1
|
Rhee SJ, Shin SH, Oh J, Jung YH, Choi CW, Kim HS, Yu KS. Population pharmacokinetic analysis of sildenafil in term and preterm infants with pulmonary arterial hypertension. Sci Rep 2022; 12:7393. [PMID: 35513541 PMCID: PMC9072418 DOI: 10.1038/s41598-022-11038-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022] Open
Abstract
Sildenafil is widely used off-label in pediatric patients with pulmonary arterial hypertension (PAH). This study was conducted to characterize the pharmacokinetics (PK) of sildenafil in term and preterm neonates with PAH, by developing a population PK model, and to suggest appropriate doses to achieve clinically effective concentrations. A population PK modelling analysis was performed using sildenafil and its metabolite N-desmethyl sildenafil (DMS) concentration data from 19 neonates with PAH, whose gestational ages ranged 24–41 weeks. They received sildenafil orally at a dose of 0.5–0.75 mg/kg, four times a day. To investigate the appropriate sildenafil dose, simulations were conducted according to body weight which was significant covariate for sildenafil clearance. A one-compartment model with first-order absorption adequately described the PKs of sildenafil and DMS. Sildenafil clearance was expected to increase rapidly with increasing body weight. In the simulation, sildenafil doses > 1 mg/kg was required to achieve and maintain target concentrations of sildenafil and to expect timely clinical effects in term and preterm infants. These results could be utilized for the safer and more effective use of sildenafil in term and preterm infants.
Collapse
Affiliation(s)
- Su-Jin Rhee
- Department of Pharmacy, Wonkwang University College of Pharmacy, Iksan, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaeseong Oh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Effectiveness and short-term survival associated with adding sildenafil to conventional therapy in the management of children with pulmonary hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2019.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
3
|
Ivy DD, Feinstein JA, Yung D, Mullen MP, Kirkpatrick EC, Hirsch R, Austin ED, Fineman J, Truong U, Solum D, Deng CQ, Hopper RK. Oral treprostinil in transition or as add-on therapy in pediatric pulmonary arterial hypertension. Pulm Circ 2019; 9:2045894019856471. [PMID: 31215336 PMCID: PMC6628532 DOI: 10.1177/2045894019856471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Treprostinil, a prostacyclin analogue, is approved for the treatment of pulmonary
arterial hypertension (PAH) in adults. Transition from parenteral to oral
treprostinil has been successfully accomplished in adults with PAH but not in
children. In this multicenter study, pediatric patients treated with parenteral
(Cohort 1) or inhaled (Cohort 2) treprostinil were transitioned to oral
treprostinil. Prostacyclin-naïve individuals on background oral PAH therapy
received oral treprostinil as add-on therapy (Cohort 3). Successful transition
was oral treprostinil dose maintenance through week 24. Patients were monitored
for adverse events (AEs), 6-min walk distance (6MWD), PAH symptoms, World Health
Organization (WHO) Functional Class (FC), cardiac magnetic resonance imaging
(cMRI), cardiopulmonary exercise testing (CPET), and quality of life through 24
weeks. A total of 32 patients were enrolled in the study; 23 (72%) were girls
(mean age = 12.2 years). All patients were on background oral PAH therapy.
Overall, patients (96.9%) maintained transition to oral treprostinil; one
patient (Cohort 1) transitioned to oral treprostinil, then back to parenteral
after experiencing syncope and WHO FC change from II to III. Cohorts 1, 2, and 3
received a final mean oral treprostinil dose of 5.6, 3.3, and 4.5 mg t.i.d.,
respectively. All cohorts had variable changes in 6MWD, cMRI, and CPET. Overall,
12 serious AEs were reported. All patients had drug-related AEs including
headache (81%), diarrhea (69%), nausea (66%), vomiting (66%), and flushing
(56%). Pediatric patients maintained transition to oral treprostinil with
preservation of exercise capacity and WHO FC. Prostanoid-related AEs were most
common and similar to those reported in adults.
Collapse
Affiliation(s)
- D Dunbar Ivy
- 1 Children's Hospital of Colorado, Aurora, CO, USA
| | - Jeffrey A Feinstein
- 2 Lucile Packard Children's Hospital Stanford and Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Russel Hirsch
- 6 Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Eric D Austin
- 7 Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jeffrey Fineman
- 8 University of California San Francisco, San Francisco, CA, USA
| | - Uyen Truong
- 1 Children's Hospital of Colorado, Aurora, CO, USA
| | - Derek Solum
- 9 United Therapeutics, Research Triangle Park, NC, USA
| | - C Q Deng
- 9 United Therapeutics, Research Triangle Park, NC, USA
| | - Rachel K Hopper
- 2 Lucile Packard Children's Hospital Stanford and Stanford University School of Medicine, Palo Alto, CA, USA.,10 Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
4
|
Dhariwal AK, Bavdekar SB. Sildenafil in pediatric pulmonary arterial hypertension. J Postgrad Med 2016; 61:181-92. [PMID: 26119438 PMCID: PMC4943407 DOI: 10.4103/0022-3859.159421] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening disease of varied etiologies. Although PAH has no curative treatment, a greater understanding of pathophysiology, technological advances resulting in early diagnosis, and the availability of several newer drugs have improved the outlook for patients with PAH. Sildenafil is one of the therapeutic agents used extensively in the treatment of PAH in children, as an off-label drug. In 2012, the United States Food and Drug Administration (USFDA) issued a warning regarding the of use high-dose sildenafil in children with PAH. This has led to a peculiar situation where there is a paucity of approved therapies for the management of PAH in children and the use of the most extensively used drug being discouraged by the regulator. This article provides a review of the use of sildenafil in the treatment of PAH in children.
Collapse
Affiliation(s)
- A K Dhariwal
- Department of Pediatrics, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | | |
Collapse
|