Zhang Chun-Yan, Gu Jian, Li Yu-Zhen, Lu Wei
Department of Pharmacy, People Hospital, Peking University, Beijing 100044, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2008 Feb;16(1):106-10.
The aim of this study was to investigate the population pharmacokinetic characteristics of high-dose methotrexate (HDMTX) administered in children with acute lymphoblastic leukemia (ALL) for individualizing methotrexate dose regimen with routine plasma concentration data. The data of 329 children with acute lymphoblastic leukemia administering HDMTX in hospital were collected from 2003 to 2006. Population pharmacokinetics model, parameters, inter-and intra-individual variation were estimated by nonlinear mixed effect modes (NONMEM) software. The effects of the covariates including sex, age, body weight, alkalization and hydration volumes as well as biochemical parameters on the clearance and apparent volume of distribution of methotrexate were explored and the final model was established. The results showed that according to one compartment open pharmacokinetic model with first-order absorption and first-order elimination used in the modeling procedure, the factor that significantly influenced the clearance and apparent volume of distribution of methotrexate was weight (p<0.05). The final model in this study was: CL=7.0 x [1 + 0.0218 x (WT-31.1)] x EXP (eta(CL)) (L/h); V=32.8 x [1 + 0.0288 x (WT-31.1)] x EXP (eta(V)) (L), where 31.1 (kg) was the average body weight of the population. The inter individual variation (CV) of CL and V were 19.4% and 31.0% respectively. It is concluded that the population pharmacokinetic model of HDMTX in children with ALL is established. The obtained final model and population pharmacokinetics parameters of methotrexate may be useful for individualization treatment.
本研究旨在探讨大剂量甲氨蝶呤(HDMTX)在急性淋巴细胞白血病(ALL)患儿中的群体药代动力学特征,以便利用常规血浆浓度数据个体化甲氨蝶呤给药方案。收集了2003年至2006年在医院接受HDMTX治疗的329例急性淋巴细胞白血病患儿的数据。采用非线性混合效应模型(NONMEM)软件估算群体药代动力学模型、参数、个体间和个体内变异。探讨了性别、年龄、体重、碱化和水化量以及生化参数等协变量对甲氨蝶呤清除率和表观分布容积的影响,并建立了最终模型。结果表明,在建模过程中采用具有一级吸收和一级消除的一室开放药代动力学模型,显著影响甲氨蝶呤清除率和表观分布容积的因素是体重(p<0.05)。本研究的最终模型为:CL = 7.0 x [1 + 0.0218 x (WT - 31.1)] x EXP (eta(CL)) (L/h);V = 32.8 x [1 + 0.0288 x (WT - 31.1)] x EXP (eta(V)) (L),其中31.1(kg)为群体平均体重。CL和V的个体间变异(CV)分别为19.4%和31.0%。结论是建立了ALL患儿HDMTX的群体药代动力学模型。所获得的甲氨蝶呤最终模型和群体药代动力学参数可能有助于个体化治疗。