Novel strategy to personalise use of ibuprofen for closure of patent ductus arteriosus in preterm neonates
Autor: | Marc Pfister, Andrew Atkinson, Michael J. Rieder, George Jacob, Samira Samiee-Zafarghandy, Tamara van Donge, Cornelis Smit, Gerhard Fusch, John N. van den Anker |
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Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty Neonatal intensive care unit Population Administration Oral Gestational Age Ibuprofen Infant Premature Diseases 030226 pharmacology & pharmacy 03 medical and health sciences 0302 clinical medicine Pharmacokinetics Intensive Care Units Neonatal 030225 pediatrics Ductus arteriosus medicine Humans Infant Very Low Birth Weight Prospective Studies Neonatology education Ductus Arteriosus Patent education.field_of_study medicine.diagnostic_test business.industry Anti-Inflammatory Agents Non-Steroidal Infant Newborn Gestational age medicine.anatomical_structure Therapeutic drug monitoring Area Under Curve Anesthesia Pediatrics Perinatology and Child Health Female Drug Monitoring business Infant Premature medicine.drug |
Zdroj: | Archives of Disease in Childhood. 107:86-91 |
ISSN: | 1468-2044 0003-9888 |
Popis: | ObjectiveExploration of a novel therapeutic drug monitoring (TDM) strategy to personalise use of ibuprofen for closure of patent ductus arteriosus (PDA) in preterm neonates.DesignProspective, single-centre, open-label, pharmacokinetics study in preterm neonates.SettingNeonatal intensive care unit at McMaster Children’s Hospital.PatientsNeonates with a gestational age ≤28+6 weeks treated with oral ibuprofen for closure of a PDA.MethodsPopulation pharmacokinetic parameters, concentration-time profiles and exposure metrics were obtained using pharmacometric modelling and simulation.Main outcome measureAssociation between ibuprofen plasma concentrations measured at various sampling time points on the first day of treatment and attainment of the target exposure over the first 3 days of treatment (AUC0–72h >900 mg·hour/L).ResultsTwenty-three preterm neonates (median birth weight 780 g and gestational age 25.9 weeks) were included, yielding 155 plasma ibuprofen plasma samples. Starting from 8 hours’ postdose on the first day, a strong correlation between ibuprofen concentrations and AUC0–72h was observed. At 8 hours after the first dose, an ibuprofen concentration >20.5 mg/L was associated with a 90% probability of reaching the target exposure.ConclusionWe designed a novel and practical TDM strategy and have shown that the chance of reaching the target exposure (AUC0–72h >900 mg·hour/L) can be predicted with a single sample collection on the first day of treatment. This newly acquired knowledge can be leveraged to personalise ibuprofen dosing regimens and improve the efficacy of ibuprofen use for pharmacological closure of a PDA. |
Databáze: | OpenAIRE |
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