建模和模拟,以告知阿皮克萨班在急性淋巴细胞白血病或淋巴细胞淋巴瘤治疗asparaginase的儿科的剂量
Praneeth Jarugula1, Toni Ajavon-Hartmann1, Obinna Obianom2
1Bristol Myers Squibb, Lawrenceville, New Jersey, USA.
Clinical pharmacology and therapeutics
|April 30, 2025
概括
阿皮克萨班显示出在患有白血病或淋巴瘤的儿童中预防血栓的潜力. 一个人群的药理动力学模型证实了儿童患者的适当剂量,支持其作为抗血栓治疗的使用.
科学领域:
- 药理学 药理学是指药理学的学科.
- 儿科瘤学 儿科瘤学
- 血液学 血液学 血液学
背景情况:
- 静脉血栓塞栓症 (VTE) 是患有急性淋巴细胞白血病 (ALL) 或淋巴细胞淋巴瘤 (LL) 的儿科患者的重大并发症.
- 标准的抗凝疗可能会在这个脆弱人群中带来风险.
- 直接口服抗凝剂阿皮克萨班正在儿童ALL/LL患者的VTE预防中进行研究.
研究的目的:
- 描述阿皮克萨班在患有ALL或LL的儿科患者群体药理动力学 (PPK).
- 评估这个队列中阿皮克萨班度和抗FXa活性 (AXA) 之间的关系.
- 确认一个分级的固定剂量疗法的适宜性,以达到目标的阿皮克萨班暴露.
主要方法:
- 使用PREVAPIXIII期研究的数据开发了一种更新的两部分人群药理动力学 (PPK) 模型.
- 共变量分析确定患者类型 (ALL/LL) 是影响阿皮克萨班吸收率 (Ka) 和中央分布体积 (Vc/F) 的重要因素.
- 药理动力学/药理动力学 (PK/PD) 分析使用线性回归来评估阿皮克萨班度与抗FXa活性之间的相关性.
主要成果:
- 与成人相比,儿童ALL/LL患者的Ka (52.4%低) 和Vc/F (43.1%低) 显著降低.
- 与其他儿科VTE风险组相比,ALL/LL患者的阿皮克萨班吸收率 (Ka) 显著较低 (81.1%较低).
- 模拟证实,拟议的固定剂量,重量分级疗法在儿科患者 (28天至<18岁) 中实现了目标阿皮克萨班暴露.
结论:
- 在儿科ALL/LL患者中,阿皮克萨班的药理动力学可变性受疾病类型的影响.
- 已建立的按重量分级的剂量方案确保了足够的阿皮克萨班暴露,用于预防儿科ALL/LL.LL.的VTE.
- 阿皮克萨班显示出作为ALL或LL的儿科患者有效的抗血栓剂的潜力.
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