基于群体药动学的奥卡西平儿童个体化给药模式的建立

目的基于群体药动学(PPK)和贝叶斯原理,建立奥卡西平的癫痫患儿个体化给药工作模式,促进临床合理用药。方法利用已发表的中国癫痫患儿口服奥卡西平后的PPK模型和JPKD-Bayesian软件建立奥卡西平个体化给药的预测模型。运用该模型对100例癫痫患儿进行个体化给药方案设计。患儿按设计方案规律服药2~4周后测定10-羟基卡马西平的稳态血清谷浓度并与模型预测值相比较,计算平均预测误差、平均绝对预测误差、平均相对预测误差、相对预测误差在±20%和±30%内的比例来验证模型的预测性能。结果个体化给药预测模型的平均预测误差为(0.54±2.00)mg·L~(-1),平均绝对预测误差为(1.75±1.09)mg·L~(-1),平均相对预测误差为(3.86±14.56)%,其中分别有78%和96%的血药浓度数据相对预测误差在±20%和±30%以内。血药浓度预测值对实测值的决定系数R2=87.8%。上述验证结果说明模型的预测准确度和精密度均较高。结论本研究成功建立了可用于儿科患者实施奥卡西平个体化给药的预测模型和完整的工作模式,有助于临床合理用药。     

基于群体药动学模型的奥卡西平个体化给药软件研制

目的 研制基于群体药动学（population pharmacokinetics,PPK）模型的奥卡西平（oxcarbazepine,OXC）个体化给药软件。方法 根据已建立的成人和儿童OXC活性代谢物10,11-二氢-10-羟基卡马西平（monohydroxycarbazepine,MHD）的PPK模型信息,运用MyEclipse、SQL Server、JRE等工具研制OXC给药软件。软件开发方案包括软件需求分析、软件概要设计、软件详细设计、软件编码、软件测试以及软件维护和二次开发。结果 研制的OXC给药软件可实现患者信息输入和管理,能自动调用NONMEM软件,能预测多种具体给药方案下的MHD血药浓度,供临床制定初始给药方案参考,而且能结合已有的血药浓度监测信息和Bayesian反馈法更精准地预测血药浓度,辅助临床进一步优化给药方案。结论 基于MHD的PPK模型研制的给药软件能快捷方便地辅助成人和儿童癫痫患者OXC的个体化给药。     

基于PPK研究的癫痫患儿奥卡西平药动学参数分析

目的通过分析癫痫患儿奥卡西平的群体药动学研究,探讨影响奥卡西平药动学参数的因素,为临床制定个体化给药方案提供依据。方法检索CNKI、万方、维普、EMBASE和PubMed等中英文文献数据库,收集基于非线性混合效应模型的癫痫患儿奥卡西平群体药动学研究。结果共纳入11篇癫痫患儿奥卡西平群体药动学研究。人口学特征(年龄、体重和体表面积等)、血液生化指标、遗传因素、合并用药和剂量等不同程度影响患儿奥卡西平药动学参数估算。年龄、身高与体重等显著影响分布容积;体重、体表面积与合并用药等影响体内清除率。结论已发表的癫痫患儿奥卡西平群体药动学研究中,药动学参数估计值存在差异,且有不同程度的个体间变异,有必要进一步评价各因素对患儿奥卡西平药动学参数的影响。     

基于群体药动学的老年患者漏服奥氮平补服剂量仿真研究

目的 基于前期已建立的老年精神障碍患者奥氮平群体药动学模型,研究漏服场景下补服剂量,为临床提供补服方案。方法 以临床常用方案奥氮平10 mg,口服,每晚9点1次进行仿真,设计1次漏服、连续2次和3次漏服3个场景。应用NONMEM软件分析数据,评估不同漏服场景对奥氮平血药浓度的影响,并设计相应的补救方案。补服策略分为2次补服和1次补服,2次补服指患者立即服用10 mg,在下次计划时间服用补服剂量,之后按原剂量方案服药。1次补服指跳过漏服剂量,在下次计划时间通过1次补服剂量,之后按常规服用。以血药浓度迅速达到稳态浓度水平为标准,考察相应的最佳补服剂量,补服剂量可最小精确到2.5 mg。结果 漏服2、3次低于治疗窗的风险比漏服1次高,漏服3次所需要的补服剂量更大。在2次补服策略下,随着延迟时间的增加,第2次补服剂量逐渐减少。采取1次补服策略,其剂量并非常规经验的剂量加倍,若剂量加倍补服,可能会增加不良反应的风险。结论 本研究通过群体药动学研究,制定了老年患者漏服奥氮平后的补救方案,可为临床药物治疗决策提供参考。:     

奥卡西平活性代谢产物10，11－二氢－10－羟基卡马西平在成人癫痫患者中的群体药动学及个体化给药的实验研究

奥卡西平是一种前药,在体内代谢为10,11－二氢－10－羟基卡马西平（Monohydroxycarbazepine,MHD）而发挥作用;本文对其在成人癫痫患者中的群体药动学及个体化给药的实验研究概况进行综述。     

RP-HPLC法测定癫痫患者血浆中奥卡西平血药浓度和药动学研究

目的建立人血浆中奥卡西平药物浓度的RP-HPLC检测方法,并研究其在人体内的药动学。方法采用液–液萃取法,用萃取液甲基叔丁基醚萃取癫痫患者血浆中的奥卡西平后,以阿普唑仑为内标。色谱柱为Kromasil 100A C18(250mm×4.6 mm,5μm),柱温40℃,流动相为甲醇–乙腈–水–磷酸(30∶30∶40∶0.04),体积流量1.0 mL/min,紫外检测波长243 nm,固定进样量20μL。以3p97软件计算10名受试者清晨空腹单剂量口服奥卡西平片600 mg后的平均药动学参数。结果血浆中内源性杂质对样品测定无干扰,奥卡西平在21.6~2 160.0μg/L(r=0.999 2)线性关系良好,最低定量限21.6μg/L;方法回收率为95.45%~107.69%;日内RSD值为4.97%~7.35%,日间RSD值为4.81%~11.27%。含药血浆经3次冻融后稳定性良好。结论本方法操作快速、简便、灵敏度高、准确度好,可用于含奥卡西平血样的即时检测分析和临床药动学研究。     

RP-HPLC法测定人血浆中奥卡西平浓度及其药动学研究

目的:建立以反相高效液相色谱法测定人血浆中奥卡西平浓度的方法,并研究其药动学。方法:血样经二氯甲烷提取并速浓采缩用后流进样量分时析间,程色序谱,柱紫为外检Hy测pe波rsi长lC为18,2流57动n相m,为柱甲温醇为-205.1℃m,o固l·L定-进1醋样酸量铵为溶5液0(μ用L,H内3P标O为4调地p西H值泮至。约另4以.8)3p-9三7软乙件胺(计60算∶480名∶0受.1)试,流者清晨空腹单剂量口服奥卡西平胶囊300mg后的平均药动学参数。结果:奥卡西平血药浓度在0.0351～2.245μg·mL-1范围内线性关系良好(r=0.9994),最低定量浓度0.0351μg·mL-1;方法回收率为93.48%～107.29%;日内RSD为1.17%～7.54%,日间RSD为5.88%～10.32%。t1/2Ke为(16.93±5.80)h,tma(x5.88±3.00)h,Cma(x0.56±0.38)μg·mL-1,AUC0～48为(12.11±5.76)ng·h·mL-1。结论:本方法灵敏、准确,可用于奥卡西平的临床血药浓度测定及药动学研究。     

中国成年癫痫患者奥卡西平活性代谢产物的群体药动学

目的：建立中国癫痫患者奥卡西平活性代谢产物10-羟基卡马西平的群体药动学模型,进而取得对癫痫患者有效的数据参数,为癫痫患者给出有针对性的给药治疗依据。方法：通过实地收集参与研究使用奥卡西平片患者血液药物含量监测数据,利用NLME软件来实现近似群体药动学数学逻辑模型,建立基础模型和统计学模型后,考察年龄、体质量、合并用药等潜在影响10-羟基卡马西平药动学的相关变量参数,将Bootstrap估得的和原始数据估得的参数值进行对比分析,确保模型对实验有效以及测验结果稳定,对建立的模型通过自举法进行验证。结果：共收集了119个患者的180个浓度点,所建立的10-羟基卡马西平的群体药动学模型符合一级吸收、一级消除的一室模型,CL/F及V_d/F群体值分别为1.22 L·h^-1和43.21 L;K_a固定为0.5 h^-1。体表面积对10-羟基卡马西平的清除率有显著影响。结论：初步建立了中国癫痫患者奥卡西平活性代谢产物10-羟基卡马西平的群体药动学模型,为癫痫患者给出了有针对性的给药治疗依据。     

卡马西平在癫痫患儿中的群体药动学研究

目的:研究卡马西平(CBZ)在癫痫患儿中的群体药动学。方法:回顾性收集我院119例服用CBZ的门诊癫痫患儿的稳态血药浓度(n=122)。用非线性混合效应模型(NONMEM)法进行数据分析,定量考察年龄、性别、体重、日剂量和合用其他抗癫痫药对CBZ清除率的影响。采用一房室开放模型和一级吸收和消除的药动学模型,按照固定吸收速率常数文献值,最终求算CBZ的清除率。结果:最终拟合群体药动学模型为:CL=0.593·(体重/28.5)0.63·日剂量0.569。性别、合用丙戊酸钠不影响CBZ的清除率。结论:用NONMEM法估算CBZ的清除率和推荐剂量,可为临床制订个体化给药方案、提高疗效、降低药物的毒副作用提供依据。     

First dose and steady-state pharmacokinetics of oxcarbazepine and its 10-hydroxy metabolite

Summary The pharmacokinetics of oxcarbazepine (a new anticonvulsant which is a congener of carbamazepine) and of its 10-hydroxy metabolite were studied at the outset of therapy in 8 adult epileptics comedicated with other anticonvulsants. The pharmacokinetic study was repeated under steady-state conditions after 3 months of drug intake in 6 of these subjects.The plasma elimination half-life of oxcarbazepine appeared to lie in the range 1.0–2.5 h, and that of its 10-hydroxy metabolite averaged 8.4 h. The apparent oral clearance of the parent drug (averaging 2.51·kg^–1·h^–1) was high enough to suggest substantial presystemic elimination. The oral clearance fell after 3 months of drug intake, but the half-lives of the drug and metabolite showed no statistically significant change over this time. Steady-state plasma levels of both drug and metabolite were linearly related to drug dose, metabolite levels averaging 9 times those of the parent substance.     

再生障碍性贫血患儿的环孢素群体药动学研究

目的：建立环孢素在再生障碍性贫血患儿中的群体药动学模型,为其临床个体化用药提供依据。方法：回顾性收集94例再生障碍性贫血患儿的194份血药浓度常规监测数据,应用NONMEM（7.2.0）软件建立药动学模型,用一级条件估计及交互作用（FOCE-Ⅰ）估算药动学参数和个体间、个体内变异。定量考察人口学特征、生化指标、血常规指标、合并用药及CYP3A4＊18B、CYP3A5＊3基因多态性等协变量对药动学参数的影响,采用自举法对最终模型的稳定性进行评价。结果：基础模型选用一房室、一级吸收和一级消除模型。环孢素的群体药动学参数：表观清除率（CL/F）为（29.5±1.3）L/h,表观分布容积（V/F）为（419.4±52.2）L。CL/F和V/F的个体间变异分别为27.8%和0.14%,个体内变异为36.4%和70ng/ml。按照最终模型,仅有年龄对CL/F有显著影响。自举法验证结果表明模型较稳定。结论：本研究建立的再生障碍性贫血患儿的环孢素群体药动学模型可为该群体的临床个体化用药提供依据。     

Estimation of the impact of noncompliance on pharmacokinetics: an analysis of the influence of dosing regimens

AIMS

To determine whether, for oxybutynin and risperidone, drug exposure is better with less frequent dosing regimens than with regimens that require more frequent dosing.

METHODS

Pharmacokinetic models of oxybutynin (5 mg twice-daily and 10 mg once-daily) and risperidone (2 mg once-daily orally and 25 mg fortnightly intramuscular injection) were developed. Simulations of multiple doses were performed by use of stochastic models of dose-taking compliance and clinic visit attendance.

RESULTS

At therapeutic concentrations and with typical patterns of noncompliance, intramuscular injections of risperidone resulted in a 41% (SD 12%) greater pharmacokinetic coverage than the oral dose, 76% (SD 10%) vs. 35% (SD 7%). No discernable differences were evident between once- and twice-daily formulations of oxybutynin, 29.2% (SD 10%) vs. 29.0% (SD 13%).

CONCLUSIONS

For equivalent doses for each drug, the longer acting preparation of risperidone, but not oxybutynin, is pharmacokinetically more forgiving of noncompliance than the shorter acting counterparts. Further analysis is required to confirm whether these observations are valid clinically.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Patient compliance is better with formulations that require less frequent dosing than with formulations that require more frequent dosing.
• Intramuscular risperidone and long-acting oxybutynin are two examples of medicines reformulated for less frequent dosing.
• However, it is not clear whether better compliance with less frequent dosing regimens translates to improved therapeutic outcome.

WHAT THIS STUDY ADDS

• At equivalent daily doses and typical patterns of compliance, fortnightly intramuscular depot administrations of risperidone provide better pharmacokinetic coverage than once-daily oral dosing.
• Once-daily dosing of oxybutynin is no better at maintaining pharmacokinetic exposure than twice-daily dosing at half strength.
• The use of simulated compliance data as input to pharmacokinetic models is useful to assess the impact of noncompliance on internal drug exposure.

     

基于群体药动学模型的万古霉素个体化给药软件研制及应用

目的:研发基于建立的成人和老年群体药动学(population pharmacokinetics,PPK)模型的万古霉素(vancomycin,VCM)个体化给药软件。方法:根据已建立的成人和老年VCM的PPK模型信息,运用MyEclipse、SQL Server、JRE等工具软件研发VCM给药软件。软件开发方案包括需求分析,概要设计,详细设计,软件编码,软件测试以及软件维护和二次开发。结果:研制的VCM给药软件可实现感染患者信息输入和管理,软件通过接口调用非线性混合效应模型(NONMEM)软件,不仅能预测多种具体VCM给药方案下的血药浓度,供临床医师制定初始用药方案参考,而且能结合已有的血药浓度监测信息和贝叶斯反馈法更精准地预测血药浓度,辅助临床医师进一步优化给药方案。软件应用于VCM血药浓度解读,药师向临床做出剂量调整建议。采纳建议组患者复查的血药浓度均达到目标血药浓度范围。结论:本研究基于VCM的PPK模型研制的给药软件能快速方便地辅助成人和老年感染患者VCM的个体化给药。     

Determination of optimal vitamin D3 dosing regimens in HIV-infected paediatric patients using a population pharmacokinetic approach

AimsTo investigate 25-hydroxycholecalciferol [25(OH)D] population pharmacokinetics in children and adolescents, to establish factors that influence 25(OH)D pharmacokinetics and to assess different vitamin D₃ dosing schemes to reach sufficient 25(OH)D concentrations (>30 ng ml⁻¹).MethodsThis monocentric prospective study included 91 young HIV-infected patients aged 3 to 24 years. Patients received a 100 000 IU vitamin D₃ supplementation. A total of 171 25(OH)D concentrations were used to perform a population pharmacokinetic analysis.ResultsAt baseline 28% of patients had 25(OH)D concentrations below 10 ng ml⁻¹, 69% between 10 and 30 ng ml⁻¹ and 3% above 30 ng ml⁻¹. 25(OH)D pharmacokinetics were best described by a one compartment model with an additional production parameter reflecting the input from diet and sun exposure. The effects of skin phototype and bodyweight were significant on 25(OH)D production before any supplementation. The basal level was 27% lower in non-white skin phototype patients and was slightly decreased with bodyweight. No significant differences in 25(OH)D concentrations were related to antiretroviral drugs. To obtain concentrations between 30 and 80 ng ml⁻¹, patients with baseline concentrations between 10 and 30 ng ml⁻¹ should receive 100 000 IU per 3 months. However, vitamin D deficient patients (<10 ng ml⁻¹) would need an intensive phase of 100 000 IU per 2 weeks (two times) followed 2 weeks later by a maintenance phase of 100 000 IU per 3 months.ConclusionsSkin phototype and bodyweight had an influence on the basal production of 25(OH)D. According to 25(OH)D baseline concentrations, dosing schemes to reach sufficient concentrations are proposed.     

用群体药代动力学预测癫痫儿童丙戊酸钠血药浓度

目的 用群体药代动力(PPK)模型和贝叶斯法预测血药浓度。方法 用癫痫儿童丙戊酸钠PPK模型和USC~*PACK软件中的贝叶斯程序,对100例新癫痫患儿丙戊酸钠的血药浓度进行预测。将预测值与实测值做配对t检验,相关和回归分析,计算平均预测误差、预测误差的百分比、不同预测误差百分比的符合率及其95％可信区间、构成比和评价预测的准确程度。结果 预测值与实测值的相关系数为0.99,P<0.001,线性回归Y_(OBS)=0.99)Y_(PRED),决定系数为0.98,P<0.001;平均预测误差为-0.43μg·mL~(-1),预测误差百分比分别为5％,10％,15％,20％,25％,30％的符合率为62％,74％,82％,85％,89％,93％。结论 PPK模型和贝叶斯法可准确预测丙戊酸钠稳态血药浓度。     

反相-高效液相色谱法测定奥卡西平活性代谢物及其在健康人体的药代动力学特征

目的建立测定奥卡西平活性代谢物的高效液相色谱法并进行药代动力学研究。方法10名健康志愿者单剂量口服奥卡西平300mg;血浆样品经液-液萃取,用高效液相色谱法检测奥卡西平10-单羟基代谢物(MHD)。用3P87程序进行数据处理。结果此方法适于血浆MHD浓度的检测。单剂量口服奥卡西平后,MHD的血浆浓度符合一级吸收的一室模型;其主要药代动力学参数为:tmax=(4.10±0.79)h,Cmax=(4.64±0.53)mg·L-1,t1/2ke=(15.05±2.32)h,AUC0-48=(112.97±14.25)mg·h·L-1。结论该法能高效、灵敏、准确地测定血浆中MHD。     

Population pharmacokinetics of artemether and dihydroartemisinin following single intramuscular dosing of artemether in African children with severe falciparum malaria

AIMS: To determine the population pharmacokinetics of artemether and dihydroartemisinin in African children with severe malaria and acidosis associated with respiratory distress following an intramuscular injection of artemether. METHODS: Following a single intramuscular (i.m.) injection of 3.2 mg kg-1 artemether, blood samples were withdrawn at various times over 24 h after the dose. Plasma was assayed for artemether and dihydroartemisinin by gas chromatography-mass spectrometry. The software program NONMEM was used to fit the concentration-time data and investigate the influence of a range of clinical characteristics (respiratory distress and metabolic acidosis, demographic features and disease) on the pharmacokinetics of artemether and dihydroartemisinin. RESULTS: A total of 100 children with a median age of 36.4 (range 5-108) months were recruited into the study and data from 90 of these children (30 with respiratory distress and 60 with no respiratory distress) were used in the population pharmacokinetic analysis. The best model to describe the disposition of artemether was a one-compartment model with first-order absorption and elimination. The population estimate of clearance (clearance/bioavailability, CL/F) was 14.3 l h-1 with 53% intersubject variability and that of the terminal half-life was 18.5 h. If it was assumed that artemisin displays "flip-flop" kinetics, the elimination half-life was estimated to be 21 min and the corresponding volume of distribution was 8.44 l, with an intersubject variability of 104%. None of the covariates could be identified as having any influence on the disposition of artemether. The disposition of dihydroartemisinin was fitted separately using a one-compartment linear model in which the volume of distribution was fixed to the same value as that of artemether. Assuming that artemether is completely converted to dihydroartemisinin, the estimated value of CL/F for dihydroartemisinin was 93.5 l h-1, with an intersubject variability of 90.2%. The clearance of dihydroartemisinin was formation rate limited. CONCLUSIONS: Administration of a single 3.2 mg kg-1 i.m. dose of artemether to African children with severe malaria and acidosis is characterized by variable absorption kinetics, probably related to drug formulation characteristics rather than to pathophysiological factors. Use of i.m. artemether in such children needs to be reconsidered.