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英夫利昔单抗治疗炎症性肠病:在临床环境中利用基于生理的药代动力学模型

Infliximab in Inflammatory Bowel Disease: Leveraging Physiologically Based Pharmacokinetic Modeling in the Clinical Context.

作者信息

Petric Zvonimir, Gonçalves João, Paixão Paulo

机构信息

Department of Pharmacological Sciences, Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, 1649-004 Lisbon, Portugal.

Biopharmaceutical and Molecular Biotechnology Unit, Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, 1649-004 Lisbon, Portugal.

出版信息

Biomedicines. 2024 Sep 1;12(9):1974. doi: 10.3390/biomedicines12091974.

Abstract

In this study, a physiologically based pharmacokinetic (PBPK) modeling framework was employed to explore infliximab exposure following intravenous (5 mg/kg) and subcutaneous administration (encompassing the approved 120 mg flat-fixed dose as a switching option) in virtual adult and pediatric patients with inflammatory bowel disease (IBD). The PBPK model and corresponding simulations were conducted using the PK-Sim software platform. The PBPK simulation indicated that a 120 mg subcutaneous flat-fixed dose might not be optimal for heavier adults with IBD, suggesting the need for infliximab dose escalation. For an older virtual pediatric patient (14 years old), subcutaneous administration of a 120 mg flat-fixed dose appears to be a feasible IBD treatment option. In the final exploration scenario, the model was extended to predict hypothetical subcutaneous infliximab doses in a virtual pediatric population (6-18 years old), stratified into three weight bands (20-30 kg, 30-45 kg, and 45-70 kg), that would yield post-switch trough concentrations of infliximab comparable to those seen in adults with the 120 mg flat-fixed subcutaneous dose. The PBPK-model-informed dose suggestions were 40 mg for the 20-30 kg band, 80 mg for the 30-45 kg band, and 120 mg for the 45-70 kg band. As demonstrated in this paper, the PBPK modeling framework can serve as a versatile tool in clinical pharmacology to investigate various clinical scenarios, such as exploring alternative dosing regimens and routes of administration, ultimately advancing IBD treatment across diverse (sub)populations of clinical interest.

摘要

在本研究中,采用了基于生理学的药代动力学(PBPK)建模框架,以探讨英夫利昔单抗在虚拟的成年和儿科炎症性肠病(IBD)患者中静脉注射(5mg/kg)和皮下给药(包括批准的120mg固定剂量作为转换选择)后的暴露情况。使用PK-Sim软件平台进行PBPK模型和相应模拟。PBPK模拟表明,120mg皮下固定剂量对于体重较重的成年IBD患者可能不是最佳选择,这表明需要增加英夫利昔单抗的剂量。对于年龄较大的虚拟儿科患者(14岁),皮下注射120mg固定剂量似乎是一种可行的IBD治疗选择。在最后的探索场景中,该模型被扩展以预测虚拟儿科人群(6-18岁)中假设的皮下英夫利昔单抗剂量,该人群分为三个体重组(20-30kg、30-45kg和45-70kg),转换后英夫利昔单抗的谷浓度与接受120mg皮下固定剂量的成年人相当。PBPK模型提供的剂量建议为:20-30kg组40mg,30-45kg组80mg,45-70kg组120mg。如本文所示,PBPK建模框架可作为临床药理学中的一种通用工具,用于研究各种临床场景,例如探索替代给药方案和给药途径,最终推动针对不同临床相关(亚)人群的IBD治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e56d/11429320/edebf4f76342/biomedicines-12-01974-g001.jpg

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