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Population Pharmacokinetic Model of Methotrexate in Brazilian Pediatric Patients with Acute Lymphoblastic Leukemia

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Abstract

Objectives

Methotrexate (MTX) is subject to therapeutic drug monitoring because of its high pharmacokinetic variability and safety risk outside the therapeutic window. This study aimed to develop a population pharmacokinetic model (popPK) of MTX for Brazilian pediatric acute lymphoblastic leukemia (ALL) patients who attended the Hospital de Clínicas de Porto Alegre, Brazil.

Methods

The model was developed using NONMEM 7.4 (Icon®), ADVAN3 TRANS4, and FOCE-I. To explain inter-individual variability, we evaluated covariates from demographic, biochemical, and genetic data (single nucleotide polymorphisms [SNPs] related to the transport and metabolism of drugs).

Results

A two-compartment model was built using 483 data points from 45 patients (0.33–17.83 years of age) treated with MTX (0.25–5 g/m2) in different cycles. Serum creatinine (SCR), height (HT), blood urea nitrogen (BUN) and a low BMI stratification (according to the z-score defined by the World Health Organization [LowBMI]) were added as clearance covariates. The final model described MTX clearance as \(CL (L/h)= 8.02 \;x {\left(\frac{SCR}{{Median}_{SCR}}\right)}^{-0.401} \;x\; {{\left(\frac{HT}{{Median}_{HT}}\right)}^{0.957}\;x\; {\left(\frac{BUN}{{Median}_{BUN}}\right)}^{-0.181}\;x\; \left(1-0.266\right)}_{LowBMI}\). In the two-compartment structural model, the central and peripheral compartment volumes were 26.8 L and 8.47 L, respectively, and the inter-compartmental clearance was 0.218 L/h. External validation of the model was performed through a visual predictive test and metrics using data from 15 other pediatric ALL patients.

Conclusion

The first popPK model of MTX was developed for Brazilian pediatric ALL patients, which showed that inter-individual variability was explained by renal function and factors related to body size.

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Data Availability

The raw data used in this study is available upon direct request to the authors.

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Acknowledgements

The authors acknowledge Laura Ben Olivo for helping with model revision and external validation.

Funding

This work was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES, Finance Code 001) and by the PPSUS/FAPERGS, Rio Grande do Sul, Brazil (#21/2551–0000065-1).

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  1. Pharmacokinetics and PK/PD Modeling Laboratory, Pharmaceutical Sciences Graduate Program, Federal University of Rio Grande do Sul, 2752 Ipiranga Ave., Santana, RS, 90610-000, Porto Alegre, Brazil

    Pricilla de Oliveira Henz, Bibiana Verlindo de Araújo & Teresa Dalla Costa

  2. Medical Sciences Graduate Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Amanda Valle Pinhatti & Bibiana Verlindo de Araújo

  3. Pediatric Oncology Service, Hospital de Clínicas de Porto Alegre, Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Amanda Valle Pinhatti & Lauro José Gregianin

  4. Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Manoela Martins & Marina Curra

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de Oliveira Henz, P., Pinhatti, A.V., Gregianin, L.J. et al. Population Pharmacokinetic Model of Methotrexate in Brazilian Pediatric Patients with Acute Lymphoblastic Leukemia. Pharm Res 40, 1777–1787 (2023). https://doi.org/10.1007/s11095-023-03544-7

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