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丁丙诺啡在成人、儿童和早产新生儿中的基于生理的药代动力学(PBPK)建模

Physiologically-Based Pharmacokinetic (PBPK) Modeling of Buprenorphine in Adults, Children and Preterm Neonates.

作者信息

Kovar Lukas, Schräpel Christina, Selzer Dominik, Kohl Yvonne, Bals Robert, Schwab Matthias, Lehr Thorsten

机构信息

Department of Clinical Pharmacy, Saarland University, 66123 Saarbrücken, Germany.

Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany.

出版信息

Pharmaceutics. 2020 Jun 23;12(6):578. doi: 10.3390/pharmaceutics12060578.

Abstract

Buprenorphine plays a crucial role in the therapeutic management of pain in adults, adolescents and pediatric subpopulations. However, only few pharmacokinetic studies of buprenorphine in children, particularly neonates, are available as conducting clinical trials in this population is especially challenging. Physiologically-based pharmacokinetic (PBPK) modeling allows the prediction of drug exposure in pediatrics based on age-related physiological differences. The aim of this study was to predict the pharmacokinetics of buprenorphine in pediatrics with PBPK modeling. Moreover, the drug-drug interaction (DDI) potential of buprenorphine with CYP3A4 and P-glycoprotein perpetrator drugs should be elucidated. A PBPK model of buprenorphine and norbuprenorphine in adults has been developed and scaled to children and preterm neonates, accounting for age-related changes. One-hundred-percent of the predicted AUC values in adults (geometric mean fold error (GMFE): 1.22), 90% of individual AUC predictions in children (GMFE: 1.54) and 75% in preterm neonates (GMFE: 1.57) met the 2-fold acceptance criterion. Moreover, the adult model was used to simulate DDI scenarios with clarithromycin, itraconazole and rifampicin. We demonstrate the applicability of scaling adult PBPK models to pediatrics for the prediction of individual plasma profiles. The novel PBPK models could be helpful to further investigate buprenorphine pharmacokinetics in various populations, particularly pediatric subgroups.

摘要

丁丙诺啡在成人、青少年和儿童亚人群的疼痛治疗管理中起着关键作用。然而,关于丁丙诺啡在儿童尤其是新生儿中的药代动力学研究很少,因为在这一人群中进行临床试验特别具有挑战性。基于生理的药代动力学(PBPK)模型能够根据与年龄相关的生理差异预测儿科患者的药物暴露情况。本研究的目的是通过PBPK模型预测丁丙诺啡在儿科患者中的药代动力学。此外,还应阐明丁丙诺啡与CYP3A4和P-糖蛋白作用药物之间的药物-药物相互作用(DDI)潜力。已建立了成人丁丙诺啡和去甲丁丙诺啡的PBPK模型,并根据与年龄相关的变化将其扩展到儿童和早产新生儿。成人预测的AUC值的100%(几何平均倍数误差(GMFE):1.22)、儿童个体AUC预测值的90%(GMFE:1.54)和早产新生儿的75%(GMFE:1.57)符合2倍接受标准。此外,成人模型用于模拟与克拉霉素、伊曲康唑和利福平的DDI情况。我们证明了将成人PBPK模型扩展到儿科以预测个体血浆谱的适用性。新型PBPK模型可能有助于进一步研究丁丙诺啡在不同人群尤其是儿科亚组中的药代动力学。

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