Edoxaban is an oral, direct, once-daily, factor Xa inhibitor developed for stroke prevention in patients with atrial fibrillation and for the treatment and secondary prevention of recurrent thromboembolism in patients with acute symptomatic venous thromboembolism. Among elderly patients who require anticoagulation therapies, some may have end-stage renal disease (ESRD). This open-label, phase 1, randomised, two-way crossover study was conducted to evaluate the pharmacokinetics of edoxaban in 10 subjects on haemodialysis. Eligible subjects with ESRD on chronic haemodialysis received a single, oral dose of edoxaban 15 mg 2 hours (h) prior to (on-dialysis) or in between (off-dialysis) haemodialysis sessions. Haemodialysis resulted in a minor decrease in mean total exposure (AUC0-∞; 676.2 ng·h/ml) as compared with that observed in subjects off-dialysis (691.7 ng·h/ml). Mean maximum observed plasma concentration (Cmax) values were comparable between on-dialysis and off-dialysis treatments (53.3 vs 56.3 ng/ml, respectively). Mean apparent total body clearance (CL/F) values were 24.1 and 22.5 l/h during the on-dialysis and off-dialysis treatment periods, respectively. Dialyser clearance was 5.7 l/h and haemodialysis clearance was 6.1 l/h. Haemodialysis clearance was only 6.1 l/h, suggesting that it only accounts for one-fourth of the total clearance in these subjects. A single, oral dose of 15 mg of edoxaban was well tolerated by subjects with ESRD. In conclusion, based on these single-dose PK data, a supplementary dose of edoxaban may not be required following a haemodialysis session. Importantly, haemodialysis is not an effective mechanism for removal of edoxaban from the blood.

译文

:Edoxaban是一种口服,直接,每日一次的Xa因子抑制剂,被开发用于房颤患者的中风预防以及急性症状性静脉血栓栓塞的复发性血栓栓塞的治疗和二级预防。在需要抗凝治疗的老年患者中,有些患者可能患有晚期肾病(ESRD)。进行了这项开放标签的1期随机,双向交叉研究,以评估edoxaban在10例血液透析患者中​​的药代动力学。符合条件的接受慢性血液透析的ESRD受试者在(透析前)或透析(非透析)之间2小时(小时)接受edoxaban 15 mg的单次口服剂量。与非透析患者的平均总暴露量(691.7 ng·h / ml)相比,血液透析导致平均总暴露量(AUC0-∞; 676.2 ng·h / ml)略有下降。平均最大观察血浆浓度(Cmax)值在透析和非透析治疗之间相当(分别为53.3 ng / ml和56.3 ng / ml)。在透析期和非透析期,平均总表观清除率(CL / F)分别为24.1和22.5 l / h。透析清除率为5.7 l / h,血液透析清除率为6.1 l / h。血液透析清除率仅为6.1 l / h,这表明这些透析清除率仅占总清除率的四分之一。 ESRD受试者可以很好地耐受15 mg的单次口服edoxaban。总之,基于这些单剂量PK数据,血液透析后可能不需要补充剂量的edoxaban。重要的是,血液透析不是从血液中去除依多沙班的有效机制。

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