Cargando…
Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model
Ustekinumab is a monoclonal antibody used in Crohn’s disease (CD). Dose optimization in case of non-response and the role of pharmacokinetic–pharmacodynamic (PK-PD) monitoring remain unresolved dilemmas in clinical practice. We aimed to develop a population PK-PD model for ustekinumab in CD and simu...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538292/ https://www.ncbi.nlm.nih.gov/pubmed/34683880 http://dx.doi.org/10.3390/pharmaceutics13101587 |
_version_ | 1784588470568615936 |
---|---|
author | Aguiar Zdovc, Jurij Hanžel, Jurij Kurent, Tina Sever, Nejc Koželj, Matic Smrekar, Nataša Novak, Gregor Štabuc, Borut Dreesen, Erwin Thomas, Debby Vovk, Tomaž Ostanek, Barbara Drobne, David Grabnar, Iztok |
author_facet | Aguiar Zdovc, Jurij Hanžel, Jurij Kurent, Tina Sever, Nejc Koželj, Matic Smrekar, Nataša Novak, Gregor Štabuc, Borut Dreesen, Erwin Thomas, Debby Vovk, Tomaž Ostanek, Barbara Drobne, David Grabnar, Iztok |
author_sort | Aguiar Zdovc, Jurij |
collection | PubMed |
description | Ustekinumab is a monoclonal antibody used in Crohn’s disease (CD). Dose optimization in case of non-response and the role of pharmacokinetic–pharmacodynamic (PK-PD) monitoring remain unresolved dilemmas in clinical practice. We aimed to develop a population PK-PD model for ustekinumab in CD and simulate efficacy of alternative dosing regimens. We included 57 patients and recorded their characteristics during 32 weeks after starting with ustekinumab therapy. Serum ustekinumab concentration was prospectively measured and fecal calprotectin (FC) concentration was used to monitor the disease activity. Ustekinumab PK-PD was described by a two-compartment target-mediated drug disposition model linked to an indirect response model. Lower fat-free mass, higher serum albumin, previous non-exposure to biologics, FCGR3A-158 V/V variant and lower C-reactive protein were associated with higher ustekinumab exposure. Model-based simulation suggested that 41.9% of patients receiving standard dosing achieve biochemical remission at week 32. In patients not achieving remission with standard dosing at week 16, transition to 4-weekly subcutaneous maintenance dosing with or without intravenous reinduction resulted in comparably higher remission rates at week 32 (51.1% vs. 49.2%, respectively). Our findings could be used to guide stratified ustekinumab treatment in CD, particularly in patients with unfavorable characteristics, who might benefit from early transition to 4-weekly maintenance dosing. |
format | Online Article Text |
id | pubmed-8538292 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-85382922021-10-24 Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model Aguiar Zdovc, Jurij Hanžel, Jurij Kurent, Tina Sever, Nejc Koželj, Matic Smrekar, Nataša Novak, Gregor Štabuc, Borut Dreesen, Erwin Thomas, Debby Vovk, Tomaž Ostanek, Barbara Drobne, David Grabnar, Iztok Pharmaceutics Article Ustekinumab is a monoclonal antibody used in Crohn’s disease (CD). Dose optimization in case of non-response and the role of pharmacokinetic–pharmacodynamic (PK-PD) monitoring remain unresolved dilemmas in clinical practice. We aimed to develop a population PK-PD model for ustekinumab in CD and simulate efficacy of alternative dosing regimens. We included 57 patients and recorded their characteristics during 32 weeks after starting with ustekinumab therapy. Serum ustekinumab concentration was prospectively measured and fecal calprotectin (FC) concentration was used to monitor the disease activity. Ustekinumab PK-PD was described by a two-compartment target-mediated drug disposition model linked to an indirect response model. Lower fat-free mass, higher serum albumin, previous non-exposure to biologics, FCGR3A-158 V/V variant and lower C-reactive protein were associated with higher ustekinumab exposure. Model-based simulation suggested that 41.9% of patients receiving standard dosing achieve biochemical remission at week 32. In patients not achieving remission with standard dosing at week 16, transition to 4-weekly subcutaneous maintenance dosing with or without intravenous reinduction resulted in comparably higher remission rates at week 32 (51.1% vs. 49.2%, respectively). Our findings could be used to guide stratified ustekinumab treatment in CD, particularly in patients with unfavorable characteristics, who might benefit from early transition to 4-weekly maintenance dosing. MDPI 2021-09-30 /pmc/articles/PMC8538292/ /pubmed/34683880 http://dx.doi.org/10.3390/pharmaceutics13101587 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Aguiar Zdovc, Jurij Hanžel, Jurij Kurent, Tina Sever, Nejc Koželj, Matic Smrekar, Nataša Novak, Gregor Štabuc, Borut Dreesen, Erwin Thomas, Debby Vovk, Tomaž Ostanek, Barbara Drobne, David Grabnar, Iztok Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model |
title | Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model |
title_full | Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model |
title_fullStr | Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model |
title_full_unstemmed | Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model |
title_short | Ustekinumab Dosing Individualization in Crohn’s Disease Guided by a Population Pharmacokinetic–Pharmacodynamic Model |
title_sort | ustekinumab dosing individualization in crohn’s disease guided by a population pharmacokinetic–pharmacodynamic model |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538292/ https://www.ncbi.nlm.nih.gov/pubmed/34683880 http://dx.doi.org/10.3390/pharmaceutics13101587 |
work_keys_str_mv | AT aguiarzdovcjurij ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT hanzeljurij ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT kurenttina ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT severnejc ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT kozeljmatic ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT smrekarnatasa ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT novakgregor ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT stabucborut ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT dreesenerwin ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT thomasdebby ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT vovktomaz ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT ostanekbarbara ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT drobnedavid ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel AT grabnariztok ustekinumabdosingindividualizationincrohnsdiseaseguidedbyapopulationpharmacokineticpharmacodynamicmodel |