Scheier Joerg, Nelson Peter J, Schneider Antoine, Colombier Sébastien, Kindgen-Milles Detlef, Deliargyris Efthymios N, Nolin Thomas D
CytoSorbents Europe GmbH, Berlin, Germany.
CytoSorbents Corporation, Monmouth Junction, NJ.
Crit Care Explor. 2022 May 9;4(5):e0688. doi: 10.1097/CCE.0000000000000688. eCollection 2022 May.
The CytoSorb hemoadsorption device (CytoSorbents Inc, Monmouth Junction, NJ) is increasingly used in many critical disease states. The potential impact on the pharmacokinetic (PK) of concomitantly administered drugs must be considered in clinical practice. The current review summarizes relevant mechanistic principles, available preclinical and clinical data, and provides general guidance for the management of concomitant drug administration during CytoSorb therapy.
Detailed search strategy using the PubMed and OVID MEDLINE databases, as well as presented congress abstracts for studies on drug removal by the CytoSorb device.
Human, animal, and bench-top studies with PK or drug-removal data during CytoSorb therapy were selected for inclusion. Publications reporting on CytoSorb treatments for drug overdose were not considered.
Relevant PK data were examined and synthesized for narrative review.
To date, PK data during CytoSorb hemoadsorption are available for more than 50 drugs, including analgesics, antiarrhythmics, anticonvulsants, antidepressants, antihypertensives, antiinfectives, antithrombotics, anxiolytics, and immunosuppressants. Based on available PK data, drugs were categorized into low (<30%), moderate (30-60%), or high rates of removal (>60%), or, alternatively, according to clearance increase relative to endogenous clearance: negligible (<25%), low (25-100%), moderate (100-400%), or high (>400%). In most reports, additional impact of the extracorporeal platform where CytoSorb was integrated was not available. Based on available data and considering drug, patient, and setup-specific aspects, general dosing guidance for clinical practice was developed.
CytoSorb therapy may increase drug elimination through active removal. However, the extent of removal is heterogeneous, and its clinical significance, if any, depends on the broader clinical context, including a patient's specific endogenous drug clearance and the underlying extracorporeal platform used. The available data, although not definitive, allow for general guidance on dosing adjustments during CytoSorb therapy; however, any treatment decisions should always be complemented by clinical judgment and therapeutic drug monitoring, when available.
CytoSorb血液吸附装置（CytoSorbents公司，新泽西州蒙茅斯章克申）在许多危重病状态下的使用日益增多。在临床实践中必须考虑其对同时使用药物的药代动力学（PK）的潜在影响。本综述总结了相关的作用机制原理、现有的临床前和临床数据，并为CytoSorb治疗期间同时用药的管理提供了一般指导。
使用PubMed和OVID MEDLINE数据库进行详细检索，并查阅了关于CytoSorb装置药物清除研究的会议摘要。
纳入了在CytoSorb治疗期间有PK或药物清除数据的人体、动物和台架研究。未考虑关于CytoSorb治疗药物过量的报道。
检查并综合相关PK数据进行叙述性综述。
迄今为止，已有超过50种药物在CytoSorb血液吸附期间的PK数据，包括镇痛药、抗心律失常药、抗惊厥药、抗抑郁药、抗高血压药、抗感染药、抗血栓药、抗焦虑药和免疫抑制剂。根据现有的PK数据，将药物分为低清除率（<30%）、中等清除率（30 - 60%）或高清除率（>60%），或者根据相对于内源性清除率的清除率增加情况分类：可忽略不计（<25%）、低（25 - 100%）、中等（100 - 400%）或高（>400%）。在大多数报告中，未提供整合了CytoSorb的体外平台的额外影响。根据现有数据并考虑药物、患者和设备特定方面，制定了临床实践的一般给药指导。
CytoSorb治疗可能通过主动清除增加药物消除。然而，清除程度存在异质性，其临床意义（如果有的话）取决于更广泛的临床背景，包括患者特定的内源性药物清除率和所使用的基础体外平台。现有数据虽然不确切，但可为CytoSorb治疗期间的剂量调整提供一般指导；然而，任何治疗决策都应始终辅以临床判断和治疗药物监测（如有）。
