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Mattioli F, Fucile C, Del Bono V, Marini V, Parisini A, Molin A, Zuccoli ML, Milano G, Danesi R, Marchese A, Polillo M, Viscoli C, Pelosi P, Martelli A, Di Paolo A. Population pharmacokinetics and probability of target attainment of meropenem in critically ill patients. Eur J Clin Pharmacol 2016; 72:839-48. [PMID: 27048201 DOI: 10.1007/s00228-016-2053-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients admitted to intensive care unit (ICU) with Klebsiella pneumoniae infections are characterized by high mortality. The aims of the present study were to investigate the population pharmacokinetics parameters and to assess the probability of target attainment of meropenem in critically ill patients to provide information for more effective regimens. METHODS Twenty-seven consecutive patients were included in the study. Meropenem was administered as 3-h intravenous (i.v.) infusions at doses of 1-2 g every 8 or 12 h. Meropenem plasma concentrations were measured by a high-performance liquid chromatography (HPLC) method, and a population pharmacokinetics analysis was performed using NONMEM software. Meropenem plasma disposition was simulated for extended (3 h; 5 h) or continuous i.v. infusions, and the following parameters were calculated: time during which free drug concentrations were above minimum inhibitory concentration (MIC) (fT > MIC), free minimum plasma concentrations above 4× MIC (fCmin > 4× MIC), probability of target attainment (PTA), and cumulative fraction of response (CFR). RESULTS Gender and severity of sepsis affected meropenem clearance, whose typical population values ranged from 6.22 up to 12.04 L/h (mean ± standard deviation (SD) value, 9.38 ± 4.47 L/h). Mean C min value was 7.90 ± 7.91 mg/L, suggesting a high interindividual variability. The simulation confirmed that 88 and 97.5 % of patients achieved effective C min > 4× MIC values after 3- and 5-h i.v. infusions of meropenem 2 g × 3/day, respectively. On the contrary, the same total daily doses reached the target C min > 4× MIC values in 100 % of patients when administered as continuous i.v. infusions. CONCLUSIONS Several factors may influence meropenem pharmacokinetics in ICU patients. Continuous i.v. infusions of meropenem seem to be more effective than standard regimens to achieve optimal therapeutic targets.
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Affiliation(s)
- Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy.
| | - Carmen Fucile
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Valeria Marini
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Andrea Parisini
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Alexandre Molin
- Anesthesia and Intensive Care, Department Surgical Sciences and Integrated Diagnostics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Maria Laura Zuccoli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Giulia Milano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
| | - Anna Marchese
- Section of Microbiology-DISC, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Marialuisa Polillo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
| | - Claudio Viscoli
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Department Surgical Sciences and Integrated Diagnostics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Antonietta Martelli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
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Polillo M, Galimberti S, Baratè C, Petrini M, Danesi R, Di Paolo A. Pharmacogenetics of BCR/ABL Inhibitors in Chronic Myeloid Leukemia. Int J Mol Sci 2015; 16:22811-29. [PMID: 26402671 PMCID: PMC4613337 DOI: 10.3390/ijms160922811] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 01/29/2023] Open
Abstract
Chronic myeloid leukemia was the first haematological neoplasia that benefited from a targeted therapy with imatinib nearly 15 years ago. Since then, several studies have investigated the role of genes, their variants (i.e., polymorphisms) and their encoded proteins in the pharmacokinetics and pharmacodynamics of BCR-ABL1 tyrosine kinase activity inhibitors (TKIs). Transmembrane transporters seem to influence in a significant manner the disposition of TKIs, especially that of imatinib at both cellular and systemic levels. In particular, members of the ATP-binding cassette (ABC) family (namely ABCB1 and ABCG2) together with solute carrier (SLC) transporters (i.e., SLC22A1) are responsible for the differences in drug pharmacokinetics. In the case of the newer TKIs, such as nilotinib and dasatinib, the substrate affinity of these drugs for transporters is variable but lower than that measured for imatinib. In this scenario, the investigation of genetic variants as possible predictive markers has led to some discordant results. With the partial exception of imatinib, these discrepancies seem to limit the application of discovered biomarkers in the clinical settings. In order to overcome these issues, larger prospective confirmative trials are needed.
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MESH Headings
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Animals
- Biological Transport
- Drug Resistance, Neoplasm
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Organic Cation Transport Proteins/genetics
- Organic Cation Transport Proteins/metabolism
- Pharmacogenetics
- Protein Kinase Inhibitors/pharmacokinetics
- Protein Kinase Inhibitors/pharmacology
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Affiliation(s)
- Marialuisa Polillo
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Via Roma 57, 56126 Pisa, Italy.
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Via Roma 57, 56126 Pisa, Italy.
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Via Roma 57, 56126 Pisa, Italy.
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
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Crea F, Di Paolo A, Liu HH, Polillo M, Clermont PL, Guerrini F, Ciabatti E, Ricci F, Baratè C, Fontanelli G, Barsotti S, Morganti R, Danesi R, Wang Y, Petrini M, Galimberti S, Helgason CD. Polycomb genes are associated with response to imatinib in chronic myeloid leukemia. Epigenomics 2015; 7:757-65. [PMID: 26343356 DOI: 10.2217/epi.15.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 12/19/2022] Open
Abstract
AIM Imatinib is a tyrosine kinase inhibitor that has revolutionized the treatment of chronic myeloid leukemia (CML). Despite its efficacy, about a third of patients discontinue the treatment due to therapy failure or intolerance. The rational identification of patients less likely to respond to imatinib would be of paramount clinical relevance. We have shown that transmembrane transporter hOCT1 genotyping predicts imatinib activity. In parallel, Polycomb group genes (PcGs) are epigenetic repressors implicated in CML progression and in therapy resistance. PATIENTS & METHODS We measured the expression of eight PcGs in paired pre- and post-imatinib bone marrow samples from 30 CML patients. RESULTS BMI1, PHC3, CBX6 and CBX7 expression was significantly increased during imatinib treatment. Post-treatment levels of CBX6 and CBX7 predicted 3-month response rate. Measurement of post-treatment BMI1 levels improved the predictive power of hOCT1 genotyping. CONCLUSION These results suggest that the expression levels of PcGs might be useful for a more accurate risk stratification of CML patients.
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Affiliation(s)
- Francesco Crea
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Vancouver Prostate Centre, Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada.,Department of Life Health & Chemical Sciences, The Open University, UK
| | - Antonello Di Paolo
- Department of Clinical & Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | - Hui Hsuan Liu
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Marialuisa Polillo
- Department of Clinical & Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | - Pier-Luc Clermont
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Francesca Guerrini
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Elena Ciabatti
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Federica Ricci
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Giulia Fontanelli
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Sara Barsotti
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical & Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Romano Danesi
- Department of Clinical & Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | - Yuzhuo Wang
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Vancouver Prostate Centre, Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Mario Petrini
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Sara Galimberti
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Cheryl D Helgason
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
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Di Paolo A, Polillo M, Lastella M, Bocci G, Del Re M, Danesi R. Methods: for studying pharmacogenetic profiles of combination chemotherapeutic drugs. Expert Opin Drug Metab Toxicol 2015; 11:1253-67. [PMID: 26037261 DOI: 10.1517/17425255.2015.1053460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/28/2023]
Abstract
INTRODUCTION Molecular and genetic analysis of tumors and individuals has led to patient-centered therapies, through the discovery and identification of genetic markers predictive of drug efficacy and tolerability. Present therapies often include a combination of synergic drugs, each of them directed against different targets. Therefore, the pharmacogenetic profiling of tumor masses and patients is becoming a challenge, and several questions may arise when planning a translational study. AREAS COVERED The review presents the different techniques used to stratify oncology patients and to tailor antineoplastic treatments according to individual pharmacogenetic profiling. The advantages of these methodologies are discussed as well as current limits. EXPERT OPINION Facing the rapid technological evolution for genetic analyses, the most pressing issues are the choice of appropriate strategies (i.e., from gene candidate up to next-generation sequencing) and the possibility to replicate study results for their final validation. It is likely that the latter will be the major obstacle in the future. However, the present landscape is opening up new possibilities, overcoming those hurdles that have limited result translation into clinical settings for years.
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Affiliation(s)
- Antonello Di Paolo
- University of Pisa, Department of Clinical and Experimental Medicine, Via Roma 55, 56126 Pisa , Italy +39 050 2218755 ; +39 050 2218758 ;
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Carulli G, Baratè C, Marini A, Ottaviano V, Cervetti G, Fontanelli G, Guerrini F, Arici R, Guerri V, Di Paolo A, Polillo M, Ferreri MI, Galimberti S, Petrini M. Reduced circulating B-lymphocytes and altered B-cell compartments in patients suffering from chronic myeloid leukaemia undergoing therapy with Imatinib. Hematol Oncol 2014; 33:250-2. [DOI: 10.1002/hon.2156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Giovanni Carulli
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Claudia Baratè
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Alessandra Marini
- Laboratory of Clinical Pathology, Section of Flow Cytometry; Versilia Hospital; Lido di Camaiore Italy
| | - Virginia Ottaviano
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Giulia Cervetti
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Giulia Fontanelli
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Francesca Guerrini
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Roberta Arici
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Valentina Guerri
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Antonello Di Paolo
- Division of Pharmacology; Department of Clinical and Experimental Medicine,University of Pisa; Pisa Italy
| | - Marialuisa Polillo
- Division of Pharmacology; Department of Clinical and Experimental Medicine,University of Pisa; Pisa Italy
| | - Maria I. Ferreri
- Laboratory of Cytogenetics, AOUP; University of Pisa; Pisa Italy
| | - Sara Galimberti
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
| | - Mario Petrini
- Division of Hematology, Department of Clinical and Experimental Medicine; University of Pisa; Pisa Italy
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Marconcini R, Di Paolo A, Polillo M, Galli L, Antonuzzo A, Farnesi A, Sbrana A, Biasco E, Derosa L, Ricci S, Falcone A. Therapeutic Drug Monitoring of Imatinib in Gist Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Paolo A, Polillo M, Tascini C, Lewis R, Menichetti F, Danesi R. Different Recommendations for Daptomycin Dosing Over Time in Patients With Severe Infections. Clin Infect Dis 2014; 58:1788-9. [DOI: 10.1093/cid/ciu230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Di Paolo A, Polillo M, Capecchi M, Cervetti G, Baratè C, Angelini S, Guerrini F, Fontanelli G, Arici R, Ciabatti E, Grassi S, Bocci G, Hrelia P, Danesi R, Petrini M, Galimberti S. The c.480C>G polymorphism of hOCT1 influences imatinib clearance in patients affected by chronic myeloid leukemia. Pharmacogenomics J 2014; 14:328-35. [PMID: 24589908 DOI: 10.1038/tpj.2014.7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 01/17/2014] [Accepted: 01/31/2014] [Indexed: 12/30/2022]
Abstract
The aim of the study was to investigate any possible influence of polymorphisms of transmembrane transporters human organic cation transporter 1 (hOCT1), ABCB1, ABCG2 on imatinib pharmacokinetics in 33 men and 27 women (median age and range, 56 and 27-79 years, respectively) affected by chronic myeloid leukemia. A population pharmacokinetic analysis was performed to investigate imatinib disposition in every patient and the role of transporter polymorphisms. Results showed that the α1-acid glycoprotein and the c.480C>G genotype of hOCT1 had a significant effect on apparent drug clearance (CL/F) being responsible, respectively, for a 20% and 10% decrease in interindividual variability (IIV) of CL/F (from 50.1 up to 19.6%). Interestingly, 25 patients carrying at least one polymorphic c.480 G allele had a significant lower CL/F value with respect to the 35 c.480CC individuals (mean±s.d., 9.6±1.6 vs 12.1±2.3 l h(-1), respectively; P<0.001). In conclusion, the hOCT1 c.480C>G SNP may significantly influence imatinib pharmacokinetics, supporting further analyses in larger groups of patients.
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Affiliation(s)
- A Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - M Polillo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - M Capecchi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - G Cervetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - C Baratè
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - S Angelini
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, Bologna, Italy
| | - F Guerrini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - G Fontanelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - R Arici
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - E Ciabatti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - S Grassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - G Bocci
- 1] Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy [2] Istituto Toscano Tumori, Via Alderotti 86/N, Florence, Italy
| | - P Hrelia
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, Bologna, Italy
| | - R Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - M Petrini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
| | - S Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, Pisa, Italy
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Di Paolo A, Tascini C, Polillo M, Gemignani G, Nielsen EI, Bocci G, Karlsson MO, Menichetti F, Danesi R. Population pharmacokinetics of daptomycin in patients affected by severe Gram-positive infections. Int J Antimicrob Agents 2013; 42:250-5. [PMID: 23891432 DOI: 10.1016/j.ijantimicag.2013.06.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 06/04/2013] [Accepted: 06/08/2013] [Indexed: 11/19/2022]
Abstract
A population pharmacokinetic analysis of daptomycin was performed based on therapeutic drug monitoring (TDM) data from 58 patients receiving doses of 4-12 mg/kg for the treatment of severe Gram-positive infections. At a daily dose of 8 mg/kg, daptomycin plasma concentrations (mean ± S.D.) were 76.9 ± 9.8 mg/L at the end of infusion and 52.7 ± 15.4 mg/L and 11.4 ± 5.4 mg/L at 0.5 h and 23 h after drug administration, respectively. The final model was a one-compartmental model with first-order elimination, with estimated clearance (CL) of 0.80 ± 0.14 L/h and a volume of distribution (V(d)) of 0.19 ± 0.05 L/kg. Creatinine clearance (CL(Cr)) was identified as having a significant influence on daptomycin CL, and a decrease in CL(Cr) of 30 mL/min from the median value (80 mL/min) was associated with a reduction of daptomycin CL from 0.80 L/h to 0.73 L/h. These results confirm that the presence of severe infection may be associated with an altered disposition of daptomycin, with an increased Vd. MICs were available in 41 patients and results showed that 38 and 31 subjects achieved AUC/MIC values associated with bacteriostatic (>400) and bactericidal effects (>800), respectively. Of note, 31 of these 41 subjects experienced a clinical improvement or were cured. Although daptomycin pharmacokinetics may be influenced by infections, effective AUC/MIC values were achieved in the majority of patients. The present model may be applied in clinical settings for a TDM routine on the basis of a sparse blood sampling protocol.
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Affiliation(s)
- Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
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Di Paolo A, Bocci G, Polillo M, Del Re M, Di Desidero T, Lastella M, Danesi R. Pharmacokinetic and pharmacogenetic predictive markers of irinotecan activity and toxicity. Curr Drug Metab 2012; 12:932-43. [PMID: 21787264 DOI: 10.2174/138920011798062283] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/26/2011] [Accepted: 04/27/2011] [Indexed: 12/31/2022]
Abstract
After the rapid development of new classes of antineoplastic drugs, research activities have focused their efforts to the identification of predictive markers of drug activity and tolerability. Irinotecan (CPT-11) may induce severe toxicities (diarrhea, neutropenia) that limit its clinical use, but the increasing knowledge of its pharmacokinetics offered a potential approach to treatment optimization. Pharmacokinetics, the first area of investigation, has identified markers such as biliary index, the relative extent of conversion and the glucuronidation ratio, which are capable to define the risk for severe adverse effects. Because of the existence of some issues concerning the adoption of pharmacokinetic strategies to optimize CPT-11 dose and schedule, analyses of genetic polymorphisms seemed to offer a more reliable and safer approach for the identification of patients at risk than pharmacokinetics. In this view, the uridine diphosphate glucuronosil transferase isoform 1A1 (UGT1A1) was associated with significant changes in disposition of CPT-11 and its metabolites, and consequently with treatment-induced toxicities. However, the complex pharmacokinetics of irinotecan and the involvement of several enzymes other than UGT (i.e., carboxyl estherases, CYP450 isoforms), and transmembrane transporters (ABCB1, ABCC1, ABCG2, SLCO1B1) make difficult the identification of patients with an optimal sensitivity and specificity, and a large part of variability among patients still remains unexplained. Furthermore, prospective clinical studies that should demonstrate the reliability of those pharmacokinetic and pharmacogenetic markers are still lacking. In the present review, pharmacokinetic and pharmacogenetic markers will be discussed.
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Affiliation(s)
- Antonello Di Paolo
- Division of Pharmacology, Department of Internal Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
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Viaggi B, Paolo AD, Danesi R, Polillo M, Ciofi L, Tacca MD, Malacarne P. Linezolid in the central nervous system: Comparison between cerebrospinal fluid and plasma pharmacokinetics. ACTA ACUST UNITED AC 2011; 43:721-7. [DOI: 10.3109/00365548.2011.582140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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