A Prediction Model of Drug Exposure in Cirrhotic Patients According to Child–Pugh Classification

Steelandt, Julie; Jean-Bart, E.; Goutelle, Sylvain; Tod, Michel

doi:10.1007/s40262-015-0288-9

Cited by 18 publications

(20 citation statements)

References 72 publications

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“…The developed practical guidance is based on information from the product information (Table ) and data extracted from 69 articles included in the literature review (Figure ) . Twelve of the included studies focused on pharmacokinetics (Table ), 51 on safety, and six studied both safety and pharmacokinetics of PPIs.…”

Section: Resultsmentioning

confidence: 99%

“…In ten studies (level 3 and 4) with a total of 140 patients, the pharmacokinetics of omeprazole were explored (Table ) . Two articles showed higher exposure with increasing severity of cirrhosis, and a modelling study predicted the same . In CTP A, the AUC was slightly higher in comparison with healthy controls, in CTP B it was doubled, and exposure was more than doubled in CTP C patients.…”

Section: Resultsmentioning

confidence: 99%

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Safe use of proton pump inhibitors in patients with cirrhosis

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Bouma

Burger

et al. 2018

Brit J Clinical Pharma

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AimsProton pump inhibitors (PPIs) belong to the most frequently used drugs, also in patients with cirrhosis. PPIs are extensively metabolized by the liver, but practice guidance on prescribing in cirrhosis is lacking. We aim to develop practical guidance on the safe use of PPIs in patients with cirrhosis.MethodsA systematic literature search identified studies on the safety (i.e. adverse events) and pharmacokinetics of PPIs in cirrhotic patients. This evidence and data from the product information was reviewed by an expert panel who classified drugs as safe; no additional risks known; additional risks known; unsafe; or unknown. Guidance was aimed at the oral use of PPIs and categorized by the severity of cirrhosis, using the Child–Turcotte–Pugh (CTP) classification.ResultsA total of 69 studies were included. Esomeprazole, omeprazole and rabeprazole were classified as having ‘no additional risks known’. A reduction in maximum dose of omeprazole and rabeprazole is recommended for CTP A and B patients. For patients with CTP C cirrhosis, the only PPI advised is esomeprazole at a maximum dosage of 20 mg per day. Pantoprazole and lansoprazole were classified as unsafe because of 4‐ to 8‐fold increased exposure. The use of PPIs in cirrhotic patients has been associated with the development of infections and hepatic encephalopathy and should be carefully considered.ConclusionsWe suggest using esomeprazole, omeprazole or rabeprazole in patients with CTP A or B cirrhosis and only esomeprazole in patients with CTP C. Pharmacokinetic changes are also important to consider when prescribing PPIs to vulnerable, cirrhotic patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Safe use of proton pump inhibitors in patients with cirrhosis

Weersink

Bouma

Burger

et al. 2018

Brit J Clinical Pharma

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“…Factors of variability such as CYP polymorphisms and cirrhosis may also be incorporated in the IMSM approach [15,16,23]. In the DDI-predictor website, both are accommodated.…”

Section: Discussionmentioning

confidence: 99%

“…• In case of cirrhosis, mainly by reducing the CRs by a factor depending on the severity of the disease, according to the Child-Pugh score [23].…”

Section: Methodsmentioning

confidence: 99%

“…Multiple interactions between two drugs, involving several CYPs or simultaneous inhibition and induction, are also accommodated. These drug interactions may also be predicted according to the genotype of the patient, in case of polymorphic CYPs (i.e., 2D6, 2C9 and 2C19) [15,17,18], and in case of cirrhosis, according to Child-Pugh severity score [23]. The website includes a database for validation purpose: predictions for a large number of substrates-interactor pairs may be compared with published data.…”

Section: Evaluation Of the Imsm Predictionsmentioning

confidence: 99%

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Comparison of the Static In Vivo Approach to a Physiologically Based Pharmacokinetic Approach for Metabolic Drug–Drug Interactions Prediction

Tod

Pierrillas

Bourguignon

et al. 2016

Int. J. Pharmacokinet.

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Background:The in vivo mechanistic static model (IMSM) and the physiologically based pharmacokinetic (PBPK) model are two approaches used to predict the magnitude of drug-drug interactions (DDIs). The aim of this study was to evaluate the performance of IMSM and to compare IMSM with the PBPK approach implemented in Simcyp. Methods:The predictive performances of IMSM were evaluated on a panel of 628 DDIs. Subsequently, the IMSM and PBPK approaches were compared on a set of 104 DDIs. Results: The IMSM yielded 85% of predictions within 1.5-fold of the observed value on the 628 DDIs panel. The predictive performances of IMSM were better than those of the PBPK approach (median fold error 1 vs 0.86 on 104 studies; p = 0.02). Conclusion:The IMSM approach is an alternative tool for metabolic DDIs prediction.

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Dose Adjustment in Patients with Liver Cirrhosis – Comparison of Two Different Modeling Approaches

Ozbey

Bachmann

Duthaler

et al. 2023

Clin Pharma and Therapeutics

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Failure to perform adequate dose adjustment in patients with liver cirrhosis may be associated with increased toxicity. We compared the prediction of area under the curve (AUC) and clearance for the six compounds of the Basel phenotyping cocktail (caffeine, efavirenz, flurbiprofen, omeprazole, metoprolol, and midazolam) using a well‐known physiology‐based pharmacokinetic approach (physiologically‐based pharmacokinetic [PBPK] approach, Simcyp) and a novel top‐down method based on the systemic clearance in healthy volunteers adjusted for markers of liver and renal dysfunction (“top‐down approach”). With few exceptions, plasma concentration‐time curves were accurately predicted by the PBPK approach. In comparison to the measured AUC and clearance of these drugs in patients with liver cirrhosis and healthy controls, except for efavirenz, the estimates of both approaches were within two standard deviations of the mean for total and free drug concentrations. For both approaches, a correction factor for dose adjustment in patients with liver cirrhosis could be calculated for the drugs administered. AUCs calculated using the adjusted doses were comparable to the AUCs measured in control subjects, with slightly more accurate predictions generated by the PBPK approach. For drugs with a free fraction < 50%, predictions using free drug concentrations were more accurate than with total drug concentrations. In conclusion, both methods provided good qualitative predictions of the changes by liver cirrhosis in the pharmacokinetics of the six compounds investigated. The top‐down approach is easier to implement but the PBPK approach predicted changes in drug exposure more accurately than the top‐down approach and provided reliable estimates for plasma concentrations.

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A Prediction Model of Drug Exposure in Cirrhotic Patients According to Child–Pugh Classification

Cited by 18 publications

References 72 publications

Safe use of proton pump inhibitors in patients with cirrhosis

Safe use of proton pump inhibitors in patients with cirrhosis

Comparison of the Static In Vivo Approach to a Physiologically Based Pharmacokinetic Approach for Metabolic Drug–Drug Interactions Prediction

Dose Adjustment in Patients with Liver Cirrhosis – Comparison of Two Different Modeling Approaches

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