在2R2随机对照试验中,为结核病预防治疗使用标准剂量和高剂量里法辛的群体药动力学建模
Fajri Gafar1,2,3, Elin M Svensson4,5, Vycke Yunivita3,6
1Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
The Journal of infectious diseases
|January 27, 2026
概括
用于结核病预防疗法 (TPT) 的高剂量里法辛增加了药物暴露的比例. 各国之间观察到里芬素生物可用性的显著差异,影响了TPT的有效性.
科学领域:
- 药理动力学和药理动力学
- 传染性疾病 传染性疾病
- 药物开发 药物开发
背景情况:
- 高剂量里法西因显示有可能缩短结核病预防疗法 (TPT).
- 了解里芬素的药理动力学对于优化TPT疗法至关重要.
- 这项研究描述了结核病感染的个体中标准剂量和高剂量里法匹辛的种群药理动力学.
研究的目的:
- 描述TPT标准剂量和高剂量里法匹辛的种群药理动力学.
- 评估不同剂量方案对利芬素暴露的影响.
- 为了确定导致利芬素药理动力学变化的因素.
主要方法:
- 一个随机试验 (2R2) 比较了为期两个月的高剂量利芬素 (20或30毫克/公斤/天) 和为期四个月的标准剂量利芬素 (10毫克/公斤/天).
- 药物动力学子研究在印度尼西亚,加拿大和越南进行.
- 使用非线性混合效应建模来分析从密集和稀疏采样中获得的利法素的药理动力学.
主要成果:
- 一个带有过境区吸收和和性肝提取的单间模型最好地描述了 rifampicin 的药理动力学.
- 与印度尼西亚相比,在加拿大 (-21.8%) 和越南 (-12.3%) 观察到较低的生物可用性,可能是由于药物配方的差异.
- 度-时间曲线下的24小时区域与剂量相比增加了更多,印度尼西亚的暴露率更高,其次是越南和加拿大.
结论:
- 高剂量的利芬辛会导致暴露的比例增加,这是由于高剂量的非线性清除导致的.
- 观察到里芬素暴露在不同国家之间存在显著的差异.
- 诸如国家特定配方,无脂肪质量和未测量的混因素等因素可能导致观察到的药物动力学变异.
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