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Clinical Pharmacokinetics
Published in: Clinical Pharmacokinetics 6/2019

Open Access 01-06-2019 | Tuberculosis | Original Research Article

Personalized Tuberculosis Treatment Through Model-Informed Dosing of Rifampicin

Authors: Stijn W. van Beek, Rob ter Heine, Ron J. Keizer, Cecile Magis-Escurra, Rob E. Aarnoutse, Elin M. Svensson

Published in: Clinical Pharmacokinetics | Issue 6/2019

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Abstract

Background and objective

This study proposes a model-informed approach for therapeutic drug monitoring (TDM) of rifampicin to improve tuberculosis (TB) treatment.

Methods

Two datasets from pulmonary TB patients were used: a pharmacokinetic study (34 patients, 373 samples), and TDM data (96 patients, 391 samples) collected at Radboud University Medical Center, The Netherlands. Nine suitable population pharmacokinetic models of rifampicin were identified in the literature and evaluated on the datasets. A model developed by Svensson et al. was found to be the most suitable based on graphical goodness of fit, residual diagnostics, and predictive performance. Prediction of individual area under the concentration–time curve from time zero to 24 h (AUC24) and maximum concentration (Cmax) employing various sampling strategies was compared with a previously established linear regression TDM strategy, using sampling at 2, 4, and 6 h, in terms of bias and precision (mean error [ME] and root mean square error [RMSE]).

Results

A sampling strategy using 2- and 4-h blood collection was selected to be the most suitable. The bias and precision of the two strategies were comparable, except that the linear regression strategy was more biased in prediction of the AUC24 than the model-informed approach (ME of 9.9% and 1.5%, respectively). A comparison of resulting dose advice, using predictions on a simulated dataset, showed no significant difference in sensitivity or specificity between the two methods. The model was successfully implemented in the InsightRX precision dosing platform.

Conclusion

Blood sampling at 2 and 4 h, combined with model-based prediction, can be used instead of the currently used linear regression strategy, shortening the sampling by 2 h and one sampling point without performance loss while simultaneously offering flexibility in sampling times.
Appendix
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Metadata
Title
Personalized Tuberculosis Treatment Through Model-Informed Dosing of Rifampicin
Authors
Stijn W. van Beek
Rob ter Heine
Ron J. Keizer
Cecile Magis-Escurra
Rob E. Aarnoutse
Elin M. Svensson
Publication date
01-06-2019
Publisher
Springer International Publishing
Published in
Clinical Pharmacokinetics / Issue 6/2019
Print ISSN: 0312-5963
Electronic ISSN: 1179-1926
DOI
https://doi.org/10.1007/s40262-018-00732-2

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