Population Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
Modeling of Oxypurinol in Hmong Adults with Gout and/or Hyperuricemia
Abstract
Aim: Quantify identifiable sources of variability, including key
pharmacogenetic variants in oxypurinol pharmacokinetics and their
pharmacodynamic effect on serum urate. Methods: Hmong participants
(n=34) received 100 mg allopurinol twice daily for 7 days followed by
150 mg allopurinol twice daily for 7 days. Serum urates (SU) were
obtained pre- and post-allopurinol. Serum oxypurinol concentrations were
obtained at times 0, 2, 4, and 6 hours after the last dose. A sequential
population pharmacokinetic pharmacodynamics (PKPD) analysis with
non-linear mixed-effects modeling evaluated the impact of
anthropometrics, concomitant medications, and genetic variants on
oxypurinol PKPD parameters. Allopurinol maintenance dose to achieve
target SU was simulated based on the final PKPD model. Results: A
one-compartment model with first order absorption and elimination best
described the oxypurinol concentration-time data. Inhibitory of SU by
oxypurinol was described with a direct inhibitory Emax model using
steady-state oxypurinol concentrations. Fat-free body mass, estimated
creatinine clearance and SLC22A12 rs505802 genotype were found to
predict differences in oxypurinol clearance. Oxypurinol concentration
required to inhibit 50% of xanthine dehydrogenase activity was affected
by PDZK1 rs12129861 genotype. Most individuals with both
PDZK1 rs12129861 AA and SLC22A12 rs505802 CC genotypes
achieve target SU with allopurinol below the maximum dose, regardless of
renal function and body mass. In contrast, individuals with both
PDZK1 rs12129861 GG and SLC22A12 rs505802 TT genotypes
would require more than the maximum dose, thus alternative medications.
Conclusion: The proposed allopurinol dosing guide uses individuals’
fat-free mass, renal function, and SLC22A12 rs505802 and
PDZK1 rs12129861 genotypes to achieve target SU.