在婴儿和儿童中使用布苏尔方剂量的新方法,该方法基于人口的药理动力学分析
Frank M Balis1,2, Elizabeth Rieger3, Nancy J Bunin3
1Division of Oncology, Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA. balisf@CHOP.edu.
种群的药理动力学建模细化了小儿病患者的布苏尔方剂量. 通过使用身体表面积 (BSA) 的新剂量策略,比传统的基于体重的剂量在显著更多的儿童中实现了治疗性布苏尔AUC.
科学领域:
- 药理动力学和药理动力学
- 儿科瘤学 儿科瘤学
- 药物的新陈代谢和处置
背景情况:
- 布苏尔是一种关键的化疗剂,用于血液造血干细胞移植的调节方案.
- 精确的布苏尔剂量是最大限度地提高疗效和最小化儿科患者的毒性至关重要的.
- 目前基于体重的剂量策略可能会导致某些儿科群体的非最佳暴露.
研究的目的:
- 将人口药理动力学建模应用于小儿治疗药物监测 (TDM) 数据集.
- 完善用于婴儿和接受移植的儿童的布苏尔剂量方法.
主要方法:
- 一个单间的药理动力学模型与来自328名儿科患者的TDM数据相匹配.
- 布苏尔方清除的年龄依赖性与体重与身体表面积 (BSA) 的比例相比较.
- 用BSA尺度剂量和BSA带剂量表来模拟布苏尔AUC,用于BSA<0.5m2的婴儿和儿童.
主要成果:
- 按体重扩展的布苏尔清除显示出显著的年龄依赖性,在年轻儿童中清除率更高.
- 在5岁以下的儿童中,有48%的儿童在基于体重的剂量下具有治疗次的布苏尔AUC.
- 与较小婴儿的BSA带表相结合的BSA缩放剂量,与基于体重的剂量相比,在49%的患者中实现了治疗AUC.
结论:
- 开发的模型预测在儿科患者中改善了治疗布苏尔AUC的实现.
- 建议使用100 mg/m2/day的BSA缩放剂量,并与BSA<0.5 m2的婴儿剂量表相结合.
- 这种精细的剂量策略增强了儿科busulfan治疗中的治疗药物暴露.
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