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Möhlmann JE, Ezzafzafi S, Lindemans CA, Jansen MHA, Nierkens S, Huitema ADR, van Luin M. Pharmacokinetics and Pharmacodynamics of Systemic Corticosteroids in Autoimmune and Inflammatory Diseases: A Review of Current Evidence. Clin Pharmacokinet 2024:10.1007/s40262-024-01419-7. [PMID: 39264575 DOI: 10.1007/s40262-024-01419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Systemic corticosteroids have a long history of use in the treatment of autoimmune and inflammatory diseases. Both efficacy and safety show large interindividual variability (IIV), suggesting that corticosteroids may have the potential for individualised dosing strategies to optimise therapy. This systematic review aims to provide an overview of current evidence on the pharmacokinetic (PK) and pharmacodynamic (PD) relationships of systemic corticosteroids in patients with autoimmune and inflammatory diseases. METHODS A systematic literature search was conducted in PubMed and Embase for PK/PD studies of systemic corticosteroids in autoimmune and inflammatory diseases in humans published until December 2023. Studies were scored from 1 to 5 according to criteria for the levels of evidence, as inspired by the Oxford Centre for Evidence-Based Medicine. RESULTS Twelve studies (1981-2016) were included. The majority of these studies had a small sample size. The corticosteroids involved were prednisone, prednisolone, methylprednisolone and budesonide. Substantial IIV of corticosteroid PK was described in all studies. Evidence for a relationship between the PK of corticosteroids and efficacy was inconclusive and limited. However, there was some evidence for a relationship between the PK of prednisolone and the severity of Cushingoid features. CONCLUSION There is insufficient evidence to draw firm conclusions on the potential associations between PK and clinical outcome of systemic corticosteroid treatment in autoimmune and inflammatory diseases. This is remarkable given the many decades that steroid drugs have been used in clinical care. Prospective research is recommended with robust and well-defined cohorts to fully quantify the PK/PD associations of corticosteroids.
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Affiliation(s)
- Julia E Möhlmann
- Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands.
| | - Solaiman Ezzafzafi
- Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Caroline A Lindemans
- Department of Stem Cell Transplantation, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marc H A Jansen
- Department of Paediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Stefan Nierkens
- Department of Stem Cell Transplantation, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Department of Translational Immunology, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
- Department of Pharmacology, Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Matthijs van Luin
- Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
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Fingerprick Microsampling Methods Can Replace Venepuncture for Simultaneous Therapeutic Drug Monitoring of Tacrolimus, Mycophenolic Acid, and Prednisolone Concentrations in Adult Kidney Transplant Patients. Ther Drug Monit 2023; 45:69-78. [PMID: 36097333 DOI: 10.1097/ftd.0000000000001024] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Kidney transplant patients undergo repeated and frequent venepunctures during allograft management. Microsampling methods that use a fingerprick draw of capillary blood, such as dried blood spots (DBS) and volumetric absorptive microsamplers (VAMS), have the potential to reduce the burden and volume of blood loss with venepuncture. METHODS This study aimed to examine microsampling approaches for the simultaneous measurement of tacrolimus, mycophenolic acid, mycophenolic acid glucuronide (MPAG), and prednisolone drug concentrations compared with standard venepuncture in adult kidney transplant patients. DBS and VAMS were simultaneously collected with venepuncture samples from 40 adult kidney transplant patients immediately before and 2 hours after immunosuppressant dosing. Method comparison was performed using Passing-Bablok regression, and bias was assessed using Bland-Altman analysis. Drug concentrations measured through microsampling and venepuncture were also compared by estimating the median prediction error (MPE) and median absolute percentage prediction error (MAPE). RESULTS Passing-Bablok regression showed a systematic difference between tacrolimus DBS and venepuncture [slope of 1.06 (1.01-1.13)] and between tacrolimus VAMS and venepuncture [slope of 1.08 (1.03-1.13)]. Tacrolimus values were adjusted for this difference, and the corrected values showed no systematic differences. Moreover, no systematic differences were observed when comparing DBS or VAMS with venepuncture for mycophenolic acid and prednisolone. Tacrolimus (corrected), mycophenolic acid, and prednisolone microsampling values met the MPE and MAPE predefined acceptability limits of <15% when compared with the corresponding venepuncture values. DBS and VAMS, collected in a controlled environment, simultaneously measured multiple immunosuppressants. CONCLUSIONS This study demonstrates that accurate results of multiple immunosuppressant concentrations can be generated through the microsampling approach, with a preference for VAMS over DBS.
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Matsumoto A, Shiraiwa K, Suzuki Y, Tanaka K, Kawano M, Iwasaki T, Tanaka R, Tatsuta R, Tsumura H, Itoh H. Sensitive quantification of free pazopanib using ultra-high performance liquid chromatography coupled to tandem mass spectrometry and assessment of clinical application. J Pharm Biomed Anal 2021; 206:114348. [PMID: 34509660 DOI: 10.1016/j.jpba.2021.114348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
Pazopanib is widely used to treat renal cell carcinomas and soft tissue tumors in Japan. Although several reports demonstrated the usefulness of therapeutic drug monitoring (TDM) of pazopanib, those studies measured only total pazopanib concentration. For drugs with high protein binding rates such as pazopanib, measuring free concentrations may be clinically more useful than measuring total concentrations. In this study, we aimed to develop a high-throughput method for quantification of free pazopanib in human plasma using ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Free pazopanib was separated by ultrafiltration. After a simple solid-phase extraction step using a 96-well plate, pazopanib was analyzed by UHPLC-MS/MS in positive electrospray ionization mode. The novel method fulfilled the requirements of the US Food and Drug Administration guidelines for assay validation, and the lower limit of quantification was 0.05 ng/mL. The calibration curve was linear over the concentration range of 0.05-50 ng/mL. The average recovery rate was 66.9 ± 2.1% (mean ± SD). The precision was below 7.02%, and accuracy was within 10.60% across all quality control levels. Matrix effect varied between 44.4% and 60.4%. This assay was successfully applied to measure trough free pazopanib concentrations in three patients treated with pazopanib for soft tissue tumors. We succeeded to develop a novel high-throughput UHPLC-MS/MS method for quantification of free pazopanib in human plasma. This method can be applied to TDM for patients receiving pazopanib in the clinical setting.
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Affiliation(s)
- Asami Matsumoto
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Ken Shiraiwa
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan.
| | - Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Tatsuya Iwasaki
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University Faculty of Medicine, Yufu-shi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
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Kristensen T, Birn H, Ivarsen P. A randomised controlled unblinded multicentre non-inferiority trial with activated vitamin D and prednisolone treatment in patients with minimal change nephropathy (ADAPTinMCN). Trials 2021; 22:442. [PMID: 34247632 PMCID: PMC8273943 DOI: 10.1186/s13063-021-05393-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimal change nephropathy (MCN) is a common cause of nephrotic syndrome in both adults and children. International guidelines recommend treatment with prednisolone 1 mg/kg/day to adults. This dose is derived from an empirically established dose in children, although children generally attain remission faster and relapse more rapidly than adults. Prednisolone is associated with multiple and serious adverse events. Activated vitamin D has been shown to reduce albuminuria in other glomerular renal diseases with a minimum of adverse events. This study tests the hypothesis that a new treatment regimen in MCN combining reduced dose prednisolone and active vitamin D is as efficient in inducing remission and has fewer and less severe adverse events than standard prednisolone. Furthermore, we aim to establish models allowing for more personalized medicine based on assessment of the individual's prednisolone metabolism. METHODS A randomised controlled multicentre non-inferior unblinded trial including 96 adult, incident patients with biopsy-proven MCN, albuminuria > 3 g/day, and an estimated glomerular filtration rate (eGFR) > 30 ml/min from renal departments in Denmark. Patients are randomised to standard prednisolone (1 mg/kg/day) or reduced prednisolone (0.5 mg/kg/day) and alfacalcidol (0.5 μg/day). The primary outcome is the rate of remissions after 16 weeks and the time from diagnosis to remission. The study will include a saliva test to characterise prednisolone pharmacokinetics and compare them to genetic variations in specific liver enzymes responsible for prednisolone metabolism. DISCUSSION Reducing the prednisolone dose is expected to reduce the number of severe adverse events. This study will examine if reduced prednisolone dose with active vitamin D but without additional immunosuppression is feasible in the treatment of MCN and will reduce the number of adverse events. The findings can potentially change current guidelines for treatment of MCN in adults. Additional outcomes on inter-individual pharmacokinetic and metabolic variations may allow for a more personalised treatment strategy. TRIAL REGISTRATION EudraCT 2017-001206-16, ClinicalTrials.gov NCT03210688 . Registered on June 3, 2017.
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Affiliation(s)
- Tilde Kristensen
- Department of Internal Medicine, renal unit, Regional Hospital Viborg, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Henrik Birn
- Department of Nephrology, Aarhus University Hospital and Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Per Ivarsen
- Department of Nephrology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Tanaka R, Suzuki Y, Goto K, Yasuda N, Koga H, Kai S, Ohchi Y, Sato Y, Kitano T, Itoh H. Development and validation of sensitive and selective quantification of total and free daptomycin in human plasma using ultra-performance liquid chromatography coupled to tandem mass spectrometry. J Pharm Biomed Anal 2018; 165:56-64. [PMID: 30502552 DOI: 10.1016/j.jpba.2018.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022]
Abstract
Recently, several studies on pharmacokinetics parameters of daptomycin reported that plasma trough concentration was linked to efficacy and adverse effects, suggesting the usefulness of therapeutic drug monitoring. Although some methods for determining total daptomycin concentration using liquid chromatography coupled to tandem mass spectrometry were established previously, no sensitive quantification method for free drug concentration was established. In this study, we aimed to develop a quantitative method of measuring both total and free daptomycin concentrations using ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS), by which both trough and maximum concentrations can be measured. Plasma samples were prepared by solid phase extraction. Free fractions were obtained by ultrafiltration. The assay fulfilled the requirements of US Food and Drug Administration and the European Medicines Agency for assay validation. The methods for total and free drug showed good fit over wide ranges of 0.5-200 and 0.04-40 μg/mL, with lower limits of quantitation of 0.5 and 0.04 μg/mL, respectively. Recovery rate of free daptomycin from ultrafiltration was approximately 100%. Extraction recovery rates of total and free drug measurements ranged from 57.1 to 67.4% and 54.6 to 62.3%, while matrix effect varied between 111.9 and 118.7% and 104.0 and 127.1%, respectively. The maximum and trough concentrations of total and free daptomycin in plasma from two patients in intensive care unit were successfully determined, demonstrating the feasibility of clinical application of the novel methods for determining plasma total and free daptomycin concentrations. In conclusion, we succeeded to develop a sensitive and selective method using UPLC-MS/MS for quantitative measurement of total and free daptomycin concentrations in plasma.
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Affiliation(s)
- Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan.
| | - Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Koji Goto
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Norihisa Yasuda
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Hironori Koga
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Shinya Kai
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Yuhki Sato
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
| | - Takaaki Kitano
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu-shi, Oita, Japan
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Prednisolone and Prednisone Pharmacokinetics in Pediatric Renal Transplant Recipients—A Prospective Study. Ther Drug Monit 2017; 39:472-482. [DOI: 10.1097/ftd.0000000000000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Suzuki Y, Tanaka R, Oyama N, Nonoshita K, Hashinaga K, Umeki K, Sato Y, Hiramatsu K, Kadota JI, Itoh H. Sensitive and selective quantification of total and free itraconazole and hydroxyitraconazole in human plasma using ultra-performance liquid chromatography coupled to tandem mass spectrometry. Clin Biochem 2017; 50:1228-1236. [PMID: 28928005 DOI: 10.1016/j.clinbiochem.2017.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/30/2017] [Accepted: 09/13/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Protein-free (unbound) drug concentrations have been reported to be better biomarker of pharmacodynamics compared with total drug concentrations. In this study, we developed and validated an assay for the quantification of total and free itraconazole and hydroxyitraconazole, a main metabolite with antifungal activity, in human plasma using ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS). DESIGN & METHODS Plasma sample was ultra-filtrated for the measurement of free itraconazole and hydroxyitraconazole concentrations. The samples were prepared by solid phase extraction, and then subject to UPLC-MS/MS quantification. RESULTS The assay fulfilled the requirements of the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) guidelines for assay validation, with a lower limit of quantification of 10ng/mL for total itraconazole and hydroxyitraconazole, and 0.1 and 0.5ng/mL for free itraconazole and hydroxyitraconazole, respectively. Recovery rates of total itraconazole and hydroxyitraconazole from whole plasma ranged from 53.3% to 64.0%, and recovery rates of free itraconazole and hydroxyitraconazole from ultrafiltrated plasma ranged from 81.6% to 98.7%. Matrix effect varied between 79.1% and 109.4% for total itraconazole and hydroxyitraconazole, and between 81.3% and 99.7% for free itraconazole and hydroxyitraconazole. The assay was successfully applied to therapeutic drug monitoring of itraconazole in three patients with chronic progressive pulmonary aspergillosis or invasive pulmonary aspergillosis. Plasma free hydroxyitraconazole concentrations were 8.1-, 23.3-, and 51.1-fold higher than plasma free itraconazole concentrations in the three patients. CONCLUSIONS A method for sensitive and selective quantification of plasma total and free itraconazole and hydroxyitraconazole concentrations was developed using UPLC-MS/MS. Free hydroxyitraconazole concentration may be most important in therapeutic drug monitoring of itraconazole.
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Affiliation(s)
- Yosuke Suzuki
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan.
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Nobuhiro Oyama
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Ko Nonoshita
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Kazuhiko Hashinaga
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Hasama-machi, Oita, Japan
| | - Kenji Umeki
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Hasama-machi, Oita, Japan
| | - Yuhki Sato
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
| | - Kazufumi Hiramatsu
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Hasama-machi, Oita, Japan
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Hasama-machi, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Hasama-machi, Oita, Japan
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