开发和验证一个人群的药理动力学模型,以指导肺移植后的外科手术期间的塔克罗利斯剂量
Todd A Miano1,2, Athena F Zuppa3, Rui Feng1
1Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
肺移植后的塔克罗利斯清除值显著变化. 纳入患者因素的种群药动力学模型可以帮助个性化塔克罗利斯剂量,以获得更好的结果.
科学领域:
- 药理动力学 药理动力学
- 免疫抑制是一种免疫抑制.
- 移植医学 移植医学 移植医学
背景情况:
- 塔克罗利马斯是肺移植后的主要免疫抑制剂.
- 早期塔克罗利斯暴露的变化与不良结果有关.
- 有限的数据存在于早期的肺移植后塔克罗利斯的药理动力学.
研究的目的:
- 在早期的肺移植后接受者中开发塔克罗利斯的种群药动力学模型.
- 确定影响该群体中塔克罗利斯清除的关键共变量.
主要方法:
- 对270名肺移植接受者的回顾性药理动力学研究.
- 非线性混合效应建模以创建一个人群PK模型.
- 在114名患者的单独队列中进行验证;进行共变量分析.
主要成果:
- 开发了一种具有固定的吸收率的1个隔间模型.
- 手术后的一天,血值,移植类型,CYP3A5基因型,体重和CYP抑制剂药物暴露影响了塔克罗利斯的清除.
- 术后第14天,塔克罗利斯清除量增加了3倍以上.
结论:
- 在肺移植后的早期阶段,塔克罗利斯清除非常动态.
- 具有移植特异性共变量的群体PK模型可以提供精确剂量的信息.
- 需要进一步的多中心研究来完善这些模型.
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