Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy
Abstract Pregnancy can increase the risk of latent tuberculosis infection (LTBI) progression to tuberculosis (TB) disease. Isoniazid (INH) is the preferred preventative treatment for LTBI in pregnancy. INH is mainly cleared by N‐acetyltransferase 2 (NAT2) but the pharmacokinetics (PK) of INH in diff...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-11-01
|
| Series: | Clinical and Translational Science |
| Online Access: | https://doi.org/10.1111/cts.13614 |
| _version_ | 1797627421072031744 |
|---|---|
| author | Ogochukwu U. Amaeze Nina Isoherranen |
| author_facet | Ogochukwu U. Amaeze Nina Isoherranen |
| author_sort | Ogochukwu U. Amaeze |
| collection | DOAJ |
| description | Abstract Pregnancy can increase the risk of latent tuberculosis infection (LTBI) progression to tuberculosis (TB) disease. Isoniazid (INH) is the preferred preventative treatment for LTBI in pregnancy. INH is mainly cleared by N‐acetyltransferase 2 (NAT2) but the pharmacokinetics (PK) of INH in different NAT2 phenotypes during pregnancy is not well characterized. To address this knowledge gap, we used physiologically based pharmacokinetic (PBPK) modeling to evaluate NAT2 phenotype‐specific effects of pregnancy on INH disposition. A whole‐body PBPK model for INH was developed and verified for non‐pregnant NAT2 fast (FA), intermediate (IA), and slow (SA) acetylators. Model predictive performance was assessed using a drug‐specific model acceptance criterion for mean plasma area under the curve (AUC) and peak plasma concentration (Cmax), and the absolute average fold error (AAFE) for individual plasma concentrations. The verified model was extended to simulate INH disposition during pregnancy in NAT2 SA, IA, and FA populations. A sensitivity analysis was conducted using the verified PBPK model and known changes in INH disposition during pregnancy to determine whether NAT2 activity changes during pregnancy or other INH clearance pathways are altered. This analysis suggested that NAT2 activity is unchanged while other INH clearance pathways increase by ~80% during pregnancy. The model was applied to explore the effect of pregnancy on INH disposition in two ethnic populations with different NAT2 phenotype distributions and with high TB burden. Our PBPK model can be used to predict INH disposition during pregnancy in diverse populations and expanded to other drugs cleared by NAT2 during pregnancy. |
| first_indexed | 2024-03-11T10:23:54Z |
| format | Article |
| id | doaj.art-a5882e6e05c44aa7a97309f50c2691c1 |
| institution | Directory Open Access Journal |
| issn | 1752-8054 1752-8062 |
| language | English |
| last_indexed | 2024-03-11T10:23:54Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Translational Science |
| spelling | doaj.art-a5882e6e05c44aa7a97309f50c2691c12023-11-16T04:14:34ZengWileyClinical and Translational Science1752-80541752-80622023-11-0116112163217610.1111/cts.13614Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancyOgochukwu U. Amaeze0Nina Isoherranen1Department of Pharmaceutics University of Washington, School of Pharmacy Seattle Washington USADepartment of Pharmaceutics University of Washington, School of Pharmacy Seattle Washington USAAbstract Pregnancy can increase the risk of latent tuberculosis infection (LTBI) progression to tuberculosis (TB) disease. Isoniazid (INH) is the preferred preventative treatment for LTBI in pregnancy. INH is mainly cleared by N‐acetyltransferase 2 (NAT2) but the pharmacokinetics (PK) of INH in different NAT2 phenotypes during pregnancy is not well characterized. To address this knowledge gap, we used physiologically based pharmacokinetic (PBPK) modeling to evaluate NAT2 phenotype‐specific effects of pregnancy on INH disposition. A whole‐body PBPK model for INH was developed and verified for non‐pregnant NAT2 fast (FA), intermediate (IA), and slow (SA) acetylators. Model predictive performance was assessed using a drug‐specific model acceptance criterion for mean plasma area under the curve (AUC) and peak plasma concentration (Cmax), and the absolute average fold error (AAFE) for individual plasma concentrations. The verified model was extended to simulate INH disposition during pregnancy in NAT2 SA, IA, and FA populations. A sensitivity analysis was conducted using the verified PBPK model and known changes in INH disposition during pregnancy to determine whether NAT2 activity changes during pregnancy or other INH clearance pathways are altered. This analysis suggested that NAT2 activity is unchanged while other INH clearance pathways increase by ~80% during pregnancy. The model was applied to explore the effect of pregnancy on INH disposition in two ethnic populations with different NAT2 phenotype distributions and with high TB burden. Our PBPK model can be used to predict INH disposition during pregnancy in diverse populations and expanded to other drugs cleared by NAT2 during pregnancy.https://doi.org/10.1111/cts.13614 |
| spellingShingle | Ogochukwu U. Amaeze Nina Isoherranen Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy Clinical and Translational Science |
| title | Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy |
| title_full | Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy |
| title_fullStr | Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy |
| title_full_unstemmed | Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy |
| title_short | Application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy |
| title_sort | application of a physiologically based pharmacokinetic model to predict isoniazid disposition during pregnancy |
| url | https://doi.org/10.1111/cts.13614 |
| work_keys_str_mv | AT ogochukwuuamaeze applicationofaphysiologicallybasedpharmacokineticmodeltopredictisoniaziddispositionduringpregnancy AT ninaisoherranen applicationofaphysiologicallybasedpharmacokineticmodeltopredictisoniaziddispositionduringpregnancy |