从含有埃法维伦兹的疗法转换后肌肉内卡博特格拉维尔和里尔皮维林度
Sara Bettonte1,2, Mattia Berton1,2, Felix Stader3
1Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.
British journal of clinical pharmacology
|July 31, 2023
概括
在 efavirenz 后切换到注射式卡博特格拉维尔/里尔皮维林 (IM CAB/RPV) 是安全的. 基于生理学的药物动力学建模表明药物水平仍然有效,在过渡期间避免低于最佳度.
科学领域:
- 药理学 药理学是指药理学的学科.
- 药理动力学 药理动力学
- 艾滋病毒治疗 艾滋病毒治疗
背景情况:
- 肌肉内注射卡博特格拉维尔/里尔皮维林 (IM CAB/RPV) 是用于治疗艾滋病毒的长效注射药物.
- 已知伊法维伦兹诱导UGT1A1和CYP3A4酶,这些酶会代谢IM CAB/RPV.
- 从efavirenz切换到IM CAB/RPV可能会导致因酶诱导而导致低于最佳的药物水平.
研究的目的:
- 模拟从 efavirenz 切换到 IM CAB/RPV. 的药理动力学特征.
- 在此切换过程中使用生理学基础的药理动力学 (PBPK) 建模来评估低于最佳药物度的风险.
- 为了评估这种过渡在广泛和缓慢的efavirenz代谢者的安全性.
主要方法:
- 针对IM卡博特格拉维尔,IM rilpivirine 和 efavirenz 开发并对临床数据进行验证的PBPK模型.
- 验证了PBPK模型在从efavirenz转换到其他抗逆转录病毒药物期间预测药物相互作用的能力.
- 在停止服用埃法维伦兹后的虚拟队列中,模拟IM CAB/RPV度,考虑不同的代谢剂状态.
主要成果:
- 预测在停止 efavirenz 治疗后,IM CAB 度的适度下降 (11% 在第一天,13% 在第七天,8% 在第14天).
- 在整个转换期间,模拟的CAB度保持在最低疗效值 (664 ng/mL) 以上.
- IM RPV度略有下降,在efavirenz后的第7天最低的下降率为10%.
结论:
- 从基于efavirenz的疗法转换为IM CAB/RPV,不太可能导致药物水平低于最佳水平的时期.
- PBPK 建模支持此开关的安全性,保持治疗药物度.
- 对于患者来说,无论他们的efavirenz代谢器状态如何,过渡被认为是安全的.
相关概念视频
Subviral Agents
42
Subviral agents are infectious entities that resemble viruses but lack one or more viral components, such as a capsid or essential replication machinery. These agents include viroids, prions, and satellites, each possessing distinct structural and functional characteristics that influence their mode of infection and replication.Viroids are the simplest subviral agents, consisting of circular, single-stranded RNA molecules without a protein coat. They exclusively infect plants, relying entirely...
42
Retroviruses
12.4K
Retroviruses and retrotransposons both insert copies of their genetic elements into the genome of the host cell. Thus, the viral genes are passed on when the host genome is replicated or translated. A typical retroviral DNA sequence contains 3-4 genes that encode the different proteins required for its structural assembly and function as a molecular parasite. This DNA is transcribed into a single mRNA, which is very similar in structure to conventional mRNAs, i.e., it is capped at the 5’...
12.4K
Hepatic Drug Excretion: Enterohepatic Cycling
1.6K
Enterohepatic cycling involves the active secretion of drugs and their metabolites into the bile via transporters in the canalicular membrane of hepatocytes. This secretion is an integral part of the digestive process, releasing these substances into the gastrointestinal (GI) tract.
Post-release drugs and metabolites can be reabsorbed into the body from the intestine. For conjugated metabolites like glucuronides, reabsorption requires enzymatic hydrolysis by intestinal microflora. This...
Post-release drugs and metabolites can be reabsorbed into the body from the intestine. For conjugated metabolites like glucuronides, reabsorption requires enzymatic hydrolysis by intestinal microflora. This...
1.6K
Drug Dosage Regimen: Overview
3.6K
A drug dosage regimen describes the specific instructions and schedule for administering a drug to a patient. It considers factors such as drug dosage, frequency, route of administration, and duration of treatment. Designing an appropriate dosage regimen for a patient aims to achieve a target drug concentration at the site of action.
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...
3.6K
Hepatic Drug Excretion: Influencing Factors
155
The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
155
Retrovirus Life Cycles
46.2K
Retroviruses have a single-stranded RNA genome that undergoes a special form of replication. Once the retrovirus has entered the host cell, an enzyme called reverse transcriptase synthesizes double-stranded DNA from the retroviral RNA genome. This DNA copy of the genome is then integrated into the host’s genome inside the nucleus via an enzyme called integrase. Consequently, the retroviral genome is transcribed into RNA whenever the host’s genome is transcribed, allowing the...
46.2K


