Gotta, V;
Bielicki, JA;
Paioni, P;
Csajka, C;
Bräm, DS;
Berger, C;
Giger, E;
Buettcher, M;
Posfay-Barbe, KM;
Van den Anker, J;
et al.
Gotta, V; Bielicki, JA; Paioni, P; Csajka, C; Bräm, DS; Berger, C; Giger, E; Buettcher, M; Posfay-Barbe, KM; Van den Anker, J; Pfister, M
(2024)
Pharmacometric in silico studies used to facilitate a national dose standardisation process in neonatology - application to amikacin.
Swiss Med Wkly, 154.
p. 3632.
ISSN 1424-3997
https://doi.org/10.57187/s.3632
SGUL Authors: Bielicki, Julia Anna
Abstract
BACKGROUND AND AIMS: Pharmacometric in silico approaches are frequently applied to guide decisions concerning dosage regimes during the development of new medicines. We aimed to demonstrate how such pharmacometric modelling and simulation can provide a scientific rationale for optimising drug doses in the context of the Swiss national dose standardisation project in paediatrics using amikacin as a case study. METHODS: Amikacin neonatal dosage is stratified by post-menstrual age (PMA) and post-natal age (PNA) in Switzerland and many other countries. Clinical concerns have been raised for the subpopulation of neonates with a post-menstrual age of 30-35 weeks and a post-natal age of 0-14 days ("subpopulation of clinical concern"), as potentially oto-/nephrotoxic trough concentrations (Ctrough >5 mg/l) were observed with a once-daily dose of 15 mg/kg. We applied a two-compartmental population pharmacokinetic model (amikacin clearance depending on birth weight and post-natal age) to real-world demographic data from 1563 neonates receiving anti-infectives (median birth weight 2.3 kg, median post-natal age six days) and performed pharmacometric dose-exposure simulations to identify extended dosing intervals that would ensure non-toxic Ctrough (Ctrough <5 mg/l) dosages in most neonates. RESULTS: In the subpopulation of clinical concern, Ctrough <5 mg/l was predicted in 59% versus 79-99% of cases in all other subpopulations following the current recommendations. Elevated Ctrough values were associated with a post-natal age of less than seven days. Simulations showed that extending the dosing interval to ≥36 h in the subpopulation of clinical concern increased the frequency of a desirable Ctrough below 5 mg/l to >80%. CONCLUSION: Pharmacometric in silico studies using high-quality real-world demographic data can provide a scientific rationale for national paediatric dose optimisation. This may increase clinical acceptance of fine-tuned standardised dosing recommendations and support their implementation, including in vulnerable subpopulations.
Item Type: |
Article
|
Additional Information: |
Copyright (c) 2024 SMW supporting association
This work is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/) |
Keywords: |
Infant, Newborn, Humans, Child, Infant, Amikacin, Neonatology, Birth Weight, Anti-Bacterial Agents, Drug Administration Schedule, Humans, Birth Weight, Amikacin, Anti-Bacterial Agents, Drug Administration Schedule, Neonatology, Child, Infant, Infant, Newborn, 1103 Clinical Sciences, General & Internal Medicine |
SGUL Research Institute / Research Centre: |
Academic Structure > Infection and Immunity Research Institute (INII) |
Journal or Publication Title: |
Swiss Med Wkly |
ISSN: |
1424-3997 |
Language: |
eng |
Dates: |
Date | Event |
---|
8 April 2024 | Published |
|
Publisher License: |
Creative Commons: Attribution 4.0 |
PubMed ID: |
38635904 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/116446 |
Publisher's version: |
https://doi.org/10.57187/s.3632 |
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