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健康人群中替考拉宁静脉给药的群体药代动力学模型,用于评估组织暴露情况。

A population pharmacokinetic model of intravenous telavancin in healthy individuals to assess tissue exposure.

机构信息

Department I of Pharmacology, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, University of Cologne, Gleueler Straße 24, 50931, Cologne, Germany.

Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

出版信息

Naunyn Schmiedebergs Arch Pharmacol. 2019 Sep;392(9):1097-1106. doi: 10.1007/s00210-019-01647-w. Epub 2019 May 6.

Abstract

Non-compartmental analysis of telavancin microdialysis data indicated a sustained exposure in soft tissues and that unbound plasma concentrations were underestimated in vitro. The objective of the present evaluation was to develop a population pharmacokinetic model of telavancin to describe its plasma protein binding, its distribution into muscle, and subcutaneous tissue and to predict pharmacokinetic/-dynamic target attainment (PTA). Total plasma concentrations and microdialysate concentrations (plasma, subcutaneous, and muscle tissue) were available up to 24 h (plasma microdialysate, up to 8 h) post-dose from eight healthy subjects after a single intravenous infusion of 10 mg/kg telavancin. Population pharmacokinetic modeling and simulations were performed using NONMEM. A two-compartment model with saturable protein binding best described plasma concentrations. Plasma unbound fractions at steady state were 23, 15, and 11% at 100, 50, and 10% of the maximum predicted concentrations respectively. Distribution into muscle and subcutaneous tissue was non-linear and described appropriately by one additional compartment each. Based on total plasma concentrations, predicted median (95% confidence interval) values of AUC/MIC (MIC 0.125 mg/L, clinical breakpoint for MRSA) at steady state were 4009 [3421-4619] with a PTA of 96 [78-100] %. The fAUC/MIC in muscle was 496 [227-1232] with a PTA of 100 [98-100] %. The %fT was approximately 100% in plasma and interstitial space fluid of muscle and subcutaneous tissues up to an MIC of 0.25 mg/L. The model provided a new hypothesis on telavancin plasma protein binding in vivo. Proposed pharmacodynamic targets in plasma and muscle are achieved with currently approved doses of 10 mg/kg daily.

摘要

非房室分析替拉万星微透析数据表明,在软组织中有持续的暴露,并且未结合的血浆浓度在体外被低估。本评估的目的是建立替拉万星的群体药代动力学模型,以描述其与蛋白的结合、在肌肉和皮下组织中的分布,并预测药代动力学/药效学目标达标率(PTA)。在单剂量 10mg/kg 替拉万星静脉输注后,8 名健康受试者在 24 小时内(血浆微透析液,长达 8 小时)提供了总血浆浓度和微透析液浓度(血浆、皮下和肌肉组织)。使用 NONMEM 进行群体药代动力学建模和模拟。一个具有饱和蛋白结合的两室模型最佳地描述了血浆浓度。在稳态时,血浆未结合分数分别为 100、50 和 10%最大预测浓度时的 23、15 和 11%。向肌肉和皮下组织的分布是非线性的,每个部位各有一个额外的隔间来适当描述。基于总血浆浓度,稳态时 AUC/MIC(MIC0.125mg/L,MRSA 的临床折点)的预测中位数(95%置信区间)值为 4009[3421-4619],PTA 为 96[78-100]%。肌肉中的 fAUC/MIC 为 496[227-1232],PTA 为 100[98-100]%。在 MIC 达到 0.25mg/L 时,在血浆和肌肉间质空间液体中,%fT 约为 100%。该模型提供了替拉万星体内蛋白结合的新假说。目前批准的每日 10mg/kg 剂量可在血浆和肌肉中达到拟议的药效学目标。

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