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作者信息

Cheng Shen, Flora Darcy R, Rettie Allan E, Brundage Richard C, Tracy Timothy S

机构信息

Metrum Research Group, United States.

Present Affiliation: GRYT Health Inc., United States.

出版信息

Drug Metab Dispos. 2022 Jul 7;50(9):1302-11. doi: 10.1124/dmd.122.000877.

Abstract

The objective of this study is to conduct a population pharmacokinetic (PK) model-based analysis on 10 warfarin metabolites (4'-, 6-, 7-, 8- and 10-hydroxylated (OH)-S- and R- warfarin), when warfarin is administered alone or together with either fluconazole or rifampin. One or two compartment PK models expanded from target mediated drug disposition (TMDD) models developed previously for warfarin enantiomers were able to sufficiently characterize the PK profiles of 10 warfarin metabolites in plasma and urine under different conditions. Model-based analysis shows CYP2C9 mediated metabolic elimination pathways are more inhibitable by fluconazole (% formation CL (CL) of 6- and 7-OH-S-warfarin decrease: 73.2% and 74.8%) but less inducible by rifampin (% CL of 6- and 7-OH-S-warfarin increase: 85% and 75%), compared with non-CYP2C9 mediated elimination pathways (% CL of 10-OH-S-warfarin and CL of S-warfarin decrease in the presence of fluconazole: 65.0% and 15.3%; % CL of 4'- 8- and 10-OH-S-warfarin increase in the presence of rifampin: 260%, 127% and 355%), which potentially explains the genotype-dependent DDIs exhibited by S-warfarin, when warfarin is administrated together with fluconazole or rifampin. Additionally, for subjects with and variants, a model-based analysis of warfarin metabolite profiles in subjects with various genotypes demonstrates CYP2C9 mediated elimination is less important and non-CYP2C9 mediated elimination is more important, compared with subjects without these variants. To our knowledge, this is so far one of the most comprehensive population-based PK analyses of warfarin metabolites in subjects with various genotypes under different co-medications. The studies we wish to publish are potentially impactful. The need for a TMDD pharmacokinetic model and the demonstration of genotyped-dependent drug interactions may explain the extensive variability in dose-response relationships that are seen in the clinical dose adjustments of warfarin.

摘要

本研究的目的是,在单独使用华法林或与氟康唑或利福平联合使用时,对10种华法林代谢产物(4'-、6-、7-、8-和10-羟基化(OH)-S-和R-华法林)进行基于群体药代动力学(PK)模型的分析。从先前为华法林对映体开发的目标介导药物处置(TMDD)模型扩展而来的一房室或二房室PK模型,能够充分表征不同条件下血浆和尿液中10种华法林代谢产物的PK曲线。基于模型的分析表明,与非CYP2C9介导的消除途径相比,CYP2C9介导的代谢消除途径更易被氟康唑抑制(6-和7-OH-S-华法林的%生成清除率(CL)降低:73.2%和74.8%),但较少被利福平诱导(6-和7-OH-S-华法林的%CL增加:85%和75%)(氟康唑存在时10-OH-S-华法林的%CL和S-华法林的CL降低:65.0%和15.3%;利福平存在时4'-、8-和10-OH-S-华法林的%CL增加:260%、127%和355%),这可能解释了华法林与氟康唑或利福平联合使用时S-华法林表现出的基因型依赖性药物相互作用。此外,对于携带 和 变体的受试者,对不同 基因型受试者的华法林代谢产物谱进行基于模型的分析表明,与没有这些变体的受试者相比,CYP2C9介导的消除不太重要,非CYP2C9介导的消除更重要。据我们所知,这是迄今为止在不同联合用药情况下,对不同 基因型受试者的华法林代谢产物进行的最全面的基于群体的PK分析之一。我们希望发表的这些研究可能具有重大影响。对TMDD药代动力学模型的需求以及基因型依赖性药物相互作用的证明,可能解释了华法林临床剂量调整中所见的剂量反应关系的广泛变异性。

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本文引用的文献

1
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Drug Metab Dispos. 2022 Jul 7;50(9):1287-301. doi: 10.1124/dmd.122.000876.
2
Warfarin dosing algorithms: A systematic review.华法林剂量算法:系统评价。
Br J Clin Pharmacol. 2021 Apr;87(4):1717-1729. doi: 10.1111/bcp.14608. Epub 2020 Nov 18.

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