title: A combined pharmacometric analysis of dabigatran etexilate in healthy volunteers and patients with atrial fibrillation or undergoing orthopaedic surgery.
abstract: Dabigatran etexilate is the orally bioavailable pro-drug of dabigatran, a direct thrombin inhibitor. Using data from eight clinical studies in healthy volunteers and patients with non-valvular atrial fibrillation (AF) or undergoing orthopaedic surgery (OS), population pharmacokinetic (PK) and pharmacodynamic (PD) models were developed to investigate whether the PK and PD of dabigatran differ across different populations. In both healthy volunteers (n=80) and patients (n=1,965), the PK of dabigatran was best described by a two-compartment disposition model with first-order absorption and elimination. Renal function was the only covariate shown to have a clinically relevant impact on dabigatran exposure. The patient PK model was successfully applied in predicting exposure observed in the RE-LY trial evaluating dabigatran treatment in patients with non-valvular AF. The relationship between dabigatran plasma concentrations and activated partial thromboplastin time in healthy volunteers and patients (n=762) was best described with a combination of a linear model and a maximum effect (Emax) model, consistent with previous reports. PK/PD relationships were robust across the various populations tested and were not affected by any of the covariates examined. In summary, the PK of dabigatran is sufficiently consistent to allow extrapolation of data generated in healthy volunteers to patients with AF or undergoing OS.
authors.affiliation: Boehringer Ingelheim Pharma GmbH & Co KG, Translational Medicine - Pharmacometrics, 88397 Biberach an der Riss, Germany. chantaratsamon.dansirikul@boehringer-ingelheim.com
authors.forename: C
authors.initials: C
authors.lastname: Dansirikul
authors.forename: T
authors.initials: T
authors.lastname: Lehr
authors.forename: K-H
authors.initials: KH
authors.lastname: Liesenfeld
authors.forename: S
authors.initials: S
authors.lastname: Haertter
authors.forename: A
authors.initials: A
authors.lastname: Staab
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000493:pharmacokinetics*; D002626:Chemistry, Pharmaceutical / Q000379:methods; D003198:Computer Simulation; D000069604:Dabigatran; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009985:Orthopedics / Q000379:methods; D010314:Partial Thromboplastin Time; D011725:Pyridines / Q000493:pharmacokinetics*; D013917:Thrombin / Q000037:antagonists & inhibitors; D013997:Time Factors
chemical_list: D001562:Benzimidazoles; D011725:Pyridines; D013917:Thrombin; D000069604:Dabigatran