Sensitivity analysis of pharmacokinetic and pharmacodynamic systems: I. A structural approach to sensitivity analysis of physiologically based pharmacokinetic models

Based on a frequency response approach to the sensitivity analysis of pharmacokinetic models, the concept of structural sensitivity is introduced. The core of this concept is the factorization of the system sensitivity into two multipliers. The first one, called structural sensitivity index, has an analytical form, which depends solely on the structure and connectivity of the system and does not depend on the drug administered or the factor perturbed. The second multiplier, the parameter sensitivity index, depends on the drug properties, the tissue of interest and the parameter perturbed, but is largely independent of the structure of the system. The structural and parametric sensitivity indices can be evaluated and analyzed separately. The most important feature of the proposed approach is that the conclusions drawn from the analysis of the structural sensitivity index are valid across all mammalian species, as the latter share a common anatomical and physiological structure. The concept of structural sensitivity is illustrated on the commonly used structure of the whole body physiologically based pharmacokinetic models by showing that the factorization of the sensitivity carried out arises naturally from the mechanism of the distribution of perturbations throughout the organism. The concept of structural sensitivity has interesting practical implications. It enables the formal proof of relationships and facts that have been observed previously. Moreover, the conclusions drawn introduce in fact a ranking of the tissues or subsystems with respect to their impact on the model outputs. From this ranking, direct recommendations regarding the design of experiments for whole-body physiologically based pharmacokinetic models are derived.     

脑微透析技术及其在脑内药动/药效学研究中的应用

<正>脑微透析技术是从神经科学基础上发展起来的,是一种实现连续在线监测活体脑内完整细胞外液物质(包括内源性和外源性物质)动态变化的新型     

A pharmacokinetic/pharmacodynamic approach to predict the cumulative cortisol suppression of inhaled corticosteroids

The suppression of endogenous cortisol release is one of the major systemic side effects of inhaled corticosteroids in the treatment of asthma. The circadian rhythm of the endogenous cortisol release and the resulting plasma concentrations as well as the release suppression during corticosteroid therapy could previously be described with an integrated PK/PD model. Based on this model, a PK/PD approach was developed to quantify and predict the cumulative cortisol suppression (CCS) as a surrogate marker for the systemic activity of inhaled corticosteroid therapy. The presented method was applied to predict CCS after single doses and during short-term multiple dosing of the inhaled corticosteroids flunisolide (FLU), fluticasone propionate (FP), and triamcinolone acetonide (TCA), and after oral methylprednisolone as systemic reference therapy. Drug-specific PK and PD parameters were obtained from previous single-dose studies and extrapolated to the multiple-dose situation. For single dosing, a similar CCS within the range of 16-21% was predicted for FP 250 micrograms, FLU 500 micrograms, and TCA 1000 micrograms. For multiple dosing, a respective CCS of 28-33% was calculated for FLU 500 micrograms bid, FP 250 micrograms, bid, and TCA 1000 micrograms bid. Higher cortisol suppression compared to these single and multiple dosing regimens of the inhaled corticosteroids was predicted after oral doses of only 1 mg and 2 mg methylprednisolone, respectively. The predictive power of the approach was evaluated by comparing the PK/PD-based simulations with data reported previously in clinical studies. The predicted CCS values were in good correlation with the clinically observed results. Hence, the presented PK/PD approach allows valid predictions of CCS for single and short-term multiple dosing of inhaled corticosteroids and facilitates comparisons between different dosing regimens and steroids.     

磷霉素的药动学、药效学及临床应用新进展

近年磷霉素在临床抗感染治疗中日益受到重视,磷霉素PK/PD理论的研究以及在预防感染、多重耐药菌严重感染等方面都有了许多新的成果,本文对磷霉素的药动学、药效学研究及临床应用最新进展作一综述。     

基于治疗药物监测的重症患者头孢吡肟PK/PD研究

目的探索临床使用头孢吡肟的重症感染患者首次治疗药物监测(TDM)后的谷浓度及药动学/药效学(PK/PD)参数达标情况。方法采用高效液相色谱法测定患者头孢吡肟血药浓度,以谷浓度值为参考,计算f_T>MIC100%的比例,并分析不同MIC值下各PK/PD目标值的达标情况。结果 117例患者的首次谷浓度为(24.31±19.38)μg·mL~(-1),个体间差异大;f_T>MIC100%的达标率为65.81%;有20例(17.09%)患者首次谷浓度超过5 MIC,患者个体间变异大;其中37例肾功能重度减退患者(CLcr<30 mL·min~(-1))中有13例(35.14%)患者浓度超过5 MIC;117例患者中18例(15.38%)确认为头孢吡肟耐药病原菌感染(MIC>8μg·mL~(-1)),其f_T>MIC 100%的达标率仅为5.56%。结论在重症患者中,对于高MIC患者以及肾功能损伤患者,经验性给药往往达不到合理的PK/PD参数指标,有必要在重症感染患者中开展基于TDM的头孢吡肟个体化给药方案设计。     

Population pharmacokinetic and pharmacodynamic models of remifentanil in healthy volunteers using artificial neural network analysis

AIMS: An ordinary sigmoid E(max) model could not predict overshoot of electroencephalographic approximate entropy (ApEn) during recovery from remifentanil effect in our previous study. The aim of this study was to evaluate the ability of an artificial neural network (ANN) to predict ApEn overshoot and to evaluate the predictive performance of the pharmacokinetic model, and pharmacodynamic models of ANN with respect to data used. METHODS: Using a reduced number of ApEn instances (n = 1581) to make NONMEM modelling feasible and complete ApEn data (n = 24 509), the presence of overshoot was assessed. A total of 1077 measured remifentanil concentrations and ApEn data, and a total of 24 509 predicted concentrations and ApEn data were used in the pharmacodynamic model A and B of ANN, respectively. The testing subset of model B (n = 7352) was used to evaluate the ability of ANN to predict overshoot of ApEn. Mean squared error (MSE) was calculated to evaluate the predictive performance of the ANN models. RESULTS: With complete ApEn data, ApEn overshoot was observed in 66.7% of subjects, but only in 37% with a reduced number of ApEn instances. The ANN model B predicted 77.8% of ApEn overshoot. MSE (95% confidence interval) was 57.1 (3.22, 71.03) for the pharmacokinetic model, 0.148 (0.004, 0.007) for model A and 0.0018 (0.0017, 0.0019) for model B. CONCLUSIONS: The reduced ApEn instances interfered with the approximation of true electroencephalographic response. ANN predicted 77.8% of ApEn overshoot. The predictive performance of model B was significantly better than that of model A.     

The pharmacokinetic and pharmacodynamic characteristics of diazepam in different populations of rats

Significant differences in diazepam pharmacokinetics in different populations of rats both within one family and within one species were revealed. A high degree of correlation between the pharmacokinetic parameters and pharmacodynamic indices indicates that the myorelaxant effect is in a direct dependence on diazepam concentration in the rat organism.     

Individualised dosing of amikacin in neonates: a pharmacokinetic/pharmacodynamic analysis

Purpose  To examine the pharmacokinetics of amikacin and its pharmacokinetic pharmacodynamic (PKPD) relationship in neonates. To develop an alternative dosing strategy for amikacin in neonates. Methods  A population PKPD analysis was performed using data collected from 80 neonates with gestational ages from 24 to 41 weeks. The final pharmacokinetic model analysed 358 amikacin concentrations. All neonates were > 72 hours postnatal age. Simulations were performed to develop a new dosing strategy. Results  The final covariate model was clearance = 0.23 × (current weight/2)^0.691 × (postmenstrual age/40)^3.23 and volume of distribution = 0.957 × (current weight/2)^0.89. Following the logistic regression analysis of treatment failure, new amikacin target concentrations were estimated and used in development of an alternative dosing strategy. Conclusion  Simulation of a new dosing regimen yielded the following recommendations: 15 mg/kg at 36-h intervals, 14 mg/kg at 24-h intervals and 15 mg/kg at 24-h intervals for neonates ≤28 weeks, 29–36 weeks and ≥37 weeks postmenstrual age respectively.     

Comparing the performance of FOCE and different expectation-maximization methods in handling complex population physiologically-based pharmacokinetic models

For the purpose of population pharmacometric modeling, a variety of mathematic algorithms are implemented in major modeling software packages to facilitate the maximum likelihood modeling, such as FO, FOCE, Laplace, ITS and EM. These methods are all designed to estimate the set of parameters that maximize the joint likelihood of observations in a given problem. While FOCE is still currently the most widely used method in population modeling, EM methods are getting more popular as the current-generation methods of choice because of their robustness with more complex models and sparse data structures. There are several versions of EM method implementation that are available in public modeling software packages. Although there have been several studies and reviews comparing the performance of different methods in handling relatively simple models, there has not been a dedicated study to compare different versions of EM algorithms in solving complex PBPK models. This study took everolimus as a model drug and simulated PK data based on published results. Three most popular EM methods (SAEM, IMP and QRPEM) and FOCE (as a benchmark reference) were evaluated for their estimation accuracy and converging speed when solving models of increased complexity. Both sparse and rich sampling data structure were tested. We concluded that FOCE was superior to EM methods for simple structured models. For more complex models and/ or sparse data, EM methods are much more robust. While the estimation accuracy was very close across EM methods, the general ranking of speed (fastest to slowest) was: QRPEM, IMP and SAEM. IMP gave the most realistic estimation of parameter standard errors, while under- and over- estimation of standard errors were observed in SAEM and QRPEM methods.     

A survey of population analysis methods and software for complex pharmacokinetic and pharmacodynamic models with examples

An overview is provided of the present population analysis methods and an assessment of which software packages are most appropriate for various PK/PD modeling problems. Four PK/PD example problems were solved using the programs NONMEM VI beta version, PDx-MCPEM, S-ADAPT, MONOLIX, and WinBUGS, informally assessed for reasonable accuracy and stability in analyzing these problems. Also, for each program we describe their general interface, ease of use, and abilities. We conclude with discussing which algorithms and software are most suitable for which types of PK/PD problems. NONMEM FO method is accurate and fast with 2-compartment models, if intra-individual and interindividual variances are small. The NONMEM FOCE method is slower than FO, but gives accurate population values regardless of size of intra- and interindividual errors. However, if data are very sparse, the NONMEM FOCE method can lead to inaccurate values, while the Laplace method can provide more accurate results. The exact EM methods (performed using S-ADAPT, PDx-MCPEM, and MONOLIX) have greater stability in analyzing complex PK/PD models, and can provide accurate results with sparse or rich data. MCPEM methods perform more slowly than NONMEM FOCE for simple models, but perform more quickly and stably than NONMEM FOCE for complex models. WinBUGS provides accurate assessments of the population parameters, standard errors and 95% confidence intervals for all examples. Like the MCPEM methods, WinBUGS's efficiency increases relative to NONMEM when solving the complex PK/PD models.     

Liquid chromatographic analysis of sulfaquinoxaline and its application to pharmacokinetic studies in rabbits

A specific, sensitive high-performance liquid chromatographic method is described for sulfaquinoxaline (I) and its major metabolite, the N4-acetyl metabolite (II), in biological fluids. Detection limits for I and II were 0.25 and 0.50 micrograms/mL in plasma and 0.10 and 0.20 micrograms/mL in urine, respectively. The pharmacokinetics of sulfaquinoxaline and its metabolite were studied in New Zealand White rabbits after individual doses of 50 mg/kg of sulfaquinoxaline and its metabolite were administered intravenously. Mean (+/- SD) plasma half-lives were 12.7 (8.0) h for sulfaquinoxaline and 15.4 (3.5) h for the metabolite. After administration of the N-acetyl metabolite sulfaquinoxaline appeared in the plasma and urine indicating that deacetylation had occurred. The repercussions of this observation are briefly discussed with respect to two rabbits in which plasma analyses and complete urine collections were made. As sulfaquinoxaline is administered prophylactically to rabbits by some breeders, it is recommended that investigators allow a washout period of about one week after receipt of the animals.     

Development of multi-route physiologically-based pharmacokinetic models for ethanol in the adult,pregnant, and neonatal rat

Biofuel blends of 10% ethanol (EtOH) and gasoline are common in the USA, and higher EtOH concentrations are being considered (15–85%). Currently, no physiologically-based pharmacokinetic (PBPK) models are available to describe the kinetics of EtOH-based biofuels. PBPK models were developed to describe life-stage differences in the kinetics of EtOH alone in adult, pregnant, and neonatal rats for inhalation, oral, and intravenous routes of exposure, using data available in the open literature. Whereas ample data exist from gavage and intravenous routes of exposure, kinetic data from inhalation exposures are limited, particularly at concentrations producing blood and target tissue concentrations associated with developmental neurotoxicity. Compared to available data, the three models reported in this paper accurately predicted the kinetics of EtOH, including the absorption, peak concentration, and clearance across multiple datasets. In general, model predictions for adult and pregnant animals matched inhalation and intravenous datasets better than gavage data. The adult model was initially better able to predict the time-course of blood concentrations than was the neonatal model. However, after accounting for age-related changes in gastric uptake using the calibrated neonate model, simulations consistently reproduced the early kinetic behavior in blood. This work provides comprehensive multi-route life-stage models of EtOH pharmacokinetics and represents a first step in development of models for use with gasoline-EtOH blends, with additional potential applicability in investigation of the pharmacokinetics of EtOH abuse, addiction, and toxicity.     

Development of multi-route physiologically-based pharmacokinetic models for ethanol in the adult, pregnant, and neonatal rat

Biofuel blends of 10% ethanol (EtOH) and gasoline are common in the USA, and higher EtOH concentrations are being considered (15-85%). Currently, no physiologically-based pharmacokinetic (PBPK) models are available to describe the kinetics of EtOH-based biofuels. PBPK models were developed to describe life-stage differences in the kinetics of EtOH alone in adult, pregnant, and neonatal rats for inhalation, oral, and intravenous routes of exposure, using data available in the open literature. Whereas ample data exist from gavage and intravenous routes of exposure, kinetic data from inhalation exposures are limited, particularly at concentrations producing blood and target tissue concentrations associated with developmental neurotoxicity. Compared to available data, the three models reported in this paper accurately predicted the kinetics of EtOH, including the absorption, peak concentration, and clearance across multiple datasets. In general, model predictions for adult and pregnant animals matched inhalation and intravenous datasets better than gavage data. The adult model was initially better able to predict the time-course of blood concentrations than was the neonatal model. However, after accounting for age-related changes in gastric uptake using the calibrated neonate model, simulations consistently reproduced the early kinetic behavior in blood. This work provides comprehensive multi-route life-stage models of EtOH pharmacokinetics and represents a first step in development of models for use with gasoline-EtOH blends, with additional potential applicability in investigation of the pharmacokinetics of EtOH abuse, addiction, and toxicity.     

液相色谱法测定羟基喜树碱含量及药动学研究

目的:建立一个简单、快速、灵敏的柱切换高效液相色谱法测定人血清中10-羟基喜树碱(HCPT)含量。方法:生物样品首先在装有限进介质(RAM)填料的预柱中净化和富集,然后转移到C18分析柱分析待测物,用荧光法检测。结果:整个分析时间8 min。在1~1000 ng/mL浓度范围内,HCPT显良好的线性关系,日内、日间变异小于5%,最低检测限为0.1 ng/mL。结论:本法已应用于临床病人注射HCPT后的药代动力学研究,结果符合一房室模型并计算出它的药动学参数。     

Rapid and sensitive analysis of melatonin by LC-MS/MS and its application to pharmacokinetic study in dogs

A rapid and sensitive liquid chromatography tandem mass spectrometry method was established and validated for determination of melatonin in dog plasma using desvenlafaxine as an internal standard (IS). Plasma samples were pretreated by liquid–liquid extraction with ethyl acetate. Chromatographic separation was carried out on a C18 column at a flow rate of 0.2 ml/min by an isocratic mobile phase of methanol : 5 mM ammonium acetate : formic acid (40:60:0.1, v/v/v). Positive ion mode detection was performed using multiple reaction monitoring (MRM) at m/z 233.2→174.2 for melatonin and m/z 264.2→58.2 for desvenlafaxine. The method was linear in the concentration range of 0.020–10 ng/ml with a correlation coefficient ≥0.996. The intra- and inter-assay precision (%RSD) values were within 12.6% (LLOQ 15.2%), and accuracy (%RE) ranged from −1.8% to 5.0% (LLOQ ±16.5%). The total analysis time was 3.0 min. The method was fully validated and successfully applied to a pharmacokinetic study of melatonin prolonged-release tablet in Beagle dogs. The values of half-life and T_max were similar to the corresponding data reported before.     

A general model-based design of experiments approach to achieve practical identifiability of pharmacokinetic and pharmacodynamic models

The use of pharmacokinetic (PK) and pharmacodynamic (PD) models is a common and widespread practice in the preliminary stages of drug development. However, PK–PD models may be affected by structural identifiability issues intrinsically related to their mathematical formulation. A preliminary structural identifiability analysis is usually carried out to check if the set of model parameters can be uniquely determined from experimental observations under the ideal assumptions of noise-free data and no model uncertainty. However, even for structurally identifiable models, real-life experimental conditions and model uncertainty may strongly affect the practical possibility to estimate the model parameters in a statistically sound way. A systematic procedure coupling the numerical assessment of structural identifiability with advanced model-based design of experiments formulations is presented in this paper. The objective is to propose a general approach to design experiments in an optimal way, detecting a proper set of experimental settings that ensure the practical identifiability of PK–PD models. Two simulated case studies based on in vitro bacterial growth and killing models are presented to demonstrate the applicability and generality of the methodology to tackle model identifiability issues effectively, through the design of feasible and highly informative experiments.     

Prediction of clinical response based on pharmacokinetic/pharmacodynamic models of 5-hydroxytryptamine reuptake inhibitors in mice

Background and purpose:Bridging the gap between preclinical research and clinical trials is vital for drug development. Predicting clinically relevant steady-state drug concentrations (Css) in serum from preclinical animal models may facilitate this transition. Here we used a pharmacokinetic/pharmacodynamic (PK/PD) modelling approach to evaluate the predictive validity of 5-hydroxytryptamine (5-HT; serotonin) transporter (SERT) occupancy and 5-hydroxytryptophan (5-HTP)-potentiated behavioral syndrome induced by 5-HT reuptake inhibitor (SRI) antidepressants in mice.Experimental approach:Serum and whole brain drug concentrations, cortical SERT occupancy and 5-HTP-potentiated behavioral syndrome were measured over 6 h after a single subcutaneous injection of escitalopram, paroxetine or sertraline. [(3)H]2-(2-dimethylaminomethylphenylsulphanyl)-5-methyl-phenylamine ([(3)H]MADAM) was used to assess SERT occupancy. For PK/PD modelling, an effect-compartment model was applied to collapse the hysteresis and predict the steady-state relationship between drug exposure and PD response.Key results:The predicted Css for escitalopram, paroxetine and sertraline at 80% SERT occupancy in mice are 18 ng mL(-1), 18 ng mL(-1) and 24 ng mL(-1), respectively, with corresponding responses in the 5-HTP behavioral model being between 20-40% of the maximum.Conclusions and implications:Therapeutically effective SERT occupancy for SRIs in depressed patients is approximately 80%, and the corresponding plasma Css are 6-21 ng mL(-1), 21-95 ng mL(-1) and 20-48 ng mL(-1) for escitalopram, paroxetine and sertraline, respectively. Thus, PK/PD modelling using SERT occupancy and 5-HTP-potentiated behavioral syndrome as response markers in mice may be a useful tool to predict clinically relevant plasma Css values.British Journal of Pharmacology (2008) 155, 276-284; doi:10.1038/bjp.2008.243; published online 16 June 2008.