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Cao A, Li Q, Han M, Liu Q, Liang H, Tan L, Guan Y. Physiologically Based Pharmacokinetic Modeling of Vancomycin and its Comparison with Population Pharmacokinetic Model in Neonates. J Clin Pharmacol 2024. [PMID: 39223982 DOI: 10.1002/jcph.6126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Vancomycin has a narrow therapeutic window and a high inter-individual pharmacokinetic variability, especially in neonates with fast maturational and pathophysiological changes, that needs individualized dosing. Physiologically based pharmacokinetic (PBPK) model and population pharmacokinetic (PopPK) model are both useful tools in model-informed precision dosing, while the former is under research in application of vancomycin in neonates. This study aimed to develop a PBPK model of vancomycin in adult and pediatric population, and compared it with published PopPK model (priori or Bayesian method) in predicting vancomycin concentration in 230 neonatal patients (postmenstrual age, PMA, 25-45 weeks). The developed PBPK model showed a good fit between predictions and observations. PBPK model and PopPK model are complementary in different clinical scenarios of vancomycin application. The physiological-change description of PBPK model showed a superior advantage in initial dosing optimization. As for subsequent dose optimization, PopPK Bayesian forecasting performed better than the PBPK estimation in neonates. However, initial precision dosing tools for early neonates (with PMA < 36 weeks) still need further exploitation.
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Affiliation(s)
- Ailing Cao
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Qiaoxi Li
- Department of Pharmacy, The First People's Hospital of Foshan, Foshan, China
| | - Minzhen Han
- Department of Pharmacy, The Second Affiliated Hospital of Guizhou Medical University, Kaili, China
| | - Qian Liu
- Department of Pharmacy, The Second Affiliated Hospital of Guizhou Medical University, Kaili, China
| | - Heng Liang
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Lu Tan
- Department of Pharmacy, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yanping Guan
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
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Holford N, O'Hanlon CJ, Allegaert K, Anderson B, Falcão A, Simon N, Lo YL, Thomson AH, Sherwin CM, Jacqz-Aigrain E, Llanos-Paez C, Hennig S, Mockus L, Kirkpatrick C. A physiological approach to renal clearance: From premature neonates to adults. Br J Clin Pharmacol 2023. [PMID: 38031322 DOI: 10.1111/bcp.15978] [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: 09/29/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS We propose using glomerular filtration rate (GFR) as the physiological basis for distinguishing components of renal clearance. METHODS Gentamicin, amikacin and vancomycin are thought to be predominantly excreted by the kidneys. A mixed-effects joint model of the pharmacokinetics of these drugs was developed, with a wide dispersion of weight, age and serum creatinine. A dataset created from 18 sources resulted in 27,338 drug concentrations from 9,901 patients. Body size and composition, maturation and renal function were used to describe differences in drug clearance and volume of distribution. RESULTS This study demonstrates that GFR is a predictor of two distinct components of renal elimination clearance: (1) GFR clearance associated with normal GFR and (2) non-GFR clearance not associated with normal GFR. All three drugs had GFR clearance estimated as a drug-specific percentage of normal GFR (gentamicin 39%, amikacin 90% and vancomycin 57%). The total clearance (sum of GFR and non-GFR clearance), standardized to 70 kg total body mass, 176 cm, male, renal function 1, was 5.58 L/h (95% confidence interval [CI] 5.50-5.69) (gentamicin), 7.77 L/h (95% CI 7.26-8.19) (amikacin) and 4.70 L/h (95% CI 4.61-4.80) (vancomycin). CONCLUSIONS GFR provides a physiological basis for renal drug elimination. It has been used to distinguish two elimination components. This physiological approach has been applied to describe clearance and volume of distribution from premature neonates to elderly adults with a wide dispersion of size, body composition and renal function. Dose individualization has been implemented using target concentration intervention.
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Affiliation(s)
- Nick Holford
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Conor J O'Hanlon
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Brian Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Amilcar Falcão
- Faculty of Pharmacy, Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Nicolas Simon
- Aix Marseille Univ, Hop Sainte Marguerite, Service de Pharmacologie clinique, Marseille, France
| | - Yoke-Lin Lo
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alison H Thomson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Catherine M Sherwin
- University of Otago, Dunedin, New Zealand
- University of Utah, Salt Lake City, Utah, USA
- Department of Pediatrics, Wright State University Boonshoft School of Medicine/Dayton Children's Hospital, Dayton, Ohio, USA
| | - Evelyne Jacqz-Aigrain
- Paediatric Pharmacology and Pharmacogenetics, APHP Hôpital Saint-Louis - University Paris Cité, Paris, France
| | | | - Stefanie Hennig
- University of Queensland, Brisbane, Australia
- Certara, Inc., Princeton, New Jersey, USA
| | - Linas Mockus
- Chemical Engineering Department, Purdue University, West Lafayette, Indiana, USA
| | - Carl Kirkpatrick
- Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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