Relationship between Didanosine Exposure and Surrogate Marker Response in Human Immunodeficiency Virus-Infected Outpatients |
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| Authors: | John M. Adams Mark J. Shelton Ross G. Hewitt Thaddeus H. Grasela Mary DeRemer Gene D. Morse |
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| Affiliation: | Laboratory for Antiviral Research1. and Departments of Pharmacy Practice2. and Medicine,4. Schools of Pharmacy and Medicine, State University of New York at Buffalo, and the Antiviral Clinical Pharmacology Unit, Immunodeficiency Clinic, Erie County Medical Center,3. Buffalo, New York, and Pharmaceutical Outcomes Research, Inc., Williamsville, New York5. |
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| Abstract: | We used information available from routine clinic visits to characterize the pharmacokinetics of didanosine in 82 human immunodeficiency virus-infected patients. A total of 271 blood samples were collected for the measurement of didanosine concentrations in plasma (mean ± standard deviation [SD], 3.30 ± 2.21 samples/patient). Bayesian estimates of didanosine oral clearance (CLoral) were obtained for these patients by the POSTHOC option within the NONMEM software package. Population priors from a previous NONMEM analysis of didanosine pharmacokinetics were used. The mean ± SD CLoral was 132 ± 27.7 liters/h, which agrees reasonably well with estimates obtained from previous pharmacokinetic studies of didanosine. Estimates of individual didanosine exposure were then used to consider potential relationships between drug exposure and surrogate marker response over a 6-month period. No correlations were found between the didanosine area under the concentration-time curve from 0 to 6 months and the absolute CD4 cell count (r = 0.305; 0.1 < P < 0.2), weight response (r = 0.0857; P > 0.4), or percentage of CD4 lymphocytes (r = 0.0559; P > 0.4). Future efforts to characterize didanosine exposure in outpatients by random sampling methods should involve more directed efforts to limit residual variability in the data. |
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