Wang Yanlin, Wang Xiaofeng, Larsen Frank, Cahill Dana, Zoubroulis Argie, Ward Caroline, Kohegyi Eva, Raoufinia Arash
Otsuka Pharmaceutical Development & Commercialization Inc., Princeton, NJ, USA.
H. Lundbeck A/S, Valby, Denmark.
J Clin Pharmacol. 2023 Nov;63(11):1290-1299. doi: 10.1002/jcph.2307. Epub 2023 Aug 1.
Due to the customary delay between medication approvals in adult and adolescent populations, adolescents with schizophrenia may receive off-label antipsychotic treatment, without empirically justified dosing recommendations. In order to accelerate pediatric drug development, the US Food and Drug Administration (FDA) released a general advice letter to sponsors permitting the effectiveness of atypical antipsychotics for the treatment of schizophrenia in adults to be extrapolated to adolescents based on a pharmacokinetic (PK) analysis to support dose selection, plus a safety study. The aim of the present article is to describe the population PK analysis that was submitted to the FDA to inform brexpiprazole dose selection in adolescents with schizophrenia. Using a population PK model with brexpiprazole clearance and volume of distribution allometrically scaled by body weight, PK simulations showed comparable brexpiprazole dose-exposure between adults and adolescents aged 13-17 years following oral daily doses of brexpiprazole 1-4 mg, indicating that the target brexpiprazole dose of 2-4 mg/day in adults with schizophrenia is also suitable for adolescents. Based on this population PK analysis, together with a safety study in adolescents, the FDA approved brexpiprazole for the treatment of schizophrenia in adolescents aged 13-17 years, via extrapolation of the efficacy of brexpiprazole from adults to adolescents.
由于成人和青少年群体在药物批准方面存在惯常延迟,患有精神分裂症的青少年可能会接受未经验证的非标签抗精神病药物治疗,且没有基于经验的合理给药建议。为了加速儿科药物开发,美国食品药品监督管理局(FDA)向申办者发布了一封通用建议信,允许根据药代动力学(PK)分析将成人非典型抗精神病药物治疗精神分裂症的有效性外推至青少年,以支持剂量选择,同时进行一项安全性研究。本文的目的是描述提交给FDA的群体PK分析,以指导在患有精神分裂症的青少年中选择布雷哌唑的剂量。使用一个群体PK模型,其中布雷哌唑清除率和分布容积根据体重进行异速缩放,PK模拟显示,口服每日剂量为1-4mg的布雷哌唑后,成人与13-17岁青少年之间的布雷哌唑剂量-暴露情况具有可比性,这表明精神分裂症成人患者中2-4mg/天的目标布雷哌唑剂量也适用于青少年。基于这一群体PK分析,以及一项针对青少年的安全性研究,FDA通过将布雷哌唑在成人中的疗效外推至青少年,批准了布雷哌唑用于治疗13-17岁青少年的精神分裂症。
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