A Population Pharmacokinetic Model of Valproic Acid in Pediatric Patients with Epilepsy: A Non-Linear Pharmacokinetic Model Based on Protein-Binding Saturation
Background and Objective Valproic acid (VPA) follows a non-linear pharmacokinetic profile in terms of protein-binding saturation. The total daily dose regarding VPA clearance is a simple power function, which may partially explain the non-linearity of the pharmacokinetic profile; however, it may be confounded by the therapeutic drug monitoring effect. The aim of this study was to develop a population pharmacokinetic model for VPA based on protein-binding saturation in pediatric patients with epilepsy. Methods A total of 1,107 VPA serum trough concentrations at steady state were collected from 902 epileptic pediatric patients aged from 3 weeks to 14 years at three hospitals. The population pharmacokinetic model was developed using NONMEMA (R) software. The ability of three candidate models (the simple power exponent model, the dose-dependent maximum effect [DDE] model, and the protein-binding model) to describe the non-linear pharmacokinetic profile of VPA was investigated, and potential covariates were screened using a stepwise approach. Bootstrap, normalized prediction distribution errors and external evaluations from two independent studies were performed to determine the stability and predictive performance of the candidate models. Results The age-dependent exponent model described the effects of body weight and age on the clearance well. Co-medication with carbamazepine was identified as a significant covariate. The DDE model best fitted the aim of this study, although there were no obvious differences in the predictive performances. The condition number was less than 500, and the precision of the parameter estimates was less than 30 %, indicating stability and validity of the final model. Conclusion The DDE model successfully described the non-linear pharmacokinetics of VPA. Furthermore, the proposed population pharmacokinetic model of VPA can be used to design rational dosage regimens to achieve desirable serum concentrations.
基金:
National Natural Science Foundation of ChinaNational Natural Science Foundation of China [81072702]; Major Research and Development Project of Innovative Drugs, China Ministry of Science and Technology [2012ZX09303004-001]
第一作者机构:[1]Fudan Univ, Childrens Hosp, Shanghai 200040, Peoples R China;
通讯作者:
通讯机构:[6]Fudan Univ, Huashan Hosp, Dept Pharm, Shanghai 200040, Peoples R China;[7]Fudan Univ, Huashan Hosp, Dept Pharm, 12 Wu Lu Mu Qi M Rd, Shanghai 200040, Peoples R China
推荐引用方式(GB/T 7714):
Ding Junjie,Wang Yi,Lin Weiwei,et al.A Population Pharmacokinetic Model of Valproic Acid in Pediatric Patients with Epilepsy: A Non-Linear Pharmacokinetic Model Based on Protein-Binding Saturation[J].CLINICAL PHARMACOKINETICS.2015,54(3):305-317.doi:10.1007/s40262-014-0212-8.
APA:
Ding, Junjie,Wang, Yi,Lin, Weiwei,Wang, Changlian,Zhao, Limei...&Jiao, Zheng.(2015).A Population Pharmacokinetic Model of Valproic Acid in Pediatric Patients with Epilepsy: A Non-Linear Pharmacokinetic Model Based on Protein-Binding Saturation.CLINICAL PHARMACOKINETICS,54,(3)
MLA:
Ding, Junjie,et al."A Population Pharmacokinetic Model of Valproic Acid in Pediatric Patients with Epilepsy: A Non-Linear Pharmacokinetic Model Based on Protein-Binding Saturation".CLINICAL PHARMACOKINETICS 54..3(2015):305-317