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Dojolvi

triheptanoin
small moleculeAnaplerotic energy substrateOral medium-chain (C7) triglyceride liquidLong-chain fatty acid oxidation disorders (LC-FAOD)
Species
RatPig
Longest study
39 wk
Genotox
Conducted Conducted
Carcinogenicity
Not conducted Not conducted
Repro
Conducted Conducted
First dose
Not conducted Not stated publicly

Speciesopen answer page →

Species
Minipig (GLP); published rat dietary study
“A 9-month repeat dose oral toxicity study in juvenile minipigs was submitted in support of the safety of long-term administration of triheptanoin in adult and pediatric patients. In addition, a published 9-month dietary toxicity study of triheptanoin in rats was submitted in support of the safety in rodents.”
✓ VerifiedFDA integrated review, p. 81Source ↗
Why that species
Not stated in public reviews

The reviews list the species but not why. For small molecules, ICH M3(R2) expects one rodent and one non-rodent species, chosen with in vitro metabolism, protein binding and exposure data compared with human.

“In vitro metabolic and plasma protein binding data for animals and humans and systemic exposure data (ICH S3A, Ref. 7) in the species used for repeated-dose toxicity studies generally should be evaluated before initiating human clinical trials.”
✓ VerifiedICH 2009: ICH M3(R2): Guidance on Nonclinical Safety Studies for the Conduct…, p. 11Source ↗

Pre-IND readiness checklist →

Surrogate molecule
No surrogate; the clinical compound was tested
“The chronic (9-month) dietary toxicity of triheptanoin was assessed in juvenile male and female minipigs (the equivalent human age of >2 years) at doses of 10%, 30%, or 50% DCI following dosing (study UX007-PC002).”
✓ VerifiedFDA integrated review, p. 59Source ↗

Study lengthopen answer page →

Longest pivotal study
39 (9-month juvenile minipig)
“The no observed adverse effect level (NOAEL) for daily administration of triheptanoin for 9 months in minipigs was 50% DCI.”
✓ VerifiedFDA integrated review, p. 59Source ↗
Pivotal GLP studies
9-month GLP dietary study in juvenile minipigs with 3-month interim sacrifice and 4-week recovery
“In the dietary administration of UX007 to male and female juvenile minipigs at doses of 0%, 10%, 30%, or 50% DCI for 9 months with a 4-week recovery and a 3-month interim sacrifice”
✓ VerifiedFDA integrated review, p. 81Source ↗
Route in tox
Oral (dietary admixture)
“In the dietary administration of UX007 to male and female juvenile minipigs at doses of 0%, 10%, 30%, or 50% DCI for 9 months”
✓ VerifiedFDA integrated review, p. 81Source ↗

Skipped studiesopen answer page →

Genotoxicity
Negative in Ames, in vitro chromosome aberration (human lymphocytes) and in vivo rat micronucleus assays
“Triheptanoin was not mutagenic in the Ames assay up to 4800 µg/plate, did not induce chromosomal aberration in vitro in human peripheral blood lymphocytes up to 409 µg/ml, and it was negative in the in vivo rat micronucleus assay at up to 2000 mg/kg/day.”
✓ VerifiedFDA integrated review, p. 59Source ↗
Carcinogenicity
Not conducted
“Nonclinical animal studies evaluating long-term administration of triheptanoin have not been conducted to assess the carcinogenic potential of the drug.”
✓ VerifiedUS prescribing informationSource ↗
Reproductive & developmental
Rat and rabbit EFD: increased skeletal malformations and decreased litter weights at high dietary doses
“Administration of dietary triheptanoin to pregnant rats at doses approximately 2 times above, and pregnant rabbits approximately equal to the targeted clinical dose of 35% DCI resulted in increased incidence of skeletal malformations and decreased litter weights in both species and reduced number of viable litters in rabbits.”
✓ VerifiedUS prescribing informationSource ↗
Safety pharmacology
Not stated in public reviews
Not reported in the public reviews. Reviewers summarise selectively, so this usually means it wasn't discussed publicly, not that it wasn't studied.

First doseopen answer page →

First-in-human starting dose
Not stated in public reviews
Why it's blank

The public FDA and EMA reviews of Dojolvi don't say how the first human dose was chosen. That rationale is in the IND, which is confidential, so it is missing for most approved products.

How it's usually set for small molecules outside oncology

Find the highest dose with no adverse effects (NOAEL) in each animal species, convert it to a human equivalent dose, usually by body surface area, pick the most appropriate species, then divide by a safety factor (default 10) to get the maximum recommended starting dose.

“In general, one should consider using a safety factor of at least 10. The MRSD should be obtained by dividing the HED by the safety factor.”
✓ VerifiedFDA 2005: Estimating the Maximum Safe Starting Dose in Initial Clinical…, p. 7Source ↗
This product's starting point

NOAEL / key findings: Minipig NOAEL 50% DCI, the highest dose tested; no target organs (FDA integrated review, p. 82)

Full method, every step sourced →

NOAEL / key findings
Minipig NOAEL 50% DCI, the highest dose tested; no target organs
“The NOAEL for systemic toxicity was the highest administered dose of 50% DCI in minipigs.”
✓ VerifiedFDA integrated review, p. 82Source ↗

Risksopen answer page →

Immune & cytokine safety
Not a dermal sensitizer in guinea pigs
“Triheptanoin was not a dermal sensitizing agent in male albino guinea pigs.”
✓ VerifiedFDA integrated review, p. 61Source ↗
Biodistribution & persistence
Dose-related exposure to heptanoate and C5 ketone metabolites without accumulation over 9 months in minipigs
“The dose-related increase in the primary metabolites (heptanoic acid and C5 ketone bodies) showed systemic exposure to UX007, but no accumulation after 9 months of treatment.”
✓ VerifiedFDA integrated review, p. 82Source ↗
Modality-specific risk
Possible rodent intestinal tumorigenicity; taste-aversion-driven developmental effects
“The proliferative changes observed in the rat intestine may suggest that oral administration of triheptanoin has a potential for causing tumors in rodents.”
✓ VerifiedFDA integrated review, p. 59Source ↗

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