Clinical therapeutics最新文献

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Managed Entry Agreements: Tools of Necessity, Works in Progress
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-02-01 DOI: 10.1016/j.clinthera.2024.12.017
Paul Beninger MD, MBA
{"title":"Managed Entry Agreements: Tools of Necessity, Works in Progress","authors":"Paul Beninger MD, MBA","doi":"10.1016/j.clinthera.2024.12.017","DOIUrl":"10.1016/j.clinthera.2024.12.017","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 2","pages":"Pages 115-116"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corrigendum to: “Prevalence of Potential Drug Interactions With Direct-Acting Antivirals for COVID-19 Among Hospitalized Patients” [Clin Ther 2024;46:778–784] “COVID-19在住院患者中与直接作用抗病毒药物潜在相互作用的患病率”[临床杂志,2024;46:778-784]。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-02-01 DOI: 10.1016/j.clinthera.2024.11.013
Essy Mozaffari PharmD, MPH, MBA , Aastha Chandak PhD , Andrew Ustianowski MD, PhD , Christina G. Rivera PharmD, RPh , Neera Ahuja MD, FACP , Heng Jiang MPH , Mark Berry PhD , Jason F. Okulicz MD , Alpesh N. Amin MD
{"title":"Corrigendum to: “Prevalence of Potential Drug Interactions With Direct-Acting Antivirals for COVID-19 Among Hospitalized Patients” [Clin Ther 2024;46:778–784]","authors":"Essy Mozaffari PharmD, MPH, MBA , Aastha Chandak PhD , Andrew Ustianowski MD, PhD , Christina G. Rivera PharmD, RPh , Neera Ahuja MD, FACP , Heng Jiang MPH , Mark Berry PhD , Jason F. Okulicz MD , Alpesh N. Amin MD","doi":"10.1016/j.clinthera.2024.11.013","DOIUrl":"10.1016/j.clinthera.2024.11.013","url":null,"abstract":"","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 2","pages":"Page 178"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Population Pharmacokinetics of Ledipasvir/Sofosbuvir in Pediatric Patients: Impact of Acute Lymphoblastic Leukemia 雷地帕韦/索非布韦在儿科患者中的群体药代动力学:对急性淋巴细胞白血病的影响。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-02-01 DOI: 10.1016/j.clinthera.2024.11.022
Aya M. AbdelMagid PhD , Maggie M. Abbassi PhD , Fatma S. Ebeid MD, MRCPCH , Manal H. El-Sayed MD, PhD , Samar F. Farid PhD
{"title":"Population Pharmacokinetics of Ledipasvir/Sofosbuvir in Pediatric Patients: Impact of Acute Lymphoblastic Leukemia","authors":"Aya M. AbdelMagid PhD ,&nbsp;Maggie M. Abbassi PhD ,&nbsp;Fatma S. Ebeid MD, MRCPCH ,&nbsp;Manal H. El-Sayed MD, PhD ,&nbsp;Samar F. Farid PhD","doi":"10.1016/j.clinthera.2024.11.022","DOIUrl":"10.1016/j.clinthera.2024.11.022","url":null,"abstract":"<div><h3>Purpose</h3><div>The pharmacokinetic (PK) profile of direct-acting antivirals, namely ledipasvir/sofosbuvir (LDV/SOF), might be altered in patients with acute lymphoblastic leukemia (ALL), affecting the optimum dose needed for hepatitis C virus treatment. Limited data are available evaluating the population PK of LDV/SOF and SOF metabolite GS-331007. We aimed to study whether ALL could affect population PK parameters of LDV, SOF, and the SOF major metabolite GS-331007 in hepatitis C virus-infected children, develop and validate a predictive PK model of LDV/SOF disposition in this special population, and identify their explained and unexplained sources of variability.</div></div><div><h3>Methods</h3><div>Population PK modeling was performed using MonolixSuite software using the non-linear mixed effect modeling approach. Different compartmental models, absorption models, and lag times for absorption parameters were tested to find out the best-fitting base model. For final model development, data-driven systematic covariate analysis using conditional sampling for the stepwise approach based on the correlation tests method has been performed. The final models were then evaluated using internal validation approaches.</div></div><div><h3>Findings</h3><div>The PK results of 22 fully compliant patients were included in the population PK analysis. LDV and SOF were best described by a 1-compartment model with zero-order absorption and lag time, while the 2-compartment model with first-order absorption and lag time was the best-fitting model for the SOF metabolite. The internal validation approach confirmed the good predictive power of the selected models. The patients’ weight explained the variability in the volume of distribution of LDV and the systemic clearance of SOF and LDV. The final SOF model also included a statistically significant covariate of steatosis stage on its volume of distribution, while the final GS-331007 model included mean corpuscular volume values on GS-331007 central compartment volume, packed cell volume, and direct bilirubin values on metabolite intercompartmental clearance.</div></div><div><h3>Implications</h3><div>The presence of ALL did not explain any variability in the developed population PK models for SOF, LDV, and GS-331007. Despite weight being a significant covariate in the final models suggesting that weight-based dosing of LDV/SOF is better than fixed dosing, the fixed dosing (45/200 mg LDV/SOF) is more practical in terms of simplicity in dosing children at home besides the proved efficacy and safety through both the clinical outcomes and PK exposure results. Weight-based dosing is still hindered due to the absence of exposure-response analysis, and the unavailability of dose-flexible formulas in the market. Future studies are required to support these findings.</div></div><div><h3>ClinicalTrials.gov identifier</h3><div>NCT03903185.</div></div>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":"47 2","pages":"Pages e5-e15"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bioequivalence of Water-Soluble Progesterone Injection (GenSci070) in Healthy Chinese Postmenopausal Women Volunteers.
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-01-30 DOI: 10.1016/j.clinthera.2024.12.015
Rong Song, Xue Wu, Liang Xin, Chan Sun, Yuzhou Gui, Hongjie Qian, Chen Yu, Qian Chen, Tianhong Luo, Ying Ding, Weiwei Gao, Xiaoyan Zhu, Jingying Jia
{"title":"Bioequivalence of Water-Soluble Progesterone Injection (GenSci070) in Healthy Chinese Postmenopausal Women Volunteers.","authors":"Rong Song, Xue Wu, Liang Xin, Chan Sun, Yuzhou Gui, Hongjie Qian, Chen Yu, Qian Chen, Tianhong Luo, Ying Ding, Weiwei Gao, Xiaoyan Zhu, Jingying Jia","doi":"10.1016/j.clinthera.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.12.015","url":null,"abstract":"<p><strong>Purpose: </strong>To study the pharmacokinetic characteristics of progesterone (GenSci070) in healthy Chinese postmenopausal women volunteers and to evaluate the bioequivalence and safety of GenSci070 and reference formulation.</p><p><strong>Methods: </strong>In this randomized, open-label, single-center, single-dose, 2-period, 2-sequence, 2-way crossover study, 50 postmenopausal healthy women were recruited and received a single subcutaneous injection of test (GenSci070) or reference formulation 25 mg, respectively. Plasma progesterone concentrations were measured using liquid chromatography-tandem mass spectrometry, and pharmacokinetic parameters were calculated by noncompartmental analysis method using Phoenix WinNonlin 8.3.1 software to evaluate the bioequivalence. The safety profile was evaluated by adverse events, physical examination, vital signs, laboratory tests, 12-lead ECG, etc. FINDINGS: The geometric mean ratios (90% CIs) for C<sub>max</sub>, AUC<sub>0-t</sub>, and AUC<sub>0-∞</sub> of the test and reference formulations were 92.70% (87.29%-98.44%), 96.26% (94.02%-98.55%), and 95.46% (93.27%-97.71%), respectively. They were all within the acceptable bioequivalence range of 80% to 125%. Thirty-one treatment-emergent adverse events occurred in 22 participants (44.0%) who received test formulation and 21 treatment-emergent adverse events occurred in 16 participants (32.0%) who received reference formulation, all events were mild.</p><p><strong>Implications: </strong>The water-soluble progesterone injection (GenSci070) demonstrated bioequivalence to the marketed progesterone injection (Lubion) and exhibited a good safety profile in this study.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Potential of Albumin-Bilirubin Score for Estimating the Voriconazole-Induced Hepatotoxicity Undergoing Therapeutic Drug Monitoring: A Single-Center Retrospective Cohort Study.
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-01-30 DOI: 10.1016/j.clinthera.2025.01.006
Yuki Asai, Hideo Kato, Isao Tawara, Yuki Nakano, Takuya Iwamoto
{"title":"Potential of Albumin-Bilirubin Score for Estimating the Voriconazole-Induced Hepatotoxicity Undergoing Therapeutic Drug Monitoring: A Single-Center Retrospective Cohort Study.","authors":"Yuki Asai, Hideo Kato, Isao Tawara, Yuki Nakano, Takuya Iwamoto","doi":"10.1016/j.clinthera.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.clinthera.2025.01.006","url":null,"abstract":"<p><strong>Purpose: </strong>Despite implementation of therapeutic drug monitoring (TDM) for voriconazole, the incidence of hepatotoxicity remains high. The albumin-bilirubin (ALBI) score may be useful for estimating voriconazole-induced hepatotoxicity. This pilot study aimed to investigate whether the ALBI score could estimate voriconazole-induced hepatotoxicity during TDM implementation.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study included 134 patients. The primary outcome was voriconazole-induced hepatotoxicity. The cutoff value of the ALBI score was determined using a receiver operating characteristic curve. The cumulative risk of hepatotoxicity was evaluated using Kaplan-Meier curve analysis with a log-rank test for the cutoff value and ALBI grade. Moreover, the group of patients with the trough concentration of voriconazole 1-4 μg/mL was also investigated.</p><p><strong>Findings: </strong>The incidence of hepatotoxicity was 13.4% (18/134). The cutoff value of the ALBI score was -1.91 (sensitivity, 0.611; specificity, 0.655; area under the curve, 0.615). The cumulative risk of hepatotoxicity was significantly higher in the ALBI score ≥-1.91 group than in the ALBI score <-1.91 group (P = 0.024) and patients with higher ALBI grades tended to be at higher risk (P = 0.080). The cumulative risk tended to be higher with ALBI ≥-1.91 in the trough concentration 1-4 μg/mL group; however, no significant difference was found (P = 0.134).</p><p><strong>Implications: </strong>The pilot study indicated that the ALBI score ≥-1.91 may be an indicator for voriconazole-induced hepatotoxicity even when TDM is conducted. Because this study was a single-center and small cohort design, further studies should be conducted using a large datasets and translational research.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Vancomycin Dosing in Patients on Intermittent Hemodialysis-A Retrospective Study.
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-01-27 DOI: 10.1016/j.clinthera.2025.01.001
Jacqueline Martin, Colin M Curtain, Mohammed S Salahudeen, Sonja Janson, Sachin Kodgire, Danny Tsai
{"title":"Vancomycin Dosing in Patients on Intermittent Hemodialysis-A Retrospective Study.","authors":"Jacqueline Martin, Colin M Curtain, Mohammed S Salahudeen, Sonja Janson, Sachin Kodgire, Danny Tsai","doi":"10.1016/j.clinthera.2025.01.001","DOIUrl":"https://doi.org/10.1016/j.clinthera.2025.01.001","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the incidence of therapeutic target attainment using a three-times per week protocol for vancomycin therapy given during the last hour of intermittent hemodialysis (HD).</p><p><strong>Methods: </strong>A single-center retrospective cohort study was conducted of patient medical records in a remote dialysis center from January 2017 to July 2023. Adult patients with chronic kidney disease stage 5 on ≥3 months of intermittent HD who had received a course of vancomycin therapy with ≥1 serum vancomycin concentration recorded were included. Demographic and dosing data were collected. Clinician adherence with the dosing protocol and attainment of the therapeutic target (trough concentration within 15-20 mg/L) following the loading and maintenance doses were assessed. Factors associated with target nonattainment following the loading dose were analyzed, and the 48- and 72-h maintenance dosing intervals were analyzed for target nonattainment.</p><p><strong>Findings: </strong>A total of 98 vancomycin courses (67 patients) were available for analysis. Only 38% of the loading doses were prescribed as per protocol. Following the loading dose, 25% of trough concentrations achieved the therapeutic target concentration (15-20 mg/L), 25% returned a supra-therapeutic concentration (>20 mg/L) and 50% were sub-therapeutic (<15 mg/L). When compared with those achieving target, sub-therapeutic concentrations were associated with a lower loading dose (median 16.6 vs 20.0 mg/kg, P < 0.002), and supra-therapeutic concentrations had a shorter dosing interval between the loading dose and first maintenance dose (median 31.5 vs 39.0 h, P = 0.06). Of the 201 maintenance trough concentrations collected, 65% were therapeutic, 21% were sub-therapeutic and 14% were supra-therapeutic, with an overall median trough concentration of 17.3 mg/L. As the treatment duration increased, an increase was seen in the number of dose adjustments required to achieve the target trough concentration. The 48-h dosing interval was associated with more supra-therapeutic concentrations and the 72-h interval was associated with more sub-therapeutic concentrations (df = 2, P = 0.022).</p><p><strong>Implications: </strong>We have identified a high rate of target nonattainment for HD patients on a three times a week vancomycin dosing regimen. We recommend a loading dose of 20 to 25 mg/kg irrespective of the indication and a better-defined dosing interval after the loading dose. A higher maintenance dose should be prescribed when the time to next dialysis session is 72 h. Further pharmacokinetic studies are needed to assess factors influencing target concentration attainment following the maintenance doses and to determine an optimal dosing regimen.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Apheresis in the Remission of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis.
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-01-24 DOI: 10.1016/j.clinthera.2024.12.016
Nerea Moreno-Herraiz, Alicia Saz-Lara, Iván Cavero-Redondo, Carla Geovanna Lever-Megina, Óscar Martínez-Cifuentes, Iris Otero-Luis
{"title":"Efficacy of Apheresis in the Remission of Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis.","authors":"Nerea Moreno-Herraiz, Alicia Saz-Lara, Iván Cavero-Redondo, Carla Geovanna Lever-Megina, Óscar Martínez-Cifuentes, Iris Otero-Luis","doi":"10.1016/j.clinthera.2024.12.016","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.12.016","url":null,"abstract":"<p><strong>Purpose: </strong>Sudden sensorineural hearing loss (SSHL) is an abrupt hearing loss, often of unknown cause. Apheresis is a treatment option aimed at improving blood hemorheology by removing pathogenic blood components. There are currently no previous meta-analyses on its efficacy. Therefore, the aim of this study was to evaluate the efficacy of apheresis in achieving total, complete, and partial remission of SSHL, as well as remission outcomes based on the type of apheresis used.</p><p><strong>Methods: </strong>A systematic search was performed in PubMed, Scopus, Web of Science, and the Cochrane Library until March 2024. Random-effects models were used to calculate pooled estimates of treatment success rates (TSR) and their respective 95% CI to analyze the efficacy of apheresis in the remission of SSHL. Subgroup analyses were performed by type of apheresis (HELP-apheresis and rheopheresis).</p><p><strong>Findings: </strong>The systematic review included 12 studies (10 in the meta-analysis) involving 786 adults with SSHL. The effect of apheresis showed significant total remission (TSR: 0.55; 95% CI: 0.47, 0.64), complete remission (TSR: 0.21; 95% CI: 0.11, 0.30), and partial remission (TSR: 0.43; 95% CI: 0.37, 0.48). Subgroup analysis revealed significant remission rates for HELP-apheresis (TSR: 0.58; 95% CI: 0.52, 0.64) and rheopheresis (TSR: 0.51; 95% CI: 0.30, 0.72).</p><p><strong>Implications: </strong>These findings support apheresis as an equally or more effective treatment for SSHL, particularly in cases where corticosteroid therapy fails. However, due to the unknown etiology of SSHL, further clinical trials with larger, diverse populations are essential to confirm these results.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of Oral Medication in Weight Loss Management: A Systematic Review and Network Meta-Analysis.
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-01-21 DOI: 10.1016/j.clinthera.2024.12.013
Benedictus Benedictus, Vincent Kurniawan Pratama, Christopher William Purnomo, Kenneth Tan, Ratih Puspita Febrinasari
{"title":"Efficacy of Oral Medication in Weight Loss Management: A Systematic Review and Network Meta-Analysis.","authors":"Benedictus Benedictus, Vincent Kurniawan Pratama, Christopher William Purnomo, Kenneth Tan, Ratih Puspita Febrinasari","doi":"10.1016/j.clinthera.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.12.013","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review was conducted to determine which type of oral medication for obesity provides the best weight loss effect.</p><p><strong>Methods: </strong>This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline. For this systematic review, we used 3 databases for journal searches: PubMed, ScienceDirect, and Scopus. This study only included randomized controlled trials or open-label clinical trials. There was no year limit used in the journal search for this systematic review.</p><p><strong>Findings: </strong>Eighteen randomized controlled trials, with a total population of 12,259 patients, were included. Of 18 studies, 15 were used for network meta-analysis. Based on the results of the network meta-analysis, weight loss was found in phentermine/topiramate (mean difference [MD], -3.28; 95% CI, -4.47 to -2.09), semaglutide (MD, -2.92; 95% CI, -4.38 to -1.46), phentermine (MD, -2.31; 95% CI, -3.82 to -0.81), naltrexone/bupropion (MD, -1.68; 95% CI, -2.87 to -0.49), topiramate (MD, -1.67; 95% CI, -2.86 to -0.48), and orlistat (MD, -1.44; 95% CI, -2.32 to -0.55). There were no significant differences among the groups. However, compared with placebo, all oral obesity therapies provide better benefits in weight loss (MD, -2.12; 95% CI, -2.64 to -1.59; P ≤ 0.00001).</p><p><strong>Implications: </strong>Oral antiobesity drugs provide better weight loss than placebo. However, some side effects can be incurred by utilizing the drug for weight loss, especially related to the gastrointestinal system. Nonetheless, in clinical settings, consideration should be given to particular patients to reduce risk of side effects.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physiologically Based Pharmacokinetic Modeling to Refine Dosing of Posaconazole in Young Children. 以生理为基础的药代动力学模型改进泊沙康唑在幼儿中的剂量。
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-01-17 DOI: 10.1016/j.clinthera.2024.12.018
Paul Malik, Paola Mian
{"title":"Physiologically Based Pharmacokinetic Modeling to Refine Dosing of Posaconazole in Young Children.","authors":"Paul Malik, Paola Mian","doi":"10.1016/j.clinthera.2024.12.018","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.12.018","url":null,"abstract":"<p><strong>Purpose: </strong>Posaconazole is a broad-spectrum antifungal for treating and preventing invasive fungal infections (IFIs) in immunocompromised individuals, including children as young as 2 years. Available in delayed-release (DR) oral suspension, intravenous formulation, and older immediate-release (IR) formulation (off-label in younger children), dosing harmonization across age groups and formulations remains inconsistent. This inconsistency arises from the unique physiology of young children and posaconazole's pH-dependent absorption. Limited pharmacokinetic (PK) data for children under 2 years complicates dosing, as absorption, distribution, metabolism, and excretion processes are underdeveloped and age-dependent. This work aims to harmonize pediatric dosing for children aged 2 to 7 years and extend dosing guidance for those aged 6 months to 2 years using physiologically-based PK (PBPK) modeling.</p><p><strong>Methods: </strong>An adult PBPK model was created using posaconazole's physicochemical properties and ADME characteristics with virtual populations from PK-Sim. Calibrated with single-dose data from healthy subjects, the model was verified by predicting PK following multiple doses in adults at risk for IFIs. The model was then scaled to children, accounting for developmental anatomy and physiology, including UGT1A4 ontogeny. The pediatric model was evaluated against observed data from children aged 2 to 7 years. Simulations were conducted to harmonize dosing across formulations and extend dosing to children as young as 6 months, acknowledging standard plasma concentration targets for treatment of IFIs (1000 ng/mL) as well as prophylaxis (700 ng/mL).</p><p><strong>Findings: </strong>The pediatric model adequately captured observed PK data from literature following all three formulations. The IR oral suspension is impractical and likely subtherapeutic for most children under 7 years due to solubility limits. Intravenous doses of 11-13 mg/kg once daily (QD) may be optimal for treatment, and 8 to 9 mg/kg QD for prophylaxis, varying by age. Oral DR suspension doses of 12 to 14 mg/kg QD for treatment and 8.5 to 10 mg/kg QD for prophylaxis may be optimal, also age-dependent. Dividing the total daily dose by a factor of 0.7 and administering twice daily can achieve similar trough levels.</p><p><strong>Implications: </strong>PBPK modeling for posaconazole bridges the gap between PK principles and clinical practice, potentially improving therapeutic outcomes and minimizing risks associated with inadequate dosing in pediatric patients.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Real-World Treatment Patterns Among US Patients With Type 2 Diabetes Mellitus Initiating Treatment With Once Weekly Semaglutide for Diabetes. 美国2型糖尿病患者的现实世界治疗模式:开始每周一次的西马鲁肽治疗糖尿病
IF 3.2 4区 医学
Clinical therapeutics Pub Date : 2025-01-17 DOI: 10.1016/j.clinthera.2024.12.014
Caroline Swift, Monica Frazer, Andrew Sargent, Michael Leszko, Erin Buysman, Noelle N Gronroos, Sara Alvarez, Tyler J Dunn, Josh Noone
{"title":"Real-World Treatment Patterns Among US Patients With Type 2 Diabetes Mellitus Initiating Treatment With Once Weekly Semaglutide for Diabetes.","authors":"Caroline Swift, Monica Frazer, Andrew Sargent, Michael Leszko, Erin Buysman, Noelle N Gronroos, Sara Alvarez, Tyler J Dunn, Josh Noone","doi":"10.1016/j.clinthera.2024.12.014","DOIUrl":"https://doi.org/10.1016/j.clinthera.2024.12.014","url":null,"abstract":"<p><strong>Purpose: </strong>Injectable once weekly semaglutide for diabetes (OW sema) is a medication approved in 2017 for the treatment of patients with type 2 diabetes (T2DM). In clinical trials, OW sema has been shown to be effective at helping patients achieve glycemic targets. However, more data are needed to understand how patients who initiate treatment with OW sema are treated in the real world and to aid prescribers in making treatment decisions. This study characterized noninsulin antidiabetic medication use patterns among US patients with T2DM initiating treatment with OW sema.</p><p><strong>Methods: </strong>In this retrospective, claims-based study, patients (15,588) were included if they had at least 1 claim for OW sema between January 1, 2018 and December 31, 2019, were at least 18 years old, were continuously enrolled in the health plan, and had at least 1 claim indicating a diagnosis of T2DM. All patients had at least 1 line of therapy (LOT) that started on the date of the first fill for OW sema. Data related to pre-index date demographics and clinical characteristics were collected, as were data on patient regimens and LOTs. The length of the LOT was calculated, and the top 10 noninsulin treatment regimens were reported in each LOT.</p><p><strong>Findings: </strong>In the first LOT, OW sema monotherapy was the most common regimen. More than one third (36.5%) of patients had 1 LOT until the end of follow-up and most patients who had a second (52.1%) or third (72.0%) LOT continued it to the end of the study. Among the top 10 regimens, 42.2% of patients with a second LOT and 45.8% of patients with a third LOT had an LOT that included OW sema.</p><p><strong>Implications: </strong>This study describes medication regimens within the first year of OW sema use. Among patients initiating OW sema, monotherapy was the most common regimen. These results provide insight into real-world usage patterns of this medication.</p>","PeriodicalId":10699,"journal":{"name":"Clinical therapeutics","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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