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Naruhashi S, Fujii T, Yamada H, Pai SM, Ninomiya N. Evaluation of Hemoglobin Response to Treatment With Enarodustat Using Pharmacometric Approach in Japanese Anemic Patients With Chronic Kidney Disease. J Clin Pharmacol 2023; 63:180-196. [PMID: 36057843 DOI: 10.1002/jcph.2148] [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: 06/27/2022] [Accepted: 08/29/2022] [Indexed: 01/21/2023]
Abstract
Enarodustat (JTZ-951) is a hypoxia-inducible factor prolyl hydroxylase inhibitor that has been approved and marketed in Japan for patients with anemia with chronic kidney disease (CKD). The pharmacometric approach was applied to assess the relationship between plasma concentrations of enarodustat and hemoglobin (Hb) levels, and to provide information regarding the optimal use of enarodustat in clinical practice by simulations based on the pharmacokinetic and pharmacodynamic (PK/PD) model that was developed. The PK/PD data of enarodusat obtained from phase 2 and phase 3 studies in Japanese patients with CKD were well described by the models: a 1-compartment model with first-order absorption and elimination for PK, and a semimechanistic model based on transit compartment model for PD. Although several factors were identified as statistically significant covariates on the PK/PD of enarodustat, model-based simulations showed that none of them had clinically relevant impacts on the treatment effect (ie, Hb levels) of enarodustat. Hence, enarodustat treatment provides the stable Hb control with the initial dose (hemodialysis-dependent CKD: 4 mg/day, non-dialysis-dependent CKD: 2 mg/day) and maintenance dose (1-8 mg/day) to the patients with varied demographic characteristics.
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Affiliation(s)
- Shinya Naruhashi
- Clinical Pharmacology, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
| | - Takashi Fujii
- Clinical Pharmacology, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
| | - Hiroyuki Yamada
- Clinical Pharmacology, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
| | - Sudhakar M Pai
- Clinical Pharmacology, Akros Pharma Inc., Princeton, New Jersey, USA
| | - Noriko Ninomiya
- Clinical Pharmacology, Pharmaceutical Division, Japan Tobacco Inc., Tokyo, Japan
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Clements JD, Perez Ruixo JJ, Gibbs JP, Doshi S, Perez Ruixo C, Melhem M. Receiver Operating Characteristic Analysis and Clinical Trial Simulation to Inform Dose Titration Decisions. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2018; 7:771-779. [PMID: 30246497 PMCID: PMC6263661 DOI: 10.1002/psp4.12354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/23/2018] [Indexed: 11/12/2022]
Abstract
Optimal dose selection in clinical trials is problematic when efficacious and toxic concentrations are close. A novel quantitative approach follows for optimizing dose titration in clinical trials. A system of pharmacokinetics (PK), pharmacodynamics, efficacy, and toxicity was simulated for scenarios characterized by varying degrees of different types of variability. Receiver operating characteristic (ROC) and clinical trial simulation (CTS) were used to optimize drug titration by maximizing efficacy/safety. The scenarios included were a low-variability base scenario, and high residual (20%), interoccasion (20%), interindividual (40%), and residual plus interindividual variability scenarios, and finally a shallow toxicity slope scenario. The percentage of subjects having toxicity was reduced by 87.4% to 93.5%, and those having efficacy was increased by 52.7% to 243%. Interindividual PK variability may have less impact on optimal cutoff values than other sources of variability. ROC/CTS methods for optimizing dose titration offer an individualized approach that leverages exposure-response relationships.
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Affiliation(s)
- John David Clements
- Clinical Pharmacology and Modeling & Simulation, Amgen Inc., Thousand Oaks, California, USA
| | - Juan Jose Perez Ruixo
- Clinical Pharmacology and Pharmacometrics, Janssen Research and Development, Beerse, Belgium
| | - John P Gibbs
- Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, Illinois, USA
| | - Sameer Doshi
- Clinical Pharmacology and Modeling & Simulation, Amgen Inc., Thousand Oaks, California, USA
| | - Carlos Perez Ruixo
- Clinical Pharmacology and Pharmacometrics, Janssen Research and Development, Beerse, Belgium
| | - Murad Melhem
- Clinical Pharmacology, Vertex Pharmaceuticals, Boston, Massachusetts, USA
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Keller F, Hann A. Clinical Pharmacodynamics: Principles of Drug Response and Alterations in Kidney Disease. Clin J Am Soc Nephrol 2018; 13:1413-1420. [PMID: 29769182 PMCID: PMC6140566 DOI: 10.2215/cjn.10960917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Pharmacokinetics and pharmacodynamics follow the logic of cause and consequence. Receptor-mediated and reversible effects can be distinguished from direct and irreversible effects. Reversible effects are capacity-limited and saturable whereas irreversible effects are limited only by the number of viable targets. In the case of receptor-mediated and reversible effects a threshold and a ceiling concentration can be defined. Antimicrobial drugs with concentration-dependent action are distinguished from drugs with time-dependent action. Concentration-dependent effects are associated with a high ceiling concentration and the target is the high peak. Time-dependent effects are associated with a high threshold concentration and the target is the high trough. During kidney dysfunction, alterations of drug response are usually attributed to pharmacokinetic but rarely to pharmacodynamic changes. Dose adjustment calculations, therefore, tacitly presume that pharmacodynamic parameters remain unchanged while only pharmacokinetic parameters are altered in kidney failure. Kidney dysfunction influences the pharmacokinetic parameters of at least 50% of all essential drugs. Clinicians usually consider pharmacokinetics when kidney disease is found, but pharmacodynamics is as important. Alterations of pharmacodynamic parameters are conceivable but only rarely reported in kidney failure. Sometimes surprising dosing adjustments are needed when pharmacodynamic concepts are brought into the decision process of which dose to choose. Pharmacokinetics and pharmacodynamics should both be considered when any dosing regimen is determined.
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Affiliation(s)
- Frieder Keller
- Center for Internal Medicine, University Hospital, Ulm, Germany
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Reynaldo-Fernández G, Solozábal J, Amaro D, Fernández-Sánchez EM, Rodríguez-Vera L, Bermejo M, Mangas-Sanjuan V, Troconiz IF. Semi-mechanistic Pharmacokinetic/Pharmacodynamic model of three pegylated rHuEPO and ior®EPOCIM in New Zealand rabbits. Eur J Pharm Sci 2018; 120:123-132. [PMID: 29729414 DOI: 10.1016/j.ejps.2018.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/19/2022]
Abstract
Marketed formulations of erythropoietin (EPO) ior®EPOCIM, MIRCERA® and two newly developed pegylated-EPO analogues (PEG-EPO 32 and 40 kDa) formulations were intravenously administered to New Zealand rabbits. A semi-mechanistic Pharmacokinetic/Pharmacodynamic (PK/PD) model describing in a simultaneous and integrated form the time course of reticulocytes, red blood cells and hemoglobin was built to account for the time course of hematopoiesis stimulation after erythropoietin administration. Data analysis was performed based on the population approach with the software NONMEM version 7.3. Erythropoietin disposition of each of the administered formulations was best described with a two compartment model and linear elimination. Different formulations show different clearance and apparent volume of distribution of the central compartment but share estimates of inter-compartmental clearance and apparent peripheral volume of distribution. A semi-mechanistic model including cell proliferation, maturation, and homeostatic regulation provided a good description of the data regardless the type of erythropoietin formulation administered. The system-, and drug-related parameters showed consistency and differed across formulations, respectively. A single IV administration of PEG-EPO 32 and 40 kDa formulations in New Zealand rabbits achieves a median change of 27% and 22% on RET levels, and of 47% and 63% on RBC and HGB levels, respectively compared to MIRCERA®. The administration of new branched PEG-chains formulations improves PK and PD properties of EPO, in terms of increasing elimination half-lives and pharmacological activity on RET, RBC and HGB compared to commercially available formulations (ior®EPOCIM and MIRCERA®).
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Affiliation(s)
- G Reynaldo-Fernández
- Department of Pharmacy, Institute of Pharmacy & Foods, University of Havana, Havana, Cuba
| | | | - D Amaro
- Center of Molecular Immunology, Cuba
| | - E M Fernández-Sánchez
- Department of Pharmacy, Institute of Pharmacy & Foods, University of Havana, Havana, Cuba
| | - L Rodríguez-Vera
- Department of Pharmacy, Institute of Pharmacy & Foods, University of Havana, Havana, Cuba
| | - M Bermejo
- Engineering: Pharmacy and Pharmaceutical Technology Area, Miguel Hernandez University, Spain
| | - V Mangas-Sanjuan
- Pharmacy and Pharmaceutical Technology Area, University of Valencia, Spain; Institute of Molecular Recognition and Technological Development (IDM), Joint Centre of Polytechnic University of Valencia and University of Valencia, Spain.
| | - I F Troconiz
- Pharmacometrics & Systems Pharmacology, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
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Warady BA, Barcia J, Benador N, Jankauskiene A, Olson K, Podracka L, Shavkin A, Srivaths P, Wong CJ, Petersen J. De novo weekly and biweekly darbepoetin alfa dosing in pediatric patients with chronic kidney disease. Pediatr Nephrol 2018; 33:125-137. [PMID: 28815341 DOI: 10.1007/s00467-017-3758-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Darbepoetin alfa is a commonly prescribed erythropoiesis-stimulating agent (ESA) for correcting anemia in pediatric chronic kidney disease (CKD) patients. However, little information exists on its use in ESA-naïve patients. This study evaluated the efficacy and safety of darbepoetin alfa in pediatric patients initiating ESA therapy. METHODS One-hundred sixteen pediatric ESA-naïve subjects (aged 1-18 years) with CKD stages 3-5D and hemoglobin (Hb) <10 g/dl from 43 centers in the US, Europe, and Mexico were randomized by age (three groups) and dialysis status (yes vs. no) to receive darbepoetin alfa once weekly (QW) or every 2 weeks (Q2W) subcutaneously (not on dialysis and peritoneal dialysis subjects) and intravenously (hemodialysis subjects). The drug was titrated to achieve Hb levels of 10.0-12.0 g/dl over 25 weeks. Patient- and parent-reported health-related outcomes were measured by the Pediatric Quality of Life Inventory (PedsQL™) in children ≥2 years. RESULTS In both groups, mean Hb concentrations increased to ≥11.0 g/dl over the first 3 months of treatment and remained stable within the 10.0-12.0 g/dl target range. The median time to achieve hemoglobin ≥10 g/dl was slightly longer for subjects <12 years (QW and Q2W, both 28 days) vs. those ≥12 years (23 and 22 days, respectively). Adverse event profiles were similar between groups, with QW, four (7%) and Q2W, five (9%). PedsQL™ scores showed modest increases. CONCLUSIONS Darbepoetin alfa can be safely administered either QW or Q2W to ESA-naïve pediatric patients with CKD-related anemia to achieve Hb targets of 10.0-12.0 g/dl.
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Affiliation(s)
- Bradley A Warady
- University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, MO, 64108, USA.
| | - John Barcia
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nadine Benador
- Rady Children's Hospital, University of California at San Diego, San Diego, CA, USA
| | | | | | - Ludmila Podracka
- 1st Dept Pediatric Children's Hospital, Comenius University, Bratislava, Slovakia
| | | | - Poyyapakkam Srivaths
- Department of Pediatric Medicine - Renal, Texas Children's Hospital, Houston, TX, USA
| | - Cynthia J Wong
- Division of Pediatric Nephrology, Stanford University, Palo Alto, CA, USA
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Wu L, Mould DR, Perez Ruixo JJ, Doshi S. Assessment of hemoglobin responsiveness to epoetin alfa in patients on hemodialysis using a population pharmacokinetic pharmacodynamic model. J Clin Pharmacol 2015; 55:1157-66. [PMID: 25907551 DOI: 10.1002/jcph.527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/16/2015] [Indexed: 11/09/2022]
Abstract
A population pharmacokinetic pharmacodynamic (PK/PD) model describing the effect of epoetin alfa on hemoglobin (Hb) response in hemodialysis patients was developed. Epoetin alfa pharmacokinetics was described using a linear 2-compartment model. PK parameter estimates were similar to previously reported values. A maturation-structured cytokinetic model consisting of 5 compartments linked in a catenary fashion by first-order cell transfer rates following a zero-order input process described the Hb time course. The PD model described 2 subpopulations, one whose Hb response reflected epoetin alfa dosing and a second whose response was unrelated to epoetin alfa dosing. Parameter estimates from the PK/PD model were physiologically reasonable and consistent with published reports. Numerical and visual predictive checks using data from 2 studies were performed. The PK and PD of epoetin alfa were well described by the model.
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Keller F, Ludwig U, Czock D. Pharmacokinetic and pharmacodynamic considerations on the erythropoietin effect and adverse events of darbepoetin. Expert Opin Drug Metab Toxicol 2014; 11:139-47. [PMID: 25466552 DOI: 10.1517/17425255.2015.989832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In the TREAT and RED-HF trials, patients who received a high darbepoetin dose had an increased risk of adverse events. To find an explanation, the published literature was analyzed on the pharmacokinetics and pharmacodynamics of darbepoetin. AREAS COVERED Based on the sigmoid Emax model, the concentration producing 50% of the maximum erythropoietin effect is reported as CE50 = 0.41 ng/ml and the Hill coefficient as H = 3.0 for darbepoetin. Accordingly, a pharmacodynamics-based threshold concentration can be estimated with CE05 = 0.153 ng/ml producing 5% of Emax and a ceiling concentration with CE95 = 1.098 ng/ml producing 95% of Emax, respectively. EXPERT OPINION Darbepoetin trough levels should not be less than the threshold concentration but peak levels above the ceiling concentration could be associated with an increased risk of adverse events. The time span associated with the concentration fluctuation between the ceiling and the threshold concentration is estimated with 236 h (= 2.84 times elimination half-life of 83 h) and shorter than the 336 h when dosing every other week. According to such time-dependent pharmacodynamics, a weekly dosing regimen might be more effective and associated with less adverse events than higher doses every other week in patients with suboptimal response to a normal darbepoetin dose.
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Affiliation(s)
- Frieder Keller
- University Hospital, Center for Internal Medicine, Department Innere 1, Nephrology , Albert-Einstein-Allee 23, D-89070 Ulm , Germany +49 731 500 44561 ; +49 731 500 44567 ;
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Pharmacokinetic and Pharmacodynamic Relationship of AMG 811, An Anti-IFN-γ IgG1 Monoclonal Antibody, in Patients with Systemic Lupus Erythematosus. Pharm Res 2014; 32:640-53. [DOI: 10.1007/s11095-014-1492-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/15/2014] [Indexed: 01/03/2023]
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Koch G, Krzyzanski W, Pérez-Ruixo JJ, Schropp J. Modeling of delays in PKPD: classical approaches and a tutorial for delay differential equations. J Pharmacokinet Pharmacodyn 2014; 41:291-318. [DOI: 10.1007/s10928-014-9368-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/26/2014] [Indexed: 01/09/2023]
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10
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Kagan L. Pharmacokinetic Modeling of the Subcutaneous Absorption of Therapeutic Proteins. Drug Metab Dispos 2014; 42:1890-905. [DOI: 10.1124/dmd.114.059121] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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11
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Clinical pharmacokinetics and pharmacodynamics of erythropoiesis-stimulating agents. Clin Pharmacokinet 2014; 52:1063-83. [PMID: 23912564 DOI: 10.1007/s40262-013-0098-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cloning of the EPO gene in the early 1980s allowed for the development of recombinant erythropoietins and analogues [erythropoiesis-stimulating agents (ESAs)], offering an alternative to transfusion as a method of raising haemoglobin (Hb) levels, which have been used for more than 20 years to treat anaemia in millions of anaemic patients. There are now a number of ESAs available worldwide for the treatment of anaemia, approved for different routes of administration (intravenous and subcutaneous) and dosing intervals (three times weekly, weekly, biweekly and monthly). In this review, we discuss the pharmacokinetic characteristics, including absorption, distribution and elimination processes, across the different ESAs. Incomplete and slow lymphatic absorption, with limited extravascular distribution, and minor contributions of the target-mediated drug disposition to the overall elimination are the common characteristics across the marketed ESA. Additionally, we assess the similarities and differences of ESAs related to pharmacodynamics in the context of the different biomarkers used to monitor the magnitude and duration of the effect, and introduce the concept of the minimum effective concentration of the ESA. The relationship between the minimum effective concentration and the half-life suggests that the time during which drug concentrations are above the minimum effective concentration is the main determinant of ESA efficacy in increasing Hb levels. The tolerance phenomenon and its physiological mechanism and implications for ESA dosing are discussed. Finally, the areas of future clinical pharmacology research are envisioned.
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McCarthy JT, Hocum CL, Albright RC, Rogers J, Gallaher EJ, Steensma DP, Gudgell SF, Bergstralh EJ, Dillon JC, Hickson LJ, Williams AW, Dingli D. Biomedical system dynamics to improve anemia control with darbepoetin alfa in long-term hemodialysis patients. Mayo Clin Proc 2014; 89:87-94. [PMID: 24388026 DOI: 10.1016/j.mayocp.2013.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the value of a biomedical system dynamics (BMSD) approach for optimization of anemia management in long-term hemodialysis patients because elevated hemoglobin levels and high doses of erythropoiesis-stimulating agents (ESAs) may negatively affect survival in this population. PATIENTS AND METHODS A model of erythropoiesis and its response to ESAs on the basis of a BMSD method (Mayo Clinic Anemia Management System [MCAMS]) was developed. Thereafter, an open-label, prospective, nonrandomized practice quality improvement project was performed with retrospective analysis in 8 community-based outpatient hemodialysis facilities. All prevalent hemodialysis patients seen from January 1, 2007, through December 31, 2010 (300-342 patients per month), were included with darbepoetin as the ESA. The primary outcome was the percentage of patients who attained the desired hemoglobin level. Secondary outcome measures included the percentage of patients with hemoglobin values above the desired range and mean dose of darbepoetin used. RESULTS The 3 treatment periods were (1) standard ESA protocol in 2007, (2) transition to the MCAMS (2008 to June 2009), and (3) stability period with the MCAMS used in all hemodialysis facilities (2009 to 2010). In the first 6 months of 2007, 69% of patients were in the desired range and 26% were above the range. In comparison, during the first 5 months of 2010, 83% were in and 6% were above the range (P<.001). The mean monthly darbepoetin dose per patient decreased from 304 μg in 2007 to 173 μg by the second half of 2009 (P<.001). CONCLUSION With the introduction of the MCAMS, more patients had hemoglobin levels in the desired range and fewer patients exceeded the target range, with a concomitant 40% reduction in darbepoetin use.
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Affiliation(s)
- James T McCarthy
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
| | - Craig L Hocum
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | | | | | - David P Steensma
- Division of Hematologic Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | | | - Eric J Bergstralh
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - John C Dillon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Amy W Williams
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN
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Hörl WH. Differentiating factors between erythropoiesis-stimulating agents: an update to selection for anaemia of chronic kidney disease. Drugs 2013; 73:117-30. [PMID: 23338536 DOI: 10.1007/s40265-012-0002-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Erythropoiesis-stimulating agents (ESAs) have become a hallmark of anaemia therapy in patients with chronic kidney disease (CKD). Although different ESAs are available for the treatment of renal anaemia, each nephrologist should select a single ESA for an individual patient. Epoetin alfa and epoetin beta have been used 1-3 times weekly but extended-interval dosing up to every 4 weeks is also effective in a substantial majority of CKD patients. However, the epoetin dose necessary to achieve or maintain target haemoglobin (Hb) levels increases substantially as the dosing interval increases. Subcutaneous administration of short-acting ESAs is more effective than the intravenous route of administration. Darbepoetin alfa and the continuous erythropoietin receptor activator (CERA) have been developed as a treatment for anaemia with extended administration intervals (every 2 weeks and every 4 weeks, respectively). Dose requirements for these long-acting ESAs are independent of the route of administration. Patents of short-acting ESAs have expired, which has opened the field for biosimilars. Epoetin biosimilars approved by the European Medicines Agency (EMA) or the US Food and Drug Administration (FDA) have been shown to have a comparable efficacy and safety profile to their originators. An alarming increase in pure red cell aplasia (PRCA) in Thailand with follow-on epoetins manufactured in Asia (but also those manufactured in Latin America) indicates that stringent country-specific approval and pharmacovigilance protocols for ESAs manufactured in non-North American and non-EU European countries are urgently needed. Two PRCA cases occurring with subcutaneous HX575 (one certain, one likely) indicate that chances of inducing a more immunogenic product are unpredictable, even with a biosimilar epoetin approved under the EMA biosimilar approval pathway. Phase III clinical trials with peginesatide, a pegylated synthetic peptide-based ESA without any homology to erythropoietin raised safety concerns in non-dialysis CKD patients but not in dialysis patients.
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Affiliation(s)
- Walter H Hörl
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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14
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Naik H, Tsai MC, Fiedler-Kelly J, Qiu P, Vakilynejad M. A Population Pharmacokinetic and Pharmacodynamic Analysis of Peginesatide in Patients with Chronic Kidney Disease on Dialysis. PLoS One 2013; 8:e66422. [PMID: 23840463 PMCID: PMC3686692 DOI: 10.1371/journal.pone.0066422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/05/2013] [Indexed: 11/30/2022] Open
Abstract
Peginesatide (OMONTYS®) is an erythropoiesis-stimulating agent that was indicated in the United States for the treatment of anemia due to chronic kidney disease in adult patients on dialysis prior to its recent marketing withdrawal by the manufacturer. The objective of this analysis was to develop a population pharmacokinetic and pharmacodynamic model to characterize the time-course of peginesatide plasma and hemoglobin concentrations following intravenous and subcutaneous administration. Plasma samples (n = 2,665) from 672 patients with chronic kidney disease (on or not on dialysis) and hemoglobin samples (n = 18,857) from 517 hemodialysis patients (subset of the 672 patients), were used for pharmacokinetic-pharmacodynamic model development in NONMEM VI. The pharmacokinetic profile of peginesatide was best described by a two-compartment model with first-order absorption and saturable elimination. The relationship between peginesatide and hemoglobin plasma concentrations was best characterized by a modified precursor-dependent lifespan indirect response model. The estimate of maximal stimulatory effect of peginesatide on the endogenous production rate of progenitor cells (Emax) was 0.54. The estimate of peginesatide drug concentration required for 50% of maximal response (EC50) estimates was 0.4 µg/mL. Several significant (P<0.005) covariates affected simulated peginesatide exposure by ≤36%. Based upon ≤0.2 g/dL effects on simulated hemoglobin levels, none were considered clinically relevant.
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Affiliation(s)
- Himanshu Naik
- Pharmacometrics, Takeda Global Research and Development, Inc., Deerfield, Illinois, United States of America
| | - Max C. Tsai
- Pharmacometrics, Takeda Global Research and Development, Inc., Deerfield, Illinois, United States of America
| | - Jill Fiedler-Kelly
- Pharmacometric Services, Cognigen Corporation, Buffalo, New York, United States of America
| | - Ping Qiu
- Clinical Science, Takeda Global Research and Development, Inc., Deerfield, Illinois, United States of America
| | - Majid Vakilynejad
- Pharmacometrics, Takeda Global Research and Development, Inc., Deerfield, Illinois, United States of America
- * E-mail:
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Yan X, Chen Y, Krzyzanski W. Methods of solving rapid binding target-mediated drug disposition model for two drugs competing for the same receptor. J Pharmacokinet Pharmacodyn 2012; 39:543-60. [PMID: 22926955 DOI: 10.1007/s10928-012-9267-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/23/2012] [Indexed: 11/25/2022]
Abstract
The target-mediated drug disposition (TMDD) model has been adopted to describe pharmacokinetics for two drugs competing for the same receptor. A rapid binding assumption introduces total receptor and total drug concentrations while free drug concentrations C (A) and C (B) are calculated from the equilibrium (Gaddum) equations. The Gaddum equations are polynomials in C (A) and C (B) of second degree that have explicit solutions involving complex numbers. The aim of this study was to develop numerical methods to solve the rapid binding TMDD model for two drugs competing for the same receptor that can be implemented in pharmacokinetic software. Algebra, calculus, and computer simulations were used to develop algorithms and investigate properties of solutions to the TMDD model with two drugs competitively binding to the same receptor. A general rapid binding approximation of the TMDD model for two drugs competing for the same receptor has been proposed. The explicit solutions to the equilibrium equations employ complex numbers, which cannot be easily solved by pharmacokinetic software. Numerical bisection algorithm and differential representation were developed to solve the system instead of obtaining an explicit solution. The numerical solutions were validated by MATLAB 7.2 solver for polynomial roots. The applicability of these algorithms was demonstrated by simulating concentration-time profiles resulting from exogenous and endogenous IgG competing for the neonatal Fc receptor (FcRn), and darbepoetin competing with endogenous erythropoietin for the erythropoietin receptor. These models were implemented in ADAPT 5 and Phoenix WinNonlin 6.0, respectively.
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Affiliation(s)
- Xiaoyu Yan
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14260, USA
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16
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Krzyzanski W, Perez Ruixo JJ. Lifespan based indirect response models. J Pharmacokinet Pharmacodyn 2012; 39:109-23. [PMID: 22212685 PMCID: PMC3684441 DOI: 10.1007/s10928-011-9236-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/15/2011] [Indexed: 01/18/2023]
Abstract
In the field of hematology, several mechanism-based pharmacokinetic-pharmacodynamic models have been developed to understand the dynamics of several blood cell populations under different clinical conditions while accounting for the essential underlying principles of pharmacology, physiology and pathology. In general, a population of blood cells is basically controlled by two processes: the cell production and cell loss. The assumption that each cell exits the population when its lifespan expires implies that the cell loss rate is equal to the cell production rate delayed by the lifespan and justifies the use of delayed differential equations for compartmental modeling. This review is focused on lifespan models based on delayed differential equations and presents the structure and properties of the basic lifespan indirect response (LIDR) models for drugs affecting cell production or cell lifespan distribution. The LIDR models for drugs affecting the precursor cell production or decreasing the precursor cell population are also presented and their properties are discussed. The interpretation of transit compartment models as LIDR models is reviewed as the basis for introducing a new LIDR for drugs affecting the cell lifespan distribution. Finally, the applications and limitations of the LIDR models are discussed.
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Affiliation(s)
- Wojciech Krzyzanski
- Department of Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA.
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Yan X, Lowe PJ, Fink M, Berghout A, Balser S, Krzyzanski W. Population pharmacokinetic and pharmacodynamic model-based comparability assessment of a recombinant human Epoetin Alfa and the Biosimilar HX575. J Clin Pharmacol 2011; 52:1624-44. [PMID: 22162538 DOI: 10.1177/0091270011421911] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to develop an integrated pharmacokinetic and pharmacodynamic (PK/PD) model and assess the comparability between epoetin alfa HEXAL/Binocrit (HX575) and a comparator epoetin alfa by a model-based approach. PK/PD data-including serum drug concentrations, reticulocyte counts, red blood cells, and hemoglobin levels-were obtained from 2 clinical studies. In sum, 149 healthy men received multiple intravenous or subcutaneous doses of HX575 (100 IU/kg) and the comparator 3 times a week for 4 weeks. A population model based on pharmacodynamics-mediated drug disposition and cell maturation processes was used to characterize the PK/PD data for the 2 drugs. Simulations showed that due to target amount changes, total clearance may increase up to 2.4-fold as compared with the baseline. Further simulations suggested that once-weekly and thrice-weekly subcutaneous dosing regimens would result in similar efficacy. The findings from the model-based analysis were consistent with previous results using the standard noncompartmental approach demonstrating PK/PD comparability between HX575 and comparator. However, due to complexity of the PK/PD model, control of random effects was not straightforward. Whereas population PK/PD model-based analyses are suited for studying complex biological systems, such models have their limitations (statistical), and their comparability results should be interpreted carefully.
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Affiliation(s)
- Xiaoyu Yan
- Department of Pharmaceutical Sciences, 565 B Hochstetter Hall, State University of New York at Buffalo, Buffalo, NY 14260, USA
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