Ontology highlight
ABSTRACT: Background
Obese individuals are often underrepresented in clinical trials, leading to a lack of dosing guidance.Objective
This study aimed to investigate which physiological parameters and drug properties determine drug disposition changes in obese using our physiologically based pharmacokinetic (PBPK) framework, informed with obese population characteristics.Methods
Simulations were performed for ten drugs with clinical data in obese (i.e., midazolam, triazolam, caffeine, chlorzoxazone, acetaminophen, lorazepam, propranolol, amikacin, tobramycin, and glimepiride). PBPK drug models were developed and verified first against clinical data in non-obese (body mass index (BMI) ≤ 30 kg/m2) and subsequently in obese (BMI ≥ 30 kg/m2) without changing any drug parameters. Additionally, the PBPK model was used to study the effect of obesity on the pharmacokinetic parameters by simulating drug disposition across BMI, starting from 20 up to 60 kg/m2.Results
Predicted pharmacokinetic parameters were within 1.25-fold (71.5%), 1.5-fold (21.5%) and twofold (7%) of clinical data. On average, clearance increased by 1.6% per BMI unit up to 64% for a BMI of 60 kg/m2, which was explained by the increased hepatic and renal blood flows. Volume of distribution increased for all drugs up to threefold for a BMI of 60 kg/m2; this change was driven by pKa for ionized drugs and logP for neutral and unionized drugs. Cmax decreased similarly across all drugs while tmax remained unchanged.Conclusion
Both physiological changes and drug properties impact drug pharmacokinetics in obese subjects. Clearance increases due to enhanced hepatic and renal blood flows. Volume of distribution is higher for all drugs, with differences among drugs depending on their pKa/logP.
SUBMITTER: Berton M
PROVIDER: S-EPMC9998327 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
Berton Mattia M Bettonte Sara S Stader Felix F Battegay Manuel M Marzolini Catia C
Clinical pharmacokinetics 20221226 2
<h4>Background</h4>Obese individuals are often underrepresented in clinical trials, leading to a lack of dosing guidance.<h4>Objective</h4>This study aimed to investigate which physiological parameters and drug properties determine drug disposition changes in obese using our physiologically based pharmacokinetic (PBPK) framework, informed with obese population characteristics.<h4>Methods</h4>Simulations were performed for ten drugs with clinical data in obese (i.e., midazolam, triazolam, caffein ...[more]