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  • Population Pharmacokinetics...
    He, Yang, PhD; Brunstrom-Hernandez, Janice E., MD; Thio, Liu Lin, MD, PhD; Lackey, Shellie, RN; Gaebler-Spira, Deborah, MD; Kuroda, Maxine M., PhD, MPH; Stashinko, Elaine, PhD, RN; Hoon, Alexander H., MD, MPH; Vargus-Adams, Jilda, MD; Stevenson, Richard D., MD; Lowenhaupt, Stephanie, RN, CCRC; McLaughlin, John F., MD; Christensen, Ana, MPH; Dosa, Nienke P., MD, MPH; Butler, Maureen, BSN; Schwabe, Aloysia, MD; Lopez, Christina, CCRP; Roge, Desiree, MD; Kennedy, Diane, RN, PhD, CCRC; Tilton, Ann, MD; Krach, Linda E., MD; Lewandowski, Andrew, PhD; Dai, Hongying, PhD; Gaedigk, Andrea, PhD; Leeder, J. Steven, PharmD, PhD; Jusko, William J., PhD

    The Journal of pediatrics, 05/2014, Volume: 164, Issue: 5
    Journal Article

    Objective To characterize the population pharmacokinetics (PK) of oral baclofen and assess impact of patient-specific covariates in children with cerebral palsy (CP) in order to support its clinical use. Subjects design Children (2-17 years of age) with CP received a dose of titrated oral baclofen from 2.5 mg 3 times a day to a maximum tolerated dose of up to 20 mg 4 times a day. PK sampling followed titration of 10-12 weeks. Serial R- and S-baclofen plasma concentrations were measured for up to 16 hours in 49 subjects. Population PK modeling was performed using NONMEM 7.1 (ICON PLC; Ellicott City, Maryland). Results R- and S-baclofen showed identical concentration-time profiles. Both baclofen enantiomers exhibited linear and dose/kg-proportional PK, and no sex differences were observed. Average baclofen terminal half-life was 4.5 hours. A 2-compartment PK model with linear elimination and transit absorption steps adequately described concentration-time profiles of both baclofen enantiomers. The mean population estimate of apparent clearance/F was 0.273 L/h/kg with 33.4% inter-individual variability (IIV), and the apparent volume of distribution (Vss /F) was 1.16 L/kg with 43.9% IIV. Delayed absorption was expressed by a mean transit time of 0.389 hours with 83.7% IIV. Body weight, a possible genetic factor, and age were determinants of apparent clearance in these children. Conclusion The PK of oral baclofen exhibited dose-proportionality and were adequately described by a 2-compartment model. Our population PK findings suggest that baclofen dosage can be based on body weight (2 mg/kg per day) and the current baclofen dose escalation strategy is appropriate in the treatment of children with CP older than 2 years of age.