title: Effects of body size and gender on the population pharmacokinetics of artesunate and its active metabolite dihydroartemisinin in pediatric malaria patients.
abstract: Despite the important role of the antimalarial artesunate and its active metabolite dihydroartemisinin (DHA) in malaria treatment efforts, there are limited data on the pharmacokinetics of these agents in pediatric patients. This study evaluated the effects of body size and gender on the pharmacokinetics of artesunate-DHA using data from pediatric and adult malaria patients. Nonlinear mixed-effects modeling was used to obtain a base model consisting of first-order artesunate absorption and one-compartment models for artesunate and for DHA. Various methods of incorporating effects of body size descriptors on clearance and volume parameters were tested. An allometric scaling model for weight and a linear body surface area (BSA) model were deemed optimal. The apparent clearance and volume of distribution of DHA obtained with the allometric scaling model, normalized to a 38-kg patient, were 63.5 liters/h and 65.1 liters, respectively. Estimates for the linear BSA model were similar. The 95% confidence intervals for the estimated gender effects on clearance and volume parameters for artesunate fell outside the predefined no-relevant-clinical-effect interval of 0.75 to 1.25. However, the effect of gender on apparent DHA clearance was almost entirely contained within this interval, suggesting a lack of an influence of gender on this parameter. Overall, the pharmacokinetics of artesunate and DHA following oral artesunate administration can be described for pediatric patients using either an allometric scaling or linear BSA model. Both models predict that, for a given artesunate dose in mg/kg of body weight, younger children are expected to have lower DHA exposure than older children or adults.
authors.affiliation: College of Pharmacy, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Morris
authors.forename: Beesan
authors.initials: B
authors.lastname: Tan
authors.forename: Stephan
authors.initials: S
authors.lastname: Duparc
authors.forename: Isabelle
authors.initials: I
authors.lastname: Borghini-Fuhrer
authors.forename: Donald
authors.initials: D
authors.lastname: Jung
authors.forename: Chang-Sik
authors.initials: CS
authors.lastname: Shin
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fleckenstein
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000962:Antimalarials / Q000493:pharmacokinetics* / Q000494:pharmacology; D037621:Artemisinins / Q000378:metabolism / Q000493:pharmacokinetics* / Q000494:pharmacology; D000077332:Artesunate; D049628:Body Size; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D005260:Female; D006207:Half-Life; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D015233:Models, Statistical; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000254:growth & development; D012737:Sex Factors
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; C039060:artenimol
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