A combined pharmacometric analysis of dabigatran etexilate in healthy volunteers and patients with atrial fibrillation or undergoing orthopaedic surgery

Chantaratsamon Dansirikul; Thorsten Lehr; Karl-Heinz Liesenfeld; Sebastian Haertter; Alexander Staab

doi:10.1160/TH11-09-0656

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2012; 107(04): 775-785
DOI: 10.1160/TH11-09-0656

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

A combined pharmacometric analysis of dabigatran etexilate in healthy volunteers and patients with atrial fibrillation or undergoing orthopaedic surgery

Authors

Chantaratsamon Dansirikul

¹Boehringer Ingelheim Pharma GmbH & Co KG, Translational Medicine, Biberach an der Riss, Germany
Thorsten Lehr

¹Boehringer Ingelheim Pharma GmbH & Co KG, Translational Medicine, Biberach an der Riss, Germany
Karl-Heinz Liesenfeld

¹Boehringer Ingelheim Pharma GmbH & Co KG, Translational Medicine, Biberach an der Riss, Germany
Sebastian Haertter

¹Boehringer Ingelheim Pharma GmbH & Co KG, Translational Medicine, Biberach an der Riss, Germany
Alexander Staab

¹Boehringer Ingelheim Pharma GmbH & Co KG, Translational Medicine, Biberach an der Riss, Germany

Abstract

Summary

Dabigatran etexilate is the orally bioavailable pro-drug of dabigatran, a direct thrombin inhibitor. Using data from eight clinical studies in healthy volunteers and patients with non-valvular atrial fibrillation (AF) or undergoing orthopaedic surgery (OS), population pharmacokinetic (PK) and pharmacodynamic (PD) models were developed to investigate whether the PK and PD of dabigatran differ across different populations. In both healthy volunteers (n=80) and patients (n=1,965), the PK of dabigatran was best described by a two-compartment disposition model with first-order absorption and elimination. Renal function was the only covariate shown to have a clinically relevant impact on dabig-atran exposure. The patient PK model was successfully applied in predicting exposure observed in the RE-LY trial evaluating dabigatran treatment in patients with non-valvular AF. The relationship between dabigatran plasma concentrations and activated partial thromboplastin time in healthy volunteers and patients (n=762) was best described with a combination of a linear model and a maximum effect (E_max) model, consistent with previous reports. PK/PD relationships were robust across the various populations tested and were not affected by any of the covariates examined. In summary, the PK of dabigatran is sufficiently consistent to allow extrapolation of data generated in healthy volunteers to patients with AF or undergoing OS.

Keywords

Dabigatran etexilate - NONMEM - pharmacometrics - population pharmacokinetics / pharmacodynamics - thrombin inhibitor

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References
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