Population Pharmacokinetic and Pharmacodynamic Analysis of Valganciclovir for Optimizing Preemptive Therapy of Cytomegalovirus Infections in Kidney Transplant Recipients

被引：4

作者：

Cojutti, Pier Giorgio ^{[1
,2
]}

Heffernan, Aaron J. ^{[3
]}

Tangden, Thomas ^{[4
]}

Della Siega, Paola ^{[5
]}

Tascini, Carlo ^{[5
]}

Roberts, Jason A. ^{[3
,6
,7
,8
,9
]}

Pea, Federico ^{[1
,2
]}

机构：

[1] Univ Bologna, Dept Med & Surg Sci, Alma Mater Studiorum, Bologna, Italy

[2] IRCCS Azienda Osped Univ Bologna, Clin Pharmacol Unit, Bologna, Italy

[3] Univ Queensland, Fac Med, Ctr Clin Res, Herston, Qld, Australia

[4] Uppsala Univ, Dept Med Sci, Uppsala, Sweden

[5] Santa Maria della Misericordia Univ Hosp Udine, ASUFC, Infect Dis Clin, Udine, Italy

[6] Royal Brisbane & Womens Hosp, Dept Pharm, Brisbane, Qld, Australia

[7] Metro North Hlth, Herston Infect Dis Inst HeIDI, Brisbane, Qld, Australia

[8] Royal Brisbane & Womens Hosp, Dept Intens Care Med, Brisbane, Qld, Australia

[9] Univ Montpellier, Nimes Univ Hosp, Div Anaesthesiol Crit Care Emergency & Pain Med, Nimes, France

来源：

ANTIMICROBIAL AGENTS AND CHEMOTHERAPY | 2023年 / 67卷 / 03期

基金：

英国医学研究理事会;

关键词：

cytomegalovirus; kidney transplant; valganciclovir PK; PD; preemptive therapy; INTRAVENOUS GANCICLOVIR; COCKCROFT-GAULT; DISEASE; PERFORMANCE; PROPHYLAXIS; STANDARD; MDRD; RISK; GFR;

D O I：

10.1128/aac.01665-22

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

This study aimed to develop a population pharmacokinetic/pharmacodynamic (PK/PD) model of valganciclovir for preemptive therapy of cytomegalovirus (CMV) infection in kidney transplant patients. A population PK/PD model was developed with Monolix. This study aimed to develop a population pharmacokinetic/pharmacodynamic (PK/PD) model of valganciclovir for preemptive therapy of cytomegalovirus (CMV) infection in kidney transplant patients. A population PK/PD model was developed with Monolix. Ganciclovir concentrations and CMV viral loads were obtained retrospectively from kidney transplant patients receiving routine clinical care. Ten thousand Monte Carlo simulations were performed with the licensed dosages adjusted for renal function to assess the probability of attaining a viral load target of <= 290 and <= 137 IU/mL. Fifty-seven patients provided 343 ganciclovir concentrations and 328 CMV viral loads for PK/PD modeling. A one-compartment pharmacokinetic model coupled with an indirect viral turnover growth model with stimulation of viral degradation pharmacodynamic model was devised. Simulations showed that 1- and 2-log(10) reduction of CMV viral load mostly occurred between a median of 5 to 6 and 12 to 16 days, respectively. The licensed dosages achieved a probability of reaching the viral load target >= 90% at days 35 to 49 and 42 to 56 for the thresholds of <= 290 and <= 137 IU/mL, respectively. Simulations indicate that in patients with an estimated glomerular filtration rate of 10 to 24 mL/min/1.73m(2), a dose increase to 450 mg every 36 h may reduce time to optimal viral load target to days 42 and 49 from a previous time of 49 and 56 days for the thresholds of <= 290 and <= 137 IU/mL, respectively. Currently licensed dosages of valganciclovir for preemptive therapy of CMV infection may achieve a viral load reduction within the first 2 weeks, but treatment should continue for >= 35 days to ensure viral load suppression.

引用

页数：10

共 32 条

[1] Oral valganciclovir is noninferior to intravenous ganciclovir for the treatment of cytomegalovirus disease in solid organ transplant recipients [J].