Phase I study of single-dose pharmacokinetics and pharmacodynamics of belatacept in adolescent kidney transplant recipients

被引:14
作者
Moudgil, Asha [1 ,2 ]
Dharnidharka, Vikas R. [3 ,4 ]
Feig, Daniel, I [5 ]
Warshaw, Barry L. [6 ,7 ]
Perera, Vidya [8 ]
Murthy, Bindu [8 ]
Roberts, Mustimbo E. [8 ]
Polinsky, Martin S. [8 ]
Ettenger, Robert B. [9 ]
机构
[1] Childrens Natl Med Ctr, Dept Kidney Transplantat, Washington, DC 20010 USA
[2] Childrens Natl Med Ctr, Dept Nephrol, Washington, DC 20010 USA
[3] Washington Univ, Div Pediat Nephrol Hypertens & Pheresis, St Louis, MO USA
[4] St Louis Childrens Hosp, St Louis, MO 63178 USA
[5] Univ Alabama Birmingham, Div Nephrol, Birmingham, AL USA
[6] Emory Univ, Dept Pediat, Atlanta, GA 30322 USA
[7] Childrens Healthcare Atlanta, Atlanta, GA USA
[8] Bristol Myers Squibb, Lawrenceville, NJ USA
[9] UCLA, Dept Pediat, Mattel Childrens Hosp, Los Angeles, CA 90024 USA
关键词
belatacept; clinical research; practice; immunosuppressant - fusion proteins and monoclonal antibodies; kidney transplantation; nephrology; living donor; pharmacokinetics; pharmacodynamics; simulation; CALCINEURIN INHIBITOR; CYCLOSPORINE; SURVIVAL; OUTCOMES; CHILDREN; REGIMEN; SAFETY; AGE;
D O I
10.1111/ajt.15236
中图分类号
R61 [外科手术学];
学科分类号
摘要
Belatacept is an intravenously infused selective T cell costimulation blocker approved for preventing organ rejection in renal transplant recipients aged >= 18 years. This phase I trial examined the pharmacokinetics and pharmacodynamics (percentage CD86 receptor occupancy [%CD86RO]) of a single dose of belatacept (7.5 mg/kg) administered to kidney transplant recipients aged 12-17 years receiving a stable calcineurin inhibitor-based immunosuppressive regimen. Nine adolescents (mean age 15.1 years) who were seropositive for Epstein-Barr virus were enrolled; all completed the 6-month study. Pharmacokinetics suggested relatively low variability of exposure (coefficients of variation for maximum observed serum concentration [C-max] and area under the serum concentration-time curve from time zero extrapolated to infinity [AUC(0-INF)] were 20% and 25%, respectively). Mean half-life (T-1/2) occurred 7.2 days postinfusion. Belatacept total body clearance was 0.48 mL/h/kg, and volume of distribution at steady-state (V-ss) was low at 0.09 L/kg. Compared with historical data from healthy adult volunteers administered a single dose of belatacept 10 mg/kg and adult kidney transplant recipients administered multiple doses of belatacept 5 mg/kg, pharmacokinetic values for adolescents were similar, indicating consistency across adolescent and adult populations. Mean %CD86RO increased with increasing belatacept concentration, indicating a direct relationship between pharmacokinetics and pharmacodynamics. Four patients reported 7 serious adverse events; none was considered related to belatacept. These data will inform belatacept dose selection in future studies of adolescent kidney transplant recipients.
引用
收藏
页码:1218 / 1223
页数:6
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