Why the study?
Heart failure causes pathological changes across multiple organs that affect drug pharmacokinetics, requiring investigation into candesartan pharmacokinetics and significant covariates impacting clearance.
What are the population pharmacokinetics and significant covariates affecting the clearance of candesartan in patients with chronic heart failure?
What are the population pharmacokinetics and significant covariates affecting the clearance of candesartan in patients with chronic heart failure?
Weight, renal function (eGFR), and diabetes significantly affect candesartan clearance in heart failure patients, suggesting a need for individualized dosing strategies.
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HF Pop-PK model identifies candesartan clearance covariates; leaves open dose personalization pending external validation.
Heart failure (HF) causes pathological changes in multiple organs, thus affecting the pharmacokinetics (PK) of drugs. The aim of this study was to investigate the PK of candesartan in patients with HF while examining significant covariates and their related impact on estimated clearance using a population PK (Pop-PK) modeling approach. Data from a prospective, multicenter study were used. Modeling and simulations were conducted using Nonlinear Mixed-Effects Modeling (NONMEM) and R software. A total of 281 white patients were included to develop the Pop-PK model. The final model developed for apparent oral clearance (CL/F) included weight, estimated glomerular filtration rate (eGFR), and diabetes, which partly explained its interindividual variability. The mean CL/F value estimated was 7.6 L/h (1.7-22.6 L/h). Simulations revealed that an important decrease in CL/F (> 25%) is obtained with the combination of the factors retained in the final model. Considering these factors, a more individualized approach of candesartan dosing should be investigated in patients with HF.
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Kassem et al. (2020) studied this question.
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