb
Dncrit 3c
FaCS Based
Current BCS-BWS
0.2
0.2
2
2
20
20
60
600
60
600
60
600
4.7
4.7
3.0
3.0
1.7
1.7
2.5
4.3
2.9
2.6
9.2
2.3
4.7
4.7
3.0
3.0
9.2
2.3
14
14
9.0
9.0
28
6.8
28
28
45
45
14
59
15d
15d
30
30
30
30
A. Dn > Dncrit
Tabs ln (1 0.85)
Dnctir SMF
supersaturated solubility.
Therefore, the equilibrium solubility of an API in plain
buffers should be smaller than the apparent solubility of a drug
in vivo from a drug product. Consequently, in vivo Do < Docrit
can be proved by using in vitro data (in vivo Do < in vitro Do <
Docrit ).
(25)
where SMF is the safe margin factor. For AUC BE of a lowpermeability drug, Dncrit > 5 is required. When applying
SMF = 3, in vitro T85% becomes approximately 30 min (Table 3). For a high-permeability drug with T1/2 = 60 min, in vitro
T85% should be set 15 min for Cmax BE (Table 3).
B. Do < Docrit
The following three reasons would justify the use of the in
vitro equilibrium solubility of an API in plain buffers to prove
Do < Docrit of a drug product in vivo.
Sugano and Terada, JOURNAL OF PHARMACEUTICAL SCIENCES
C. Pn > Pncrit
In the T1/2 more than approximately 600 min range, Fa >
0.850.90 (Pn > 2) would be appropriate to justify biowaiver
(Fig. 5). However, in the T1/2 less than approximately 600 min
range, it does not guarantee Cmax BE. When Pn < Pncrit , a proof
for Pn1 = Pn2 in vivo is required [see sections (F) or (G) below].
When using a clinical Fa value for the permeability criterion,
no safety margin would be required. However, when an in vitro
permeability assay is used as a surrogate, an appropriate safe
margin would be required.
D. Dn1 = Dn2
DOI 10.1002/jps.24391
REVIEW
E. Do1 = Do2
10
9
8
7
6
(b)
(a1)
5
F. PUWL1 = PUWL2
UWL line
4
3
(c2)
(a2)
2
1
(c1)
0
60
600
EliminationT1/2 (min)
6000
Measures
Criteria
IVIVC
Not known
In vitro permeability
Excipient restriction
IVIVC criteria
Not known
PUWL d < VE fu Papp SMF
No excipient affecting Pep
DOI 10.1002/jps.24391
10
REVIEW
Do
EIE (B)
EIE (B)
EIE (B)
EIP (E)
EIP (E)
EIEg
Pn
EIE (C)
EIP (F)
EIP (G)
EIP (F)
EIP (G)
EIEg
FaCS
BCSb
Comments
+
PL-Ue
PL-Ef
SL-U
SL-E
DRL
I
I
III
II
IV
N/A
PL-Uc
PL-Ed
a
See test and Table 4 for the annotation of each alphabet. The color filling indicates the levels of challenge to prove the BE conditions; green, OK for biowaiver;
yellow, almost OK; orange, needs more scientific evidence; red, significant challenge required.
b
BCS classes approximately corresponding to each biowaiver strategy.
c
Area (a1) in Figure 5.
d
Area (a2) in Figure 5.
e
Area (b) in Figure 5.
f
Areas (c1) and (c2) in Figure 5.
g
Derived from Dn << Pn/Do.
N/A, not applicable.
CONCLUSION
The theoretical investigations discussed here can significantly
contribute to a better understanding of oral drug absorption.
They can provide guidance for API form selection, formulation
design, and biowaiver strategy. Although it is likely that computational simulations will be used more widely in the future,
analytical solutions and classification systems will continue to
provide a way to understand the fundamentals of oral drug
absorption.
ACKNOWLEDGMENTS
The authors greatly appreciate Prof. Gordon Amidon, Prof.
Shinji Yamashita, Dr. Ryusuke Takano, and Ms. Asami Ono
for their kind suggestions and discussions. The authors also
greatly appreciate the reviewers for their kind suggestions to
improve the manuscript.
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DOI 10.1002/jps.24391