PopPK modeling supports BW band dosing of lacosamide for pediatric epilepsy.

Abstract

Personalized precision dosing remains an unmet clinical need. This study used population pharmacokinetic (PopPK) modeling to evaluate transitioning lacosamide (LCM) in children with epilepsy from body weight (BW)-based (mg/kg) to simplified BW-band or fixed-dose (mg) regimens. Real-world data from 190 patients were analyzed using nonlinear mixed-effects modeling program, comparing a BW-based model (Model I) and a genotype-guided model (Model II); the latter showed superior predictive performance. Monte Carlo simulations confirmed comparable LCM exposure across regimens, with >78% target attainment in external validation. A fixed 100 mg dose for patients ≥10 kg achieved equivalent exposure to BW-adjusted dosing, with consistent results in 1-4 years and obese patients. These findings enabled BW-band dosing as a clinically viable alternative to mg/kg regimens, while CYP2C19 genotyping further enhanced precision. This PopPK-based strategy simplifies LCM therapy without compromising efficacy, offering a practical approach to personalized epilepsy management in children.