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Revefenacin
Also known as: 864750-70-9, Td-4208, Yupelri, Gsk-1160724, Gsk1160724, Revefenacin [inn]
Molecular Formula
C35H43N5O4
Molecular Weight
597.7  g/mol
InChI Key
FYDWDCIFZSGNBU-UHFFFAOYSA-N
FDA UNII
G2AE2VE07O

Revefenacin is a novel biphenyl carbamate tertiary amine agent that belongs to the family of the long-acting muscarinic antagonists (LABA). The labile primary amide in the structure produces a "soft-drug" site that allows rapid systemic clearance and minimizing of the systemically mediated adverse reactions. The LABA group falls into a parent category known as long-acting inhaled bronchodilators and this type of agents are recommended as a maintenance therapy for chronic obstructive pulmonary disease (COPD). From the LABA group, revefenacin is the first once-daily nebulized LAMA treatment. It was developed by Theravance Biopharma and FDA approved on November 9, 2018.
Revefenacin is an Anticholinergic. The mechanism of action of revefenacin is as a Cholinergic Antagonist.
1 2D Structure

Revefenacin

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
[1-[2-[[4-[(4-carbamoylpiperidin-1-yl)methyl]benzoyl]-methylamino]ethyl]piperidin-4-yl] N-(2-phenylphenyl)carbamate
2.1.2 InChI
InChI=1S/C35H43N5O4/c1-38(34(42)29-13-11-26(12-14-29)25-40-19-15-28(16-20-40)33(36)41)23-24-39-21-17-30(18-22-39)44-35(43)37-32-10-6-5-9-31(32)27-7-3-2-4-8-27/h2-14,28,30H,15-25H2,1H3,(H2,36,41)(H,37,43)
2.1.3 InChI Key
FYDWDCIFZSGNBU-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CN(CCN1CCC(CC1)OC(=O)NC2=CC=CC=C2C3=CC=CC=C3)C(=O)C4=CC=C(C=C4)CN5CCC(CC5)C(=O)N
2.2 Other Identifiers
2.2.1 UNII
G2AE2VE07O
2.3 Synonyms
2.3.1 MeSH Synonyms

1. Biphenyl-2-ylcarbamic Acid 1-(2-((4-(4-carbamoylpiperidin-1-ylmethyl)benzoyl)methylamino)ethyl)piperidin-4-yl Ester

2. Td-4208

3. Yupelri

2.3.2 Depositor-Supplied Synonyms

1. 864750-70-9

2. Td-4208

3. Yupelri

4. Gsk-1160724

5. Gsk1160724

6. Revefenacin [inn]

7. Revefenacin [who-dd]

8. G2ae2ve07o

9. 864750-70-9 (free Base)

10. [1-[2-[[4-[(4-carbamoylpiperidin-1-yl)methyl]benzoyl]-methylamino]ethyl]piperidin-4-yl] N-(2-phenylphenyl)carbamate

11. 1-(2-(4-((4-carbamoylpiperidin-1-yl)methyl)-n-methylbenzamido)ethyl)piperidin-4-yl N-((1,1'-biphenyl)-2-yl)carbamate

12. 1-(2-(3-((4-carbamoylpiperidin-1-yl)methyl)-n-methylbenzamido)ethyl)piperidin-4-yl [1,1'-biphenyl]-2-ylcarbamate

13. Biphenyl-2-ylcarbamic Acid, 1-(2-((4-(4-carbamoylpiperidin-1-ylmethyl)benzoyl)methylamino)ethyl)piperidin-4-yl Ester

14. Carbamic Acid, N-(1,1'-biphenyl)-2-yl-, 1-(2-((4-((4-(aminocarbonyl)-1-piperidinyl)methyl)benzoyl)methylamino)ethyl)-4-piperidinyl Ester

15. Td-4208; Gsk-1160724;[1-[2-[[4-[(4-carbamoylpiperidin-1-yl)methyl]benzoyl]-methylamino]ethyl]piperidin-4-yl] N-(2-phenylphenyl)carbamate

16. Revefenacin [mi]

17. Revefenacin (usan/inn)

18. Revefenacin [usan:inn]

19. Revefenacin [usan]

20. Unii-g2ae2ve07o

21. Revefenacin;gsk1160724

22. Schembl356480

23. Chembl3833319

24. Gtpl10129

25. Revefenacin [orange Book]

26. Dtxsid701027775

27. Hms3886k17

28. Amy16789

29. Bcp15793

30. Ex-a1722

31. S5258

32. Td4208

33. Akos037649398

34. Ccg-270187

35. Cs-7743

36. Db11855

37. Sb17262

38. Bs-18189

39. Hy-15851

40. Revefenacin; Td-4208; Gsk-1160724

41. D10978

42. A903445

43. Q27278649

44. Revefenacin; Td 4208; Td4208; Gsk-1160724; Gsk1160724; Gsk 1160724

45. 1-(2-(4-((4-carbamoylpiperidin-1-yl)methyl)-n-methylbenzamido)ethyl)piperidin-4-yl [1,1'-biphenyl]-2-ylcarbamate

46. 1211931-83-7

47. Td-4208; Td 4208; Td4208; Gsk-1160724; Gsk1160724;1-(2-(4-((4-carbamoylpiperidin-1-yl)methyl)-n-methylbenzamido)ethyl)piperidin-4-yl N-((1,1'-biphenyl)-2-yl)carbamate

2.4 Create Date
2006-10-26
3 Chemical and Physical Properties
Molecular Weight 597.7 g/mol
Molecular Formula C35H43N5O4
XLogP34.1
Hydrogen Bond Donor Count2
Hydrogen Bond Acceptor Count6
Rotatable Bond Count11
Exact Mass597.33150487 g/mol
Monoisotopic Mass597.33150487 g/mol
Topological Polar Surface Area108 Ų
Heavy Atom Count44
Formal Charge0
Complexity918
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Indication

Revefenacin is indicated as an inhalation solution for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). COPD is a growing disease being the third leading cause of death in the US. This disease is characterized by not fully reversible airflow limitation.


FDA Label


5 Pharmacology and Biochemistry
5.1 Pharmacology

Revefenacin has been reported to produce a sustained, long-acting bronchodilation with lower anti-muscarinic-related side effects. In clinical trials, revefenacin demonstrated to be of a long duration of action and low systemic exposure in patients with COPD. Also, it was reported that a dose of 88 mcg can produce a clinically effective bronchodilation measured by through forced expiratory volume in 1s and serial spirometric assessments. In placebo-controlled trials, revefenacin showed a decrease in the use of albuterol rescue inhalers and sustained increases in the peak expiratory flow rate that reached a steady state at a maximum in day 7. As well, there was a reported superior lung selectivity index when compared with other LABAs such as glycopyrronium and tiotropium which produced a decreased sialagogue effect.


5.2 FDA Pharmacological Classification
5.2.1 Active Moiety
REVEFENACIN
5.2.2 FDA UNII
G2AE2VE07O
5.2.3 Pharmacological Classes
Cholinergic Antagonists [MoA]; Anticholinergic [EPC]
5.3 ATC Code

R - Respiratory system

R03 - Drugs for obstructive airway diseases

R03B - Other drugs for obstructive airway diseases, inhalants

R03BB - Anticholinergics

R03BB08 - Revefenacin


5.4 Absorption, Distribution and Excretion

Absorption

In pharmacokinetic studies, revefenacin was absorbed very rapidly and presented a linear increase in plasma exposure with Cmax, tmax and AUC that ranged between 0.02-0.15 ng/ml, 0.48-0.51 hours and 0.03-0.36 ng.h/ml, respectively. The bioaccumulation of revefenacin was very limited and the steady-state was achieved by day 7.


Route of Elimination

After reaching maximum concentration, revefenacin concentrations decline in a biphasic manner. This elimination kinetics is observed by a rapid declining plasma concentration followed by a slow apparent bi-exponential elimination. Renal elimination of revefenacin is limited and it presents a mean cumulative amount excreted in urine as the unchanged drug of < 0.2% of the administered dose. Following intravenous revefenacin administration, 54% of the dose is recovered in feces and 27% was recovered in urine which confirms a high hepatobiliary processing.


Volume of Distribution

After intravenous administration of revefenacin, the reported volume of distribution is 218 L which suggests an extensive distribution to the tissues.


Clearance

The renal clearance of revefenacin is negligible and thus, the clearance rate is not a major parameter for this drug.


5.5 Metabolism/Metabolites

Revefenacin presents a high metabolic liability producing a rapid metabolic turnover after being distributed from the lung. This metabolic process is done primarily via enzymatic hydrolysis via CYP2D6 to its major hydrolytic metabolite THRX-195518.


5.6 Biological Half-Life

The apparent terminal half-life of a dose of 350 mcg of revefenacin was 22.3-70 hours.


5.7 Mechanism of Action

Revefenacin is an inhaled bronchodilator muscarinic antagonist with a long-acting bronchodilation activity. It has been shown to present a high affinity and behaved as a competitive antagonist of the five muscarinic cholinergic receptors. Studies have indicated that revefenacin dissociates significantly slower from the muscarinic receptor M3 (hM3) when compared to the receptor M2 (hM2) which indicates a kinetic selectivity for this subtype. This competitive antagonism produces a suppressive action of the acetylcholine-evoked calcium mobilization and contractile responses in the airway tissue. Lastly, due to the duration of the bronchodilation, revefenacin is considered a long-acting muscarinic antagonist which allows it to be dosed once daily. This response is very important for the therapy of COPD as the main goal is the reduce the frequency and severity of exacerbations which are normally driven by the presence of elevated cholinergic bronchoconstrictor tone mediated by muscarinic receptors on parasympathetic ganglia and airway smooth muscle. Hence, the activity of revefenacin produces a potent and long-lasting protection against the bronchoconstrictor response to acetylcholine or methacholine.


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