PHOTOTOXICITY STUDY OF A KETOPROFEN POULTICE IN GUINEA PIGS

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1 The Journal of Toxicological Sciences, Vol.30, No.1, 19-28, PHOTOTOXICITY STUDY OF A KETOPROFEN POULTICE IN GUINEA PIGS Yutaka OKUMURA 1, Hitoshi YAMAUCHI 1, Satoshi TAKAYAMA 1, Hitoshi KATO 2 and Masami KOKUBU 2 1 Saitama Daiichi Pharmaceutical Co., Ltd., Research Department, 8-1 Minamisakae-cho, Kasukabe, Saitama , Japan 2 Panapharm Laboratories Co., Ltd., 1285 Kurisaki-machi, Uto, Kumamoto , Japan (Received May 25, 2004; Accepted November 15, 2004) ABSTRACT Ketoprofen has been reported to have such side effects as photosensitive dermatitis in humans (The Ministry of Health, Labour and Welfare, 2001). In the present study, as part of a safety evaluation of, an application drug containing ketoprofen, phototoxicity of was examined in guinea pigs. In the present skin phototoxicity study, was applied for 12 hr. Ultraviolet (UV) rays were irradiated to examine whether or not elicited skin reaction. Two kinds of UV-A plus UV-B dual irradiation and UV-A single irradiation were used for the elicitation. With UV-A plus UV-B dual irradiation on the application site, no skin reaction was observed at UV irradiation side in any animals, in contrast to the case of the positive control, 8-methoxypsoralen (). Similar results were obtained with UV-A single irradiation. From these results, that contained ketoprofen did not show any skin phototoxicity in the guinea pig. KEY WORDS: Phototoxicity, Ketoprofen, 8-Methoxypsolaren (), Minimum erythema (MED), Guinea pigs INTRODUCTION Ketoprofen is a nonsteroidal antiphlogistic with anti-inflammatory, analgesic and antipyretic effects. Various formulations of ketoprofen have been developed, but ketoprofen is usually prepared for external application in tapes. As side effects, contact skin sensitivity and photosensitivity are well known in use of such products. The Ministry of Health, Labour and Welfare (MHLW) officially announced amended details for use of tape drugs for affixation with ketoprofen and application of drugs containing ketoprofen on December 20, 2001 (The Ministry of Health, Labour and Welfare, 2001). Additionally, the MHLW has provided information about safety measures and outlines for clinical cases of severe contact skin sensitivity and photosensitivity with externally applied ketoprofen external application drug (Pharmaceuticals and Medical Devices Safety Information No.173, January, 2002). Photosensitive dermatitis is a rash arising and limited to an area of sunlight exposure, which retrieves by protection against solar rays and returns by re-exposure. It is categorized as extrinsic and intrinsic. The photosensitive dermatitis reported as a side effect of ketoprofen external application is extrinsic, since it is considered to result from injury to skin tissue due to ketoprofen activated by photo-energy (Bagheri et al., 2000). It consists of both phototoxic and photosensitive skin reactions. The latter arises from cell-mediated hypersensitivity responses involving immunological reactions. Among non-steroid anti-inflammatory drugs, ketoprofen is an important compound causing photosensitive contact dermatitis (Bagheri et al., 2000). Correspondence: Yutaka OKUMURA

2 20 Y. OKUMURA et al. Many clinical cases have documented photosensitive contact dermatitis of ketoprofen gels (Durbize et al., 2003; Vigan et al., 2002; Durieu et al., 2001; Veyrac et al., 2002). For phototoxic skin reactions of ketoprofen, many studies have been carried out in vitro. There were a few cases, however, that phototoxicity was examined minutely in vivo. Negative phototoxicity was observed in a guinea pig skin phototoxicity study of ketoprofen (Sugiura et al., 2002). Mice given ketoprofen by single oral dosing and irradiated with UV-A did not demonstrate any change due to the phototoxicity (Ljunggren and Lundberg, 1985). In contrast, positive results of phototoxicity of ketoprofen were obtained in vitro (Ljunggren, 1985). For example, after human erythrocytes were incubated with ketoprofen, hemolysis arose with UV-A irradiation (Eberlein-Konig et al., 1996). Furthermore, in a photo-basophil-histamine release test (PBHRT) performed with human leukocytes, histamine release was related with exposure to UV-A under incubation with ketoprofen (Przybilla et al., 1987)., a poultice containing ketoprofen, is applied for medical treatment of inflammatory algesic disease. As part of a comprehensive safety evaluation, phototoxicity of poultice was tested in guinea pigs exposed to UV rays. When poultice was applied at 0.51 mg/site as ketoprofen (2.25 cm 2 /site) for 12 hr of clinical use time, we examined whether skin phototoxicity due to ketoprofen arose after irradiationbyuvray.foruvrayirradiation,uv-aplus UV-B dual irradiation and UV-A single irradiation were used. UV-B was irradiated at Joule/cm 2,or 80% of the minimum individual MED (0.11 Joule/cm 2 ) to avoid appearance of UV-B induced erythema. UV-A wasirradiatedat10,20and40joule/cm 2. MATERIALS AND METHODS Materials (Lot No. KZ389) provided by Saitama Daiichi Pharmaceutical Co., Ltd. was used as the test. The poultice is composed of unwoven cloth, light yellow ointment material and coating film, and has a distinctive smell. As a positive control, 8- methoxypsoralen (, Lot No DZ, Wako Pure Chemical Industries, Ltd.) was used. Acetone (Lot No. ELQ5209, Wako Pure Chemical Industries, Ltd.) was employed as the vehicle. The test, positive control and acetone were stored at room temperature in a locker in the test room. The positive control was dissolved in acetone to give a 1 w/v % solution just before use. s Forty four male guinea pigs (Crj : Hartley) aged 5 weeks were purchased from Charles River, Japan, Inc. During the 6-day quarantine and acclimation period, clinical signs were monitored and body weights were measured to confirm the health condition of the animals. The 10 animals were employed for MED measurement, and the 30 animals for the phototoxicity study. The remaining 4 animals were excluded from the study. studies were conducted in compliance with the Ethical Committee Regulations in Panapharm Laboratories Co., Ltd. The 2 or 3 animals per cage were housed in aluminum cages (W H D: mm) in an animal room which was controlled at a temperature of 24 ± 2 C (permissible range: C), with a relative humidity 55 ± 10% (permissible range: 35-75%), a 12-hr light/dark cycle (lighting from 7:00A.M. to 7:00P.M.) and changes/hr ventilation. The animals were allowed free access to a pellet diet (RC4, Oriental Yeast Co., Ltd.) and drinking water supplemented with NaOCl (about 0.2 ppm) from an automatic water supply system. Study for measurement of the minimum erythemainduction (MED) After hairs on guinea pig s whole back skin were shaved with an electric clipper and an electric shaver, a sheet of lighttight plate with ten punch holes ( cm) was placed on the back. UV-B was irradiated at about 10 cm distance from the light source, and the holes were covered one by one at intervals of 30 sec during the irradiation. The irradiation at which erythema first appeared 24 hr after the irradiation was decided as the individual MED. The mean value was taken as the group MED. Skin phototoxicity study Six groups were prepared with five guinea pigs each (Table 1). The animals were assigned according to a stratified sequential randomization method on the basis of body weight one day before UV ray irradiation. Test was applied in the area of 1.5 cm 1.5 cm (2.25 cm 2, 0.51 mg/site). The dosing area is usually employed for a phototoxicity study. Positive control,, was used in a volume of 0.1 ml of 1 w/ v% solution /site (1.0 mg/site), which is usually employed for a phototoxicity study. In the study measuring the minimum erythema-induction for the determination of the study conditions of skin phototox-

3 21 Phototoxicity study of a ketoprofen poultice in guinea pigs. icity, UV erythema induced by UV-B was confirmed in 8 animals. For the minimum individual erythemainduction, the minimum value was 0.11 Joule/cm 2 and the maximum value 0.22 Joule/cm 2, and the mean minimum erythema-induction was 0.18 Joule/ cm 2. After the hairs on the whole back skin were clipped with a clipper and an electric shaver, 4 squares of 1.5 cm 1.5 cm were allocated in 2 rows and 2 lines (Group I-VI as shown in Fig. 1). To a pair of squares in one row, the test was applied for 12 hr. After removal of the poultice, the 2 squares of the other one row each received 0.1 ml of positive control. Thirty minutes later, the right half of the back skin was covered with a sheet of aluminum foil (non-irradiation part) and UV rays (wavelength : UV-A, nm or UV-B, nm) were irradiated to the application sites on the left back skin (Fig. 1). After UV-B was irradiated to animals of Group I-III at 80% (0.088 Joule/ cm 2 ) of the minimum value for individual MED, UV-A was irradiated immediately. The animals in Group IV- VI received UV-A alone. A UV-A light tube (TOSHIBA LIGHTING & TECHNOLOGY CORPORATION, Black light, FL20S BLB-A) and a UV-B light tube (TOSHIBA MEDICAL SUPPLY Corporation, TOREX FL20S E-30/DMR) were used as light sources in a UV-ray irradiation apparatus (Dermaray M-DMR- 1, TOSHIBA MEDICAL SUPPLY Corporation), with a plate glass filter attached to cut off wavelengths under 320 nm on the UV-A light tube installation side. The distance from the skin to the light source was approximately 10 cm. The intensity of UV rays was measured with a UV-ray meter (UVR D, TOKYO OPTICAL Corporation) just before irradiation, and irradiation time was calculated from the results. was carried out according to the method of Morikawa et al. (1974). Application time of test was determined as 12 hr based on the clinical application. In this study, erythema and edema formation at the irradiation sites were observed in all animals, when judged by Draize s method (Draize, 1959) in contrast to the non-irradiation sites 24, 48 and 72 hr after the end of irradiation. Fig. 1. Application pattern Table 1. Groups and UV ray irradiation conditions. Group UV ray No. of Article Dose Sex No. (UV-A ) animals No. I II III IV V UV-B UV-A cm b) (10 Joule/cm 2 ) 1 w/v% 0.1 ml/site UV-B UV-A cm b) (20 Joule/cm 2 ) 1 w/v% 0.1 ml/site UV-B UV-A cm b) (40 Joule/cm 2 ) 1 w/v% 0.1 ml/site UV-A cm b) (10 Joule/cm 2 ) 1 w/v% 0.1 ml/site UV-A cm b) (20 Joule/cm 2 ) 1 w/v% 0.1 ml/site UV-A Miltax VI cm b) (40 Joule/cm 2 ) 1 w/v% 0.1 ml/site : Eighty % (0.088 Joule/cm 2 ) of the minimum UV-B MED was irradiated. b) : Concentration of Ketoprofen (Actual value : 0.51 mg/site)

4 22 Y. OKUMURA et al. 1) formation Score Skin Reaction 0 No erythema 1 Very slight erythema (barely perceptible) 2 Well-defined erythema 3 Moderate to severe erythema Severe erythema (beet redness) to slight eschar 4 formation (injuries in depth) 2) formation Score Skin Reaction 0 No edema 1 Very slight edema (barely perceptible) Slight edema (edges of area well-defined by 2 definite raising) 3 Moderate edema (raised approximately 1 mm) Severe edema (raised more than 1 mm and 4 extending beyond area of exposure) Positive rate (%) = (Number of animals showing phototoxicity positive reactions / Number of animals employed) 100 On the basis of the above tables for items 1) and 2), scores for erythema and edema formation for each were totaled for all animals at each observation time. The total scores were divided by the of animals employed to obtain mean scores. Comparing the irradiation site with a non-irradiation one, phototoxicity was concluded to be positive when the score for the irradiation site was higher. Clinical observations were carried out once daily for all animals. Body weight measurement was performed at the pre-dosing of the test and on the final observation day. The animals were euthanized by means of cutting the outside iliac artery under ether anesthesia. Statistical analysis Mean value of body weights of animals employed and their standard deviation were calculated in each group. Statistical analysis was not performed. RESULTS Minimum erythema-induction (MED) The MEDs are shown in Table 2. due to UV ray was observed in 8 of 10 animals irradiated with UV-B. Two animals in which skin reaction was not observed were excluded from the MED measurement study, since it was judged that it did not succeed in proper UV-B irradiation. The irradiation times needed to induce erythema were 120 sec (2 cases) at minimum and 240 sec (4 cases) at maximum. Individual MED values were 0.11 Joule/cm 2 at minimum and 0.22 Joule/cm 2 at maximum. The mean MED was 0.18 Joule/cm 2 for 8 animals. Clinical findings and body weights In Group I to VI, no abnormal clinical findings was observed during the observation period from Day 0 ( application day) to Day 4 (the end of observation). The range of body weight was g on Day 0, and obvious body weight change was not observed till Day 4. Skin phototoxicity study Details for skin reactions due to phototoxicity are shown in Table 3 and Appendix 1. InGroupI-III,24,48and72hrafterirradiation (UV-AUV-B), no erythema due to UV ray was Table 2. The minimum erythema-induction for UV-B irradiation. time 1) Mean intensity of MED 2) Mean MED ± Standard * (sec) UV ray (mw/cm 2 ) (Joule/cm 2 ) (Joule/cm 2 ) deviation ) The minimum irradiation time to observe erythema. 2) Q (Joule/cm 2 )=t (sec) (mw/cm 2 ) 10 3 *: Data for No.1003 and No.1006 were not adopted since no skin reaction was observed.

5 23 Phototoxicity study of a ketoprofen poultice in guinea pigs. observed on both irradiation and non-irradiation sides at application sites. At 1 w/v% application sites, 24, 48 and 72 hr after irradiation (UV- AUV-B), erythema due to UV ray was observed on the irradiation side. In Group IV-VI, 24, 48 and 72 hr after irradiation (UV-A),noerythemaduetoUVraywasobservedon both irradiation and non-irradiation sides at application sites. At 1 w/v% application sites, 24, 48 and 72 hr after irradiation (UV-A), erythema due to UV ray was observed on the irradiation side. DISCUSSION The mean value of the minimum erythemainduction (MED) was calculated based on the data from 8 animals eliciting erythema by UV-B. In this study, the mean MED was 0.18 Joule/ cm 2 and thus much lower than the value of 0.72 Joule/cm 2 for guinea pigs and 0.44 Joule/cm 2 for humans reported previously (Morikawa et al., 1974). When UV-A was irradiated at 10, 20 or 40 Joule/ cm 2 after UV-B irradiation on application sites, no skin reactions were observed, clearly contrasting with the positive findings with. Similar results were obtained with UV-A alone. It has been reported that the sensitivity to skin phototoxicity is highest in rabbits followed by rats, guinea pigs, hairless mice and miniature pigs (Morikawa et al., 1974). However, the relation between such sensitivity and the MED value is unclear. It has been reported that species, experiment time and individual variation have an influence on the MED value (Fujii, 1991). Morikawa et al. (1974) found that the human MED value is lower than that of the guinea pig, while the sensitivity in human to UV rays is higher. Table 3. Skin phototoxicity reaction. Group Number of Mean score 1) Positive rate 3) No. animals (Joule/cm 2 ) 24 hr 2) 48 hr 72 hr (%) I 5 UV-A: II 5 UV-A: III 5 UV-A: IV 5 UV-A: V 5 UV-A: VI 5 UV-A: ) Mean score = Sum of score for erythma formation and edema formation at each observation time/number of animals. 2) 3) Positive rate = (Number of phototoxicity-positive animals/numbers of animals employed) 100.

6 24 Y. OKUMURA et al. Appendix 1 Individual score (Group No. I). (Joule/cm 2 ) UV-A: UV-A: hr 48 hr 72 hr Appendix 1 (continued) Individual score (Group No. II). 24 hr (Joule/cm 2 ) UV-A: UV-A: hr 72 hr 1 1

7 25 Phototoxicity study of a ketoprofen poultice in guinea pigs. Appendix 1 (continued) Individual score (Group No. III). (Joule/cm 2 ) UV-A: UV-A: hr 48 hr 72 hr Appendix 1 (continued) Individual score (Group No. IV). (Joule/cm 2 ) UV-A: UV-A: hr 48 hr 72 hr

8 26 Y. OKUMURA et al. Appendix 1 (continued) Individual score (Group No. V). (Joule/cm 2 ) UV-A: UV-A: hr 48 hr 72 hr 1 1 Appendix 1 (continued) Individual score (Group No. VI). 24 hr (Joule/cm 2 ) UV-A: UV-A: hr 72 hr 1 1

9 27 Phototoxicity study of a ketoprofen poultice in guinea pigs. However, the guinea pig s MED measured in the present study was lower than the human. The situation is further complicated by the fact that when skin sensitivity to raw cosmetics materials was compared at several skin irritation studies in human and guinea pig, the skin reactions in the latter were generally greater (Tatsumi and Hayakawa, 1991). Skin phototoxicity is a kind of irritation reaction due to tissue injury of photoactivated compounds. Considering our findings of no skin phototoxicity induced by containing ketoprofen in the present study, it can be applied to a human situation with good confidence. Since skin phototoxicity due to positive control,, was confirmed, it was judged that there was no problem for animals employed in the study. Photosensitive dermatitis as a side effect of nonsteroid anti-inflammatory drugs is usually considered to concern UV ray exposure. Ketoprofen in vitro is capable of inducing histamine release and cell membrane destruction with UV ray irradiation. Ketoprofendependent histamine release due to UV-A irradiation alone was observed in human leukocytes (Przybilla et al., 1987). Human erythrocytes undergo ketoprofendependent hemolysis due to UV-A irradiation alone and the rate may change when UV-B is also applied. Ketoprofen-dependent hemolysis also occurs with UV- B irradiation alone, but UV-B does not always enhance ketoprofen-dependent hemolysis due to UV-A irradiation (Ljunggren, 1985, Eberlein-Konig, 1996). It should further be borne in mind that visible light in photo-hemolysis studies in vitro may induce ketoprofen-dependent and other non-steroid anti-inflammatory drug-dependent cell membrane destruction more strongly than UV-A (Becker, 1996). It may be necessary to further investigate the photosensitive dermatitis in relation to visible light. In future, therefore, in vivo studies of ketoprofen-dependent phototoxicity due to visible light should be carried out to confirm its safety. REFERENCES Bagheri, H., Lhiaubet, V., Montastruc, J.L. and Chouini-Lalanne, N. (2000) : Photosensitivity to ketoprofen: Mechanisms and pharmacoepidemiological data. Drug Saf., 22, Becker, L., Eberlein-Konig, B. and Przybilla, B. (1996) : Phototoxicity of non-steroidal antiinflammatory drugs: In vitro studies with visible light. Acta. Derm. Venereol., 76, Draize, J.H. (1959) : Dermal toxicity, Appraisal of the safety of chemicals in foods, drugs and cosmetics, pp , Association of Food & Drug Officials of the United States, Austin, Texas. Durbize, E., Vigan, M., Puzenat, E., Girardin, P., Adessi, B., Desprez, P.H., Humbert, P.H., Laurent, R. and Aubin, F. (2003) : Spectrum of cross-photosensitization in 18 consecutive patients with contact photoallergy to ketoprofen: Associated photoallergies to non-benzophenone-containing molecules. Contact Dermatitis., 48, Durieu, C., Marguery, M.C., Giordano-Labadie, F., Journe, F., Loche, F. and Bazex, J. (2001) : Photoaggravated contact allergy and contact photoallergy caused by ketoprofen: 19 cases. Ann. Dermatol. Venereol., 128, Eberlein-Konig, B., Rueff, F. and Przybilla, B. (1996): Interaction of ultraviolet-b-rich and ultraviolet- A-rich radiation in ketoprofen-induced photohemolysis. Photodermatol. Photoimmunol. Photomed., 12, Fujii, A. (1991) : Comparison with experimental animals and human: Phototoxicity and photoallergy. Hifu, 33, Suppl 11, Ljunggren, B. (1985) : Propionic acid-derived nonsteroidal antiinflammatory drugs are phototoxic in vitro. Photodermatol., 2, 3-9. Ljunggren, B. and Lundberg, K. (1985) : In vivo phototoxicity of non-steroidal anti-inflammatory drugs evaluated by the mouse tail technique. Photodermatolo., 2, Ministry of Health, Labour and Welfare (2001) : Pharmaceuticals and medical devices safety information No.173. Ministry of Health, Labour and Welfare (2001) : Revision information for attention on use (Instructions on December 20, 2001). Morikawa, F., Nakayama, Y., Fukuda, F., Hamano, M., Yokohama Y., Nagura, T., Ishihara, M. and Toda, K. (1974) : Techniques for evaluation of phototoxicity and photoallergy in laboratory animals and man. Sunlight and man, Fitzpatrick, T.B., pp , University of Tokyo Press, Tokyo. Przybilla, B., Schwab-Przybilla, U., Ruzicka, T. and Ring, J. (1987) : Phototoxicity of non-steroidal anti-inflammatory drugs demonstrated in vitro by a photo-basophil-histamine-release test. Photodermatol., 4, Sugiura, M., Hayakawa, R., Xie, Z., Sugiura K., Hiramoto, K. and Shamoto, M. (2002) : Experimental study on phototoxicity and the photosen-

10 28 Y. OKUMURA et al. sitization potential of ketoprofen, suprofen, tiaprofenic acid and benzophenone and the photocross-reactivity in guinea pigs. Photodermatol. Photoimmunol. Photomed., 18, Tatsumi, H. and Hayakawa, R. (1991) : A study on the relation between the results of guinea-pig skin irritation test and human patch test with cosmetic ingredients. Hifu, 33, Suppl 11, Veyrac, G., Paulin, M., Milpied, B., Bourin, M. and Jolliet, P. (2002) : Results of a French nationwide survey of cutaneous side effects of ketoprofen gel reported between September 1996 and August Therapie., 57, Vigan, M., Girardin, P., Desprez, P., Adessi, B., Aubin, F., Laurent, R. (2002) : Photocontact dermatitis due to ketoprofen and photosensitization to tetrachlorosalicylanide and to Fenticlor. Ann. Dermatol. Venereol., 129,