Korean J Physiol Pharmacol.  2012 Aug;16(4):273-280. 10.4196/kjpp.2012.16.4.273.

A Simple Dosing Scheme for Intravenous Busulfan Based on Retrospective Population Pharmacokinetic Analysis in Korean Patients

• Choe S
• Kim G
• Lim HS
• Cho SH
• Ghim JL
• Jung JA
• Kim UJ
• Noh G
• Bae KS
• Lee D

• KMID: 2011162
• DOI: http://doi.org/10.4196/kjpp.2012.16.4.273

Abstract

Busulfan is an antineoplastic agent with a narrow therapeutic window. A post-hoc population pharmacokinetic analysis of a prospective randomized trial for comparison of four-times daily versus once-daily intravenous busulfan was carried out to search for predictive factors of intravenous busulfan (iBu) pharmacokinetics (PK). In this study the population PK of iBu was characterized to provide suitable dosing recommendations. Patients were randomized to receive iBu, either as 0.8 mg/kg every 6 h or 3.2 mg/kg daily over 4 days prior to hematopoietic stem cell transplantation. In total, 295 busulfan concentrations were analyzed with NONMEM. Actual body weight and sex were significant covariates affecting the PK of iBu. Sixty patients were included in the study (all Korean; 23 women, 37 men; mean [SD] age, 36.5 [10.9] years; weight, 66.5 [11.3] kg). Population estimates for a typical patient weighing 65 kg were: clearance (CL) 7.6 l/h and volume of distribution (Vd) 32.2 l for men and 29.1 L for women. Inter-individual random variabilities of CL and Vd were 16% and 9%. Based on a CL estimate from the final PK model, a simple dosage scheme to achieve the target AUC0-inf (defined as median AUC0-inf with a once-daily dosage) of 26.18 mg/lxhr, was proposed: 24.79xABW0.5 mg q24h, where ABW represents the actual body weight in kilograms. The dosing scheme reduced the unexplained interindividual variabilities of CL and Vd of iBu with ABW being a significant covariate affecting clearance of iBU. We propose a new simple dosing scheme for iBu based only on ABW.

Keyword

Dosage scheme; Intravenous busulfan; Population pharmacokinetics

MeSH Terms

Body Weight
Busulfan
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Prospective Studies
Retrospective Studies
Busulfan

Figure

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  Fig. 1 Observed individual busulfan concentration-time curves. Each individual are represented by the lines connecting circles.

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  Fig. 2 Goodness-of-fit diagnostic plots for the final model. For the upper two panels, the solid line is a line of identity and the thick solid line is a loess smooth. For the lower two panels, the thick solid line is a loess smooth. iWRES, individual weighted residuals, i.e. weighted difference between the observations and individual predictions.

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  Fig. 3 Visual predictive check for BU4 arm (left) and BU1 arm (right). Simulated 95% prediction interval is shaded.

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