Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK,
J Pharmacokinet Pharmacodyn. 2014 Apr;41(2):159-71. doi: 10.1007/s10928-014-9354-4. Epub 2014 Mar 21.
Methotrexate is an antimetabolite and antifolate drug that is widely used in the treatment of malignancies and auto-immune disorders. In childhood acute lymphoblastic leukaemia, methotrexate is often combined with 6-mercaptopurine and both of them have been shown to be very effective for maintenance of remission. Large variability in the pharmacokinetics of methotrexate has led to increasing use of therapeutic drug monitoring in its clinical use to identify patients with high risk of toxicity and optimise clinical outcome. A physiologically based pharmacokinetic model was developed for methotrexate for oral and intravenous dosing and adults and paediatric use. The model has compartments for stomach, gut lumen, enterocyte, gut tissue, spleen, liver vascular, liver tissue, gall bladder, systemic plasma, red blood cells, kidney vascular, kidney tissue, skin, bone marrow, thymus, muscle and rest of body. A mechanistic model was also developed for the kidney to account for renal clearance of methotrexate via filtration and secretion. Variability on system and drug specific parameters was incorporated in the model to reflect observed clinical data and assuming the same pathways in adults and children, age-dependent changes in body size, organ volumes and plasma flows, the model was scaled to children. The model was developed successfully for adults and parameters such as net secretion clearance, biliary transit time and red blood cell distribution and binding parameters were estimated from published adult profiles. A relationship between fraction absorbed and dose using reported mean bioavailability data in the literature was also established. The model also incorporates non-linear binding in some tissues that has been described in the literature. Predictions using this model provide adequate description of observed plasma concentration data in adults and children. The model can be used to predict plasma and tissue concentrations of methotrexate following intravenous and oral dosing in adults and children and therefore help to improve clinical outcome.
甲氨蝶呤是一种抗代谢物和叶酸拮抗剂药物,广泛用于治疗恶性肿瘤和自身免疫性疾病。在儿童急性淋巴细胞白血病中,甲氨蝶呤常与 6-巯基嘌呤联合使用,两者均被证明对缓解维持非常有效。甲氨蝶呤药代动力学的较大变异性导致在其临床应用中越来越多地使用治疗药物监测来识别毒性风险高的患者,并优化临床结果。已经为口服和静脉给药的甲氨蝶呤以及成人和儿科用途开发了基于生理学的药代动力学模型。该模型有胃、肠腔、肠细胞、肠组织、脾、肝血管、肝组织、胆囊、全身血浆、红细胞、肾血管、肾组织、皮肤、骨髓、胸腺、肌肉和身体其余部分的隔室。还为肾脏开发了一个机制模型,以解释甲氨蝶呤通过过滤和分泌的肾清除。在模型中纳入了系统和药物特异性参数的变异性,以反映观察到的临床数据,并假设成人和儿童具有相同的途径,随着年龄的增长,身体大小、器官体积和血浆流量发生变化,模型按比例缩小到儿童。该模型在成人中成功开发,并且从已发表的成人资料中估计了净分泌清除率、胆汁转运时间和红细胞分布以及结合参数等参数。还建立了使用文献中报告的平均生物利用度数据的吸收分数与剂量之间的关系。该模型还包含了文献中描述的一些组织中的非线性结合。该模型对成人和儿童的观察到的血浆浓度数据的预测提供了足够的描述。该模型可用于预测成人和儿童静脉内和口服给药后甲氨蝶呤的血浆和组织浓度,从而有助于改善临床结果。