A population pharmacokinetic model of methotrexate in Korean patients
with hematologic malignancy
Abstract
Aim: This study was conducted to develop a population pharmacokinetic
(PK) model of methotrexate in Korean patients with hematologic
malignancy, identify factors affecting methotrexate PK, and propose
optimal dosage regimen for the Korean population. Methods: Data were
retrospectively collected from 188 patients with acute leukemia or
non-Hodgkin’s lymphoma who were admitted to Severance Hospital for the
period from 2005 to 2015. Using demographic factors and laboratory
results as potential covariates for PK parameters, model development was
performed using NONMEM and optimal dosing regimens were developed using
the final PK model. Results: A two-compartment model incorporating body
weight via allometry best described the data, yielding typical parameter
values of 25.99L for central volume of distribution (V_1), 18.76L for
peripheral volume of distribution (V_2), 12.9L/h for clearance (CL) and
0.646L/h for inter-compartmental clearance. Covariate analyses showed
that, at the weight of 50kg, CL decreased by 0.11 L/h for each one-year
increase in age above 14 years old and decreased to 0.8-fold when serum
creatinine level doubled, indicating the importance of age-specific dose
individualization in methotrexate treatment. Volume of distribution at
steady state derived from PK parameters (=V_1+V_2) was 0.90L/kg, which
was similar to those in the Western or Chinese population. Optimal doses
simulated from the final model successfully produced the PK measures
close to the target chosen. Conclusion: The population PK model and
optimal dosage regimens developed in this study can be used as a basis
to achieve precision dosing in Korean patients with hematologic
malignancy.