1
|
Mateos MV, Engelhardt M, Leleu X, Mesa MG, Cavo M, Dimopoulos M, Bianco M, Merlo GM, Porte CL, Richardson PG, Moreau P. Impact of prior treatment on selinexor, bortezomib, dexamethasone outcomes in patients with relapsed/refractory multiple myeloma: Extended follow-up subgroup analysis of the BOSTON trial. Eur J Haematol 2024. [PMID: 38693052 DOI: 10.1111/ejh.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To analyze the impact of prior therapies on outcomes with selinexor, bortezomib, and dexamethasone (SVd) versus bortezomib and dexamethasone (Vd) in 402 patients with relapsed/refractory multiple myeloma (RRMM) in the phase 3 BOSTON trial. METHODS Post hoc analysis of progression-free survival (PFS), overall survival (OS), and safety for lenalidomide-refractory, proteasome inhibitor (PI)-naïve, bortezomib-naïve, and one prior line of therapy (1LOT) patient subgroups. RESULTS At a median follow-up of over 28 months, clinically meaningful improvements in PFS were noted across all groups with SVd. The median SVd PFS was longer in all subgroups (lenalidomide-refractory: 10.2 vs. 7.1 months, PI-naïve: 29.5 vs. 9.7; bortezomib-naïve: 29.5 vs. 9.7; 1LOT: 21.0 vs. 10.7; p < .05). The lenalidomide-refractory subgroup had longer OS with SVd (26.7 vs. 18.6 months; HR 0.53; p = .015). In all subgroups, overall response and ≥very good partial response rates were higher with SVd. The manageable safety profile of SVd was similar to the overall patient population. CONCLUSIONS With over 2 years of follow-up, these clinically meaningful outcomes further support the use of SVd in patients who are lenalidomide-refractory, PI-naïve, bortezomib-naïve, or who received 1LOT (including a monoclonal antibody) and underscore the observed synergy between selinexor and bortezomib.
Collapse
Affiliation(s)
- Maria-Victoria Mateos
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | - Monika Engelhardt
- Interdisciplinary Cancer Center, University of Freiburg, Faculty of Freiburg, Freiburg, Germany
| | | | | | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Seràgnoli Institute of Haematology, Bologna University School of Medicine, Bologna, Italy
| | - Meletios Dimopoulos
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | | | | | | | | |
Collapse
|
2
|
Kumar S, Dispenzieri A, Bhutani D, Gertz M, Wechalekar A, Palladini G, Comenzo R, Fonseca R, Jaccard A, Kastritis E, Schönland S, la Porte C, Pei H, Tran N, Merlini G. Impact of cytogenetic abnormalities on treatment outcomes in patients with amyloid light-chain amyloidosis: subanalyses from the ANDROMEDA study. Amyloid 2023; 30:268-278. [PMID: 36779691 DOI: 10.1080/13506129.2022.2164488] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 02/14/2023]
Abstract
BACKGROUND Cytogenetic abnormalities are common in patients with amyloid light-chain (AL) amyloidosis; some are associated with poorer outcomes. This post hoc analysis of ANDROMEDA evaluated the impact of certain cytogenetic abnormalities on outcomes in this patient population. METHODS Patients with newly diagnosed AL amyloidosis were randomised 1:1 to daratumumab, bortezomib, cyclophosphamide, and dexamethasone (D-VCd) or VCd. Outcomes were evaluated in the intent-to-treat (ITT) population and in patients with t(11;14), amp1q21, del13q14, and del17p13. RESULTS Overall, 321 patients had cytogenetic testing (D-VCd, n = 155; VCd, n = 166); most common abnormalities were t(11;14) and amp1q21. At a median follow-up of 20.3 months, haematologic complete response rates were higher with D-VCd vs VCd across all cytogenetic subgroups and organ response rates were numerically higher with D-VCd vs VCd across most subgroups. Point estimates for hazard ratio of major organ deterioration-PFS and -EFS favoured D-VCd over VCd for all cytogenetic subgroups. Deep haematologic responses (involved minus uninvolved free light chains [FLC] <10 mg/L or involved FLC ≤20 mg/L) were seen in more patients with D-VCd than VCd in all ITT and t(11;14) cohorts. CONCLUSIONS These results support the use of D-VCd as standard of care in patients with newly diagnosed AL amyloidosis regardless of cytogenetic abnormalities.
Collapse
Affiliation(s)
| | | | - Divaya Bhutani
- Department of Medicine, Division of Hematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Giovanni Palladini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raymond Comenzo
- Tufts Medical Center, John C Davis Myeloma and Amyloid Program, Boston, MA, USA
| | | | - Arnaud Jaccard
- Centre Hospitalier Universitaire and Reference Center for AL Amyloidosis, Limoges, France
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefan Schönland
- Universitätsklinikum Heidelberg Medizinische Klinik V, Heidelberg, Germany
| | | | - Huiling Pei
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - NamPhuong Tran
- Janssen Research & Development, LLC, Los Angeles, CA, USA
| | - Giampaolo Merlini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
3
|
Kumar S, Dispenzieri A, Bhutani D, Gertz M, Wechalekar A, Palladini G, Comenzo R, Fonseca R, Jaccard A, Kastritis E, Schönland S, Porte CL, Pei H, Tran N, Vermeulen J, Merlini G. OAB-034: Evaluating the impact of cytogenetic abnormalities on treatment outcomes in patients with AL amyloidosis: subanalyses from the ANDROMEDA study. Clinical Lymphoma Myeloma and Leukemia 2021. [DOI: 10.1016/s2152-2650(21)02108-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
Goss GD, Jonker DJ, Laurie SA, Weberpals JI, Oza AM, Spaans JN, la Porte C, Dimitroulakos J. A phase I study of high-dose rosuvastatin with standard dose erlotinib in patients with advanced solid malignancies. J Transl Med 2016; 14:83. [PMID: 27036206 PMCID: PMC4815068 DOI: 10.1186/s12967-016-0836-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Synergistic cytotoxicity with high-dose statins and erlotinib has been demonstrated in preclinical models across a number of tumour types. In this phase I study, we evaluated the safety and potential anti-tumour activity of escalating doses of rosuvastatin in combination with the standard clinical dose of erlotinib in heavily pretreated patients with advanced solid tumours. METHODS This was a single-center, phase I open-label study to determine the safety and recommended phase two dose (RPTD) of rosuvastatin in combination with 150 mg/day standard dose of erlotinib. Using a 3 + 3 study design and 28-day cycle, escalating doses of rosuvastatin from 1 to 8 mg/kg/day × 2 weeks (cycle 1) and 3 weeks (subsequent cycles) given concurrently with erlotinib were evaluated. In order to expand the experience and to gain additional safety and pharmacokinetic data, two expansions cohorts using concurrent or alternating weekly dosing regimens at the RPTD were also evaluated. RESULTS All 24 patients enrolled were evaluable for toxicity, and 22 for response. The dose-limiting toxicity (DLT) of reversible muscle toxicity was seen at the 2 mg/kg/day dose level. Maximal tolerated dose (MTD) was determined to be 1 mg/kg/day. Thirty-three percent of patients developed at least 1 ≥ grade 2 muscle toxicity (rhabdomyolysis: 1/24, myalgia: 7/24) resulting in one study-related death. Durable stable disease for more than 170 days was seen in 25 % of patients that received concurrent treatment and were evaluable for response (n = 16). Plasma erlotinib levels on study were unaffected by the addition of rosuvastatin. CONCLUSIONS The observed disease stabilization rate of 25 % with combination therapy in this heavily pretreated population is encouraging, however, the high levels of muscle toxicities observed limited this combination strategy.
Collapse
Affiliation(s)
- Glenwood D Goss
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada. .,The Ottawa Hospital Cancer Centre, Ottawa, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Derek J Jonker
- The Ottawa Hospital Cancer Centre, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Scott A Laurie
- The Ottawa Hospital Cancer Centre, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Johanne I Weberpals
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada.,Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - Amit M Oza
- University Health Network, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
| | - Johanna N Spaans
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada
| | - Charles la Porte
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada
| | - Jim Dimitroulakos
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada. .,The Ottawa Hospital Cancer Centre, Ottawa, Canada. .,Faculty of Medicine and the Department of Biochemistry, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
5
|
Cooper C, la Porte C, Tossonian H, Sampalis J, Ackad N, Conway B. A Pilot, Prospective, Open-Label Simplification Study to Evaluate the Safety, Efficacy, and Pharmacokinetics of Once-Daily Lopinavir-Ritonavir Monotherapy in HIV-HCV Coinfected Patients: The MONOCO Study. HIV Clinical Trials 2015; 13:179-88. [DOI: 10.1310/hct1304-179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
6
|
Voduc N, la Porte C, Tessier C, Mallick R, Cameron DW. Effect of resveratrol on exercise capacity: a randomized placebo-controlled crossover pilot study. Appl Physiol Nutr Metab 2014; 39:1183-7. [PMID: 25051174 DOI: 10.1139/apnm-2013-0547] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To assess the effect on exercise capacity and tolerability of resveratrol, 13 healthy, sedentary adult volunteers were enrolled in a randomized crossover study comparing resveratrol and placebo over two 4-week periods, with a 2-week time between periods when subjects received no treatment. No significant changes in exercise duration or aerobic capacity (peak oxygen uptake) were observed. Gastrointestinal side effects were more common during resveratrol treatment (77% vs. 15%, p = 0.0048). A small reduction in fasting glucose and small but statistically significant increases in liver enzymes, total cholesterol, and triglycerides were observed, although mean results remained within normal limits. There was no change in complete blood count, inflammatory markers, renal function, or other measures of liver function.
Collapse
Affiliation(s)
- Nha Voduc
- a Department of Medicine, Division of Respirology, University of Ottawa at The Ottawa Hospital, General Campus, 501 Smyth Road, Box 211, Ottawa, ON K1H 8L6, Canada
| | | | | | | | | |
Collapse
|
7
|
Antoniou T, Loutfy MR, Brunetta J, Smith G, Halpenny R, la Porte C. Pharmacokinetics of raltegravir in the semen of HIV-infected men. Antivir Ther 2014; 19:607-11. [DOI: 10.3851/imp2750] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
|
8
|
Osborne BJW, Sheth PM, Yi TJ, Kovacs C, Benko E, Porte CL, Huibner S, Le AQ, Danroth R, Baraki B, Mazzulli T, Brumme ZL, Kaul R. Impact of Antiretroviral Therapy Duration and Intensification on Isolated Shedding of HIV-1 RNA in Semen. J Infect Dis 2013; 207:1226-34. [PMID: 23329849 DOI: 10.1093/infdis/jit026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
Tseng AL, la Porte C, Salit IE. Significant interaction between activated charcoal and antiretroviral therapy leading to subtherapeutic drug concentrations, virological breakthrough and development of resistance. Antivir Ther 2013; 18:735-8. [DOI: 10.3851/imp2685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 10/26/2022]
|
10
|
Naccarato M, Yoong D, la Porte C, Fong I. Amiodarone and concurrent antiretroviral therapy: a case report and review of the literature. Antivir Ther 2013; 19:329-39. [DOI: 10.3851/imp2715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 10/25/2022]
|
11
|
la Porte C, Voduc N, Zhang G, Seguin I, Tardiff D, Singhal N, Cameron DW. Steady-State pharmacokinetics and tolerability of trans-resveratrol 2000 mg twice daily with food, quercetin and alcohol (ethanol) in healthy human subjects. Clin Pharmacokinet 2010; 49:449-54. [PMID: 20528005 DOI: 10.2165/11531820-000000000-00000] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Trans-resveratrol is a polyphenol, which is found in red wine and has cancer chemo-preventive properties and disease-preventive properties. The pharmacokinetics of trans-resveratrol have been investigated in single-dose studies and in studies with relatively low dosages. The present study aimed to investigate the steady-state pharmacokinetics and tolerability of trans-resveratrol 2000 mg twice daily with food, quercetin and alcohol (ethanol). METHODS This was a two-period, open-label, single-arm, within-subject control study in eight healthy subjects. The steady-state 12-hour pharmacokinetics of trans-resveratrol 2000 mg twice daily were studied with a standard breakfast, a high-fat breakfast, quercetin 500 mg twice daily and 5% alcohol 100 mL. Trans-resveratrol plasma concentrations were determined using liquid chromatography with tandem mass spectrometry. RESULTS The mean (SD) area under the plasma concentration-time curve from 0 to 12 hours (AUC(12)) and maximum plasma concentration (C(max)) of trans-resveratrol were 3558 (2195) ng * h/mL and 1274 (790) ng/mL, respectively, after the standard breakfast. The high-fat breakfast significantly decreased the AUC(12) and C(max) by 45% and 46%, respectively, when compared with the standard breakfast. Quercetin 500 mg twice daily or 5% alcohol 100 mL did not influence trans-resveratrol pharmacokinetics. Diarrhoea was reported in six of the eight subjects. Significant but not clinically relevant changes from baseline were observed in serum potassium and total bilirubin levels. CONCLUSION Trans-resveratrol 2000 mg twice daily resulted in adequate exposure and was well tolerated by healthy subjects, although diarrhoea was frequently observed. In order to maximize trans-resveratrol exposure, it should be taken with a standard breakfast and not with a high-fat meal. Furthermore, combined intake with quercetin or alcohol did not influence trans-resveratrol exposure.
Collapse
Affiliation(s)
- Charles la Porte
- Ottawa Hospital Research Institute, Ottawa, Ontario K1H 8L6, Canada.
| | | | | | | | | | | | | |
Collapse
|
12
|
Singhal N, Fergusson D, Huff H, Mills EJ, la Porte C, Walmsley S, Cameron DW. Design and methods of the MAINTAIN study: a randomized controlled clinical trial of micronutrient and antioxidant supplementation in untreated HIV infection. Contemp Clin Trials 2010; 31:604-11. [PMID: 20708714 DOI: 10.1016/j.cct.2010.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 08/06/2010] [Indexed: 12/31/2022]
Abstract
Micronutrient deficiencies are common in HIV positive persons and are associated with a poorer prognosis, but the role of micronutrient supplementation in the medical management of HIV infection remains controversial, as some but not all studies show immunological and clinical benefit. Micronutrients supplementation could be a relatively low cost strategy to defer the initiation of expensive, potentially toxic and lifelong antiretroviral therapy. The MAINTAIN study is a Canadian multi-center randomized control double blind clinical trial to evaluate if micronutrient supplementation of HIV positive persons slows progression of immune deficiency and delays the need to start antiretroviral therapy and is safe, compared to standard multivitamins. Untreated asymptomatic HIV positive adults will receive a micronutrient and antioxidant preparation (n = 109) or an identical appearing recommended daily allowance multivitamin and mineral preparation (n = 109) for two years. Participants will be followed quarterly and monitored for time from baseline to CD4 T lymphocyte count <350 mm(3), or emergence of CDC-defined AIDS-defining illness, or the start of antiretroviral therapy. We will also compare safety and health related quality of life between groups. Primary analysis will compare the incidence of the composite primary outcome between study groups and will be by intention-to-treat. The study was originally expected to last three years, with accrual over one year and a minimum of two years follow up of the last enrolled participant. We discuss here the study design and methods, often used for evaluation of complementary and adjunctive treatments for health maintenance in HIV infection, which are common interventions.
Collapse
Affiliation(s)
- Neera Singhal
- Department of Medicine, University of Ottawa at Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
la Porte C, van Heeswijk R, Mitchell CD, Zhang G, Parker J, Rongkavilit C. Pharmacokinetics and tolerability of once- versus twice-daily lopinavir/ritonavir treatment in HIV-1-infected children. Antivir Ther 2009; 14:603-606. [PMID: 19578247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Once-daily lopinavir/ritonavir (LPV/r) is not approved for treatment of HIV paediatric patients. Once daily treatment in children might serve the same goals of patient comfort and adherence as in adults. METHODS HIV type-1-infected children aged 6 months to 18 years, who were virologically suppressed on an LPV/r-containing regimen, were eligible. Treatment 1 consisted of once-daily LPV/r 460/115 mg/m(2), plus two nucleoside reverse transcriptase inhibitors (NRTIs). Treatment 2 consisted of twice-daily LPV/r 230/57.5 mg/m(2) plus two NRTIs. Patients were randomized either to start with treatment 1 followed by treatment 2 or vice versa. Full pharmacokinetic profiles were analysed for lopinavir and ritonavir with a validated HPLC tandem mass spectrometry assay. RESULTS Seven patients (five girls and two boys) were included in the study. Median age was 9.8 years (range 5.8-15.5). For the once-daily treatment, the median (range) lopinavir 24 h area under the plasma -concentration-time curve (AUC(24 h)), maximum plasma concentration (C(max)) and 24 h plasma concentration (C(24 h)) were 214.6 h*mg/l (114.2-289.2), 13.5 mg/l (8.3-17.5) and 3.4 mg/l (0.6-7.4), respectively. For the twice-daily treatment the median (range) lopinavir 12 h area under the plasma concentration-time curve (AUC(12 h)), C(max) and 12 h plasma concentration (C(12 h)) were 80.9 h*mg/l (23.3-135.9), 9.8 mg/l (3.4-15.2) and 5.7 mg/l (1.7-9.7), respectively. CONCLUSIONS This study suggests that the pharmacokinetics of lopinavir after twice-daily and once-daily dosing are similar, with no observable difference in tolerability, in this group of patients between 5 and 15 years old.
Collapse
Affiliation(s)
- Charles la Porte
- Ottawa Health Research Institute, Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
| | | | | | | | | | | |
Collapse
|
15
|
la Porte C, van Heeswijk R, Mitchell CD, Zhang G, Parker J, Rongkavilit C. Pharmacokinetics and tolerability of once- versus twice-daily lopinavir/ritonavir treatment in HIV-1-infected children. Antivir Ther 2008. [DOI: 10.1177/135965350901400408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Once-daily lopinavir/ritonavir (LPV/r) is not approved for treatment of HIV paediatric patients. Once daily treatment in children might serve the same goals of patient comfort and adherence as in adults. Methods HIV type-1-infected children aged 6 months to 18 years, who were virologically suppressed on an LPV/r-containing regimen, were eligible. Treatment 1 consisted of once-daily LPV/r 460/115 mg/m2, plus two nucleoside reverse transcriptase inhibitors (NRTIs). Treatment 2 consisted of twice-daily LPV/r 230/57.5 mg/m2 plus two NRTIs. Patients were randomized either to start with treatment 1 followed by treatment 2 or vice versa. Full pharmaco-kinetic profiles were analysed for lopinavir and ritonavir with a validated HPLC tandem mass spectrometry assay. Results Seven patients (five girls and two boys) were included in the study. Median age was 9.8 years (range 5.8–15.5). For the once-daily treatment, the median (range) lopinavir 24 h area under the plasma concentration–time curve (AUC24h), maximum plasma concentration (Cmax) and 24 h plasma concentration (C24h) were 214.6 h•mg/l (114.2–289.2), 13.5 mg/l (8.3–17.5) and 3.4 mg/l (0.6–7.4), respectively. For the twice-daily treatment the median (range) lopinavir 12 h area under the plasma concentration–time curve (AUC12h), Cmax and 12 h plasma concentration (C12h) were 80.9 h•mg/l (23.3–135.9), 9.8 mg/l (3.4–15.2) and 5.7 mg/l (1.7– 9.7), respectively. Conclusions This study suggests that the pharmacokinetics of lopinavir after twice-daily and once-daily dosing are similar, with no observable difference in tolerability, in this group of patients between 5 and 15 years old.
Collapse
Affiliation(s)
- Charles la Porte
- Ottawa Health Research Institute, Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Rolf van Heeswijk
- Ottawa Health Research Institute, Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
- Present address: Tibotec BVBA, Mechelen, Belgium
| | - Charles D Mitchell
- Department of Pediatrics, University of Miami School of Medicine, Miami, FL, USA
| | - Guijun Zhang
- Ottawa Health Research Institute, Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Jackie Parker
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Chokechai Rongkavilit
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
16
|
Burger D, van der Heiden I, la Porte C, van der Ende M, Groeneveld P, Richter C, Koopmans P, Kroon F, Sprenger H, Lindemans J, Schenk P, van Schaik R. Interpatient variability in the pharmacokinetics of the HIV non-nucleoside reverse transcriptase inhibitor efavirenz: the effect of gender, race, and CYP2B6 polymorphism. Br J Clin Pharmacol 2006; 61:148-54. [PMID: 16433869 PMCID: PMC1885008 DOI: 10.1111/j.1365-2125.2005.02536.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS To characterize the demographic and pharmacogenetic factors that influence interpatient variability in the plasma concentrations of the HIV non-nucleoside reverse transcriptase inhibitor efavirenz. METHODS Data from all samples analyzed for efavirenz in our TDM service in 2002 and 2003 were reviewed. Information on gender, age, body weight, height, race, hormonal contraceptive use (in a subset of patients), and time between sampling and last intake was recorded. PCR-restriction fragment length polymorphism analysis was performed to detect the cytochrome P450 2B6 (CYP2B6) C1459T variant (present in CYP2B6*6 and CYP2B6*7) which is associated with low CYP2B6 activity. RESULTS A total of 255 patients were included in this analysis. The median plasma efavirenz concentration was 2.50 (interquartile range: 1.85-3.55) mg l(-1). Eight patients (3.1%) were considered to have a subtherapeutic plasma concentration (<1.0 mg l(-1)) and 48 (18.9%) a toxic efavirenz concentration (>4.0 mg l(-1)). Gender, time after last intake, and race were the only factors that were significantly related to plasma efavirenz concentration in a multivariate analysis. No influence was observed for body weight, hormonal contraceptive use, and the presence of the CYP2B6 C1459T polymorphism. CONCLUSIONS Gender and race are important factors in determining interpatient variability in plasma efavirenz concentrations which were unaffected by the presence of the CYP2B6 C1459T polymorphism. Physicians should be particularly alert for signs of efavirenz-induced toxicity in females and non-Caucasian patients.
Collapse
Affiliation(s)
- David Burger
- Radboud University Medical Center Nijmegen, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|