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Kohl V, Müller C, Cornely OA, Abduljalil K, Fuhr U, Vehreschild JJ, Scheid C, Hallek M, Rüping MJGT. Factors influencing pharmacokinetics of prophylactic posaconazole in patients undergoing allogeneic stem cell transplantation. Antimicrob Agents Chemother 2010; 54:207-12. [PMID: 19858252 PMCID: PMC2798545 DOI: 10.1128/aac.01027-09] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 09/30/2009] [Accepted: 10/19/2009] [Indexed: 11/20/2022] Open
Abstract
The objectives of the present study were to elucidate the factors influencing the pharmacokinetics of prophylactically administered posaconazole in allogeneic hematopoietic stem cell transplant (SCT) recipients. Between May 2007 and November 2008, clinical data were obtained from all SCT recipients at the University Hospital of Cologne undergoing therapeutic drug monitoring (TDM) of serum prophylactic posaconazole concentrations. The posaconazole concentrations were determined by high-performance liquid chromatography. We developed a population pharmacokinetic model using nonlinear mixed-effect modeling (NONMEM). The list of covariates tested included age; body weight; body height; gender; posaconazole dose; race; coadministration of antineoplastic chemotherapy; day of stem cell transplantation; concomitant ranitidine, pantoprazole, cyclosporine, or tacrolimus administration; coincident fever; diarrhea; and plasma gamma-glutamyltransferase activity. A total of 149 serum posaconazole concentrations from 32 patients were obtained. A one-compartment model with first-order absorption and elimination as the basic structural model appropriately described the data, with the apparent clearance being 75.8 liters/h (95% confidence interval [CI], 65.2 to 86.4 liters/h) and the apparent volume being distribution of 835 liters (95% CI, 559 to 1,111 liters). Among the covariates tested, significant effects were found for age (decrease in the volume of distribution of 123 liters per year of age) and the presence of diarrhea (59% loss of bioavailability). A basis for prediction of the mean posaconazole concentrations in allogeneic SCT recipients with hematological malignancies is provided for a given dose. Corresponding adjustments of the starting dose according to the presence of diarrhea and according to age appear to be justified before TDM results are available.
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Affiliation(s)
- V. Kohl
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C. Müller
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - O. A. Cornely
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - K. Abduljalil
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - U. Fuhr
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - J. J. Vehreschild
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C. Scheid
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - M. Hallek
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - M. J. G. T. Rüping
- Department of Pharmacology, University of Cologne, Cologne, Germany, Department I of Internal Medicine, University of Cologne, Cologne, Germany, Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN0706, University of Cologne, Cologne, Germany, Simcyp Limited, Sheffield, United Kingdom, Stem Cell Transplantation Program, Department I of Internal Medicine, University of Cologne, Cologne, Germany
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