BACKGROUND:Immunoglobulin products are widely used across multiple therapeutic areas such as immunodeficiency syndromes, infection and autoimmune diseases. The pharmacokinetics (PK) of immunoglobulins are well characterized in adults, but very little is known about the PK of immunoglobulins in neonates and infants (<2 years of age). OBJECTIVE:The objectives of the present study were: (1) characterize the PK of immunoglobulin intravenous preparation using model-independent (non-compartmental analysis), and (2) develop and evaluate a population PK model with extensive blood samples (8 blood samples) and sparse blood samples (2-3 blood samples). METHOD:Immunoglobulin G (IgG) concentration versus time data from very low birth weight neonates (n = 20) following intravenous administration were analyzed using nonlinear mixed effect modeling and non-compartmental approaches. Population pharmacokinetic models were developed from extensive and sparse sampling schemes. Models were evaluated based on the difference in objective function, goodness-of-fit plots and simulation based visual predictive check analysis. RESULTS:A non-compartmental analysis of IgG from neonates (bodyweight range 0.78-1.38 kg) indicated an average clearance of 3.0 ± 2.1 mL/day and volume of distribution at steady state 68 ± 25 mL. The population pharmacokinetic model from extensive sampling adequately described concentration- time data with mean clearance (2.7 mL/day), volume of central compartment (8.7 mL) and peripheral compartment (60 mL). The clearance and volume of distribution estimates using sparse sampling model (1 pre-and 2 post-dose blood samples) were comparable with extensive sampling. CONCLUSION:Our study provides important bridging data in scaling PK and dosing of immunoglobulins across a wide age range.

译文

背景:免疫球蛋白产品广泛应用于免疫缺陷综合症,感染和自身免疫性疾病等多个治疗领域。免疫球蛋白的药代动力学(PK)在成人中已得到很好的表征,但对于新生儿和婴儿(<2岁)中的免疫球蛋白PK知之甚少。
目的:本研究的目的是:(1)使用与模型无关的方法(非房室分析)表征免疫球蛋白静脉注射制剂的PK,以及(2)开发和评估具有大量血液样本(8个血液样本)的人群PK模型)和稀疏的血液样本(2-3个血液样本)。
方法:使用非线性混合效应模型和非房室方法分析静脉注射后极低出生体重新生儿(n = 20)的免疫球蛋白G(IgG)浓度与时间的关系。人群药代动力学模型是根据广泛而稀疏的抽样方案开发的。根据目标函数,拟合优度图和基于仿真的视觉预测检查分析中的差异对模型进行评估。
结果:对新生儿(体重范围0.78-1.38 kg)的IgG进行的非房室分析表明,平均清除率为3.0±2.1 mL /天,稳态时的分布体积为68±25 mL。大量采样的总体药代动力学模型充分描述了浓度-时间数据,包括平均清除率(2.7 mL /天),中心区室(8.7 mL)和外围区室(60 mL)的体积。使用稀疏采样模型(1个给药前血样和2个给药后血样)的分布估计的清除率和体积与大量采样相当。
结论:我们的研究为跨年龄范围的PK缩放和免疫球蛋白剂量提供了重要的桥梁数据。

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