在接受维持血液透析的患者中,以模型为基础优化teicoplanin剂量
Sebastian T Tandar1, Arnaud De Clercq2, Linda B S Aulin1
1Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
概括
针对血液透析患者的优化Teicoplanin剂量提高了治疗成功率. 新的剂量策略和治疗药物监测 (TDM) 增强了泰可普拉宁.
科学领域:
- 药理动力学和药理动力学
- 传染病管理 传染病管理
- 脏替代疗法是指脏替代疗法.
背景情况:
- 血液透析 (HD) 患者需要有效治疗格兰阳性感染,通常是用teicoplanin.
- 替代疗法显著改变药物药理动力学 (PK),影响治疗疗效.
- 标准的提科普拉宁剂量可能在HD患者中不足于最佳,原因是PK发生变化.
研究的目的:
- 在接受维护性HD的患者中特征提科普拉宁PK.
- 为了确定teicoplanin PK.在人际变异性的预测因素.
- 开发一个基于证据的tiacoplanin剂量策略,用于HD患者.
主要方法:
- 在31名维持性高血压/血液过患者中进行前性观察性PK研究.
- 开发一个包含透析器流量的两部分人群PK模型.
- 蒙特卡洛模拟用于评估各种剂量方案的目标实现概率 (PTA) 和治疗药物监测 (TDM).
主要成果:
- 在HD/HDF群体中观察到高的提科普拉宁清除变异性.
- 在初始剂量后,标准每周三次剂量实现了低PTA (<50%).
- 建议的固定剂量疗法 (1600毫克加载,800毫克维持) 显著增加了PTA (>60%在第1周).
- 基于Cpredialysis的TDM进一步改善了PTA,达到>70%.
结论:
- 一个优化的提科普拉宁剂量策略,包括加载剂量和TDM,可以最大限度地提高HD患者的PTA.
- 在这个人群中,高个体间的PK变异性需要TDM才能有效地治疗teicoplanin.
- 在临床采用之前,建议对拟议的剂量策略进行前性验证.
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