1. Integrated Population Pharmacokinetics of Daprodustat in Patients with Chronic Kidney Disease with Anemia.
- Author
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Mahar KM, Yang S, Mesic E, Post TM, and Goulooze SC
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Adult, Aged, 80 and over, Quinoxalines pharmacokinetics, Quinoxalines administration & dosage, Hypoxia-Inducible Factor-Proline Dioxygenases antagonists & inhibitors, Young Adult, Barbiturates pharmacokinetics, Barbiturates administration & dosage, Prolyl-Hydroxylase Inhibitors pharmacokinetics, Prolyl-Hydroxylase Inhibitors administration & dosage, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic metabolism, Anemia drug therapy, Anemia blood, Glycine analogs & derivatives, Glycine pharmacokinetics, Glycine administration & dosage, Models, Biological
- Abstract
Background and Objective: Daprodustat is a first-in-class hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) approved in the USA for treatment of anemia owing to chronic kidney disease (CKD) in dialysis-dependent adults and in Japan for treatment of CKD in dialysis- and non-dialysis dependent adults. This analysis characterized the population pharmacokinetics (PopPK) of daprodustat in adults with CKD and evaluated the influence of intrinsic and extrinsic factors., Methods: This PopPK analysis included data from one phase 2B and four phase 3 studies comprising 707 CKD subjects dose titrated to prespecified target hemoglobin levels with daprodustat doses ranging from 1 to 24 mg once daily and 2 to 48 mg given three times a week (TIW). Model development leveraged a previous phase 1/2 PopPK model. Stepwise covariate analysis included 20 extrinsic and intrinsic factors. Model evaluation used standard goodness-of-fit and visual predictive checks., Results: Daprodustat PopPK was adequately characterized using a three-compartment distribution model with first-order elimination. The absorption phase was described using five transit compartments. Oral clearance and volume of distribution was 24.6 L/h and 26.9 L, respectively. Body weight dependence (with fixed allometric coefficients) of clearance and volume terms was a statistically significant covariate. Concomitant use of clopidogrel (moderate CYP2C8 inhibitor) decreased oral clearance, resulting in higher area under the plasma concentration-time curve (AUC) ratio of 1.59 (90% CI: 1.39-1.82), subjects' dialysis status (non-dialysis versus dialysis) had an effect on absorption, with C
max ratio of 1.19 (90% CI: 1.09-1.30). None of the other investigated intrinsic or extrinsic covariates, including concomitant administration with phosphate binders, oral iron and acid reducing agents resulted in a significant change in daprodustat systemic exposure., Conclusion: The PopPK of daprodustat in the CKD population with anemia was adequately characterized. Allometrically-scaled body weight on clearance and volume, dialysis status on absorption and clopidogrel on clearance were statistically significant covariates., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)- Published
- 2024
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