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Willmann S, Keller AK, Meyer M, van der Mey D, Wirsching G, Zhang Y, Drenth HJ, Keunecke A, Vendel E, Saleh S. Population pharmacokinetics of riociguat in a pediatric population (aged ≥ 6 years) with pulmonary arterial hypertension. Pediatr Pulmonol 2023; 58:908-917. [PMID: 36507572 DOI: 10.1002/ppul.26277] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/26/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The PATENT-CHILD study investigated riociguat in children aged ≥ 6 to <18 years with pulmonary arterial hypertension (PAH) treated with tablets or an oral pediatric suspension based on bodyweight-adjusted dosing of up to 2.5 mg three times daily. PATENT-CHILD demonstrated an acceptable riociguat safety profile and individual plasma concentrations in pediatric patients were consistent with those in adult patients. METHODS Using the data set from PATENT-CHILD and building on existing population pharmacokinetic (PK) models for riociguat and its major metabolite (M1) in adults with PAH, a coupled riociguat-M1 PK model was developed. The final model developed incorporated a one-compartment model for riociguat, coupled to a one-compartment model for M1, allowing for presystemic formation of M1. It included allometric scaling exponents for bodyweight. RESULTS Apparent clearance of riociguat was similar in children and adult patients with PAH (median [interquartile range] 2.20 [1.75-3.44] and 2.08 L/h [1.55-2.97]). Factors contributing to lower PK exposure were lower riociguat maintenance dose in PATENT-CHILD, and a higher riociguat clearance in some adolescent patients, compared with adult patients. No effects of formulation, sex, or age on riociguat PK were observed. An exploratory PK/pharmacodynamics analysis found the increase in 6-min walking distance in pediatric patients treated with riociguat was not related to riociguat PK. CONCLUSIONS Body size is the main determinant of PK in growing children, and the model supports clinical data that, for children weighing < 50 kg, a bodyweight-adjusted dose of riociguat should be used to achieve a similar exposure to that observed in adults with PAH.
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Affiliation(s)
| | | | | | | | | | - Yang Zhang
- Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
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García Aguilar H, Gorenflo M, Ivy DD, Moledina S, Castaldi B, Ishida H, Cześniewicz P, Kusa J, Miera O, Pattathu J, Weng K, Ablonczy L, Apitz C, Katona M, Kurosaki K, Pulido T, Yamagishi H, Yasuda K, Cisternas G, Goth M, Lippert S, Radomskyj A, Saleh S, Willmann S, Wirsching G, Bonnet D, Beghetti M. Riociguat in children with pulmonary arterial hypertension:the PATENT‐CHILD study. Pulm Circ 2022; 12:e12133. [PMID: 36186721 PMCID: PMC9485817 DOI: 10.1002/pul2.12133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022] Open
Abstract
Riociguat, a soluble guanylate cyclase stimulator, is approved for treatment of adults with pulmonary arterial hypertension (PAH). The safety, tolerability, and pharmacokinetics (PK) of oral riociguat in a pediatric population with PAH was assessed in PATENT–CHILD (NCT02562235), a multicenter, single‐arm, 24‐week, open‐label, Phase 3 study. Patients aged 6–17 years in World Health Organization functional class (WHO‐FC) I–III treated with stable endothelin receptor antagonists and/or prostacyclin analogs received riociguat equivalent to 0.5–2.5 mg three times daily in adults, as either oral pediatric suspension or tablets, based on bodyweight. Primary outcomes were safety, tolerability, and PK of riociguat. Twenty‐four patients (mean age 12.8 years), 18 of whom were in WHO‐FC II, were enrolled. Adverse events (AEs), mostly mild or moderate, were reported in 20 patients (83%). Four patients (17%) experienced a serious AE; all resolved by study end and two (8%) were considered study‐drug related. Hypotension was reported in three patients and hemoptysis in one (all mild/moderate intensity). Riociguat plasma concentrations in pediatric patients were consistent with those published in adult patients. From baseline to Week 24, mean ± standard deviation increase in 6‐minute walking distance was 23 ± 69 m (n = 19), and mean decrease in NT‐proBNP was –66 ± 585 pg/ml (n = 14). There was no change in WHO‐FC. Two patients experienced clinical worsening events of hospitalization for right heart failure. PK results confirmed a suitable riociguat dosing strategy for pediatric patients with PAH. The data suggest an acceptable safety profile with potential efficacy signals.
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Affiliation(s)
| | - Matthias Gorenflo
- Department of Pediatric Cardiology and Congenital Cardiology Heidelberg University Medical Centre Heidelberg Germany
| | - D Dunbar Ivy
- Division of Cardiology, Department of Pediatrics University of Colorado School of Medicine, Children's Hospital Colorado Aurora CO USA
| | - Shahin Moledina
- Cardiology Department Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Biagio Castaldi
- Dipartimento di Pediatria, Azienda Ospedaliera di Padova Padova Italy
| | - Hidekazu Ishida
- Department of Pediatrics Osaka University Graduate School of Medicine Osaka Japan
| | - Paweł Cześniewicz
- Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center Wroclaw Poland
| | - Jacek Kusa
- Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center Wroclaw Poland
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center, Berlin Germany
| | - Joseph Pattathu
- Department of Pediatric Cardiology and Congenital Cardiology Heidelberg University Medical Centre Heidelberg Germany
| | - Ken‐Pen Weng
- Department of Pediatrics, Congenital Structural Heart Disease Center, Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Laszlo Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology Budapest Hungary
| | - Christian Apitz
- Division of Pediatric Cardiology University Children's Hospital Ulm Ulm Germany
| | - Marta Katona
- Department of Pediatrics Albert Szent‐Györgyi Medical Center, University of Szeged Hungary
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology National Cerebral and Cardiovascular Center Osaka Japan
| | - Tomas Pulido
- Clinical Research Department Ignacio Chavez National Heart Institute Mexico City, Mexico
| | | | - Kazushi Yasuda
- Department of Pediatric Cardiology Aichi Children's Health and Medical Center Aichi Japan
| | | | | | | | | | | | | | | | - Damien Bonnet
- M3C‐Necker, Hôpital Necker Enfants malades APHP Université de Paris Paris France
| | - Maurice Beghetti
- Paediatric Cardiology Unit University Hospitals of Geneva Geneva Switzerland
- Centre Universitaire Romand De Cardiologie Et Chirurgie Cardiaque Pédiatrique, Children's University Hospital, University of Geneva and Lausanne Geneva Switzerland
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Lerch M, Nowicki P, Manlik K, Wirsching G. Statistical Signal Detection as a Routine Pharmacovigilance Practice: Effects of Periodicity and Resignalling Criteria on Quality and Workload. Drug Saf 2016; 38:1219-31. [PMID: 26391801 PMCID: PMC4659850 DOI: 10.1007/s40264-015-0345-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The goal of signal detection in pharmacovigilance (PV) is to detect unknown causal associations between medicines and unexpected events. Statistical methods serve to detect signals and supplement traditional PV methods. Statistical signal detection (SSD) requires decisions about various settings that influence the quality and efficiency of SSD, as shown in several studies. To our knowledge, the effects of SSD periodicity and resignalling criteria on the quality and workload of routine SSD have not been published before. OBJECTIVE To analyse the effects of different periodicities and resignalling criteria on signal detection quality and signal validation workload, and to test the impact of changing the signal threshold for number of cases. METHODS We calculated signals of disproportionate reporting (SDRs) using thresholds of number of cases (N) ≥3, proportional reporting ratio ≥2 and Chi(2) ≥ 4. We retrospectively simulated recurrent SDR calculation and validation with varying periodicity (quarterly vs. monthly), resignalling criteria, and N ≥ 3 vs. N ≥ 5. RESULTS Changing the periodicity from quarterly to monthly increased the workload by 46.6 % (0 % signal loss). More restrictive resignalling criteria reduced the workload between 36.3 % (0 % signal loss) and 74.1 % (50 % signal loss). For N ≥ 3, the most efficient monthly SSD resignalling criterion reduced the workload by 36.3 % and detected all true signals earlier than quarterly SSD. N ≥ 5 reduced the workload between 13.8 and 21.4 % (0 % signal loss). CONCLUSIONS In real-life PV practice, signal detection and validation are recurrent periodic activities. Some true signals are only discovered upon resignalling. Our results demonstrate resignalling criteria with high signal detection quality and high efficiency. We found potential earlier detection of true signals using monthly SSD. Additional studies about resignalling should be performed to complement our findings.
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Affiliation(s)
| | | | - Katrin Manlik
- Global Pharmacovigilance, Bayer Pharma AG, Berlin, Germany
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