title: Population pharmacokinetics analysis of vigabatrin in adults and children with epilepsy and children with infantile spasms.
abstract: OBJECTIVE
  Vigabatrin is an inhibitor of γ-aminobutyric acid transaminase. The purpose of these analyses was to develop a population pharmacokinetics model to characterize the vigabatrin concentration-time profile for adults and children with refractory complex partial seizures (rCPS) and for children with infantile spasms (IS); to identify covariates that affect its disposition, and to enable predictions of systemic vigabatrin exposure for patients 1-12 months of age.
  
  
  METHODS
  Vigabatrin pharmacokinetic data from six randomized controlled clinical trials and one open-label study were analyzed using nonlinear mixed-effects modeling. Data collected from 349 adults with rCPS and 119 pediatric patients with rCPS or IS were used in the analyses.
  
  
  RESULTS
  A two-compartment model with first-order elimination and transit-compartment absorption consisting of five transit compartments adequately described the vigabatrin concentration-time data for these adult and pediatric patient populations. An exponential error model was used to estimate inter-individual variability for the transit-rate constant (k tr) (24.2 %), elimination rate constant (k) (14.7 %) and apparent central volume of distribution (V c/F) (18 %). For the study of children with IS, inter-occasion variability was estimated for k tr (58.1 %) and relative bioavailability (F) (26.9 %). Covariate analysis indicated that age, creatinine clearance (CLCR), and body weight were important predictors of vigabatrin pharmacokinetic parameters. Vigabatrin apparent clearance increased with increasing CLCR, consistent with renal excretion (primary pathway of vigabatrin elimination). Rate of vigabatrin absorption was dependent on age. The rate was slower in younger patients, which resulted in a smaller predicted maximum concentration and longer predicted time to maximum concentrations. Vigabatrin V c/F, apparent inter-compartmental clearance between the central and peripheral compartment, and apparent peripheral volume of distribution were increased with greater patient body weights. Sex did not contribute significantly to vigabatrin pharmacokinetic variability.
  
  
  CONCLUSIONS
  The model adequately described vigabatrin pharmacokinetic and enabled predictions of systemic exposures in pediatric patients 1-12 months of age.
authors.affiliation: Ann Arbor Pharmacometrics Group, Inc., 110 Miller Avenue, Garden Suite, Ann Arbor, MI, 48104, USA, jace.nielsen@a2pg.com.
authors.forename: Jace C
authors.initials: JC
authors.lastname: Nielsen
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Kowalski
authors.forename: Aziz
authors.initials: A
authors.lastname: Karim
authors.forename: Mahlaqa
authors.initials: M
authors.lastname: Patel
authors.forename: David L
authors.initials: DL
authors.lastname: Wesche
authors.forename: Dwain
authors.initials: D
authors.lastname: Tolbert
mesh_terms: D000328:Adult; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004827:Epilepsy / Q000097:blood*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D017711:Nonlinear Dynamics; D016032:Randomized Controlled Trials as Topic; D012640:Seizures / Q000097:blood*; D013036:Spasms, Infantile / Q000097:blood*; D020888:Vigabatrin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000097:blood
chemical_list: D004791:Enzyme Inhibitors; D005680:gamma-Aminobutyric Acid; D020888:Vigabatrin