A Comprehensive Mixed‐Method Approach to Characterize the Source of Diurnal Tacrolimus Exposure Variability in Children: Systematic Review, Meta‐analysis, and Application to an Existing Data Set.
Tacrolimus is widely reported to display diurnal variation in pharmacokinetic parameters with twice‐daily dosing. However, the contribution of chronopharmacokinetics versus food intake is unclear, with even less evidence in the pediatric population. The objectives of this study were to summarize the...
| Publicado en: | Journal of Clinical Pharmacology Vol. 64; no. 3; pp. 334 - 345 |
|---|---|
| Autores principales: | , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Mar2024
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=175703936&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 175703936 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00912700 5WH jtl: Journal of Clinical Pharmacology issn: 00912700 maglogo: Y pubinfo: dt: Mar2024 vid: 64 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 175703936 172861867 175703936 175703936 10.1002/jcph.2352 175703936 ppf: 334 ppct: 11 formats: tig: atl: A Comprehensive Mixed‐Method Approach to Characterize the Source of Diurnal Tacrolimus Exposure Variability in Children: Systematic Review, Meta‐analysis, and Application to an Existing Data Set. aug: au: Leino, Abbie D. Magee, John C. Kershaw, David B. Pai, Manjunath P. Park, Jeong M. affil: Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor MI,, USA sug: subj: Tacrolimus Pharmacokinetics Circadian Rhythm Kidney Transplantation In Infancy and Childhood Food Intake Drug-Food Interactions Evaluation Human Child Meta Analysis Descriptive Statistics Systematic Review Confidence Intervals Transplant Recipients Tacrolimus Blood Metabolic Clearance Rate Child: 6-12 years ab: Tacrolimus is widely reported to display diurnal variation in pharmacokinetic parameters with twice‐daily dosing. However, the contribution of chronopharmacokinetics versus food intake is unclear, with even less evidence in the pediatric population. The objectives of this study were to summarize the existing literature by meta‐analysis and evaluate the impact of food composition on 24‐hour pharmacokinetics in pediatric kidney transplant recipients. For the meta‐analysis, 10 studies involving 253 individuals were included. The pooled effect sizes demonstrated significant differences in area under the concentration–time curve from time 0 to 12 hours (standardized mean difference [SMD], 0.27; 95% confidence interval [CI], 0.03‐0.52) and maximum concentration (SMD, 0.75; 95% CI, 0.35‐1.15) between morning and evening dose administration. However, there was significant between‐study heterogeneity that was explained by food exposure. The effect size for minimum concentration was not significantly different overall (SMD, −0.09; 95% CI, −0.27 to 0.09) or across the food exposure subgroups. A 2‐compartment model with a lag time, linear clearance, and first‐order absorption best characterized the tacrolimus pharmacokinetics in pediatric participants. As expected, adding the time of administration and food composition covariates reduced the unexplained within‐subject variability for the first‐order absorption rate constant, but only caloric composition significantly reduced variability for lag time. The available data suggest food intake is the major driver of diurnal variation in tacrolimus exposure, but the associated changes are not reflected by trough concentrations alone. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|