Prager Marlene, Al Jalali Valentin, Zeitlinger Markus
Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Clin Pharmacokinet. 2025 Feb;64(2):193-214. doi: 10.1007/s40262-024-01442-8. Epub 2025 Jan 10.
The rise in global obesity prevalence has increased the need to understand the pharmacokinetics of drugs in overweight and obese individuals. Tuberculosis remains a significant health challenge, and its treatment outcomes can be influenced by the pharmacokinetic profiles of antitubercular agents. This literature review aims to point out the clinical pharmacokinetics of antitubercular drugs in the overweight and obese patient population, highlighting considerations for potential dosage adjustments. We conducted a comprehensive search of the PubMed US National Library of Medicine from inception to January 2024. Articles focusing on the pharmacokinetics of antitubercular agents used for both drug-susceptible and multidrug-resistant tuberculosis in overweight and obese adults were included. In total, 349 scientific articles were identified and examined for human pharmacokinetic parameters. Of these, 19 were included in this article. To highlight potential differences, pharmacokinetic data for normal-weight tuberculosis patients are also presented, albeit selectively. In general, pharmacokinetic studies of antitubercular agents in overweight and obese individuals are lacking. Fixed-dose combinations often used in the treatment of drug-susceptible tuberculosis are not recommended when treating these population groups. Rather, individual dosing based on therapeutic drug monitoring and the known solubility of the substance should be considered. To improve the management of tuberculosis in overweight and obese patients, there is an urgent need for pharmacokinetic studies and, ultimately, adequate dosing in this patient population, especially given the increasing prevalence of obesity.
全球肥胖患病率的上升增加了了解超重和肥胖个体药物药代动力学的必要性。结核病仍然是一项重大的健康挑战，其治疗结果可能会受到抗结核药物药代动力学特征的影响。这篇文献综述旨在指出超重和肥胖患者群体中抗结核药物的临床药代动力学，强调潜在剂量调整的注意事项。我们对美国国立医学图书馆的PubMed数据库进行了全面检索，检索时间从建库至2024年1月。纳入了关注超重和肥胖成年人中用于敏感结核和耐多药结核治疗的抗结核药物药代动力学的文章。总共识别并审查了349篇关于人体药代动力学参数的科学文章。其中，19篇被纳入本文。为突出潜在差异，也选择性地呈现了正常体重结核病患者的药代动力学数据。总体而言，超重和肥胖个体中抗结核药物的药代动力学研究较为缺乏。治疗敏感结核时常用的固定剂量组合在治疗这些人群时不推荐使用。相反，应考虑基于治疗药物监测和药物已知溶解度的个体化给药。为改善超重和肥胖患者的结核病管理，迫切需要进行药代动力学研究，并最终为该患者群体确定合适的剂量，尤其是考虑到肥胖患病率不断上升的情况。
