1
|
Milliken E, de Zwart AES, Alffenaar JWC, Marriott DJE, Riezebos-Brilman A, Schteinman A, Evans AM, Glanville AR, Verschuuren EAM, Reuter SE. Population pharmacokinetics of ribavirin in lung transplant recipients and examination of current and alternative dosing regimens. J Antimicrob Chemother 2020; 74:691-698. [PMID: 30452661 DOI: 10.1093/jac/dky466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/29/2018] [Accepted: 10/13/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Ribavirin is used in the treatment of respiratory paramyxovirus infection in lung transplant recipients; however, its pharmacokinetic profile in the transplant population is unknown despite the potential for alterations due to underlying pathology. Furthermore, the ability of current regimens to meet exposure targets has not been established. OBJECTIVES This study examined the pharmacokinetics of ribavirin in a lung transplant population for which current and alternative dosing regimens were assessed. METHODS Population pharmacokinetic modelling was conducted in NONMEM using concentration-time data from 24 lung transplant recipients and 6 healthy volunteers. Monte Carlo simulation was used to assess the ability of dosing regimens to achieve pre-specified target concentrations. RESULTS AND CONCLUSIONS A three-compartment model with first-order elimination most adequately described ribavirin concentration-time data, with CLCR and patient type (i.e. lung transplant) identified as significant covariates in the model. Simulations indicate that current regimens achieve efficacious concentrations within 24 h of treatment initiation that increase to supra-therapeutic levels over the treatment period. A regimen of 8 mg/kg q6h orally for 48 h followed by 8 mg/kg q24h orally for the remainder of the treatment period was predicted to result in >90% of patients exhibiting concentrations within the defined target range throughout the entire treatment course. Additional work to formally establish target therapeutic concentrations is required; however, this study provides a valuable first step in determining optimal ribavirin treatment regimens for paramyxovirus infections in the lung transplant population.
Collapse
Affiliation(s)
- Eliza Milliken
- Faculty of Medicine, The University of Notre Dame, Sydney, Australia
| | - Auke E S de Zwart
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands
| | | | - Annelies Riezebos-Brilman
- Department of Medical Microbiology, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Ana Schteinman
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Allan M Evans
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Allan R Glanville
- Faculty of Medicine, The University of Notre Dame, Sydney, Australia.,Department of Thoracic Medicine, St Vincent's Hospital, Sydney, Australia
| | - Erik A M Verschuuren
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
| | - Stephanie E Reuter
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| |
Collapse
|
2
|
Kheloufi F, Poizot-Martin I, Garraffo R, Tavenard A, Quaranta S, Renault A, Lavrut T, Bourlière M, Halfon P, Piroth L, Bellissant E, Lacarelle B, Molina JM, Solas C. ITPA deficiency and ribavirin level are still predictive of anaemia in HCV-HIV-coinfected patients receiving ribavirin combined with a first-generation DAA (ANRS HC27 study). Antivir Ther 2016; 22:461-469. [PMID: 27583701 DOI: 10.3851/imp3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND We aimed to determine the impact of inosine triphosphatase (ITPA) deficiency on ribavirin (RBV)-induced anaemia in HIV-HCV-coinfected patients receiving a triple therapy including the haematotoxic direct-acting antiviral agent boceprevir (BOC). METHODS Patients of the ANRS HC27 BocepreVIH study were genotyped for two ITPA single nucleotide polymorphisms involved in ITPA deficiency. RBV trough concentration (Ctrough) was determined at week (W)4 and W8. Impact of ITPA deficiency on anaemia, RBV Ctrough, response and haematotoxicity (grade 3/4 anaemia, erythropoietin [EPO] use, RBV dose reduction or transfusion between day [D]0 and W8) was evaluated. Impact of RBV Ctrough on anaemia was also studied. RESULTS Among the 63 genotyped patients, 33% had a predicted ITPA deficiency. ITPA deficiency was associated with a lower haemoglobin (Hb) decline both at W4 (-1.0 g/dl versus -2.1 g/dl; P=0.02) and W8 (-2.7 g/dl versus -4.1 g/dl; P=0.05). None of the patients with ITPA deficiency received EPO between D0-W8 versus 26% of patients without ITPA deficiency (P=0.01). RBV Ctrough was associated with Hb decrease both at W4 and W8 and an RBV Ctrough cutoff value of 2 µg/ml was significantly associated with a W4 Hb decline >2 g/dl. Haematotoxicity was significantly associated with a lower W4 Hb level (P=0.017), absence of ITPA deficiency (P=0.018) and higher RBV Ctrough (P=0.012). ITPA deficiency, W4 RBV Ctrough and gender were independent predictors of anaemia at W4. ITPA deficiency was not associated with virological response. CONCLUSIONS ITPA deficiency and RBV Ctrough are still predictive of RBV-induced anaemia in HIV-HCV-coinfected patients treated with RBV combined with a first-generation direct antiviral agent.
Collapse
Affiliation(s)
- Farid Kheloufi
- Aix Marseille University, APHM Timone, Service de Pharmacocinétique et Toxicologie, Marseille, France
- CRO2 INSERM U911, Marseille, France
- Centre Régional de Pharmacovigilance Marseille Provence Corse, Service de pharmacologie clinique et pharmacovigilance, APHM Sainte-Marguerite, Marseille, France
| | - Isabelle Poizot-Martin
- Aix Marseille University, APHM Sainte-Marguerite, Service d'Immuno-hématologie clinique, Marseille, France
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
| | - Rodolphe Garraffo
- Faculty of Medicine of Nice, Hôpital Pasteur, Laboratoire de Pharmacologie, Nice, France
| | - Aude Tavenard
- Rennes 1 University, Rennes, France
- Rennes University Hospital, Department of Clinical Pharmacology, Rennes, France
- INSERM 1414 CIC-P Clinical Investigation Centre, Rennes, France
| | - Sylvie Quaranta
- Aix Marseille University, APHM Timone, Service de Pharmacocinétique et Toxicologie, Marseille, France
| | - Alain Renault
- Rennes 1 University, Rennes, France
- Rennes University Hospital, Department of Clinical Pharmacology, Rennes, France
- INSERM 1414 CIC-P Clinical Investigation Centre, Rennes, France
| | - Thibault Lavrut
- Faculty of Medicine of Nice, Hôpital Pasteur, Laboratoire de Pharmacologie, Nice, France
| | - Marc Bourlière
- Service d'Hépato-Gastro-Entérologie, Hôpital Saint-Joseph, Marseille, France
| | | | - Lionel Piroth
- Infectious Diseases Department, University Hospital, and UMR 1347, University of Burgundy, Dijon, France
| | - Eric Bellissant
- Rennes 1 University, Rennes, France
- Rennes University Hospital, Department of Clinical Pharmacology, Rennes, France
- INSERM 1414 CIC-P Clinical Investigation Centre, Rennes, France
| | - Bruno Lacarelle
- Aix Marseille University, APHM Timone, Service de Pharmacocinétique et Toxicologie, Marseille, France
- CRO2 INSERM U911, Marseille, France
| | - Jean-Michel Molina
- Infectious Diseases Unit - INSERM U941, Assistance Publique Hôpitaux de Paris (AP-HP) - Saint-Louis Hospital, Paris, France
- Paris VII - Denis Diderot University, Paris, France
| | - Caroline Solas
- Aix Marseille University, APHM Timone, Service de Pharmacocinétique et Toxicologie, Marseille, France
- CRO2 INSERM U911, Marseille, France
| |
Collapse
|
3
|
Poizot-Martin I, Bellissant E, Garraffo R, Colson P, Piroth L, Solas C, Renault A, Bourlière M, Halfon P, Ghosn J, Alric L, Naqvi A, Carrieri P, Molina JM. Addition of boceprevir to PEG-interferon/ribavirin in HIV-HCV-Genotype-1-coinfected, treatment-experienced patients: efficacy, safety, and pharmacokinetics data from the ANRS HC27 study. HIV CLINICAL TRIALS 2016; 17:63-71. [PMID: 27077673 DOI: 10.1080/15284336.2015.1135553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Scarce data exist on the efficacy and safety of the PEGylated-interferon/ribavirin/boceprevir regimen in HIV/HCV-coinfected patients who failed to respond to PEGylated-interferon/ribavirin treatment. OBJECTIVES To evaluate the efficacy and safety of this drug regimen and the impact of the addition of boceprevir(BOC) on atazanavir (ATV) or raltegravir (RAL) pharmacokinetic parameters in a subgroup of patients. METHODS In this single-arm phase 2 trial, HIV-1/HCV-genotype-1-coinfected patients received PEGylated-interferonα2b (1.5 μg/kg/week)+ ribavirin (800-1400 mg/day) alone until W4 and with BOC(800 mgTID) until W48. Based on virologic response at W8, the three drugs were stopped or PEGylated-interferon/ribavirin was continued alone until W72. The primary endpoint was SVR at W24 off-therapy (SVR24). RESULTS 64 patients were included. SVR24 was achieved in 53% of patients (CI90%: 43-63%) and in 90% of previous relapsers. In univariate analysis, SVR24 was associated with response to previous HCV treatment, HCV-1b subtype, HCV-RNA decline, ribavirin-Ctrough at W4, and HCV-RNA at W8 but not to fibrosis score, IL28B genotype, or boceprevir-Ctrough at W8. In multivariate analysis, SVR24 remained associated with response to previous HCV treatment [non-responders versus null responders: OR=5.0(1.3-20.0); relapsers vs. null responders: OR=28.8(4.9-169.5)]. HCV treatment was discontinued for adverse events in 17% of patients. A 51% decrease in ATV/r-AUC0-8 h (p<0.01) and a 57% increase in RAL-AUC0-8 h (p<0.01) were observed, although atazanavir/r or raltegravir did not affect BOC-AUC0-8 h significantly. The ATV mean Cthrough fell from 763.8 ng/mL (CI 95%: 230.3-1297.3) without BOC to 507.7 ng/mL (CI 95%: 164-851.4) with BOC. CONCLUSIONS Boceprevir-based regimen demonstrated a high SVR24 rate in treatment-experienced HIV-HCV genotype-1-coinfected relapsers.
Collapse
Affiliation(s)
- Isabelle Poizot-Martin
- a Aix-Marseille University, AP-HM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique , Marseille , France.,b INSERM, UMR 912 (SESSTIM) , Marseille , France
| | - Eric Bellissant
- c Rennes 1 University, Pontchaillou University Hospital, Service de Pharmacologie , Rennes , France.,d INSERM, CIC 1414 Clinical Investigation Centre , Rennes , France
| | - Rodolphe Garraffo
- e Nice University, Pasteur University Hospital , Laboratoire de Pharmacologie et de Toxicologie Médicale , Nice , France
| | - Philippe Colson
- f Aix-Marseille University, AP-HM Timone, Fédération de Microbiologie Hospitalière , Marseille , France.,g URMITE , UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille , France
| | - Lionel Piroth
- h Bourgogne University, Bocage University Hospital , Département d'Infectiologie , UMR 1347, Dijon , France
| | - Caroline Solas
- i Aix-Marseille University, AP-HM Timone, Service de Pharmacocinétique et Toxicologie , Marseille , France.,j INSERM , UMR 911 (CRO2), Marseille , France
| | - Alain Renault
- c Rennes 1 University, Pontchaillou University Hospital, Service de Pharmacologie , Rennes , France.,d INSERM, CIC 1414 Clinical Investigation Centre , Rennes , France
| | - Marc Bourlière
- k AP-HM Saint-Joseph, Service d'Hépato-Gastro-Entérologie , Marseille , France
| | | | - Jade Ghosn
- m Paris Descartes University , PRES Sorbonne Paris-Cité, EA 7327, Paris , France.,n Paris-Sud University, AP-HP Bicêtre Hospital, Service de Médecine Interne , Le Kremlin-Bicêtre, France
| | - Laurent Alric
- o Toulouse 3 University, Purpan University Hospital, Service de Médecine Interne , Toulouse , France
| | - Alissa Naqvi
- p Nice University, Archet University Hospital, Service d'Infectiologie , Nice , France
| | - Patrizia Carrieri
- b INSERM, UMR 912 (SESSTIM) , Marseille , France.,q ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Jean-Michel Molina
- r Paris 7 - Denis Diderot University, AP-HP Saint-Louis Hospital, Service des Maladies Infectieuses et Tropicales , Paris , France
| | | |
Collapse
|
4
|
Role of therapeutic drug monitoring in pulmonary infections: use and potential for expanded use of dried blood spot samples. Bioanalysis 2015; 7:481-95. [DOI: 10.4155/bio.14.318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Respiratory tract infections are among the most common infections in men. We reviewed literature to document their pharmacological treatments, and the extent to which therapeutic drug monitoring (TDM) is needed during treatment. We subsequently examined potential use of dried blood spots as sample procedure for TDM. TDM was found to be an important component of clinical care for many (but not all) pulmonary infections. For gentamicin, linezolid, voriconazole and posaconazole dried blood spot methods and their use in TDM were already evident in literature. For glycopeptides, β-lactam antibiotics and fluoroquinolones it was determined that development of a dried blood spot (DBS) method could be useful. This review identifies specific antibiotics for which development of DBS methods could support the optimization of treatment of pulmonary infections.
Collapse
|
5
|
Abstract
OBJECTIVE(S) To examine the impact of ribavirin and abacavir coadministration on hepatitis C virus (HCV) virological response and trough ribavirin plasma concentration (Cmin) in HIV-HCV coinfected patients. DESIGN Pharmacokinetic substudy on patients from the ANRS CO-13 HEPAVIH cohort. METHODS Patients receiving ribavirin-pegylated interferon for whom a ribavirin steady state Cmin was prospectively determined were included. Rapid virological response (RVR), early virological response (EVR) and sustained virological response (SVR) as well as HCV-RNA decline were evaluated. RESULTS Overall, 124 HIV-HCV coinfected patients (95% on antiretroviral therapy) were enrolled. Of these patients, 22% received abacavir. The overall median (interquartile range) ribavirin Cmin was 1.6 mg/l (1.2-2.2) with no statistical difference between abacavir users and nonusers [1.5 mg/l (0.99-2.1) and 1.7 (1.2-2.3), P = 0.15]. RVR and EVR were 52 and 72%, respectively. There was no difference observed in the proportion of abacavir users vs. nonusers achieving RVR (respectively 59 vs. 50%, P = 0.40) or EVR (72 vs. 73%, P = 0.94), or in the HCV-RNA decline at week 4 [-2.24 log(10) IU/ml, (-3.58; -0.81) and -1.27 (-2.8; -0.47) P = 0.28] or at week 12 [-1.76 log(10) IU/ml (-3.67; -0.35) and -1.85 (-3.13; -1.13) (P = 0.58)]. The SVR rate was 45% for abacavir users and 24% for abacavir nonusers, but the difference was not statistically significant (P = 0.059). CONCLUSION In our study, there was no evidence that abacavir affected HCV treatment outcomes and the ribavirin Cmin was similar in abacavir users and nonusers, confirming the absence of pharmacokinetic interaction between abacavir and ribavirin. An abacavir-containing regimen is, therefore, a well tolerated treatment alternative for coinfected patients starting HCV treatment.
Collapse
|
6
|
Lord HL, Zhang X, Musteata FM, Vuckovic D, Pawliszyn J. In vivo solid-phase microextraction for monitoring intravenous concentrations of drugs and metabolites. Nat Protoc 2011; 6:896-924. [DOI: 10.1038/nprot.2011.329] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|