在非洲人群中,以富马酸替诺福韦二吡呋酯或替诺福韦艾拉酚胺形式给予替诺福韦的群体药代动力学。
Population pharmacokinetics of tenofovir given as either tenofovir disoproxil fumarate or tenofovir alafenamide in an African population.
机构信息
Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
出版信息
CPT Pharmacometrics Syst Pharmacol. 2023 Jun;12(6):821-830. doi: 10.1002/psp4.12955. Epub 2023 Apr 4.
Tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) are prodrugs of the nucleotide analogue tenofovir, which acts intracellularly to inhibit HIV replication. Whereas TDF converts to tenofovir in plasma and may cause kidney and bone toxicity, TAF mostly converts to tenofovir intracellularly, so it can be administered at lower doses. TAF leads to lower tenofovir plasma concentrations and lower toxicity, but there are limited data on its use in Africa. We used data from 41 South African adults living with HIV from the ADVANCE trial and described, with a joint model, the population pharmacokinetics of tenofovir given as TAF or TDF. The TDF was modeled to appear in plasma as tenofovir with a simple first-order process. Instead, two parallel pathways were used for a TAF dose: an estimated 32.4% quickly appeared as tenofovir into the systemic circulation with first-order absorption, whereas the rest was sequestered intracellularly and released into the systemic circulation as tenofovir slowly. Once in plasma (from either TAF or TDF), tenofovir disposition followed two-compartment kinetics and had a clearance of 44.7 L/h (40.2-49.5), for a typical 70-kg individual. This semimechanistic model describes the population pharmacokinetics of tenofovir when dosed as either TDF or TAF in an African population living with HIV and can be used as a tool for exposure prediction in patients, and to simulate alternative regimes to inform further clinical trials.
富马酸替诺福韦二吡呋酯(TDF)和替诺福韦艾拉酚胺(TAF)是核苷酸类似物替诺福韦的前药,在细胞内发挥作用抑制 HIV 复制。虽然 TDF 在血浆中转化为替诺福韦,可能导致肾脏和骨骼毒性,但 TAF 主要在细胞内转化为替诺福韦,因此可以低剂量给药。TAF 导致替诺福韦的血浆浓度降低和毒性降低,但在非洲使用的数据有限。我们使用 ADVANCE 试验中来自 41 名南非 HIV 感染者的数据,并用联合模型描述了 TAF 或 TDF 给药时替诺福韦的群体药代动力学。TDF 被建模为以替诺福韦的简单一级过程出现在血浆中。相反,TAF 剂量使用了两种平行途径:估计 32.4%的 TAF 迅速以替诺福韦的形式出现在全身循环中,具有一级吸收,而其余的则被隔离在细胞内,并缓慢以替诺福韦的形式释放到全身循环中。一旦进入血浆(无论是来自 TAF 还是 TDF),替诺福韦的处置遵循双室动力学,清除率为 44.7 L/h(40.2-49.5),对于典型的 70 公斤个体。该半机械模型描述了在非洲 HIV 感染者中以 TDF 或 TAF 给药时替诺福韦的群体药代动力学,可以作为预测患者暴露的工具,并模拟替代方案,为进一步临床试验提供信息。