期刊
JOURNAL OF CLINICAL PHARMACOLOGY
卷 61, 期 7, 页码 881-888出版社
WILEY
DOI: 10.1002/jcph.1840
关键词
antiepileptic drugs; lacosamide; pediatrics; population pharmacokinetics; real‐ world data
资金
- National Science Foundation [0711134, 0933959, 1041709, 1041710]
- Direct For Computer & Info Scie & Enginr
- Office of Advanced Cyberinfrastructure (OAC) [0933959, 0711134] Funding Source: National Science Foundation
- Direct For Computer & Info Scie & Enginr
- Office of Advanced Cyberinfrastructure (OAC) [1041709, 1041710] Funding Source: National Science Foundation
Analysis of real-world data indicated that lacosamide dosing should be adjusted based on age to match exposure levels seen in different pediatric age groups, with older children requiring the same dose as recommended for children >= 4 years of age, while younger children and infants may need higher doses.
The antiepileptic drug lacosamide (LCM) is approved in the United States and the European Union as monotherapy as well as adjunctive therapy for the treatment of focal seizures in children >= 4 years of age and adults. Using real-world therapeutic drug monitoring data, we performed a pharmacometric analysis for 315 pediatric patients (>1 month to <18 years of age) who received lacosamide as both monotherapy and adjunctive therapy. Population pharmacokinetic modeling was performed using nonlinear mixed-effects modeling with a 1-compartment structural model with linear elimination, where clearance and volume of distribution were allometrically scaled for body weight, with no further need for age-associated maturation functions. A covariate analysis for age, sex, race, and coadministration of other antiepileptic drugs identified phenobarbital and felbamate to significantly increase lacosamide clearance (1.71- and 1.46-fold, respectively). Based on the developed population pharmacokinetic model, simulations were performed in virtual pediatric patients to explore age-associated dose requirements to match lacosamide exposure in patient groups of different age with the exposure achieved in children >= 4 year of age with the weight-based dosing recommendations provided by the US Food and Drug Administration. Based on this approach, our analysis suggested that children >= 3 years of age needed the same dose as recommended by the US Food and Drug Administration for children >= 4 years of age (12 mg/kg/d), while children 1 to 3 years of age may need 13 to 14 mg/kg/d and infants between 1 month and 1 year of age may need 15 to 18 mg/kg/d (based on their actual age) to match the exposure seen in children >= 4 years of age.
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