title: Population pharmacokinetics of liposomal amphotericin B and caspofungin in allogeneic hematopoietic stem cell recipients.
abstract: Liposomal amphotericin B (LAMB) and caspofungin (CAS) are important antifungal agents in allogeneic hematopoietic stem cell transplant (aHSCT) recipients. Little is known, however, about the pharmacokinetics (PK) of both agents and their combination in this population. The PK of LAMB and CAS and the potential for PK interactions between both agents were investigated within a risk-stratified, randomized phase II clinical trial in 53 adult aHSCT recipients with granulocytopenia and refractory fever. Patients received either LAMB (n = 17; 3 mg/kg once a day [QD]), CAS (n = 19; 50 mg QD; day 1, 70 mg), or the combination of both (CAS-LAMB; n = 17) for a median duration of 10 to 13 days (range, 4 to 28 days) until defervescence and granulocyte recovery. PK sampling was performed on days 1 and 4. Drug concentrations in plasma (LAMB, 405 samples; CAS, 458 samples) were quantified by high-pressure liquid chromatography and were analyzed using population pharmacokinetic modeling. CAS concentration data best fitted a two-compartment model with a proportional error model and interindividual variability (IIV) for clearance (CL) and central volume of distribution (V(1)) (CL, 0.462 liter/h ± 25%; V(1), 8.33 liters ± 29%; intercompartmental clearance [Q], 1.25 liters/h; peripheral volume of distribution [V(2)], 3.59 liters). Concentration data for LAMB best fitted a two-compartment model with a proportional error model and IIV for all parameters (CL, 1.22 liters/h ± 64%; V(1), 19.2 liters ± 38%; Q, 2.18 liters/h ± 47%; V(2), 52.8 liters ± 84%). Internal model validation showed predictability and robustness of both models. None of the covariates tested (LAMB or CAS comedication, gender, body weight, age, body surface area, serum bilirubin, and creatinine clearance) further improved the models. In summary, the disposition of LAMB and CAS was best described by two-compartment models. Drug exposures in aHSCT patients were comparable to those in other populations, and no PK interactions were observed between the two compounds.
authors.affiliation: Centre for Clinical Trials Muenster, University Hospital Muenster, Muenster, Federal Republic of Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Würthwein
authors.forename: Charlotte
authors.initials: C
authors.lastname: Young
authors.forename: Claudia
authors.initials: C
authors.lastname: Lanvers-Kaminsky
authors.forename: Georg
authors.initials: G
authors.lastname: Hempel
authors.forename: Mirjam N
authors.initials: MN
authors.lastname: Trame
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: Helmut
authors.initials: H
authors.lastname: Ostermann
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Heinz
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.forename: Hedwig
authors.initials: H
authors.lastname: Kolve
authors.forename: Joachim
authors.initials: J
authors.lastname: Boos
authors.forename: Gerda
authors.initials: G
authors.lastname: Silling
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Groll
mesh_terms: D000293:Adolescent; D000328:Adult; D000380:Agranulocytosis / Q000097:blood / Q000188:drug therapy*; D000666:Amphotericin B / Q000097:blood / Q000493:pharmacokinetics*; D000935:Antifungal Agents / Q000097:blood / Q000493:pharmacokinetics; D000077336:Caspofungin; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000097:blood / Q000493:pharmacokinetics*; D005260:Female; D005334:Fever / Q000097:blood / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin
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