title: Population pharmacokinetic analysis of the oral thrombin inhibitor dabigatran etexilate in patients with non-valvular atrial fibrillation from the RE-LY trial.
abstract: BACKGROUND
  Dabigatran etexilate (DE) is an orally absorbed prodrug of dabigatran, a thrombin inhibitor that exerts potent anticoagulant and antithrombotic activity.
  
  
  OBJECTIVE
  To characterize the pharmacokinetics of dabigatran in patients with non-valvular atrial fibrillation (AF) from the Randomized Evaluation of Long-term Anticoagulant Therapy (RE-LY) trial and to quantify the effect of selected factors on pharmacokinetic (PK) model parameters.
  
  
  METHODS
  A total of 27 706 dabigatran plasma concentrations from 9522 patients who received DE 110 or 150 mg twice daily were analyzed with non-linear mixed-effects modeling.
  
  
  RESULTS
  The pharmacokinetics of dabigatran were best described by a two-compartment disposition model with first-order absorption. The covariates creatinine clearance (CRCL), age, sex, heart failure and the ethnic subgroup 'South Asian' exhibited statistically significant effects on apparent clearance of dabigatran. Body weight and hemoglobin significantly influenced the apparent volume of distribution of the central compartment. Concomitant medication with proton-pump inhibitors, amiodarone and verapamil significantly affected the bioavailability. However, all of the statistically significant factors that were identified, except for renal function status, showed only small to moderate effects (< 26% change in exposure at steady state). On the basis of simulations from the final population PK model, a dose of 75 mg twice daily would result in similar exposure for severely renally impaired patients with CRCL of 15-30 mL min(-1) and patients with normal renal function receiving 150 mg twice daily.
  
  
  CONCLUSIONS
  The analysis provides a thorough PK characterization of dabigatran in the AF patient population from RE-LY. None of the covariates investigated, with the exception of renal function, warrants dose adjustment.
authors.affiliation: Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany. karl-heinz.liesenfeld@boehringer-ingelheim.com
authors.forename: K-H
authors.initials: KH
authors.lastname: Liesenfeld
authors.forename: T
authors.initials: T
authors.lastname: Lehr
authors.forename: C
authors.initials: C
authors.lastname: Dansirikul
authors.forename: P A
authors.initials: PA
authors.lastname: Reilly
authors.forename: S J
authors.initials: SJ
authors.lastname: Connolly
authors.forename: M D
authors.initials: MD
authors.lastname: Ezekowitz
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
authors.forename: L
authors.initials: L
authors.lastname: Wallentin
authors.forename: S
authors.initials: S
authors.lastname: Haertter
authors.forename: A
authors.initials: A
authors.lastname: Staab
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D001835:Body Weight; D000069604:Dabigatran; D004347:Drug Interactions; D005006:Ethnicity; D006454:Hemoglobins; D006801:Humans; D007674:Kidney Diseases; D008875:Middle Aged; D008962:Models, Theoretical; D010599:Pharmacokinetics; D010949:Plasma; D011355:Prodrugs; D011725:Pyridines / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D013917:Thrombin / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D001562:Benzimidazoles; D006454:Hemoglobins; D011355:Prodrugs; D011725:Pyridines; D013917:Thrombin; D000069604:Dabigatran