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Fornari C, Arrieta A, Bradley JS, Tout M, Magalhaes P, Auriol FK, Borella E, Piana C, Della Pasqua O, Vallespir BP, Mazzei P, Bokesch PM, Hoover R, Capriati A, Habboubi N. Dose rationale for the use of meropenem/vaborbactam combination in paediatric patients with Gram-negative bacterial infections. Br J Clin Pharmacol 2024. [PMID: 38925918 DOI: 10.1111/bcp.16145] [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: 06/19/2023] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS Meropenem/vaborbactam combination is approved in adults by FDA and EMA for complicated urinary tract infections and by EMA also for other Gram-negative infections. We aimed to characterise the pharmacokinetics of both moieties in an ongoing study in children and use a model-based approach to inform adequate dosing regimens in paediatric patients. METHODS Over 4196 blood samples of meropenem and vaborbactam (n = 414 subjects) in adults, together with 114 blood samples (n = 39) in paediatric patients aged 3 months to 18 years were available for this analysis. Data were analysed using a population with prior information from a pharmacokinetic model in adults to inform parameter estimation in children. Simulations were performed to assess the suitability of different dosing regimens to achieve adequate probability of target attainment (PTA). RESULTS Meropenem/vaborbactam PK was described with two-compartment models with first-order elimination. Body weight and CLcr were significant covariates on the disposition of both drugs. A maturation function was evaluated to explore changes in clearance in neonates. PTA ≥90% was derived for children aged ≥3 months after 3.5-h IV infusion of 40 mg/kg Q8h of both meropenem and vaborbactam and 2 g/2 g for those ≥50 kg. Extrapolation of disposition parameters suggest that adequate PTA is achieved after a 3.5-h IV infusion of 20 mg/kg for neonates and infants (3 months). CONCLUSIONS An integrated analysis of adult and paediatric data allowed accurate description of sparsely sampled meropenem/vaborbactam PK in paediatric patients and provided recommendations for the dosing in neonates and infants (3 months).
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Affiliation(s)
- Chiara Fornari
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Antonio Arrieta
- Children's Hospital of Orange County, Orange, California, USA
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, California, USA
- Rady Children's Hospital, San Diego, California, USA
| | - Mira Tout
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Paulo Magalhaes
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Faten Koraichi Auriol
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Elisa Borella
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Chiara Piana
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Oscar Della Pasqua
- Clinical Pharmacology & Therapeutics, University College London, London, UK
| | - Bartomeu Piza Vallespir
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Paolo Mazzei
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | | | | | - Angela Capriati
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
| | - Nassir Habboubi
- Clinical Pharmacology, Pharmacometrics and Clinical DMPK Department, Stemline Therapeutics/Menarini Group, Pomezia, Italy
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2
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Leroux S, Elie V, Zhao W, Magreault S, Jacqz-Aigrain E. Principles and applications of pharmacometrics in drug evaluation in children. Therapie 2018; 73:165-170. [DOI: 10.1016/j.therap.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022]
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3
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Cusato J, Allegra S, Nicolò AD, Calcagno A, D'Avolio A. Precision medicine for HIV: where are we? Pharmacogenomics 2018; 19:145-165. [DOI: 10.2217/pgs-2017-0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To date, antiretroviral therapy is highly effective in HIV-affected patients, but the individualization of such a life-long therapy may be advised. This review briefly summarizes the main factors involved in the potential personalization of antiretroviral treatment. Relevant articles in English were identified by PubMed and recent congresses’ abstracts. Foremost influences concerning pharmacodynamics, therapeutic drug monitoring, pharmacogenetics, comorbidities, immune recovery and viral characteristics affecting the healthcare of HIV-positive patients are listed here. Furthermore, pharmacoeconomic aspects are mentioned. Applying pharmacokinetic and pharmacogenetic knowledge may be informative and guide the better choice of treatment in order to achieve long-term efficacy and avoid adverse events. Randomized investigations of the clinical relevance of tailored antiretroviral regimens are needed in order to obtain a better management of HIV/AIDS-affected patients.
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Affiliation(s)
- Jessica Cusato
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Sarah Allegra
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Amedeo De Nicolò
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Andrea Calcagno
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
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Vermeulen E, van den Anker JN, Della Pasqua O, Hoppu K, van der Lee JH. How to optimise drug study design: pharmacokinetics and pharmacodynamics studies introduced to paediatricians. J Pharm Pharmacol 2017; 69:439-447. [PMID: 27671925 PMCID: PMC6084327 DOI: 10.1111/jphp.12637] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In children, there is often lack of sufficient information concerning the pharmacokinetics (PK) and pharmacodynamics (PD) of a study drug to support dose selection and effective evaluation of efficacy in a randomised clinical trial (RCT). Therefore, one should consider the relevance of relatively small PKPD studies, which can provide the appropriate data to optimise the design of an RCT. METHODS Based on the experience of experts collaborating in the EU-funded Global Research in Paediatrics consortium, we aimed to inform clinician-scientists working with children on the design of investigator-initiated PKPD studies. KEY FINDINGS The importance of the identification of an optimal dose for the paediatric population is explained, followed by the differences and similarities of dose-ranging and efficacy studies. The input of clinical pharmacologists with modelling expertise is essential for an efficient dose-finding study. CONCLUSIONS The emergence of new laboratory techniques and statistical tools allows for the collection and analysis of sparse and unbalanced data, enabling the implementation of (observational) PKPD studies in the paediatric clinic. Understanding of the principles and methods discussed in this study is essential to improve the quality of paediatric PKPD investigations, and to prevent the conduct of paediatric RCTs that fail because of inadequate dosing.
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Affiliation(s)
- Eric Vermeulen
- Pediatric Clinical Research OfficeEmma Children's HospitalAcademic Medical CenterAmsterdamThe Netherlands
| | - John N. van den Anker
- Division of Pediatric Clinical PharmacologyChildren's National Health SystemWashingtonDCUSA
- Division of Paediatric Pharmacology and PharmacometricsUniversity of Basel Children's HospitalBaselSwitzerland
- Intensive Care and Department of Pediatric SurgeryErasmus Medical CenterSophia Children's HospitalRotterdamThe Netherlands
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling & SimulationGlaxoSmithKlineStockley ParkUK
- Clinical Pharmacology & TherapeuticsUniversity College LondonLondonUK
| | - Kalle Hoppu
- Poison Information CentreHelsinki University Central HospitalHelsinkiFinland
| | - Johanna H. van der Lee
- Pediatric Clinical Research OfficeEmma Children's HospitalAcademic Medical CenterAmsterdamThe Netherlands
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Janssen EJH, Bastiaans DET, Välitalo PAJ, van Rossum AMC, Jacqz-Aigrain E, Lyall H, Knibbe CAJ, Burger DM. Dose evaluation of lamivudine in human immunodeficiency virus-infected children aged 5 months to 18 years based on a population pharmacokinetic analysis. Br J Clin Pharmacol 2017; 83:1287-1297. [PMID: 28079918 DOI: 10.1111/bcp.13227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/16/2016] [Accepted: 12/18/2016] [Indexed: 01/16/2023] Open
Abstract
AIM The objectives of this study were to characterize age-related changes in lamivudine pharmacokinetics in children and evaluate lamivudine exposure, followed by dose recommendations for subgroups in which target steady state area under the daily plasma concentration-time curve (AUC0-24h ) is not reached. METHODS Population pharmacokinetic modelling was performed in NONMEM using data from two model-building datasets and two external datasets [n = 180 (age 0.4-18 years, body weight 3.4-60.5 kg); 2061 samples (median 12 per child); daily oral dose 60-300 mg (3.9-17.6 mg kg-1 )]. Steady state AUC0-24h was calculated per individual (adult target 8.9 mg·h l-1 ). RESULTS A two-compartment model with sequential zero order and first order absorption best described the data. Apparent clearance and central volume of distribution (% RSE) were 13.2 l h-1 (4.2%) and 38.9 l (7.0%) for a median individual of 16.6 kg, respectively. Bodyweight was identified as covariate on apparent clearance and volume of distribution using power functions (exponents 0.506 (20.2%) and 0.489 (32.3%), respectively). The external evaluation supported the predictive ability of the final model. In 94.5% and 35.8% of the children with a body weight >14 kg and <14 kg, respectively, the target AUC0-24h was reached. CONCLUSION Bodyweight best predicted the developmental changes in apparent lamivudine clearance and volume of distribution. For children aged 5 months-18 years with a body weight <14 kg, the dose should be increased from 8 to 10 mg kg-1 day-1 if the adult target for AUC0-24h is aimed for. In order to identify whether bodyweight influences bioavailability, clearance and/or volume of distribution, future analysis including data on intravenously administered lamivudine is needed.
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Affiliation(s)
- Esther J H Janssen
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - Diane E T Bastiaans
- Department of Pharmacy & Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pyry A J Välitalo
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - Annemarie M C van Rossum
- Division of Pediatric Infectious Diseases and Immunology, Erasmus MC/Sophia, Rotterdam, the Netherlands
| | - Evelyne Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Université Paris VII, Paris, France.,Clinical Investigation Center CIC9202, INSERM, Paris, France
| | - Hermione Lyall
- Department of Pediatrics, St Mary's Hospital, London, UK
| | - Catherijne A J Knibbe
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands.,Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - David M Burger
- Department of Pharmacy & Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
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Smania G, Baiardi P, Ceci A, Magni P, Cella M. Model-Based Assessment of Alternative Study Designs in Pediatric Trials. Part I: Frequentist Approaches. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2016; 5:305-12. [PMID: 27300083 PMCID: PMC5131885 DOI: 10.1002/psp4.12083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/25/2016] [Accepted: 04/18/2016] [Indexed: 11/10/2022]
Abstract
Alternative designs can increase the feasibility of pediatric trials when compared to classical parallel designs (PaD). In this work we present a model-based approach based on clinical trial simulations for the comparison of PaD with the alternative sequential, crossover, and randomized withdrawal (RWD) designs. Study designs were evaluated in terms of: type I and II errors, sample size per arm (SS), trial duration (TD), treatment exposures, and parameter estimate precision (EP). The crossover requires the lowest SS and TD, although it implies higher placebo and no treatment exposures. RWD maximizes exposure to active treatment while minimizing that to placebo, but requires the largest SS. SS of sequential designs can sometimes be smaller than the crossover one, although with poorer EP. This pharmacometric framework allows a multiscale comparison of alternative study designs that can be used for design selection in future pediatric trials.
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Affiliation(s)
- G Smania
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy.,Dipartimento di Ingegneria Industriale e dell'Informazione, Università degli Studi di Pavia, Pavia, Italy
| | - P Baiardi
- Direzione Scientifica Centrale, Fondazione Salvatore Maugeri, IRCCS, Pavia, Italy
| | - A Ceci
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - P Magni
- Dipartimento di Ingegneria Industriale e dell'Informazione, Università degli Studi di Pavia, Pavia, Italy
| | - M Cella
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy.,Department of Clinical Pharmacology, Global Clinical Development, Chiesi Farmaceutici, Parma, Italy
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van Hasselt JGC, van Eijkelenburg NKA, Beijnen JH, Schellens JHM, Huitema ADR. Design of a drug-drug interaction study of vincristine with azole antifungals in pediatric cancer patients using clinical trial simulation. Pediatr Blood Cancer 2014; 61:2223-9. [PMID: 25175364 DOI: 10.1002/pbc.25198] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/01/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of the current work was to perform a clinical trial simulation (CTS) analysis to optimize a drug-drug interaction (DDI) study of vincristine in children who also received azole antifungals, taking into account challenges of conducting clinical trials in this population, and, to provide a motivating example of the application of CTS in the design of pediatric oncology clinical trials. PROCEDURE A pharmacokinetic (PK) model for vincristine in children was used to simulate concentration-time profiles. A continuous model for body surface area versus age was defined based on pediatric growth curves. Informative sampling time windows were derived using D-optimal design. The CTS framework was used to different magnitudes of clearance inhibition (10%, 25%, or 40%), sample size (30-500), the impact of missing samples or sampling occasions, and the age distribution, on the power to detect a significant inhibition effect, and in addition, the relative estimation error (REE) of the interaction effect. RESULTS A minimum group specific sample size of 38 patients with a total sample size of 150 patients was required to detect a clearance inhibition effect of 40% with 80% power, while in the case of a lower effect of clearance inhibition, a substantially larger sample size was required. However, for the majority of re-estimated drug effects, the inhibition effect could be estimated precisely (REE < 25%) in even smaller sample sizes and with lower effect sizes. CONCLUSION This work demonstrated the utility of CTS for the evaluation of PK clinical trial designs in the pediatric oncology population.
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Affiliation(s)
- J G Coen van Hasselt
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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