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Wu W, Yang WS, Xu XY, Ge XL, Lu J, Wang GF, Wang Y, Li ZP. Population pharmacokinetics of oxcarbazepine active metabolite in Chinese paediatric patients with epilepsy: Model-based dose optimization. Basic Clin Pharmacol Toxicol 2024; 134:712-726. [PMID: 38506371 DOI: 10.1111/bcpt.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
The pharmacological activity of oxcarbazepine (OXC) is primarily exerted through its active 10-monohydroxy metabolite (MHD). Nonetheless, there is limited pharmacokinetic information available regarding paediatric patients with epilepsy treated with OXC, especially in infants and toddlers. Concurrently, this drug exhibits substantial variability in pharmacokinetics and therapeutic response across different individuals. We aimed to develop a model to quantitatively investigate factors that affect MHD pharmacokinetics to formulate a dosage guideline for OXC in Chinese paediatric patients. A total of 297 MHD trough concentrations were obtained from 287 epileptic children. Six body weight (BW)-based allometric models were used for population pharmacokinetic modelling, while investigating the impact of other covariates on the apparent clearance. The one-compartment model and age cut-off model for the apparent clearance (CL/F) were established to describe the pharmacokinetics of MHD. The probability to obtain target trough concentration ranges (TTCRs) of MHD between 3 and 35 mg/L was determined by Monte Carlo simulations for doses ranging from 8 to 90 mg/kg/day. A new dose optimization strategy combining the dosage guidelines and Bayesian method provides a tailored approach for Chinese paediatric epileptic patients based on their individual BW and desired TTCRs of MHD, and also supports current dose recommendations, with the exception of children weighing ≤5 kg.
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Affiliation(s)
- Wei Wu
- Department of Clinical Pharmacy, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wen-Sheng Yang
- Department of Clinical Pharmacy, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiao-Yong Xu
- Department of Clinical Pharmacy, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xi-Lin Ge
- Department of Clinical Pharmacy, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jinmiao Lu
- Department of Clinical Pharmacy, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guang-Fei Wang
- Department of Clinical Pharmacy, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zhi-Ping Li
- Department of Clinical Pharmacy, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Li X, Wei S, Wu H, Zhang Q, Zhao Z, Mei S, Feng W, Wu Y. Population pharmacokinetics of oxcarbazepine active metabolite in Chinese children with epilepsy. Eur J Pediatr 2023; 182:4509-4521. [PMID: 37493972 DOI: 10.1007/s00431-023-05092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
Oxcarbazepine (OXC) is an antiepileptic drug whose efficacy is largely attributed to its monohydroxy derivative metabolite (MHD). Nevertheless, there exists significant inter-individual variability in both the pharmacokinetics and therapeutic response of this drug. The objective of this study is to explore the impact of patients' characteristics and genetic variants on MHD clearance in a population pharmacokinetic (PPK) model of Chinese pediatric patients with epilepsy. The PPK model was developed using a nonlinear mixed effects modeling method based on 231 MHD plasma concentrations obtained from 185 children with epilepsy. The one-compartment model and combined residual model were established to describe the pharmacokinetics of MHD. Forward addition and backward elimination were employed to evaluate the impact of covariates on the model parameters. The model was evaluated using goodness-of-fit, bootstrap, visual predictive checks, and normalized prediction distribution errors. In the two final PPK models, age, estimated glomerular filtration rate (eGFR), and a combined genotype of six variants (rs1045642, rs2032582, rs7668282, rs2396185, rs2304016, rs1128503) were found to significantly reduce inter-individual variability for MHD clearance. The inter-individual clearance equals to 1.38 × (Age/4.74)0.29 × (eGFR/128.66)0.25 × eθABCB-UGT-SCN-INSR for genetic variants included model and 1.30 × (Age/4.74)0.30 × (eGFR/128.66)0.23 for model without genetic variants. The precision of all parameters was deemed acceptable, and the model exhibited good predictability while remaining stable and effective. Conclusion: Age, eGFR, and genotype may play a significant role in MHD clearance in children with epilepsy. The developed PPK models hold potential utility in facilitating oxcarbazepine dose adjustment in pediatric patients. What is Known: • The adjustment of the oxcarbazepine regimen remains difficult due to the considerable inter- and intra-individual variability of oxcarbazepine pharmacokinetics. • Body weight and co-administration with enzyme-inducing antiepileptic drugs emerge as the most influential factors contributing to the pharmacokinetics of MHD. What is New: • A positive correlation was observed between eGFR and the clearance of MHD in pediatric patients with epilepsy. • We explored the influence of genetic polymorphisms on MHD clearance and identified a combined genotype (ABCB-UGT-SCN-INSR) that exhibited a significant association with MHD concentration.
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Affiliation(s)
- Xingmeng Li
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Shifeng Wei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Han Wu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Qiang Zhang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Shenghui Mei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing, 100070, People's Republic of China.
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100069, People's Republic of China.
| | - Weixing Feng
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China.
| | - Yun Wu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China.
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Yang Q, Hu Y, Zhang X, Zhang X, Dai H, Li X. Population pharmacokinetics of oxcarbazepine 10-monohydroxy derivative in Chinese adult epileptic patients. Eur J Hosp Pharm 2023; 30:e90-e96. [PMID: 35787526 PMCID: PMC10086726 DOI: 10.1136/ejhpharm-2022-003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Oxcarbazepine (OXC) is metabolised to active 10-monohydroxy derivative (MHD) after oral administration. Using this fact we aimed to develop an MHD population pharmacokinetic (PPK) model in Chinese adult epileptic patients to facilitate the clinical implementation of model-guided individualised drug therapy. METHODS We collected blood samples from Chinese adult epileptic patients taking OXC at the Second Affiliated Hospital of Zhejiang University School of Medicine. We used high performance liquid chromatography (HPLC-MS/MS) with tandem mass spectrometry to detect MHD concentrations in the blood samples. We collected various data from patients including their demographic, pathological, and physiological information. MassARRAY method was used to detect ABCC2, ABCB1, SCN8A, SCN1A, SCN2A, SCN3A, UGT1A9, and UGT2B7 gene polymorphisms. We used a nonlinear mixed-effects modelling method to develop the PPK model and we predicted dosing regimens through simulation. RESULT In total we collected 164 blood samples from 118 patients. We found that a one-compartment model with first-order absorption better described the in vivo MHD pharmacokinetics. UGT2B7 gene (rs7439366) site mutation and the combined use of valproic acid enhanced the MHD clearance rate. We divided patients into groups based on the UGT2B7 genotype and whether they were also using valproic acid at the same time. Individualised OXC dosing regimens were proposed for different subgroups of patients. CONCLUSION In Chinese adult epileptic patients, individualised drug administration can be facilitated using a PPK model of OXC. TRIAL REGISTRATION NUMBER ChiCTR-OOC-17012141.
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Affiliation(s)
- QiaoWei Yang
- Department of Pharmacy, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
- Department of Pharmacy, Sanmen People's Hospital, Taizhou, Zhejiang Province, People's Republic of China
| | - Yan Hu
- Department of Pharmacy, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - XuanLing Zhang
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, Beijing, China
| | - XiaoMin Zhang
- Department of Pharmacy, Sanmen People's Hospital, Taizhou, Zhejiang Province, People's Republic of China
| | - Haibin Dai
- Department of Pharmacy, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Xingang Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, Beijing, China
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Li ZR, Wang CY, Lin WW, Chen YT, Liu XQ, Jiao Z. Handling Delayed or Missed Dose of Antiseizure Medications: A Model-Informed Individual Remedial Dosing. Neurology 2023; 100:e921-e931. [PMID: 36450606 PMCID: PMC9990430 DOI: 10.1212/wnl.0000000000201604] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Delayed or missed antiseizure medications (ASMs) doses are common during long-term or lifelong antiepilepsy treatment. This study aims to explore optimal individualized remedial dosing regimens for delayed or missed doses of 11 commonly used ASMs. METHODS To explore remedial dosing regimens, Monte Carlo simulation was used based on previously identified and published population pharmacokinetic models. Six remedial strategies for delayed or missed doses were investigated. The deviation time outside the individual therapeutic range was used to evaluate each remedial regimen. The influences of patients' demographics, concomitant medication, and scheduled dosing intervals on remedial regimens were assessed. RxODE and Shiny in R were used to perform Monte Carlo simulation and recommend individual remedial regimens. RESULTS The recommended remedial regimens were highly correlated with delayed time, scheduled dosing interval, and half-life of the ASM. Moreover, the optimal remedial regimens for pediatric and adult patients were different. The renal function, along with concomitant medication that affects the clearance of the ASM, may also influence the remedial regimens. A web-based dashboard was developed to provide individualized remedial regimens for the delayed or missed dose, and a user-defined module with all parameters that could be defined flexibly by the user was also built. DISCUSSION Monte Carlo simulation based on population pharmacokinetic models may provide a rational approach to propose remedial regimens for delayed or missed doses of ASMs in pediatric and adult patients with epilepsy.
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Affiliation(s)
- Zi-Ran Li
- From the Department of Pharmacy (Z.L., C.W., Y.C., X.L., Z.J.), Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Pharmacy (Z.L., X.L.), Huashan Hospital, Fudan University, Shanghai, China; Department of Pharmacy (W.L.), The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; and School of Basic Medicine and Clinical Pharmacy (Y.C.), China Pharmaceutical University, Nanjing, China.
| | - Chen-Yu Wang
- From the Department of Pharmacy (Z.L., C.W., Y.C., X.L., Z.J.), Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Pharmacy (Z.L., X.L.), Huashan Hospital, Fudan University, Shanghai, China; Department of Pharmacy (W.L.), The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; and School of Basic Medicine and Clinical Pharmacy (Y.C.), China Pharmaceutical University, Nanjing, China
| | - Wei-Wei Lin
- From the Department of Pharmacy (Z.L., C.W., Y.C., X.L., Z.J.), Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Pharmacy (Z.L., X.L.), Huashan Hospital, Fudan University, Shanghai, China; Department of Pharmacy (W.L.), The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; and School of Basic Medicine and Clinical Pharmacy (Y.C.), China Pharmaceutical University, Nanjing, China.
| | - Yue-Ting Chen
- From the Department of Pharmacy (Z.L., C.W., Y.C., X.L., Z.J.), Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Pharmacy (Z.L., X.L.), Huashan Hospital, Fudan University, Shanghai, China; Department of Pharmacy (W.L.), The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; and School of Basic Medicine and Clinical Pharmacy (Y.C.), China Pharmaceutical University, Nanjing, China
| | - Xiao-Qin Liu
- From the Department of Pharmacy (Z.L., C.W., Y.C., X.L., Z.J.), Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Pharmacy (Z.L., X.L.), Huashan Hospital, Fudan University, Shanghai, China; Department of Pharmacy (W.L.), The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; and School of Basic Medicine and Clinical Pharmacy (Y.C.), China Pharmaceutical University, Nanjing, China
| | - Zheng Jiao
- From the Department of Pharmacy (Z.L., C.W., Y.C., X.L., Z.J.), Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Pharmacy (Z.L., X.L.), Huashan Hospital, Fudan University, Shanghai, China; Department of Pharmacy (W.L.), The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; and School of Basic Medicine and Clinical Pharmacy (Y.C.), China Pharmaceutical University, Nanjing, China.
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Chen YT, Wang CY, Yin YW, Li ZR, Lin WW, Zhu M, Jiao Z. Population pharmacokinetics of oxcarbazepine: a systematic review. Expert Rev Clin Pharmacol 2021; 14:853-864. [PMID: 33851561 DOI: 10.1080/17512433.2021.1917377] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Oxcarbazepine is commonly used as first-line treatment for partial and generalized tonic-clonic seizures. Owing to the high pharmacokinetic variability, several population pharmacokinetic models have been developed for oxcarbazepine to explore potential covariates that affect its pharmacokinetic variation. AREAS COVERED This review summarizes the published population pharmacokinetic studies of oxcarbazepine in children and adults available in PubMed and Embase databases. The quality of the retrieved studies was evaluated, and significant covariates that may have an impact on the dosage regimen of oxcarbazepine were explored. EXPERT OPINION The pharmacokinetics of oxcarbazepine was founded to be affected by body weight and co-administration with enzyme inducers. Pediatric patients require a higher dose per kilogram than adults because children generally have a higher clearance than adults. Moreover, to maintain the target concentration, patients co-administrate with enzyme inducers need a higher dose than monotherapy due to higher clearance in those patients. Because limited information is available for exposure-response relationship, additional pharmacokinetic/pharmacodynamics investigations of oxcarbazepine need to be conducted to optimize the dosage regimen in clinical practice.
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Affiliation(s)
- Yue-Ting Chen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Chen-Yu Wang
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Wei Yin
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zi-Ran Li
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei-Wei Lin
- Department of Pharmacy, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Min Zhu
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zheng Jiao
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Zhao Q, Jin S, Liu Q, Zhao Z, Feng W, Mei S. Simultaneous Determination of Lamotrigine, Topiramate, Oxcarbazepine, and 10,11-dihydro-10-hydroxycarbazepine in Human Blood Plasma by UHPLC-MS/MS. CURR ANAL CHEM 2020. [DOI: 10.2174/1573411016666200108143049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background:
Lamotrigine (LTG), topiramate (TPM), and oxcarbazepine (OXC) are
commonly used antiepileptic drugs. The bioactivity and toxicity of these drugs were related to their
blood concentrations which varied greatly among individuals and required to be monitored for dose
adjustment. However, the commercial method for monitoring of these drugs is not available in China.
Methods:
A UHPLC-MS/MS method for simultaneous determination of LTG, TPM, OXC, and OXC
active metabolite (10,11-dihydro-10-hydroxycarbazepine, MHD) was developed and validated according
to the guidelines and applied in clinical practice.
Results:
he separation was achieved by using methanol and water (both contain 0.1% formic acid)
at 0.4 mL/min under gradient elution within 3 min. For all analytes, the isotope internal standard was
used; the selectivity was good without significant carry over; LTG and TPM were linear between
0.06 to 12 mg/L while OXC and MHD were linear between 0.03 to 6 mg/L, the upper limit could be
10-fold higher because 10-fold dilution with water did not affect the results; the intra-day and interday
bias and imprecision were -13.11% to 5.42% and < 13.32%; the internal standard normalized recovery
and matrix factor were 90.95% to 111.94% and 95.57% to 109.91%; and all analytes were
stable under tested conditions. LTG and OXC-D4 shared two ion pairs m/z 257.1 > 212.0 and 257.1 >
184.0, and m/z 257.1 > 240.0 was suggested for OXC-D4 quantitation. Lamotrigine and lamotrigine-
13C3 shared three ion pairs m/z 259.0 > 214.0, 259.0 > 168.0 and 259.0 > 159.0, and m/z 259.0 >
144.9 was suggested for LTG-13C3 quantitation. CBZ had a slight influence on OXC analysis only at
0.225 mg/L (bias, 20.24%) but did not affect MHD analysis. Optimization of chromatography conditions
was useful to avoid the influence of isobaric mass transitions on analysis. This method has been
successfully applied in 208 patients with epilepsy for dose adjustment.
Conclusions:
An accurate, robust, rapid, and simple method for simultaneous determination of LTG,
TPM, OXC, and MHD by UHPLC-MS/MS was developed, validated, and successfully applied in patients
with epilepsy for dose adjustment. The experiences during method development, validation,
and application might be helpful for other researchers.
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Affiliation(s)
- Qing Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing 100070, China
| | - Siyao Jin
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing 100070, China
| | - Qingyang Liu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing 100070, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing 100070, China
| | - Weixing Feng
- Department of Neurology, Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
| | - Shenghui Mei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan West Road, Fengtai District, Beijing 100070, China
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