b Rifapentine (RPT) is a rifamycin antimycobacterial and, as part of a combination therapy, is indicated for the treatment of pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis. Although the results from a number of studies indicate that rifapentine has the potential to shorten treatment duration and enhance completion rates compared to other rifamycin agents utilized in antituberculosis drug regimens (i.e., regimens 1 to 4), its optimal dose and exposure in humans are unknown. To help inform such an optimization, a physiologically based pharmacokinetic (PBPK) model was developed to predict time course, tissue-specific concentrations of RPT and its active metabolite, 25-desacetyl rifapentine (dRPT), in humans after specified administration schedules for RPT. Starting with the development and verification of a PBPK model for rats, the model was extrapolated and then tested using human pharmacokinetic data. Testing and verification of the models included comparisons of predictions to experimental data in several rat tissues and time course RPT and dRPT plasma concentrations in humans from several singleand repeated-dosing studies. Finally, the model was used to predict RPT concentrations in the lung during the intensive and continuation phases of a current recommended TB treatment regimen. Based on these results, it is anticipated that the PBPK model developed in this study will be useful in evaluating dosing regimens for RPT and for characterizing tissue-level doses that could be predictors of problems related to efficacy or safety. R ifapentine (RPT) is a rifamycin-class antibiotic indicated for the treatment of pulmonary tuberculosis (TB) caused by Mycobacterium tuberculosis and in the treatment of latent TB infection in patients at high risk of progression to TB disease. RPT has a longer half-life, increased affinity to serum protein binding (1), and a lower MIC against M. tuberculosis than rifampin, which is currently used as part of several first-line TB treatment regimens (2, 3). Moreover, the primary metabolite for RPT, 25-desacetyl rifapentine (dRPT), has also been found to be active against M. tuberculosis, although at markedly lower MICs (1, 3, 4). Because of these characteristics, RPT has been the subject of a number of clinical pharmacology studies aimed at evaluating pharmacokinetics and developing effective therapies (5-15). Although data from these investigations are valuable in their own right, mathematical modeling offers a way to complement these studies, synthesize their disparate data, and provide the clinician an additional tool to characterize and predict the absorption, distribution, metabolism, and excretion (ADME) of RPT under dosing conditions of interest.One of the very few such mathematical models was developed by Savic et al. (16), who used a classical compartmental modeling approach to assess human population pharmacokinetics of both RPT and dRPT. This model described the absorption, metabolism, and clearance of these two species and accurately predicted their time cour...
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