Clinical Pharmacokinetic Studies
Abstract
Drug efficacy and response are a function of drug concentration over time. In clinical pharmacokinetic studies, aspects of drug absorption, distribution, metabolism, and excretion over time are assessed. In the early clinical development, the pharmacokinetics of a drug is studied in healthy subjects followed by studies in patient population(s) with the aim to find the relevant dose in the target population(s). Particular pharmacokinetic studies in special populations assess the necessity of a dose adjustment from the planned/established clinical dose for patients.
Keywords
Hepatic Impairment Mean Residence Time Regular Human Insulin Insulin Glulisine Developmental DrugAbbreviations
- Ae
Amount of drug excreted unchanged in urine
- ANOVA
Analysis of variance
- AUC
Area under the curve
- BMI
Body mass index
- C12,C24
Plasma concentration 12 and 24 h after administration
- CI 90 %
90 % confidence Interval
- CLCR
Creatinine clearance
- CLR
Renal clearance
- CLtot/F
Relative total clearance
- Cmax
Maximum concentration
- Cmax
Maximum plasma concentration
- CV
Coefficient of variation
- CYP3A4
Cytochrome P450 3A4
- day –1
Study day prior to day of study medication administration
- fu
Unbound fraction of XYZ123 in plasma
- h
Hour
- INN
International nonproprietary name
- IU
International units
- L
Liter
- Mg
Milligram
- MRT
Mean residence time
- NPH
Neutral protamine Hagedorn (isophane insulin)
- Rac
Accumulation ratio
- RHI
Regular human insulin
- s.c.
Subcutaneous(ly)
- t1/2,λ1
Main elimination half-life
- t1/2,λz
Terminal elimination half-life
- t12t24
Time 12 and 24 h after administration
- Tmax
Time to maximum concentration
- tmax
Time to maximum plasma concentration
References and Further Readings
- Albers I, Hartmann H, Bircher J, Creutzfeldt W (1989) Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis. Scand J Gastroenterol 24:269–276PubMedCrossRefGoogle Scholar
- Amidon GL, Lennernäs H, Shah VP, Crison JR (1995) A theoretical basis for a biopharmaceutic drug classification: the correlation of in vitro drug product dissolution and in vivo bioavailability. Pharm Res 12:413–420PubMedCrossRefGoogle Scholar
- Bearden DT, Rodvold KA (2000) Dose adjustments for antibacterials in obese patients. Clin Pharmacokinet 38(5):415–426PubMedCrossRefGoogle Scholar
- Bieck PR (1989) Drug absorption from the colon. In: Hardy JG, Davis SS, Wilson CG (eds) Drug delivery to the gastrointestinal tract. Ellis Horwood, Chichester, pp 147–159Google Scholar
- Bjornsson TD, Callaghan JT, Einolf HJ, Fischer V, Gan L, Grimm S, Kao J, King PS, Miwa G, Ni L, Kumar G, McLeod J, Obach RS, Roberts S, Roe A, Shah A, Snikeris F, Sullivan JT, Tweedie D, Vega JM, Walsh J, Wrighton SA (2003) The conduct of in vitro and in vivo drug-drug interaction studies: a pharmaceutical research and manufacturers of America (PhRMA) perspective. Drug Metabol 31:815–832CrossRefGoogle Scholar
- Blouin RA, Kolpek JH, Mann HJ (1987) Influence of obesity on drug disposition. Clin Pharm 6(9):709–714Google Scholar
- Brunner GA, Hirschberger S, Sendlhofer G et al (2000) Post-prandial administration of the insulin analogue insulin aspart in patients with Type 1 diabetes mellitus. Diabetes Med 17:371–375CrossRefGoogle Scholar
- Burge MR, Castillo KR, Schade DS (1997) Meal composition is a determination of lispro-induced hypoglycemia in IDDM. Diabetes Care 20(2):152–155PubMedCrossRefGoogle Scholar
- Burger F, Scholtz H, Frick AD, Becker RHA (2004) Pharmacodynamics (PD) and Pharmacokinetics (PK) of Insulin Glulisine (GLU) Versus Insulin Lispro (IL) and regular Human Insulin (RHI) in Patients with Type 1 Diabetes. Abstract and poster presentations at the annual American diabetes congress ADA (American Diabetes Association)Google Scholar
- Carithers RL, Herlong HF, Diehl AM, Shaw EW, Combes B, Fallon H, Maddrey WC (1978) Methyl-prednisolone therapy in patients with severe alcoholic hepatitis. Ann Intern Med 110:685–690Google Scholar
- CPMP/EWP/1080/00 (2002) Note for guidance on clinical investigation of medicinal products in the treatment of diabetes mellitus (CPMP adopted May 2002)Google Scholar
- CPMP/EWP/462/95 (1997) Note for guidance on clinical investigations of medical products in children, September 1997Google Scholar
- CPMP/EWP/560/95 (1998) Note for guidance on the investigation of drug interactions (CPMP, June 1998)Google Scholar
- CPMP/EWP/560/95/Rev. 1 (2010) Draft guideline on the investigation of drug interactions; April 2010Google Scholar
- CPMP/EWP/968/02 (2002) Concept paper on the development of a CPMP points to consider on the evaluation of the pharmacokinetics of medicinal products in the paediatric population, May 2002Google Scholar
- CPMP/EWP/QWP/1401/98 (2002) Note for guidance on the investigation of bioavailability and bioequivalence (CPMP, January 2002)Google Scholar
- CPMP/ICH/2711/99 (2000) ICH topic E11, Step 4 note for guidance on clinical investigation of medicinal products in the pediatric population, July 2000Google Scholar
- Danne T, Rave K, Bittner C, Heise T, Frick A, Becker R (2004a) Pharmacokinetics and safety of insulin glulisine in children and adolescents with type 1 diabetes. Abstract and poster presentation at the annual European Diabetes Congress EASD (European Association for the Study of Diabetes)Google Scholar
- Danne T, Rave K, Bittner C, Heise T, Frick A, Becker R (2004b) Pharmacokinetics and safety of insulin glulisine in children and adolescents with type 1 diabetes. Abstract and poster presentation at the annual American Diabetes Congress ADA (American Diabetes Association)Google Scholar
- Danne T, Becker R, Heise T, Bittner C, Frick A, Rave K (2005) Pharmacokinetics, prandial glucose control, and safety of insulin glulisine in children and adolescents with type 1 diabetes. Diab Care 28(9):2100–2105CrossRefGoogle Scholar
- Davis SS, Hardy JG, Fara JW (1986) Transit of pharmaceutical dosage forms through the small intestine. Gut 27:886–892PubMedCrossRefGoogle Scholar
- Deroubaix X, Coquette A (2004) The Ins and Outs of human ADME studies. Bus Brief Pharmatech 2004:1–4Google Scholar
- Dickson ER, Grambsch PM, Fleming TR, Fisher LD, Langworthy A (1989) Prognosis in primary biliary cirrhosis: model for decision making. Hepatology 10:1–7PubMedCrossRefGoogle Scholar
- Duffull SB, Dooley MJ, Green B, Poole SG, Kirkpatrick CMJ (2004) A standard weight descriptor for dose adjustment in the obese patient. Clin Pharmacokinet 43:1167–1178PubMedCrossRefGoogle Scholar
- EMEA CHMP (2004) Note for guidance on the evaluation of the pharmacokinetics of medicinal products in patients with impaired renal function, December 2004. http://www.emea.europa.eu/pdfs/human/ewp/022502en.pdf
- EMEA CHMP (2005) Guideline on the evaluation of the pharmacokinetics of medicinal products in patients with impairment hepatic function, August 2005Google Scholar
- EMEA CPMP/EWP/281/96 (R1) (2007) Note for guidance on the clinical investigations of drugs used in weight control, November 2007Google Scholar
- EMEA CPMP/EWP/560/95 (1997) Note for guidance on the investigation of drug interactions, December 1997Google Scholar
- EMEA/19253/03 (2002) Concept paper: conduct of pharmacovigilance for medicines used by children, September 2002Google Scholar
- EMEA/27164/98 Rev.1 (1998) Report on the experts round table on the difficulties related to the use of new medicinal products in children held on 18 December 1997; July 1998Google Scholar
- EU CPMP (1997) Note for guidance on the investigation drug interactions, December 1997Google Scholar
- EU CPMP (1999) Note for guidance on modified release oral and transdermal dosage forms: section II (Pharmacokinetic and Clinical Evaluation), July 1999Google Scholar
- EU CPMP (2001) Note for guidance on the investigation of bioavailability and bioequivalence, July 2001Google Scholar
- EU CPMP (2002) Position paper on terminology in pharmacogenetics, November 2002Google Scholar
- EU CPMP (2003a) Points to consider on the clinical requirements of modified release products to be submitted as a line extension of an existing marketing authorization, June 2003Google Scholar
- EU CPMP (2003b) Points to consider on the clinical requirements of modified release products submitted as a line extension of an existing marketing authorization, December 2003Google Scholar
- EU CPMP (2010) Guideline on the investigation of bioequivalence, January 2010Google Scholar
- EU directive 75/318/EEC Guideline (1989) Clinical investigations of medical products in children, March 1989Google Scholar
- EU EUDRALEX 3BS11a (1994) Pharmacokinetics and metabolic studies in the safety evaluation of new medicinal products in animals, April 1994Google Scholar
- EU EUDRALEX 3CC3a (1988) Pharmacokinetic studies in man, October 1988Google Scholar
- Figg WD, Dukes GE, Lesesne HR, Carson SW, Songer SS, Pritchard JF, Hermann DJ, Powell JR, Hak LJ (1995) Comparison of quantitative methods to assess hepatic function: Pugh’s classification, indocyanine green, antipyrine, and dextromethorphan. Pharmacother 15:693–700Google Scholar
- Frick A, Becker R, Wessels D, Scholtz H (2003) Pharmacokinetic and glucodynamic profiles of insulin glulisine: an evaluation following subcutaneous administration at various injection sites. Diabetologia 46:Abs 776Google Scholar
- Frick AD, Scholtz H, Burger F, Becker RHA (2004) Absorption of insulin glulisine when mixed with NPH insulin. Abstract and poster presentation at the annual American diabetes congress ADA (American Diabetes Association)Google Scholar
- Fuhr U, Rost KL, Engelhardt R, Sachs M, Liermann D et al (1996) Evaluation of caffeine as a test drug for CYP1A2, NAT2 and CYP2E1 phenotyping in man by in vivo versus in vitro correlations. Pharmacogenetics 6:159–176PubMedCrossRefGoogle Scholar
- Garner RC (2000) Accelerator mass spectrometry in pharmaceutical research and development—an new ultrasensitive analytical method for isotope measurement. Curr Drug Metabol 1:205–213CrossRefGoogle Scholar
- Guidance for Industry (1996) The content and format for pediatric use supplements. U.S. Department of Health and Human Services, Food and Drug Administration; Center for Drug Evaluation and Research (CDER), May 1996Google Scholar
- Guidance for Industry (1998) General considerations for pediatric pharmacokinetic studies for drugs and biological products. U.S. Department of Health and Human Services, Food and Drug Administration; Center for Drug Evaluation and Research (CDER). Draft Guidance, November 1998Google Scholar
- Hardy JG, Wilson CG, Wood E (1985) Drug delivery to the proximal colon. J Pharm Pharmacol 37:874–877PubMedCrossRefGoogle Scholar
- Hardy JG, Healy JNC, Lee SW, Reynolds JR (1987) Gastrointestinal transit of an enteric coated delayed release 5-aminosalicylic acid tablet. Aliment Pharmacol Ther 1:209–216PubMedCrossRefGoogle Scholar
- ICH E4 (1994) Dose-response information to support drug registration, March 1994Google Scholar
- ICH-E5 (1998) Ethnic factors in the acceptability of foreign clinical data (R1). September 1998Google Scholar
- ICH-E7 (1994) Guideline for industry: studies in support of special populations: Geriatrics, August 1994Google Scholar
- International Conference on Harmonization E6 (R1) (2002) Guidance for industry, Good clinical practice: consolidated guidance, July 2002Google Scholar
- International Conference on Harmonization E8 (1998) Guidance on general considerations for clinical trials, March 1998Google Scholar
- International conference on harmonization M 3 (R2) (2009) Guidance on nonclinical safety studies for the conduct of human clinical trials, June 2009Google Scholar
- Jaros M, Martinek V, Piechatzek R, Frick AD, Becker RHA (2004a) Pharmacokinetics of insulin glulisine in nondiabetic renally impaired patients. Abstract and poster presentation at the annual European Diabetes Congress EASD (European Association for the Study of Diabetes)Google Scholar
- Jaros M, Martinek V, Piechatzek R, Frick AD, Becker RHA (2004b) Pharmacokinetics of insulin glulisine in nondiabetic renally impaired patients. Abstract and poster presentation at the annual American Diabetes Congress ADA (American Diabetes Association)Google Scholar
- Kelly KA (1980) Gastric emptying of liquids and solids: roles of proximal and distal stomach. Am J Physiol 230:G71–G76Google Scholar
- Kovacs SJ, Martin DE, Everitt DE, Patterson SD, Jorkasky DK (1998) Urinary excretion of 6-beta-hydroxycortisol as an in vivo marker for CYP3A induction: applications and recommendations. Clin Pharmacol Ther 63:617–622PubMedCrossRefGoogle Scholar
- Lennernäs H (1998) Human intestinal permeability. J Pharm Sci 87(4):403–410PubMedCrossRefGoogle Scholar
- Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI (1998) Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 75:193–199Google Scholar
- EU Regulation (EC) No 1901/2006 of the European parliament and of the council of 12 December 2006 on medicinal products for pediatric useGoogle Scholar
- Price JMC, Davis SS, Wilding IR (1993a) Characterization of colonic transit of non disintegrating tablets in healthy subjects. Dig Dis Sci 38:1015–1021PubMedCrossRefGoogle Scholar
- Price JMC, Davis SS, Sparrow RA, Wilding IR (1993b) The effect of meal composition on the gastrocolonic response: implications for drug delivery to the colon. Pharm Res 10:722–726PubMedCrossRefGoogle Scholar
- Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the esophagus for bleeding oesophageal varices. Br J Surg 60:646–649PubMedCrossRefGoogle Scholar
- Rave K, Klein O, Frick A, Becker R (2006) Advantage of premeal injected insulin glulisine compared with regular human insulin in subjects with Type 1 diabetes. Diabetes Care 29:1812–1817PubMedCrossRefGoogle Scholar
- Rost KL, Roots I (1994) Accelerated caffeine metabolism after omeprazole treatment is indicated by urinary metabolic ratios: coincidence with plasma clearance. Clin Pharm Ther 55(4):402–411CrossRefGoogle Scholar
- Schall R, Williams RL, for the FDA Individual Bioequivalence Working Group (1996) Towards a practical strategy for assessing individual bioequivalence. J Pharmacokin Biopharm 24:133–149CrossRefGoogle Scholar
- Singh BN (1999) Effects of food on clinical pharmacokinetics. Clin Pharmacokinet 37(3):213–255PubMedCrossRefGoogle Scholar
- Steinijans VW, Diletti E (1983) Statistical analysis of bioequivalence studies: parametric and non-parametric confidence intervals. Eur J Pharmacol 24:127–136CrossRefGoogle Scholar
- Steinijans VW, Hauschke D (1997) Individual bioequivalence. A European perspective. J Biopharm Stat 7(1):31–34PubMedCrossRefGoogle Scholar
- Strachan MW, Frier BM (1998) Optimal time of administration of insulin lispro. Diabetes Care 21(1):26–30PubMedCrossRefGoogle Scholar
- Streetman DS, Bertino JS, Nafziger AN (2000) Phenotyping drug metabolizing enzymes in adults: a review of in vivo cytochrome P450 phenotyping probes. Pharmacogentics 10:187–216CrossRefGoogle Scholar
- Tang H-S, Hu OY-P (1992) Assessment of liver function using a novel galactose single point method. Digestion 52:222–231PubMedCrossRefGoogle Scholar
- Testa R, Caglieris S, Risso D et al (1997) Monoethylglycinexylidide formation measurement as a hepatic function test to assess severity of chronic liver disease. Am J Gastroenterol 92:2268–2273PubMedGoogle Scholar
- The Declaration of Helsinki (2008) Ethical principles for medical research involving human subjects: Version adopted by the 59th WMA General Assembly, Seoul, October 2008Google Scholar
- Tran JQ, Kovacs SJ, McIntosh TS, Davis HM, Martin DE (1999) Morning spot and 24-hour urinary 6-beta-hydroxycortisol to cortisol ratios: intrainividual variability and correlation under basal conditions and conditions of CYP3A4 induction. J Clin Pharmacol 39:487–494PubMedGoogle Scholar
- US FDA (1978) General considerations for the clinical evaluation of drugs, December 1978Google Scholar
- US FDA (1989) Guideline for the study of drugs likely to be used in the elderly, November 1989Google Scholar
- US FDA (1993) Guideline for the study and evaluation of gender differences in the clinical evaluation of drugs; Notice, July 1993Google Scholar
- US FDA (1995) Guidance for industry: scale-up and post-approval changes (SUPAC-IR): chemistry, manufacturing, and control; in vitro dissolution testing and in vivo bioequivalence documentation. U.S. Department of Health and Human Services, Food and Drug Administration; Center for Drug Evaluation and Research (CDER), September 1995Google Scholar
- US FDA (1997a) Guidance for industry: drug metabolism/drug interaction studies in the drug development process: studies in vitro, April 1997Google Scholar
- US FDA (1997b) Guidance for industry: scale-up and post-approval changes (SUPAC-MR): chemistry, manufacturing, and control; in vitro dissolution testing and in vivo bioequivalence documentation. U.S. Department of Health and Human Services, Food and Drug Administration; Center for Drug Evaluation and Research (CDER), September 1997Google Scholar
- US FDA (1997c) Guidance for industry: extended release oral dosage forms: development, evaluation, and application of in vitro/in vivo correlations, September 1997Google Scholar
- US FDA (1997d) Guidance for industry: SUPAC-MR: modified release solid oral dosage forms, September 1997Google Scholar
- US FDA (1998) Guidance for industry: pharmacokinetics in patients with impaired renal function: study design, data analysis, and impact on dosing and labeling, May 1998. http://www.fda.gov/downloads/Drugs/GuidanceCompliance/RegulatoryInformation/Guidances/ucm072127.pdf
- US FDA (1999a) In vivo drug metabolism/drug interaction studies, November 1999Google Scholar
- US FDA (1999b) Guidance for industry: waiver of in vivo bioavailability and bioequivalence studies for immediate release solid oral dosage forms containing certain active moieties/active ingredients based on the biopharmaceutics classification system (BCS). U.S. Department of Health and Human Services, Food and Drug Administration; Center for Drug Evaluation and Research (CDER), January 1999Google Scholar
- US FDA (2001) Guidance for industry: statistical approaches to establishing bioequivalence. U.S. Department of Health and Human Services, Food and Drug Administration; Center for Drug Evaluation and Research (CDER), January 2001Google Scholar
- US FDA (2002) Guidance for industry: food-effect bioavailability and fed bioequivalence studies, December 2002Google Scholar
- US FDA (2003a) Guidance for industry exposure-response relationships—study design, data analysis, and regulatory applications, April 2003Google Scholar
- US FDA (2003b) Guidance for industry: bioavailability and bioequivalence studies for orally administered drug products—general considerations, (R1) March 2003Google Scholar
- US FDA (2003c) Guidance for industry: bioavailability and bioequivalence studies for nasal aerosols and nasal sprays for local action, April 2003Google Scholar
- US FDA (2003d) Guidance for industry: pharmacokinetics in patients with impaired hepatic function: study design, data analysis, and impact on dosing and labeling, May 2003Google Scholar
- US FDA (2005) Guidence for industry: pharmacogenomic data submissions, March 2005Google Scholar
- US FDA (2006a) Bioequivalence Guidance, November, 2006Google Scholar
- US FDA (2006b) Draft guidance for industry: drug interaction studies—study design, data analysis, and implications for dosing and labeling, September 2006Google Scholar
- US FDA (2007) Guidance for industry, draft (R1) developing products for weight management, February 2007Google Scholar
- US FDA (2008) Safety testing of drug metabolites, February 2008Google Scholar
- US FDA 21 CFR 361.1 (2010) Radioactive drugs for certain research uses; April, 2010Google Scholar
- Wiesner RH, Grambsch PM, Dickson ER, Ludwig J, MacCarty RL, Hunter EB et al (1989) Primary sclerosing cholangitis: natural history, prognostic factors and survival analysis. Hepatology 10:430–436PubMedCrossRefGoogle Scholar
- Zakim D, Boyer TD (1996) Hepatology: a textbook of liver disease. W. B. Saunders, PhiladelphiaGoogle Scholar
- Zhang L, Strong JM, Qiu W, Lesko LJ, Huang S-M (2006) Scientific perspectives on drug transporters and their role in drug interactions. Mol Pharm 3(1):62–69PubMedCrossRefGoogle Scholar