title: Designing a Pediatric Study for an Antimalarial Drug by Using Information from Adults.
abstract: The objectives of this study were to design a pharmacokinetic (PK) study by using information about adults and evaluate the robustness of the recommended design through a case study of mefloquine. PK data about adults and children were available from two different randomized studies of the treatment of malaria with the same artesunate-mefloquine combination regimen. A recommended design for pediatric studies of mefloquine was optimized on the basis of an extrapolated model built from adult data through the following approach. (i) An adult PK model was built, and parameters were estimated by using the stochastic approximation expectation-maximization algorithm. (ii) Pediatric PK parameters were then obtained by adding allometry and maturation to the adult model. (iii) A D-optimal design for children was obtained with PFIM by assuming the extrapolated design. Finally, the robustness of the recommended design was evaluated in terms of the relative bias and relative standard errors (RSE) of the parameters in a simulation study with four different models and was compared to the empirical design used for the pediatric study. Combining PK modeling, extrapolation, and design optimization led to a design for children with five sampling times. PK parameters were well estimated by this design with few RSE. Although the extrapolated model did not predict the observed mefloquine concentrations in children very accurately, it allowed precise and unbiased estimates across various model assumptions, contrary to the empirical design. Using information from adult studies combined with allometry and maturation can help provide robust designs for pediatric studies.
authors.affiliation: INSERM, UMRS 1138, CRC, Team 22, Université Paris 5, Université Paris 6, Paris, France caroline.petit@crc.jussieu.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Petit
authors.affiliation: Pharmacology Department, Université Paris 5, Sorbonne Paris Cité, Inserm U1129, HEGP, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jullien
authors.affiliation: LJK, UMR CNRS 5224, Université J. Fourier, Grenoble, France.
authors.forename: Adeline
authors.initials: A
authors.lastname: Samson
authors.affiliation: INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Guedj
authors.affiliation: Drugs for Neglected Diseases Initiative, Geneva, Switzerland.
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Kiechel
authors.affiliation: INSERM, UMRS 1138, CRC, Team 22, Université Paris 5, Université Paris 6, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Zohar
authors.affiliation: INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France INSERM, CIC 1414, Université Rennes 1, Rennes, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Comets
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000493:pharmacokinetics*; D049628:Body Size; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015767:Mefloquine / Q000493:pharmacokinetics*; D008962:Models, Theoretical
chemical_list: D000962:Antimalarials; D015767:Mefloquine