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Anliker-Ort M, Rodieux F, Ziesenitz VC, Atkinson A, Bielicki JA, Erb TO, Gürtler N, Holland-Cunz S, Duthaler U, Rudin D, Haschke M, van den Anker J, Pfister M, Gotta V. Pharmacokinetics-Based Pediatric Dose Evaluation and Optimization Using Saliva - A Case Study. J Clin Pharmacol 2024; 64:810-819. [PMID: 38497339 DOI: 10.1002/jcph.2428] [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: 11/26/2023] [Accepted: 02/17/2024] [Indexed: 03/19/2024]
Abstract
Understanding pharmacokinetics (PK) in children is a prerequisite to determine optimal pediatric dosing. As plasma sampling in children is challenging, alternative PK sampling strategies are needed. In this case study we evaluated the suitability of saliva as alternative PK matrix to simplify studies in infants, investigating metamizole, an analgesic used off-label in infants. Six plasma and 6 saliva PK sample collections were scheduled after a single intravenous dose of 10 mg/kg metamizole. Plasma/saliva pharmacometric (PMX) modeling of the active metabolites 4-methylaminoantipyrine (4-MAA) and 4-aminoantipyrine (4-AA) was performed. Various reduced plasma sampling scenarios were evaluated by PMX simulations. Saliva and plasma samples from 25 children were included (age range, 5-70 months; weight range, 8.7-24.8 kg). Distribution of metamizole metabolites between plasma and saliva was without delay. Estimated mean (individual range) saliva/plasma fractions of 4-MAA and 4-AA were 0.32 (0.05-0.57) and 0.57 (0.25-0.70), respectively. Residual variability of 4-MAA (4-AA) in saliva was 47% (28%) versus 17% (11%) in plasma. A simplified sampling scenario with up to 6 saliva samples combined with 1 plasma sample was associated with similar PK parameter estimates as the full plasma sampling scenario. This case study with metamizole shows increased PK variability in saliva compared to plasma, compromising its suitability as single matrix for PK studies in infants. Nonetheless, rich saliva sampling can reduce the number of plasma samples required for PK characterization, thereby facilitating the conduct of PK studies to optimize dosing in pediatric patients.
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Affiliation(s)
- Marion Anliker-Ort
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Frédérique Rodieux
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Victoria C Ziesenitz
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Pediatric and Congenital Cardiology, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Andrew Atkinson
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Infectious Diseases Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Julia A Bielicki
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
- Pediatric Infectious Diseases, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Thomas O Erb
- Pediatric Anesthesiology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Nicolas Gürtler
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Holland-Cunz
- Pediatric Surgery, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Urs Duthaler
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Deborah Rudin
- Division of Clinical Pharmacology and Toxicology, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, University Hospital Bern, University of Bern, Bern, Switzerland
| | - John van den Anker
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
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Wieringa JW, Kruizinga MD, Driessen GJA, van der Woude CJ, Julsgaard M. Validation of the Pharmacokinetic Model for Anti-TNFα Clearance in Infants Exposed to Anti-TNFα During Pregnancy. J Crohns Colitis 2024; 18:506-515. [PMID: 37823516 DOI: 10.1093/ecco-jcc/jjad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND AIMS The ECCO guideline recommends postponing live attenuated vaccines in infants exposed to anti-tumour necrosis factor alpha [anti-TNFα] in utero until drug clearance. The aim was to validate the predictive performance of the anti-TNFα clearance model. METHODS Newborns and data for anti-TNFα concentrations from the prospective PETIT cohort were included. The anti-TNFα clearance model was used to predict all measured concentrations in the PETIT cohort, based on the measured cord blood concentration and the mean population clearance described in the model. Bayesian maximum a posteriori optimization was used to estimate the use of drug monitoring. Predictive capability and drug monitoring were assessed through mean absolute error [MAE], root mean squared prediction error, and limits of agreement according to Bland and Altman. RESULTS Observed drug concentrations after birth were within the 80% prediction interval in 94% of adalimumab samples and 93% of infliximab samples. The anti-TNFα clearance model accurately predicted the concentration at 6 months after birth with an MAE of 0.03 µg/mL [SD 0.03] for adalimumab and 0.11 µg/mL [SD 0.18] for infliximab based on cord blood concentrations. Addition of an additional sample between 1 and 4 months after birth improved the predictive accuracy for infliximab (MAE 0.05 [SD 0.09]) but not for adalimumab. Guidance for use in clinical practice was formulated. CONCLUSIONS The validity of the anti-TNFα clearance model is high, and hence can be used to guide clinicians regarding the timing of live vaccines in infants exposed to adalimumab or infliximab in utero.
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Affiliation(s)
- Jantien W Wieringa
- Department of Pediatrics, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Pediatrics, Division of Paediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Matthijs D Kruizinga
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
- Juliana Children's Hospital, Haga Teaching Hospital, the Hague, The Netherlands
| | - Gertjan J A Driessen
- Department of Pediatrics, Maastricht University Medical Center, MosaKids Children's Hospital, Maastricht, The Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mette Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
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Xu B, Yang T, Zhou J, Zheng Y, Wang J, Liu Q, Li D, Zhang Y, Liu M, Wu X. Saliva as a noninvasive sampling matrix for therapeutic drug monitoring of intravenous busulfan in Chinese patients undergoing hematopoietic stem cell transplantation: A prospective population pharmacokinetic and simulation study. CPT Pharmacometrics Syst Pharmacol 2023; 12:1238-1249. [PMID: 37491812 PMCID: PMC10508574 DOI: 10.1002/psp4.13004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
Therapeutic drug monitoring (TDM) of busulfan (BU) is currently performed by plasma sampling in patients undergoing hematopoietic stem cell transplantation (HSCT). Saliva samples are considered a noninvasive TDM matrix. Currently, no salivary population pharmacokinetics (PopPKs) model for BU available. This study aimed to develop a PopPK model that can describe the relationship between plasma and saliva kinetics in patients receiving intravenous BU. The performance of the model in predicting the area under the concentration-time curve at steady state (AUCss ) based on saliva samples is evaluated. Sixty-six patients with HSCT were recruited and administered 0.8 mg/kg BU intravenously. A PopPK model for saliva and plasma was developed using the nonlinear mixed effects model. Bayesian maximum a posteriori (MAP) optimization was used to estimate the model's predictive performance. Plasma and saliva PKs were adequately described with a one-compartment model and a scaled central compartment. Body surface area correlated positively with both clearance and apparent volume of distribution (Vd), whereas alkaline phosphatase correlated negatively with Vd. Simulations demonstrated that the percentage root mean squared prediction error and lower and upper limits of agreements reduced to 10.02% and -16.96% to 22.86% based on five saliva samples. Saliva can be used as an alternative matrix to plasma in TDM of BU. The AUCss can be predicted from saliva concentration by Bayesian MAP optimization, which can be used to design personalized dosing for BU.
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Affiliation(s)
- Baohua Xu
- Department of PharmacyFujian Medical University Union HospitalFuzhouFujianChina
- School of PharmacyFujian Medical UniversityFuzhouFujianChina
| | - Ting Yang
- Department of HematologyFujian Medical University Union HospitalFuzhouFujianChina
| | - Jianxing Zhou
- Department of PharmacyFujian Medical University Union HospitalFuzhouFujianChina
- School of PharmacyFujian Medical UniversityFuzhouFujianChina
| | - You Zheng
- Department of PharmacyFujian Medical University Union HospitalFuzhouFujianChina
- School of PharmacyFujian Medical UniversityFuzhouFujianChina
| | - Jingting Wang
- College of PharmacyUniversity of MichiganAnn ArborMichiganUSA
| | - Qingxia Liu
- Department of PharmacyFujian Medical University Union HospitalFuzhouFujianChina
- School of PharmacyFujian Medical UniversityFuzhouFujianChina
| | - Dandan Li
- Department of PharmacyFujian Medical University Union HospitalFuzhouFujianChina
- School of PharmacyFujian Medical UniversityFuzhouFujianChina
| | - Yifan Zhang
- Shanghai Institute of Materia Medica, Chinese Academy of SciencesShanghaiChina
| | - Maobai Liu
- Department of PharmacyFujian Medical University Union HospitalFuzhouFujianChina
| | - Xuemei Wu
- Department of PharmacyFujian Medical University Union HospitalFuzhouFujianChina
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Liu J, Tang Y, Cheng Y, Huang W, Xiang L. Electrochemical biosensors based on saliva electrolytes for rapid detection and diagnosis. J Mater Chem B 2022; 11:33-54. [PMID: 36484271 DOI: 10.1039/d2tb02031a] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, electrochemical biosensors (ECBSs) have shown significant potential for real-time disease diagnosis and in situ physical condition monitoring. As a multi-constituent oral fluid comprising various disease signaling biomarkers, saliva has drawn much attention in the field of point-of-care (POC) testing. In particular, during the outbreak of the COVID-19 pandemic, ECBSs which hold the simplicity of a single-step assay compared with the multi-step assay of traditional testing methods are expected to relieve the human and economic burden caused by the massive and long-term sample testing process. Noteworthily, ECBSs for the detection of SARS-CoV-2 in saliva have already been developed and may replace current testing methods. Furthermore, the detection scope has expanded from routine indices such as sugar and uric acid to abnormal biomarkers for early-stage disease detection and drug level monitoring, which further facilitated the evolution of ECBSs in the last 5 years. This review is divided into several main sections. First, we discussed the latest advancements and representative research on ECBSs for saliva testing. Then, we focused on a novel kind of ECBS, organic electrochemical transistors (OECTs), which hold great advantages of high sensitivity and signal-to-noise ratio and on-site detection. Finally, application of ECBSs with integrated portable platforms in oral cavities, which lead to powerful auxiliary testing means for telemedicine, has also been discussed.
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Affiliation(s)
- Jiayi Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No 14th, 3rd section, Renmin South Road, Chengdu, 610041, China.
| | - Yufei Tang
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No 14th, 3rd section, Renmin South Road, Chengdu, 610041, China. .,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, No 14th, 3rd section, Renmin South Road, Chengdu, 610041, China
| | - Yuhua Cheng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Wei Huang
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Lin Xiang
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No 14th, 3rd section, Renmin South Road, Chengdu, 610041, China. .,Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No 14th, 3rd section, Renmin South Road, Chengdu, 610041, China
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Schouwenburg S, van der Klip RFJ, Smeets TJL, Hunfeld NGM, Flint RB, de Hoog M, Endeman H, Koch BCP, Wildschut ED, Abdulla A. Review of Scavenged Sampling for Sustainable Therapeutic Drug Monitoring: Do More With Less. Ther Drug Monit 2022; 44:215-223. [PMID: 34657093 PMCID: PMC8746914 DOI: 10.1097/ftd.0000000000000928] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Innovative and sustainable sampling strategies for bioanalytical quantification of drugs and metabolites have gained considerable interest. Scavenging can be stratified as a sustainable sampling strategy using residual material because it aligns with the green principles of waste reduction and sampling optimization. Scavenged sampling includes all biological fluids' (eg, blood, liquor, and urine) leftover from standard clinical care. This review elaborates on the past and current landscape of sustainable sampling within therapeutic drug monitoring, with a focus on scavenged sampling. METHODS In February 2021, 4 databases were searched to assess the literature on the clinical use of innovative and sustainable sampling techniques without applying publication date restrictions. Studies reporting the clinical use of scavenged blood sampling and bridging studies of scavenged sampling and normal blood sampling were eligible for inclusion. RESULTS Overall, 19 eligible studies concerning scavenged sampling were identified from 1441 records. Scavenged sampling is mainly applied in the pediatric population, although other patient groups may benefit from this strategy. The infrastructure required for scavenged sampling encounters several challenges, including logistic hurdles, storage and handling conditions, and documentation errors. A workflow is proposed with identified opportunities that guide the implementation of scavenged sampling. CONCLUSIONS This review presents current evidence on the clinical use of scavenged sampling strategies. Scavenged sampling can be a suitable approach for drug quantification to improve dosage regimens, perform pharmacokinetic studies, and explore the value of therapeutic drug monitoring without additional sample collection.
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Affiliation(s)
| | | | | | - Nicole G. M. Hunfeld
- Departments of Hospital Pharmacy and
- Adult Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert B. Flint
- Departments of Hospital Pharmacy and
- Department of Pediatrics, Division of Neonatology, Erasmus MC—Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands; and
| | - Matthijs de Hoog
- Department of Pediatric Intensive Care, Erasmus MC—Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Henrik Endeman
- Adult Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Enno D. Wildschut
- Department of Pediatric Intensive Care, Erasmus MC—Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alan Abdulla
- Departments of Hospital Pharmacy and
- Department of Pediatric Intensive Care, Erasmus MC—Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
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Kruizinga MD, Zuiker RGJA, Bergmann KR, Egas AC, Cohen AF, Santen GWE, van Esdonk MJ. Population pharmacokinetics of clonazepam in saliva and plasma: Steps towards noninvasive pharmacokinetic studies in vulnerable populations. Br J Clin Pharmacol 2021; 88:2236-2245. [PMID: 34811788 PMCID: PMC9299763 DOI: 10.1111/bcp.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022] Open
Abstract
AIM Traditional studies focusing on the relationship between pharmacokinetics (PK) and pharmacodynamics necessitate blood draws, which are too invasive for children or other vulnerable populations. A potential solution is to use noninvasive sampling matrices, such as saliva. The aim of this study was to develop a population PK model describing the relationship between plasma and saliva clonazepam kinetics and assess whether the model can be used to determine trough plasma concentrations based on saliva samples. METHODS Twenty healthy subjects, aged 18-30, were recruited and administered 0.5 or 1 mg of clonazepam solution. Paired plasma and saliva samples were obtained until 48 hours post-dose. A population pharmacokinetic model was developed describing the PK of clonazepam in plasma and the relationship between plasma and saliva concentrations. Bayesian maximum a posteriori optimization was applied to estimate the predictive accuracy of the model. RESULTS A two-compartment distribution model best characterized clonazepam plasma kinetics with a mixture component on the absorption rate constants. Oral administration of the clonazepam solution caused contamination of the saliva compartment during the first 4 hours post-dose, after which the concentrations were driven by the plasma concentrations. Simulations demonstrated that the lower and upper limits of agreements between true and predicted plasma concentrations were -28% to 36% with one saliva sample. Increasing the number of saliva samples improved these limits to -18% to 17%. CONCLUSION The developed model described the salivary and plasma kinetics of clonazepam, and could predict steady-state trough plasma concentrations based on saliva concentrations with acceptable accuracy.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, the Netherlands.,Juliana Children's Hospital, HAGA teaching Hospital, the Hague, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Annelies C Egas
- Department of Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Gijs W E Santen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
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