title: [Population pharmacokinetic/pharmacodynamic modeling of warfarin by nonlinear mixed effects model].
abstract: The study aimed to establish a population pharmacokinetic/pharmacodynamic (PPK/PD) model of warfarin. PCR-RFLP technique was used to genotype the CYP2C9 and VKORC1 polymorphisms of 73 patients. RP-HPLC-UV method was used to determine the 190 plasma concentrations of warfarin. Application of NONMEM, the clinical information and 263 international normalized ratio (INR) monitoring data were used to investigate the effect of genetic, physiological, pathological factors, other medication on clearance and anticoagulant response. The final model of warfarin PPK/PD was described as follows: CL = θCL · (WT/60)θWT · θCYP · eηCL (if CYP2C9*1/*1, θCYP = 1; if *1/*3, θCYP = 0.708); EC50 = θEC50 · θVKOR · eηEC50 (if VKORC1- 1639AA, θVKOR = 1; if GA, θVKOR = 2.01; V = θV; K(E0) = θK(E0); Emax = θEmax; E0 = θE0 · eηE0. Among them, the body weight (WT), CYP2C9 and VKORC1 genotype had conspicuous effect on warfarin PK/PD parameters. The goodness diagnosis, Bootstrap, NPDE verification showed that the final model was stable, effective and predictable. It may provide a reference for opitimizing the dose regimen of warfarin.
authors.forename: Rong-fang
authors.initials: RF
authors.lastname: Lin
authors.forename: Wei-wei
authors.initials: WW
authors.lastname: Lin
authors.forename: Chang-lian
authors.initials: CL
authors.lastname: Wang
authors.forename: Pin-fang
authors.initials: PF
authors.lastname: Huang
authors.forename: Su-jun
authors.initials: SJ
authors.lastname: Fang
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology*; D001835:Body Weight; D065729:Cytochrome P-450 CYP2C9 / Q000235:genetics*; D005838:Genotype; D006801:Humans; D019934:International Normalized Ratio; D017711:Nonlinear Dynamics; D011110:Polymorphism, Genetic; D064417:Vitamin K Epoxide Reductases / Q000235:genetics*; D014859:Warfarin / Q000493:pharmacokinetics*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; C578523:VKORC1 protein, human; D064417:Vitamin K Epoxide Reductases