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Meta-Analysis
. 2012 Sep;56(9):4927-36.
doi: 10.1128/AAC.06446-11. Epub 2012 Jul 16.

Population pharmacokinetics of palivizumab, a humanized anti-respiratory syncytial virus monoclonal antibody, in adults and children

Affiliations
Meta-Analysis

Population pharmacokinetics of palivizumab, a humanized anti-respiratory syncytial virus monoclonal antibody, in adults and children

Gabriel J Robbie et al. Antimicrob Agents Chemother. 2012 Sep.

Erratum in

  • Antimicrob Agents Chemother. 2012 Oct;56(10):5431

Abstract

Although it has been on the market for over a decade, confusion remains regarding the pharmacokinetics (PK) and optimal dosing of palivizumab, a humanized IgG1κ monoclonal antibody indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients at high risk of RSV disease. The objectives of this analysis were to characterize the population PK of palivizumab in adults and children using nonlinear mixed-effect modeling, quantify the effects of individual covariates on variability in palivizumab disposition, and compare palivizumab exposures for various dosing scenarios. Palivizumab PK data from 22 clinical studies were used for model development. The model was developed using a two-stage approach: (i) a 2-compartment model with first-order absorption after intramuscular administration was fitted to adult data, and (ii) the same structural model was fitted to the sparse pediatric data using the NONMEM $PRIOR subroutine, with informative priors obtained from the adult analysis. Body weight and an age descriptor that combines gestational age and postnatal age (PAGE) using an asymptotic-exponential model best described palivizumab clearance in pediatric patients. Palivizumab clearance increased slightly from 10.2 ml/day to 11.9 ml/day as a function of PAGE ranging from 7 to 18 months. Covariate analysis indicated a 20% higher clearance in children with chronic lung disease and in children with antidrug antibody titer values of ≥80. These covariates did not substantially explain interindividual variability. In the label-indicated pediatric population, body weight was the primary demographic factor affecting palivizumab PK. Body weight-based dosing of 15 mg/kg yields similar palivizumab concentrations in children of different gestational and postnatal ages. Simulations demonstrated that there was little difference in palivizumab PK between healthy term and premature infants. Simulations also demonstrated that the 5 monthly palivizumab doses of 15 mg/kg, consistent with the label and studied in two randomized, clinical trials, provided greater and more prolonged palivizumab exposure than did an abbreviated dosing regimen of 3 monthly doses.

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Figures

Fig 1
Fig 1
Distribution of demographic covariates at baseline: gestational age (GA) (A), GA + postnatal age (PAGE) (B), and weight (C).
Fig 2
Fig 2
Simulated concentration-time profiles from study MI-CP018 at 15 mg/kg. Observed palivizumab concentrations (open circles) are plotted with the population median concentration (dashed line) and the associated 95% prediction interval (shaded area).
Fig 3
Fig 3
Simulated concentration-time profiles from the abbreviated 3 monthly 15-mg/kg doses of palivizumab compared with 5 monthly doses. Solid lines are the median predicted concentrations; shaded areas are the 95% prediction intervals.
Fig 4
Fig 4
Simulated and observed concentration-time profiles for 15-mg/kg dose of palivizumab, stratified by age and gestational age (GA). Solid black lines are the simulated medians, blue dashed lines are the 95% prediction intervals, closed circles are predicted values, and open circles are the observed values.
Fig 5
Fig 5
Group median concentration-time profiles of palivizumab at 15 mg/kg stratified by GA + postnatal age (PAGE) and postnatal age cohorts, 0 to 6 months (A), 7 to 12 months (B), and 13 to 24 months (C).
Fig 6
Fig 6
Comparison of post hoc clearance values in children compared with clearance values expected based on allometry alone.
Fig 7
Fig 7
Covariate effects of ADA titer on clearance. Typical clearance is presented for the reference patient (70 kg, white, titer = 0, no CLD).

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References

    1. Anderson BJ, Allegaert K, Holford NH. 2006. Population clinical pharmacology of children: modelling covariate effects. Eur. J. Pediatr. 165:819–829 - PubMed
    1. Anderson BJ, Allegaert K, Van den Anker JN, Cossey V, Holford NH. 2007. Vancomycin pharmacokinetics in preterm neonates and the prediction of adult clearance. Br. J. Clin. Pharmacol. 63:75–84 - PMC - PubMed
    1. Anderson BJ, Holford NH. 2008. Mechanism-based concepts of size and maturity in pharmacokinetics. Annu. Rev. Pharmacol. Toxicol. 48:303–332 - PubMed
    1. Anderson BJ, Holford NH. 2009. Mechanistic basis of using body size and maturation to predict clearance in humans. Drug Metab. Pharmacokinet. 24:25–36 - PubMed
    1. Anderson BJ, Woollard GA, Holford NH. 2000. A model for size and age changes in the pharmacokinetics of paracetamol in neonates, infants and children. Br. J. Clin. Pharmacol. 50:125–134 - PMC - PubMed

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