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Population pharmacokinetics of bedaquiline in patients with drug-resistant TB

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OBJECTIVE: To develop a population pharmacokinetic (PK) model for bedaquiline (BDQ) to describe the concentration-time data from patients with multidrug-resistant TB (MDR-TB) in China.

METHOD: A total of 306 PK observations from 69 patients were used in a non-linear, mixed-effects modelling (NONMEM) approach. BDQ PK can be adequately described by a three-compartment model with a transit absorption model. The impact of baseline covariates, including age, sex, height, weight, alanine aminotransferase (ALT), aspartate aminotransferase (AST), apolipoprotein (ALP), total bilirubin (TBIL), direct bilirubin (DBIL), creatinine (CR), potassium (K+), calcium (Ca++) and magnesium (Mg++) on the oral clearance (CL/F) of BDQ were investigated.

RESULTS: In final population PK model, no significant covariates were found in the population PK model for BDQ. The population PK parameter estimate values for oral clearance (CL/F); CL/F between central compartment and peripheral compartment (Q1/F, Q2/F); peripheral volume of distribution (Vp1/F, VP2/F) were respectively 1.50 L/h (95% CI 1.07–1.93), 2.54 L/h (95% CI 1.67–3.41), 1,250 L (95% CI 616.9–1883.1), 2.00 L/h (95% CI 1.10–2.90) and 4,960 L (95% CI 1647.6–8272.4). Inter-individual variability on CL/F was 65.0%.

CONCLUSION: This is the first study to establish a population PK model for BDQ in Chinese patients with MDR-TB. The final model adequately described the data and had good simulation characteristics. Despite some limitations, the final population PK model was stable with good accuracy of parameter estimation.

Keywords: bedaquiline; clearance; multidrug-resistant tuberculosis; population pharmacokinetic

Document Type: Research Article

Affiliations: 1: Department of Pharmacology, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing, China 2: Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumour Research Institute, Beijing, China

Publication date: December 1, 2021

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