Population Pharmacokinetic Model of Intravenous Immunoglobulin in Patients Treated for Various Immune System Disorders

• Published in: Clinical therapeutics 2024-12, Vol.46 (12), p.e25-e37
• Main Authors: Lee, Jian Lynn, Mohamed Shah, Noraida, Makmor-Bakry, Mohd, Islahudin, Farida, Alias, Hamidah, Mohd Saffian, Shamin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biomarkers; Child; Clinical outcomes; Comorbidity; Drug dosages; Fc receptors; Female; Gene dosage; Gene polymorphism; Genetic variability; Genotype; Guillain-Barre syndrome; Histocompatibility Antigens Class I - genetics; Hospitals; Humans; Immune clearance; Immune disorders; Immune system; Immune System Diseases - drug therapy; Immunoglobulin G; Immunoglobulins; Immunoglobulins, Intravenous - administration & dosage; Immunoglobulins, Intravenous - pharmacokinetics; Intravenous administration; IVIG; Malaysia; Male; Medical research; Middle Aged; Models, Biological; Neonates; Nonlinear mixed-effects modeling; Patients; Permeability; Pharmacokinetics; Polymerase chain reaction; Polymorphism; Polymorphism, Genetic; Population; Population genetics; Population pharmacokinetics; Population studies; Receptors, Fc - genetics; Weight; Young Adult
• ISSN: 0149-2918; 1879-114X; 1879-114X
• DOI: 10.1016/j.clinthera.2024.09.018

•The final model was a 2-compartment model with linear elimination.•Total weight affects the pharmacokinetic properties of intravenous immunoglobulin (IVIG).•Disease type affects the volume of distribution in the peripheral compartment of IVIG, showing the difference in the mechanism of action of IVIG across disease types.•The influence of disease type on volume of distribution in the peripheral compartment may be associated with the degree of inflammation in the body.•Genetic polymorphism of the FcRn gene did not affect the pharmacokinetic properties of IVIG. Intravenous immunoglobulin (IVIG) is used to treat various immune system disorders, but the factors influencing its disposition are not well understood. This study aimed to estimate the population pharmacokinetic parameters of IVIG and to investigate the effect of genetic polymorphism of the FCGRT gene encoding the neonatal Fc receptor (FcRn) and clinical variability on the pharmacokinetic properties of IVIG in patients with immune system disorders. Patients were recruited from 4 hospitals in Malaysia. Clinical data were recorded, and blood samples were taken for pharmacokinetic and genetic studies. Population pharmacokinetic parameters were estimated by nonlinear mixed-effects modeling in Monolix. Age, weight, baseline immunoglobulin G concentration, ethnicity, sex, genotype, disease type, and comorbidity were investigated as potential covariates. Models were evaluated using the difference in objective function value, goodness-of-fit plots, visual predictive checks, and bootstrap analysis. A total of 292 blood samples were analyzed from 79 patients. The IVIG concentrations were best described by a 2-compartment model with linear elimination. Weight was found to be an important covariate for volume of distribution in the central compartment (Vc), volume of distribution in the peripheral compartment (Vp), and clearance in the central compartment, whereas disease type was found to be an important covariate for Vp. Goodness-of-fit plots indicated that the model fit the data adequately. Genetic polymorphism of the FCGRT gene encoding the neonatal Fc receptor did not affect the pharmacokinetic properties of IVIG. This study supports the use of dosage based on weight as per current practice. The study findings highlight that Vp is significantly influenced by the type of disease being treated with IVIG. This relationship suggests that different disease types, particularly inflammatory and autoimmune conditi