Population Pharmacokinetic Models for Tacrolimus in non-transplant
patients: A Systematic Review
Abstract
Several systematic reviews have been published on tacrolimus (TAC)
population pharmacokinetic (PPK) modeling; however, most of them have
focused on the transplant patient population. This study investigated
TAC population pharmacokinetic characteristics in non-transplant
patients through a systematic review of TAC population pharmacokinetic
studies carried out in this patient population, with the aim of
clarifying factors affecting TAC pharmacokinetic behavior and promoting
individualized TAC-based treatment in non-transplant patients. The
Cochrane Library, PubMed, and Embase databases, as well as Chinese
databases (SinoMed, Wanfang, and China National Knowledge
Infrastructure) and related references, were searched using a non-linear
mixed-effects modeling approach, from the time of inception of the
databases to July 2022, to identify TAC population pharmacokinetic
studies modeled in non-transplant patients. Eighteen studies, all from
Asian countries (China and Korea), were included in this study. Of these
studies, 56% and 28% were carried out in pediatric and adult patients,
respectively. Over half of the studies (56%) were conducted in patients
with nephrotic syndrome. Combined medications, body weight, genetic
polymorphisms, and physiological function were the most common
covariates affecting TAC clearance, and variability in the apparent
volume of distribution was largely explained by body weight. In
addition, only 2 studies assessed the developed models through external
evaluation. In non-transplanted patients, factors that affect TAC
pharmacokinetics include combined medications, body weight, genetic
polymorphisms, and physiological function. Recent investigations have
focused mainly on Asian populations, and expanded trials that will use
external evaluations for relevant model assessment are required to
investigate generalizability to other ethnic populations.