Trofinetide

Identification

Summary

Trofinetide is a drug used to treat Rett syndrome in children and adults.

Brand Names
Daybue
Generic Name
Trofinetide
DrugBank Accession Number
DB06045
Background

Trofinetide is a novel synthetic analog of glypromate, also known as glycine–proline–glutamate (GPE), a naturally occurring protein in the brain and the N-terminal tripeptide of insulin-like growth factor 1 (IGF-1).1 Trofinetide was approved by the FDA on March 10, 2023, for the treatment of Rett syndrome,5,6 which is an X-linked neurodevelopmental disorder characterized by a range of cognitive, motor, and autonomic symptoms.1 Trofinetide is believed to work by reducing inflammation and apoptosis of neurons.2

Type
Small Molecule
Groups
Approved, Investigational
Structure
Weight
Average: 315.326
Monoisotopic: 315.143035408
Chemical Formula
C13H21N3O6
Synonyms
  • glycyl-L-2-methylprolyl-L-glutamic acid
  • Trofinetide
External IDs
  • NNZ 2566
  • NNZ-2566

Pharmacology

Indication

Trofinetide is indicated for the treatment of Rett syndrome in adults and pediatric patients two years of age and older.4

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Associated Conditions
Indication TypeIndicationCombined Product DetailsApproval LevelAge GroupPatient CharacteristicsDose Form
Management ofRett syndrome••••••••••••••••••••••• •••••• •••••••••
Contraindications & Blackbox Warnings
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Pharmacodynamics

Trofinetide works to reduce and alleviate the symptoms of Rett syndrome.1 It is an analog of glypromate or glycine–proline–glutamate (GPE), a naturally occurring protein in the brain and the N-terminal tripeptide of insulin-like growth factor 1 (IGF-1). GPE exhibits neuroprotective properties: it protects neurons from glutamate-mediated excitotoxicity and oxidative stress at nanomolar concentrations. With a longer half-life than GPE, trofinetide is believed to exhibit similar neuroprotective properties.2

Mechanism of action

Most cases of Rett syndrome are associated with loss-of-function mutations in a gene encoding methyl CpG binding protein 2 (MECP2), a DNA binding protein with a role in epigenetic regulation of gene expression.1 These mutations are believed to lead to synaptic immaturation in the cortex, aberrant metabolism of brain cholesterol resulting in abnormal neuronal development, and abnormal neuronal signaling.3 Rett syndrome more commonly occurs in girls than boys.1

The exact mechanism of action of trofinetide in Rett syndrome has not been fully elucidated.4 In mice studies, GPE improved motor and cardiorespiratory function, increased brain weight, and prolonged the lifespan in MECP2-deficient mice. As a GPE analog, trofinetide similarly attenuated apoptosis and reduced infarct size in a dose-dependent manner in a rat model of hypoxic insult.1,2 Trofinetide exerts a multi-faceted action to reduce inflammation, excitotoxicity-induced tissue damage, and apoptosis, thereby protecting the neurons and their surrounding infrastructure.2

Absorption

Systemic exposure to trofinetide was dose-proportional across the studied dose range. The Tmax is about two to three hours after administration. Based on the mass balance study, at least 84% of the administered oral dose of 12,000 mg trofinetide was absorbed.4

A high-fat meal had negligible effects on drug exposure and reduced the Cmax by approximately 20%.4

Volume of distribution

Following oral administration, the apparent volume of distribution of trofinetide in healthy adult subjects was approximately 80 L. Minimal to no accumulation was observed following multiple-dose administration.4

Protein binding

Protein binding to human plasma is less than 6%.4

Metabolism

Trofinetide is not significantly metabolized by CYP450 enzymes. Hepatic metabolism is not a significant route of trofinetide elimination.4

Route of elimination

Trofinetide is primarily excreted in urine, with minor excretion in feces. Approximately 80% of the dose recovered in urine was in the unchanged parent drug form.4

Half-life

The effective elimination half-life of orally administered trofinetide in healthy subjects is about 1.5 hours.4

Clearance

No information is available.

Adverse Effects
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Toxicity

There is no information available regarding acute toxicity (LD50) and overdose of trofinetide.

Pathways
Not Available
Pharmacogenomic Effects/ADRs Browse all" title="About SNP Mediated Effects/ADRs" id="snp-actions-info" class="drug-info-popup" href="javascript:void(0);">
Not Available

Interactions

Drug Interactions Learn More" title="About Drug Interactions" id="structured-interactions-info" class="drug-info-popup" href="javascript:void(0);">
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.
DrugInteraction
AbemaciclibThe metabolism of Abemaciclib can be decreased when combined with Trofinetide.
AcalabrutinibThe metabolism of Acalabrutinib can be decreased when combined with Trofinetide.
AcenocoumarolThe metabolism of Acenocoumarol can be decreased when combined with Trofinetide.
AlbendazoleThe metabolism of Albendazole can be decreased when combined with Trofinetide.
AlectinibThe metabolism of Alectinib can be decreased when combined with Trofinetide.
Food Interactions
  • Take with or without food. Food decreases Cmax of trofinetide but has negligible effects on total drug exposure.

Products

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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
DaybueSolution200 mg/1mLOralAcadia Pharmaceuticals Inc.2022-12-31Not applicableUS flag

Categories

Drug Categories
Chemical TaxonomyProvided by Classyfire
Description
This compound belongs to the class of organic compounds known as oligopeptides. These are organic compounds containing a sequence of between three and ten alpha-amino acids joined by peptide bonds.
Kingdom
Organic compounds
Super Class
Organic acids and derivatives
Class
Carboxylic acids and derivatives
Sub Class
Amino acids, peptides, and analogues
Direct Parent
Oligopeptides
Alternative Parents
Glutamic acid and derivatives / N-acyl-L-alpha-amino acids / Alpha amino acid amides / Pyrrolidinecarboxamides / N-acylpyrrolidines / Heterocyclic fatty acids / Dicarboxylic acids and derivatives / Tertiary carboxylic acid amides / Secondary carboxylic acid amides / Amino acids
show 6 more
Substituents
Aliphatic heteromonocyclic compound / Alpha-amino acid amide / Alpha-amino acid or derivatives / Alpha-oligopeptide / Amine / Amino acid / Amino acid or derivatives / Azacycle / Carbonyl group / Carboxamide group
show 24 more
Molecular Framework
Aliphatic heteromonocyclic compounds
External Descriptors
Not Available
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
Z2ME8F52QL
CAS number
853400-76-7
InChI Key
BUSXWGRAOZQTEY-SDBXPKJASA-N
InChI
InChI=1S/C13H21N3O6/c1-13(5-2-6-16(13)9(17)7-14)12(22)15-8(11(20)21)3-4-10(18)19/h8H,2-7,14H2,1H3,(H,15,22)(H,18,19)(H,20,21)/t8-,13-/m0/s1
IUPAC Name
(2S)-2-{[(2S)-1-(2-aminoacetyl)-2-methylpyrrolidin-2-yl]formamido}pentanedioic acid
SMILES
C[C@]1(CCCN1C(=O)CN)C(=O)N[C@@H](CCC(O)=O)C(O)=O

References

General References
  1. Neul JL, Percy AK, Benke TA, Berry-Kravis EM, Glaze DG, Peters SU, Jones NE, Youakim JM: Design and outcome measures of LAVENDER, a phase 3 study of trofinetide for Rett syndrome. Contemp Clin Trials. 2022 Mar;114:106704. doi: 10.1016/j.cct.2022.106704. Epub 2022 Feb 8. [Article]
  2. Bickerdike MJ, Thomas GB, Batchelor DC, Sirimanne ES, Leong W, Lin H, Sieg F, Wen J, Brimble MA, Harris PW, Gluckman PD: NNZ-2566: a Gly-Pro-Glu analogue with neuroprotective efficacy in a rat model of acute focal stroke. J Neurol Sci. 2009 Mar 15;278(1-2):85-90. doi: 10.1016/j.jns.2008.12.003. Epub 2009 Jan 20. [Article]
  3. Chahil G, Bollu PC: Rett Syndrome. . [Article]
  4. FDA Approved Drug Products: DAYBUE (trofinetide) Oral Solution [Link]
  5. FDA News: FDA approves first treatment for Rett Syndrome [Link]
  6. Acadia Pharmaceuticals: Acadia Pharmaceuticals Announces U.S. FDA Approval of DAYBUE™ (trofinetide) for the Treatment of Rett Syndrome in Adult and Pediatric Patients Two Years of Age and Older [Link]
ChemSpider
9493869
RxNav
2632852
ChEMBL
CHEMBL197084
Wikipedia
Trofinetide

Clinical Trials

Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">
PhaseStatusPurposeConditionsCount
3CompletedTreatmentRett Syndrome3
2CompletedSupportive CareBrain Injury1
2CompletedTreatmentBrain Injury1
2CompletedTreatmentFragile X Syndrome1
2CompletedTreatmentRett Syndrome2

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
SolutionOral200 mg/1mL
Prices
Not Available
Patents
Patent NumberPediatric ExtensionApprovedExpires (estimated)Region
US11370755No2020-08-032040-08-03US flag
US9212204No2015-12-152032-01-27US flag

Properties

State
Solid
Experimental Properties
PropertyValueSource
boiling point (°C)655.4±55https://www.chemsrc.com/en/cas/853400-76-7_1470449.html
logP-2.22https://www.chemsrc.com/en/cas/853400-76-7_1470449.html
Predicted Properties
PropertyValueSource
Water Solubility10.4 mg/mLALOGPS
logP-3ALOGPS
logP-4.5Chemaxon
logS-1.5ALOGPS
pKa (Strongest Acidic)3.27Chemaxon
pKa (Strongest Basic)7.83Chemaxon
Physiological Charge-1Chemaxon
Hydrogen Acceptor Count7Chemaxon
Hydrogen Donor Count4Chemaxon
Polar Surface Area150.03 Å2Chemaxon
Rotatable Bond Count7Chemaxon
Refractivity73.79 m3·mol-1Chemaxon
Polarizability30.95 Å3Chemaxon
Number of Rings1Chemaxon
Bioavailability1Chemaxon
Rule of FiveYesChemaxon
Ghose FilterNoChemaxon
Veber's RuleNoChemaxon
MDDR-like RuleNoChemaxon
Predicted ADMET Features
Not Available

Spectra

Mass Spec (NIST)
Not Available
Spectra
SpectrumSpectrum TypeSplash Key
Predicted MS/MS Spectrum - 10V, Positive (Annotated)Predicted LC-MS/MSsplash10-00kb-3294000000-6c459e44fa339bb29250
Predicted MS/MS Spectrum - 10V, Negative (Annotated)Predicted LC-MS/MSsplash10-03di-1469000000-d318c29583bdca6a632c
Predicted MS/MS Spectrum - 20V, Positive (Annotated)Predicted LC-MS/MSsplash10-000x-9660000000-d673dc51307932368489
Predicted MS/MS Spectrum - 20V, Negative (Annotated)Predicted LC-MS/MSsplash10-03di-5890000000-92f4131aef1befd7a881
Predicted MS/MS Spectrum - 40V, Positive (Annotated)Predicted LC-MS/MSsplash10-01q9-9710000000-85ed75b8b6ea7632871b
Predicted MS/MS Spectrum - 40V, Negative (Annotated)Predicted LC-MS/MSsplash10-001l-9000000000-71a58144ad4ce8c12857
Predicted 1H NMR Spectrum1D NMRNot Applicable
Predicted 13C NMR Spectrum1D NMRNot Applicable
Chromatographic Properties
Collision Cross Sections (CCS)
Not Available

Enzymes

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Inhibitor
Curator comments
Trofinetide was found to be an inhibitor of this enzyme in vitro.
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
  1. FDA Approved Drug Products: DAYBUE (trofinetide) Oral Solution [Link]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Inhibitor
Curator comments
Trofinetide was found to be an inhibitor of this enzyme in vitro.
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. This isoform has specificity for phenols. Isoform 2 lacks trans...
Gene Name
UGT1A9
Uniprot ID
O60656
Uniprot Name
UDP-glucuronosyltransferase 1-9
Molecular Weight
59940.495 Da
References
  1. FDA Approved Drug Products: DAYBUE (trofinetide) Oral Solution [Link]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Inhibitor
Curator comments
Trofinetide was found to be an inhibitor of this enzyme in vitro.
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
  1. FDA Approved Drug Products: DAYBUE (trofinetide) Oral Solution [Link]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Inhibitor
Curator comments
Trofinetide was found to be an inhibitor of this enzyme in vitro.
General Function
Glucuronosyltransferase activity
Specific Function
UDPGTs are of major importance in the conjugation and subsequent elimination of potentially toxic xenobiotics and endogenous compounds. This isozyme displays activity toward several classes of xeno...
Gene Name
UGT2B15
Uniprot ID
P54855
Uniprot Name
UDP-glucuronosyltransferase 2B15
Molecular Weight
61035.815 Da
References
  1. FDA Approved Drug Products: DAYBUE (trofinetide) Oral Solution [Link]

Transporters

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Inhibitor
Curator comments
Trofinetide was found to be an inhibitor of this transporter in vitro.
General Function
Sodium-independent organic anion transmembrane transporter activity
Specific Function
Mediates the Na(+)-independent uptake of organic anions such as pravastatin, taurocholate, methotrexate, dehydroepiandrosterone sulfate, 17-beta-glucuronosyl estradiol, estrone sulfate, prostagland...
Gene Name
SLCO1B1
Uniprot ID
Q9Y6L6
Uniprot Name
Solute carrier organic anion transporter family member 1B1
Molecular Weight
76447.99 Da
References
  1. FDA Approved Drug Products: DAYBUE (trofinetide) Oral Solution [Link]
Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Inhibitor
Curator comments
Trofinetide was found to be an inhibitor of this transporter in vitro.
General Function
Sodium-independent organic anion transmembrane transporter activity
Specific Function
Mediates the Na(+)-independent uptake of organic anions such as 17-beta-glucuronosyl estradiol, taurocholate, triiodothyronine (T3), leukotriene C4, dehydroepiandrosterone sulfate (DHEAS), methotre...
Gene Name
SLCO1B3
Uniprot ID
Q9NPD5
Uniprot Name
Solute carrier organic anion transporter family member 1B3
Molecular Weight
77402.175 Da
References
  1. FDA Approved Drug Products: DAYBUE (trofinetide) Oral Solution [Link]

Drug created at November 18, 2007 18:29 / Updated at April 07, 2023 13:12