在疟疾负担较高的国家,优化针对幼儿的卢梅芬林剂量,使用药理动力学模拟
Segolene Simeon1, Emma Hughes1, Erika Wallender2
1Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA.
对5岁以下儿童进行调整的阿尔特梅瑟-卢梅方特林剂量显著改善了疟疾治疗结果. 修改后的治疗方案,特别是对于营养不良的儿童,可以提高药物的疗效,降低治疗失败率.
科学领域:
- 药理动力学和药理动力学
- 全球健康 全球健康
- 儿童传染病 儿童传染病
背景情况:
- 阿尔特梅瑟-卢梅芬特林是治疗无并发性疟疾的首要疗法,剂量由世界卫生组织 (WHO) 的体重范围指导.
- 儿童,特别是体重不足的儿童,在标准体重组方案中容易出现低剂量.
- 低于最佳剂量增加了疟疾治疗失败的风险和药物耐药性的发展.
研究的目的:
- 评估调整的阿尔特梅瑟-卢梅方丁剂量策略对达到治疗性卢梅方丁度和预防5岁以下儿童再次感染的影响.
- 为了比较世卫组织推的剂量与替代方案的疗效,包括扩展,增加,加强,以及营养不良儿童的体重与年龄相关的剂量.
主要方法:
- 在25个疟疾负担较高的国家,使用人口和健康调查分析了372,363名儿童 (<5岁) 的营养数据.
- 一个群体的药理动力学模型模拟了第7天度 (≥200 ng/mL) 和42天无疟疾状态的达到.
- 模拟包括世卫组织标准剂量,延长,增加,强化方案,以及基于年龄预期体重的营养不良儿童替代方法.
主要成果:
- 世界卫生组织的标准剂量在75%的儿童中达到目标的卢梅芬林水平,在77%的儿童中达到42天的无疟疾水平.
- 替代剂量方法增加了5%的目标水平的实现;与扩展方案相结合,它将水平提高到97%.
- 替代剂和延长剂的组合导致88%的儿童在42天内保持无疟疾.
结论:
- 目前的重量级剂量对小孩和体重不足的儿童来说是不够的,导致治疗药物水平低于最佳水平.
- 调整剂量策略,特别是基于年龄预期体重的营养不良儿童延长疗程,显著改善了治疗结果.
- 需要进一步的临床试验来验证扩展剂量方案,以适应疟疾流行地区儿童的营养状况.
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