A Bioequivalence Study of Sacubitril/Valsartan Film-coated Tablets Under Fasting Conditions

To evaluate the bioequivalence between two formulations of sacubitril/valsartan 24 mg/26 mg film-coated tablets, Entresto 50 mg (Reference) and Sacubitril and Valsartan Sodium Tablets 24 mg/26 mg (Test), after a single oral dose administration in healthy Thai subjects under fasting conditions.

This study will be an open label, single dose, randomized, two-formulation, four-period, two-sequence, fully replicate crossover study. In this study, 48 healthy subjects will be randomized into two cohorts to receive a single dose of sacubitril and valsartan 24 mg/26 mg film-coated tablets for 48 hours and will be separated by a washout period of 7 days. This study will be conducted at one clinical site.

Eligibility Criteria:
Inclusion Criteria:

1. Thai Male/Female must be 18-55 years of age, body weight \>50.0 kg with body mass index (BMI) = 18.0-30.0 kg/m2, inclusive.
2. Must be in good health as determined by medical history, vital signs (blood pressure (systolic blood pressure not lower than 100 or not over 139 mmHg, diastolic blood pressure not lower than 70 or not over 89 mmHg), body temperature, pulse rate, respiratory rate) and physical examination or showing no clinically significant abnormalities in the opinion of Principal/Clinical Investigator or designated physicians
3. Screening ECG without clinically significant abnormalities
4. Screening visit laboratory values of blood test including hematology (CBC with differential), serum potassium, FBS, BUN, Cr, and liver function test (AST, ALT, total bilirubin and ALP) must be within the normal range or showing no clinically significant abnormalities in the opinion of Principal/Clinical Investigator or designated physicians.
5. Urinalysis results within normal limit or showing no clinically significant abnormalities in the opinion of Principal/Clinical Investigator or designated physicians.
6. Must have serum HBsAg, anti-HCV and anti-HIV negative
7. Female subject must have serum β-hCG negative or showing no clinically significant abnormalities in the opinion of Principal/Clinical Investigator or designated physicians.
8. Female subject of childbearing potential or male subject agrees to use an acceptable birth control method from visit 1 to the follow-up visit. The acceptable birth control method is defined as a barrier method of contraception (including condoms, intrauterine device and diaphragm with spermicidal agent) or total abstinence from sexual intercourse from visit 1 to the follow-up visit. Hormonal contraceptives are not acceptable.
9. Female subject of non-childbearing potential (hysterectomy, both ovaries removed, surgically sterilized or postmenopausal (for at least 12 consecutive months of amenorrhea))
10. Female subject must agree not to become pregnant for the entire participation period and must have a negative result for a urine pregnancy test performing prior to dosing at Period 1, Period 2, Period 3 and Period 4.
11. Non-smoker (never smoked or no smoking within the previous 1 year)
12. Refrain from using herbal medications, cannabis containing products, dietary supplements (e.g., St. John's Wort, ginkgo biloba, garlic supplements), vitamins, grapefruit or grapefruit juice, or pomelo within 14 days before the first administration of investigational product (Day 1). Subjects must agree to refrain from these items until the last collection time-point of Period 4.
13. Subject must have ended any systemic medications or any medications that have any impact on gastrointestinal system at least 30 days prior to Day 1 or at least 5 times of elimination half-life prior to Day 1 and agree to continue their refraining throughout the follow-up period.
14. Subject must refrain from drinking caffeine and alcohol for at least 72 hours prior to Day 1 and agree to continue their refraining throughout the last collection time-point of Period 4.
15. Have the ability to understand the requirements of the study and must voluntarily sign and date an informed consent, approved by an Independent Ethics Committee (IEC)/Institutional Review Board (IRB), prior to the initiation of any screening or study-specific procedures

Exclusion Criteria:

1. Known hypersensitivity to sacubitril or valsartan or any other similar class of drugs or its components
2. Past medical history of renal and hepatic insufficiency
3. Subject has a history of any illness that, in the opinion of Principal/Clinical Investigator or designated physicians, might confound the result of the study or pose an additional risk in administering investigational product to the subject. This may include but is not limited to: a history of relevant drug or food allergies; history of cardiovascular, gastrointestinal, central nervous system disease, renal and hepatic impairment; history or presence of clinically significant illness; or history of mental illness that may affect compliance with study requirements.
4. History of hereditary or idiopathic angioedema
5. Have a history of angioedema related to previous ACE inhibitor or ARB therapy
6. Have serum potassium level \>5.4 mmol/L
7. Have history of drug abuse (in the opinion of Principal/Clinical Investigator or designated physicians, as judged by medical history) in the last 12 months
8. Have positive result of urine drug abuse testing on opioids (Mor, MTD), cannabinoids (THC), Meth, Coc or MDMA at screening visit or before dose administration at each period
9. Alcohol abuse or excessive use (in the opinion of Principal/Clinical Investigator or designated physicians, as judged by medical history) in the last 12 months
10. Have positive result of alcohol breathing test at screening visit or before dose administration at each period
11. Female subject is pregnant or breast feeding.
12. Difficulties fasting or consuming standard meals
13. Difficulties swallowing whole tablets
14. Donation or loss of whole blood:

    1. ≥50 mL and ≤499 mL within 30 days prior to Day 1
    2. ≥500 mL within 56 days prior to Day 1
15. Participation in any investigational drug study within 30 days from screening visit (from the last follow-up visit to the screening visit).