在怀孕期间使用以生理学为基础的药物动力学建模用于通过肝脏清除的药物:监管视角
Paola Coppola1, Essam Kerwash1, Susan Cole1
1Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK.
基于生理学的药物动力学建模表明,预测怀孕期间药物暴露的变化是有前途的. 然而,目前的模型需要进一步改进,以准确地捕捉孕妇的药物代谢和暴露.
科学领域:
- 药理动力学和药物新陈代谢
- 怀孕和治疗方法 怀孕和治疗方法
- 计算机建模 计算建模
背景情况:
- 基于生理学上的药理动力学 (PBPK) 模型可以预测怀孕期间药物暴露的变化.
- 有限的临床数据往往会阻碍孕妇群体准确使用药物.
- 对于许多在怀孕期间使用的药物来说,肝清除机制是重要的.
研究的目的:
- 评估现有的PBPK模型在怀孕期间肝脏清除药物的预测性能.
- 确定目前用于预测孕妇药物暴露的PBPK模型的局限性.
- 为在怀孕期间使用更可靠的PBPK模型的开发提供信息.
主要方法:
- 对11种通过肝脏机制清除的药物 (metoprolol,tacrolimus,clindamycin,ondansetron,phenytoin,咖啡因,fluoxetine,clozapine,carbamazepine,metronidazole,paracetamol) 的PBPK模型的评估.
- 将怀孕期间已知的细胞P450 (CYP) 酶活性变化纳入现有模型.
- 评估模型捕捉趋势和药理动力学变化的大小的能力.
主要成果:
- 一般来说,PBPK模型在一定程度上捕获了怀孕期间暴露变化的趋势.
- 药物动力学变化的程度和整体人群暴露的程度没有得到一致的捕捉.
- 缺乏临床数据和复杂的药物清除途径 (CYP,UGT,载体) 限制了模型的可靠性.
结论:
- 目前的PBPK模型对怀孕期间的药物暴露提供了部分预测能力,但需要改进.
- 需要进一步研究包括尿素5'-二酸-葡萄糖转移酶 (UGT) 和输送器变化.
- 改进的PBPK模型对于提高孕妇药物的安全有效使用至关重要.
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