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用于估算接受延释型他克莫司制剂的肾移植受者他克莫司暴露量的有限采样策略。

Limited sampling strategies for estimation of tacrolimus exposure in kidney transplant recipients receiving extended-release tacrolimus preparation.

机构信息

Department of Clinical Pharmacology, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Institute of Medical and Biomedical Education, St. George's, University of London, London, UK.

出版信息

Clin Transl Sci. 2022 Jan;15(1):70-78. doi: 10.1111/cts.12990. Epub 2021 Nov 15.

Abstract

Tacrolimus is the key component of most contemporary immunosuppressive drug regimens for the prevention of transplant rejection. Area under the concentration time curve over 24 h (AUC ) predicts efficacy, but predose (trough) tacrolimus blood concentration (C ) is currently used to guide dosing. In clinical or research situations where an estimate of AUC is required, collection of a full 24 h pharmacokinetic (PK) profile is cumbersome. Limited sampling strategies (LSSs) have been developed for some tacrolimus preparations but not for the new, extended-release, once-daily formulation of tacrolimus, ENVARSUS XR. Twenty-four kidney transplant recipients were enrolled in this study. Twenty-four tacrolimus PK profiles were obtained over 24 h. Multiple linear regression was used to generate LSSs with the best subset selection for accurate estimation of tacrolimus AUC . The predictive performance of each model was assessed in the evaluation group. The correlation between actual and predicted AUC was evaluated and mean percentage prediction error (MPE%), mean absolute percentage prediction error (MAE%), and root mean squared error (RMSE) were calculated for each prediction model to assess bias and precision. The selected LSSs were highly correlated to AUC compared with the correlation between C and AUC . Two and three sampling points limited sampling strategies: C , C , and C provide the most reliable and effective LSS for estimation of tacrolimus AUC in routine clinic use. These limited sampling models can be applied in therapeutic drug monitoring schemes to personalize tacrolimus dosing for kidney transplant recipients on treatment with extended-release tacrolimus.

摘要

他克莫司是目前大多数预防移植排斥反应的免疫抑制药物方案的关键组成部分。24 小时浓度时间曲线下面积(AUC)可预测疗效,但目前仍使用预剂量(谷值)他克莫司血药浓度(C)来指导剂量。在需要估计 AUC 的临床或研究情况下,采集完整的 24 小时药代动力学(PK)曲线非常繁琐。已经为一些他克莫司制剂开发了有限采样策略(LSS),但尚未为新的、延长释放、每日一次的他克莫司制剂 ENVARSUS XR 开发。本研究纳入了 24 例肾移植受者。在 24 小时内获得了 24 例他克莫司 PK 曲线。采用多元线性回归方法,使用最佳子集选择生成 LSS,以准确估计他克莫司 AUC。在评估组中评估了每个模型的预测性能。评估了实际 AUC 和预测 AUC 之间的相关性,并计算了每个预测模型的平均预测误差百分比(MPE%)、平均绝对预测误差百分比(MAE%)和均方根误差(RMSE),以评估偏差和精度。与 C 与 AUC 之间的相关性相比,所选 LSS 与 AUC 高度相关。两种和三种采样点的有限采样策略:C、C 和 C 为常规临床应用中估算他克莫司 AUC 提供了最可靠和有效的 LSS。这些有限采样模型可应用于治疗药物监测方案中,以针对接受延长释放他克莫司治疗的肾移植受者进行个体化他克莫司剂量调整。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec29/8742643/a61a6e09bba8/CTS-15-70-g001.jpg

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