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日本受试者多利培南的群体药代动力学及肾功能损害患者的蒙特卡罗模拟

Population pharmacokinetics of doripenem in Japanese subjects and Monte-Carlo simulation for patients with renal impairment.

机构信息

Clinical Pharmacology & Pharmacokinetics, Clinical Research Department, Shionogi & Co., Ltd., Japan.

Clinical Pharmacology & Pharmacokinetics, Clinical Research Department, Shionogi & Co., Ltd., Japan.

出版信息

J Infect Chemother. 2015 Feb;21(2):123-9. doi: 10.1016/j.jiac.2014.10.014. Epub 2014 Nov 11.

Abstract

Integrated analysis of all plasma concentration data obtained from phase 1 studies in Japanese subjects, including a high dose study and special population studies, was conducted to thoroughly re-investigate the pharmacokinetics of doripenem by means of a population approach. Dose adjustments for patients with renal impairment were assessed by Monte-Carlo pharmacokinetics/pharmacodynamics simulation. The population pharmacokinetics of doripenem was evaluated using 921 plasma concentration data from 92 subjects from eight phase 1 studies in Japan. The two-compartment model could well describe the plasma concentration profile of doripenem after intravenous infusion. Creatinine clearance and age were found to be covariates of doripenem clearance, and creatinine clearance was the most important factor influencing the pharmacokinetics of doripenem, which is consistent with the fact that doripenem is mainly excreted via the urine. Simulations suggest that exposures (AUC) to 1 g every 8 h for patients with normal renal function would be similar to those expected at 1 g every 12 h, 0.5 g every 8 h and 0.25 g every 8 h for patients with mild, moderate and severe renal impairment, respectively. These dosing regimens also provide sufficient exposure to doripenem from the viewpoint of the percentage of time above the minimum inhibitory concentration.

摘要

对来自日本受试者的 1 期研究(包括高剂量研究和特殊人群研究)的所有血浆浓度数据进行了综合分析,通过群体分析方法彻底重新研究了多利培南的药代动力学。通过蒙特卡罗药代动力学/药效学模拟评估了肾功能损害患者的剂量调整。使用来自日本的 8 项 1 期研究的 92 名受试者的 921 个血浆浓度数据评估了多利培南的群体药代动力学。二室模型可很好地描述多利培南静脉输注后的血浆浓度曲线。发现肌酐清除率和年龄是多利培南清除率的协变量,而肌酐清除率是影响多利培南药代动力学的最重要因素,这与多利培南主要通过尿液排泄的事实一致。模拟表明,对于肾功能正常的患者,每 8 小时给予 1 g 的暴露(AUC)与每 12 小时给予 1 g、每 8 小时给予 0.5 g 和每 8 小时给予 0.25 g 的预期暴露相似,分别为轻度、中度和重度肾功能损害。从最低抑菌浓度以上时间百分比的角度来看,这些给药方案也为多利培南提供了足够的暴露。

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