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 Publication

De Sousa Mendes, M., Hirt, D., Urien, S., Valade, E., Bouazza, N., Foissac, F., Blanche, S., Treluyer, J. M., & Benaboud, S. (2015). Physiologically-based pharmacokinetic modeling of renally excreted antiretroviral drugs in pregnant women. British journal of clinical pharmacology, 80(5), 1031–1041.

 Simcyp Version

V13

 Published Model Application

Prediction of exposure in pregnancy

 Absorption Model

First Order

Full PBPK

 Route of Elimination

• Renal Elimination
• Includes uptake by OCT2 and efflux by MRP4 in the kidney

 Perpetrator DDI

• None 

 Advantages and Limitations

• Model developed in healthy volunteers and verified in pregnant women.
• Renal transporters not verified with clinical data

 Model Compound Files

• v13_res_emtricitabine_simcyp_mendex2015

 Publication

De Sousa Mendes M, Chetty M. Are Standard Doses of Renally-Excreted  Antiretrovirals in Older Patients Appropriate: A PBPK Study Comparing Exposures in the Elderly Population With Those in Renal Impairment. Drugs R D. 2019 Dec;19(4):339-350.

 Simcyp Version

 V17

 Published Model Application

 Prediction of exposure in renal impairment

 Absorption Model

First Order

Full PBPK

 Route of Elimination

• Renal Elimination
• Additional non-specific clearance

 Perpetrator DDI

• None 

 Advantages and Limitations

• Model developed to extrapolate elderly populations and renally impaired populations.
• Model was verified in the elderly and young population

 Model Compound Files

• v17_res_emtricitabine_simcyp_mendex2019.cmpz

  Absorption Model

• First-Order

  Volume of Distribution

• Full PBPK (Method 3)
• Note: Kp scalar used

  Route of Elimination

• CYP1A2, CYP2B6, CYP2C8, CYP2D6 and CYP3A4

  Perpetrator DDI

• CYP2D6 Inhibitor
• P-gp Inhibitor

  Validation

• Two clinical studies describing pyronaridine exposure were available for model verification.  100% of predicted Cmax were within 1.5-fold of those observed whereas 40% of AUC were predicted within 1.5-fold of observed. This can be explained as observed exposure at 9mg/kg dose was lower than at 6 mg/kg.  The model recovered the observed data at the 6 mg/kg dose but then over predicted that at the higher dose.

  Limitations

• One challenge in the verification of the model is the diverse ethnicities of subjects in reported clinical data and how best to reflect this in simulations.  In the absence of virtual Korean populations within the Simulator, the Caucasian population was modified in terms of bodyweight.  In the absence of supporting information, no changes to enzyme abundance (pmol/mg) were made to the population, although changes to liver weight (as a function of body weight) and hence total CYP abundance were propagated into the model.

  Updates in V19

• Switched to Method 3 to facilitate like for like comparisons for covid- 19     repurposing strategies