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更昔洛韦在成人肾移植受者中的应用:群体药代动力学及缬更昔洛韦给药后受者体内坎地昔韦浓度-时间曲线下面积的贝叶斯估算。

Population Pharmacokinetics and Bayesian Estimation of the Area Under the Concentration-Time Curve for Ganciclovir in Adult Chinese Renal Allograft Recipients After Valganciclovir Administration.

机构信息

Department of Pharmacy, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.

Center for Organ Transplantation, Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, P. R. China.

出版信息

J Clin Pharmacol. 2021 Mar;61(3):328-338. doi: 10.1002/jcph.1735. Epub 2020 Sep 14.

Abstract

Valganciclovir (VGCV) is the prodrug of ganciclovir (GCV). The objective of this study was to establish a population pharmacokinetic model (PPK) of GCV to investigate the PK characteristics of GCV after administration of VGCV in adult Chinese renal allograft recipients. Seventy Chinese renal allograft recipients were given 450 mg (n = 41) or 900 mg (n = 29) VGCV daily. Blood samples were drawn 0-24 hours after 5 days' therapy, and GCV plasma levels were determined. The PPK model was constructed using nonlinear mixed-effects modeling, and the Bayesian estimation of AUC was constructed for an individual patient based on limited plasma samples. The PK of GCV was best described by a 2-compartment model with a first-order absorption process. The CL/F, V /F, Q/F, V /F, K , and lag time of GCV were 15.8 ± 0.71 L/h, 10.9 ± 2.38 L, 3.98 ± 0.40 L/h, 167 ± 44.0 L, 0.23 ± 0.0078 1/h, and 0.93 ± 0.017 hours, respectively. Clearance of creatinine was found to have a significant impact on the CL/F of GCV (P < .01). Sampling strategies consisted of plasma concentrations 0 and 2 and 0, 2, and 4 hours after VGCV administration were shown to be suitable for the estimation of the GCV AUC . The PPK model was acceptable and can describe the PK of GCV in Chinese renal transplant patients administered VGCV. The AUC of GCV in Chinese renal transplant patients can be calculated by a limited sampling strategy method.

摘要

缬更昔洛韦(VGCV)是更昔洛韦(GCV)的前体药物。本研究的目的是建立更昔洛韦的群体药代动力学(PPK)模型,以研究成人肾移植受者给予 VGCV 后更昔洛韦的 PK 特征。70 例中国肾移植受者每天给予 450mg(n=41)或 900mg(n=29)VGCV。在 5 天治疗后 0-24 小时内抽取血样,并测定更昔洛韦的血浆水平。使用非线性混合效应模型构建 PPK 模型,并基于有限的血浆样本为个体患者构建 AUC 的贝叶斯估计。更昔洛韦的 PK 最好用一个 2 隔室模型来描述,其中包括一个一级吸收过程。更昔洛韦的 CL/F、V/F、Q/F、V/F、K 和滞后时间分别为 15.8±0.71 L/h、10.9±2.38 L、3.98±0.40 L/h、167±44.0 L、0.23±0.00781/h 和 0.93±0.017 小时。发现肌酐清除率对 GCV 的 CL/F 有显著影响(P<0.01)。结果表明,VGCV 给药后 0 和 2 小时以及 0、2 和 4 小时的血浆浓度采样策略适合估计 GCV AUC。该 PPK 模型是可接受的,可以描述中国肾移植患者给予 VGCV 后更昔洛韦的 PK。可以通过有限的采样策略方法计算中国肾移植患者的 GCV AUC。

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