TY - JOUR
T1 - A linked physiologically based pharmacokinetic model for hydroxychloroquine and metabolite desethylhydroxychloroquine in SARS-CoV-2(−)/(+) populations
AU - Steinbronn, Claire
AU - Chhonker, Yashpal S.
AU - Stewart, Jenell
AU - Leingang, Hannah
AU - Heller, Kate B.
AU - Krows, Meighan L.
AU - Paasche-Orlow, Michael
AU - Bershteyn, Anna
AU - Stankiewicz Karita, Helen C.
AU - Agrawal, Vaidehi
AU - Laufer, Miriam
AU - Landovitz, Raphael
AU - Wener, Mark
AU - Murry, Daryl J.
AU - Johnston, Christine
AU - Barnabas, Ruanne V.
AU - Arnold, Samuel L.M.
N1 - Funding Information:
A.B. reports research support from the US National Institutes of Health, the Bill and Melinda Gates Foundation, the Foundation for Innovative New Diagnostics, and the New York City Department of Health and Mental Hygiene, and compensation for consulting services from Gates Ventures. C.J. reports consultancies to AbbVie, GSK, and Gilead, and receives research support from Gilead and royalties from UpToDate. R.V.B. reports Regeneron Pharmaceuticals provided conference abstract and manuscript writing support outside the submitted work. R.L. serves on the Scientific Advisory Board for Gilead and Merck in addition to reporting consultancy agreements for Cepheid and Janssen. All the other authors declared no competing interests for this work.
Funding Information:
C.S. was supported by a National Institute of General Medical Sciences (NIGMS) grant T32 GM007750. R.V.B. reports research support from the Bill and Melinda Gates Foundation (INV‐016204) and the National Institutes of Health. C.J. reports research support from the Bill and Melinda Gates Foundation (INV‐017062 and INV‐01620). D.J.M. was awarded funding from the University of Washington (UWSC11894 and UWSC12049).
Funding Information:
The study authors would like to acknowledge Dr. Ping Zhao of the Bill and Melinda Gates Foundation and Dr. Nina Isoherranen of the University of Washington Department of Pharmaceutics for valuable insight in the model optimization process, Dr. Miao Zhang for sharing the Simcyp files from their publication, Drs. Meagan Deming and Kristopher Paolino for their assistance, and the study participants for volunteering to submit dried blood spot samples allowing this analysis to be completed.
Publisher Copyright:
© 2023 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.
PY - 2023/7
Y1 - 2023/7
N2 - Hydroxychloroquine (HCQ) is Food and Drug Administration (FDA)-approved for malaria, systemic and chronic discoid lupus erythematosus, and rheumatoid arthritis. Because HCQ has a proposed multimodal mechanism of action and a well-established safety profile, it is often investigated as a repurposed therapeutic for a range of indications. There is a large degree of uncertainty in HCQ pharmacokinetic (PK) parameters which complicates dose selection when investigating its use in new disease states. Complications with HCQ dose selection emerged as multiple clinical trials investigated HCQ as a potential therapeutic in the early stages of the COVID-19 pandemic. In addition to uncertainty in baseline HCQ PK parameters, it was not clear if disease-related consequences of SARS-CoV-2 infection/COVID-19 would be expected to impact the PK of HCQ and its primary metabolite desethylhydroxychloroquine (DHCQ). To address the question whether SARS-CoV-2 infection/COVID-19 impacted HCQ and DHCQ PK, dried blood spot samples were collected from SARS-CoV-2(−)/(+) participants administered HCQ. When a previously published physiologically based pharmacokinetic (PBPK) model was used to fit the data, the variability in exposure of HCQ and DHCQ was not adequately captured and DHCQ concentrations were overestimated. Improvements to the previous PBPK model were made by incorporating the known range of blood to plasma concentration ratios (B/P) for each compound, adjusting HCQ and DHCQ distribution settings, and optimizing DHCQ clearance. The final PBPK model adequately captured the HCQ and DHCQ concentrations observed in SARS-CoV-2(−)/(+)participants, and incorporating COVID-19-associated changes in cytochrome P450 activity did not further improve model performance for the SARS-CoV-2(+) population.
AB - Hydroxychloroquine (HCQ) is Food and Drug Administration (FDA)-approved for malaria, systemic and chronic discoid lupus erythematosus, and rheumatoid arthritis. Because HCQ has a proposed multimodal mechanism of action and a well-established safety profile, it is often investigated as a repurposed therapeutic for a range of indications. There is a large degree of uncertainty in HCQ pharmacokinetic (PK) parameters which complicates dose selection when investigating its use in new disease states. Complications with HCQ dose selection emerged as multiple clinical trials investigated HCQ as a potential therapeutic in the early stages of the COVID-19 pandemic. In addition to uncertainty in baseline HCQ PK parameters, it was not clear if disease-related consequences of SARS-CoV-2 infection/COVID-19 would be expected to impact the PK of HCQ and its primary metabolite desethylhydroxychloroquine (DHCQ). To address the question whether SARS-CoV-2 infection/COVID-19 impacted HCQ and DHCQ PK, dried blood spot samples were collected from SARS-CoV-2(−)/(+) participants administered HCQ. When a previously published physiologically based pharmacokinetic (PBPK) model was used to fit the data, the variability in exposure of HCQ and DHCQ was not adequately captured and DHCQ concentrations were overestimated. Improvements to the previous PBPK model were made by incorporating the known range of blood to plasma concentration ratios (B/P) for each compound, adjusting HCQ and DHCQ distribution settings, and optimizing DHCQ clearance. The final PBPK model adequately captured the HCQ and DHCQ concentrations observed in SARS-CoV-2(−)/(+)participants, and incorporating COVID-19-associated changes in cytochrome P450 activity did not further improve model performance for the SARS-CoV-2(+) population.
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U2 - 10.1111/cts.13527
DO - 10.1111/cts.13527
M3 - Article
C2 - 37118968
AN - SCOPUS:85158004394
SN - 1752-8054
VL - 16
SP - 1243
EP - 1257
JO - Clinical and Translational Science
JF - Clinical and Translational Science
IS - 7
ER -