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Extrapolation of Drug Clearance in Children ≤ 2 Years of Age from Empirical Models Using Data from Children (> 2 Years) and Adults. Drugs R D 2020; 20:1-10. [PMID: 31820365 PMCID: PMC7067721 DOI: 10.1007/s40268-019-00291-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The application of modeling and simulation approaches in clinical pharmacology studies has gained momentum over the last 20 years. OBJECTIVES The objective of this study was to develop six empirical models from clearance data obtained from children aged > 2 years and adults to evaluate the suitability of the models to predict drug clearance in children aged ≤ 2 years (preterm, term, and infants). METHODS Ten drugs were included in this study and administered intravenously: alfentanil, amikacin, busulfan, cefetamet, meperidine, oxycodone, propofol, sufentanil, theophylline, and tobramycin. These drugs were selected according to the availability of individual subjects' weight, age, and clearance data (concentration-time data for these drugs were not available to the author). The chosen drugs are eliminated by extensive metabolism by either the renal route or both the renal and hepatic routes. The six empirical models were (1) age and body weight-dependent sigmoidal maximum possible effect (Emax) maturation model, (2) body weight-dependent sigmoidal Emax model, (3) uridine 5'-diphospho [body weight-dependent allometric exponent model (BDE)], (4) age-dependent allometric exponent model (ADE), (5) a semi-physiological model, and (6) an allometric model developed from children aged > 2 years to adults. The model-predicted clearance values were compared with observed clearance values in an individual child. In this analysis, a prediction error of ≤ 50% for mean or individual clearance values was considered acceptable. RESULTS Across all age groups and the ten drugs, data for 282 children were compared between observed and model-predicted clearance values. The validation data consisted of 33 observations (sum of different age groups for ten drugs). Only three of the six models (body weight-dependent sigmoidal Emax model, ADE, and semi-physiological model) provided reasonably accurate predictions of clearance (> 80% observation with ≤ 50% prediction error) in children aged ≤ 2 years. In most instances, individual predicted clearance values were erratic (as indicated by % error) and were not in agreement with the observed clearance values. CONCLUSIONS The study indicated that simple empirical models can provide more accurate results than complex empirical models.
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Hornik CP, Gonzalez D, Dumond J, Wu H, Graham EM, Hill KD, Cohen-Wolkowiez M. Population Pharmacokinetic/Pharmacodynamic Modeling of Methylprednisolone in Neonates Undergoing Cardiopulmonary Bypass. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2019; 8:913-922. [PMID: 31646767 PMCID: PMC6930860 DOI: 10.1002/psp4.12470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022]
Abstract
Methylprednisolone is used in neonates to modulate cardiopulmonary bypass (CPB)–induced inflammation, but optimal dosing and exposure are unknown. We used plasma methylprednisolone and interleukin (IL)‐6 and IL‐10 concentrations from neonates enrolled in a randomized trial comparing one vs. two doses of methylprednisolone to develop indirect response population pharmacokinetic/pharmacodynamic models characterizing the exposure–response relationships. We applied the models to simulate methylprednisolone dosages resulting in the desired IL‐6 and ‐10 exposures, known mediators of CPB‐induced inflammation. A total of 64 neonates (median weight 3.2 kg, range 2.2–4.3) contributed 290 plasma methylprednisolone concentrations (range 1.07–12,700 ng/mL) and IL‐6 (0–681 pg/mL) and IL‐10 (0.1–1125 pg/mL). Methylprednisolone plasma exposure following a single 10 mg/kg intravenous dose inhibited IL‐6 and stimulated IL‐10 production when compared with placebo. Higher (30 mg/kg) or more frequent (twice) dosing did not confer additional benefit. Clinical efficacy studies are needed to evaluate the effect of optimized dosing on outcomes.
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Affiliation(s)
- Christoph P Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julie Dumond
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Huali Wu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eric M Graham
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kevin D Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Mahmood I. Prediction of Clearance, Volume of distribution, and Half-life of Drugs in Extremely Low to Low Birth Weight Neonates: An Allometric Approach. Eur J Drug Metab Pharmacokinet 2018; 42:601-610. [PMID: 27562171 DOI: 10.1007/s13318-016-0372-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES More than 20 million infants worldwide (15.5 % of all births) are born with low birth weight. Low birth weight is associated with poor growth in childhood and a higher incidence of adult diseases, such as type 2 diabetes, hypertension and cardiovascular disease. The objective of this study was to evaluate the predictive performance of allometric models to predict clearance, volume of distribution, and half-life in extremely low to low birth weight neonates (<1 to 2.5 kg body weight). METHODS Several allometric models were used to predict clearance (4 models), volume of distribution (2 models), and half-life (2 models) in extremely low to low birth weight neonates. From the literature, clearance, volume of distribution, and half-life values for 16 drugs for these neonates were obtained. The predictive performance of these allometric models was evaluated by comparing the predicted values of the aforementioned pharmacokinetic parameters with the observed pharmacokinetic parameters in an individual neonate. For the evaluation of the predictive performance of these allometric models, there were 16 drugs with 36 (n = 279), 34 (n = 261), and 31 (n = 197) weight groups for clearance, volume of distribution, and half-life, respectively. RESULTS The prediction error of ≤50 % for mean clearance, volume of distribution, and half-life values were 69, 79, and 58 %, respectively, by proposed allometric models. The prediction error of ≤50 % for mean clearance, volume of distribution, and half-life values by theoretical allometric exponents were 0 % (exponent = 0.75), 71 % (exponent = 1.0), and 0 % (exponent = 0.25), respectively. In this analysis, out of 16 drugs, there were three drugs (ibuprofen, zidovudine, and buprenorphine) which are metabolized by glucuronidation and one drug (furosemide) is renally secreted. The predicted clearances of these four drugs were substantially higher by the proposed allometric methods. It seems that drugs of these physiological characteristics may require different method(s) to improve the prediction of clearance in the neonates. CONCLUSIONS Overall, the proposed allometric methods can predict mean pharmacokinetic parameters of drugs in extremely low to low birth weight neonates with reasonable accuracy and are of practical value during neonatal drug development.
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Affiliation(s)
- Iftekhar Mahmood
- Division of Hematology Clinical Review, Office of Blood Review and Research (OBRR), Center for Biologic Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.
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Mahmood I, Ahmad T, Mansoor N, Sharib SM. Prediction of Clearance in Neonates and Infants (≤ 3 Months of Age) for Drugs That Are Glucuronidated: A Comparative Study Between Allometric Scaling and Physiologically Based Pharmacokinetic Modeling. J Clin Pharmacol 2016; 57:476-483. [DOI: 10.1002/jcph.837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Iftekhar Mahmood
- Division of Hematology, Clinical Review Branch; Office of Blood Review & Research (OBRR); Center for Biologic Evaluation and Research; Food & Drug Administration; Silver Spring MD USA
| | - Tasneem Ahmad
- Pharma Professional Services; A-93 Ettawah Society Gadap Town Karachi Pakistan
| | - Najia Mansoor
- Department of Pharmacology; Faculty of Pharmacy & Pharmaceutical Sciences; University of Karachi; Karachi Pakistan
| | - S. M. Sharib
- Pharma Professional Services; A-93 Ettawah Society Gadap Town Karachi Pakistan
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Lin W, Heimbach T, Jain JP, Awasthi R, Hamed K, Sunkara G, He H. A Physiologically Based Pharmacokinetic Model to Describe Artemether Pharmacokinetics in Adult and Pediatric Patients. J Pharm Sci 2016; 105:3205-3213. [PMID: 27506269 DOI: 10.1016/j.xphs.2016.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/21/2016] [Accepted: 06/28/2016] [Indexed: 11/25/2022]
Abstract
Artemether is co-administered with lumefantrine as part of a fixed-dose combination therapy for malaria in both adult and pediatric patients. However, artemether exposure is higher in younger infants (1-3 months) with a lower body weight (<5 kg) as compared to older infants (3-6 months) with a higher body weight (≥5 to <10 kg), children, and adults. In contrast, lumefantrine exposure is similar in all age groups. This article describes the clinically observed artemether exposure data in pediatric populations across various age groups (1 month to 12 years) and body weights (<5 or ≥5 kg) using physiologically based pharmacokinetic (PBPK) mechanistic models. A PBPK model was developed using artemether physicochemical, biopharmaceutic, and metabolic properties together with known enzyme ontogeny and pediatric physiology. The model was verified using clinical data from adult patients after multiple doses of oral artemether, and was then applied to simulate the exposure in children and infants. The simulated PBPK concentration-time profiles captured observed clinical data. Consistent with the clinical data, the PBPK model simulations indicated a higher artemether exposure for younger infants with lower body weight. A PBPK model developed for artemether reliably described the clinical data from adult and pediatric patients.
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Affiliation(s)
- Wen Lin
- Drug Metabolism & Pharmacokinetics, Novartis Institutes for Biomedical Research, East Hanover, New Jersey 07936
| | - Tycho Heimbach
- Drug Metabolism & Pharmacokinetics, Novartis Institutes for Biomedical Research, East Hanover, New Jersey 07936.
| | - Jay Prakash Jain
- Drug Metabolism & Pharmacokinetics, Novartis Institutes for Biomedical Research, Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Rakesh Awasthi
- Drug Metabolism & Pharmacokinetics, Novartis Institutes for Biomedical Research, East Hanover, New Jersey 07936
| | - Kamal Hamed
- Global Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 07936
| | - Gangadhar Sunkara
- Drug Metabolism & Pharmacokinetics, Novartis Institutes for Biomedical Research, East Hanover, New Jersey 07936
| | - Handan He
- Drug Metabolism & Pharmacokinetics, Novartis Institutes for Biomedical Research, East Hanover, New Jersey 07936
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Pharmacokinetic Considerations in Designing Pediatric Studies of Proteins, Antibodies, and Plasma-Derived Products. Am J Ther 2016; 23:e1043-56. [DOI: 10.1097/01.mjt.0000489921.28180.b9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mahmood I. Prediction of Drug Clearance in Premature and Mature Neonates, Infants, and Children ≤2 Years of Age: A Comparison of the Predictive Performance of 4 Allometric Models. J Clin Pharmacol 2015; 56:733-9. [DOI: 10.1002/jcph.652] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Iftekhar Mahmood
- Division of Hematology Clinical Review, Office of Blood Review & Research (OBRR); Center for Biologic Evaluation and Research, US Food and Drug Administration; Silver Spring MD USA
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Mahmood I. Mechanistic versus allometric models for the prediction of drug clearance in neonates (<3 months of age). J Clin Pharmacol 2015; 55:718-20. [PMID: 25943826 DOI: 10.1002/jcph.487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/19/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Iftekhar Mahmood
- Division of Hematology Clinical Review, Office of Blood Review & Research (OBRR), Center for Biologic Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Mahmood I. Prediction of drug clearance in children: a review of different methodologies. Expert Opin Drug Metab Toxicol 2015; 11:573-87. [DOI: 10.1517/17425255.2015.1019463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Mahmood I, Staschen CM, Goteti K. Prediction of drug clearance in children: an evaluation of the predictive performance of several models. AAPS J 2014; 16:1334-43. [PMID: 25274608 PMCID: PMC4389735 DOI: 10.1208/s12248-014-9667-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/04/2014] [Indexed: 01/19/2023] Open
Abstract
The objective of this study is to evaluate the predictive performance of several models to predict drug clearance in children ≤5 years of age. Six models (allometric model (data-dependent exponent), fixed exponent of 0.75 model, maturation model, body weight-dependent model, segmented allometric model, and age-dependent exponent model) were evaluated in this study. From the literature, the clearance values for six drugs from neonates to adults were obtained. External data were used to evaluate the predictive performance of these models in children ≤5 years of age. With the exception of a fixed exponent of 0.75, the mean predicted clearance in most of the age groups was within ≤50% prediction error. Individual clearance prediction was erratic by all models and cannot be used reliably to predict individual clearance. Maturation, body weight-dependent, and segmented allometric models to predict clearances of drugs in children ≤5 years of age are of limited practical value during drug development due to the lack of availability of data. Age-dependent exponent model can be used for the selection of first-in-children dose during drug development.
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Affiliation(s)
- Iftekhar Mahmood
- Division of Hematology, Office of Blood Review & Research (OBRR), Center for Biologic Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland, 20993-0002, USA,
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Prediction of glucuronidated drug clearance in pediatrics (≤5 years): An allometric approach. Eur J Drug Metab Pharmacokinet 2014; 40:53-9. [DOI: 10.1007/s13318-014-0178-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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Mahmood I. Dosing in Children: A Critical Review of the Pharmacokinetic Allometric Scaling and Modelling Approaches in Paediatric Drug Development and Clinical Settings. Clin Pharmacokinet 2014; 53:327-46. [DOI: 10.1007/s40262-014-0134-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wang C, Allegaert K, Peeters MYM, Tibboel D, Danhof M, Knibbe CAJ. The allometric exponent for scaling clearance varies with age: a study on seven propofol datasets ranging from preterm neonates to adults. Br J Clin Pharmacol 2014; 77:149-59. [PMID: 23772816 PMCID: PMC3895356 DOI: 10.1111/bcp.12180] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 06/02/2013] [Indexed: 11/29/2022] Open
Abstract
AIM For scaling clearance between adults and children, allometric scaling with a fixed exponent of 0.75 is often applied. In this analysis, we performed a systematic study on the allometric exponent for scaling propofol clearance between two subpopulations selected from neonates, infants, toddlers, children, adolescents and adults. METHODS Seven propofol studies were included in the analysis (neonates, infants, toddlers, children, adolescents, adults1 and adults2). In a systematic manner, two out of the six study populations were selected resulting in 15 combined datasets. In addition, the data of the seven studies were regrouped into five age groups (FDA Guidance 1998), from which four combined datasets were prepared consisting of one paediatric age group and the adult group. In each of these 19 combined datasets, the allometric scaling exponent for clearance was estimated using population pharmacokinetic modelling (nonmem 7.2). RESULTS The allometric exponent for propofol clearance varied between 1.11 and 2.01 in cases where the neonate dataset was included. When two paediatric datasets were analyzed, the exponent varied between 0.2 and 2.01, while it varied between 0.56 and 0.81 when the adult population and a paediatric dataset except for neonates were selected. Scaling from adults to adolescents, children, infants and neonates resulted in exponents of 0.74, 0.70, 0.60 and 1.11 respectively. CONCLUSIONS For scaling clearance, ¾ allometric scaling may be of value for scaling between adults and adolescents or children, while it can neither be used for neonates nor for two paediatric populations. For scaling to neonates an exponent between 1 and 2 was identified.
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Affiliation(s)
- Chenguang Wang
- Division of Pharmacology, LACDR, Leiden University, Leiden, the Netherlands; Intensive Care and Department of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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