Pharmacokinetics of polymyxin B in different populations: a systematic review

Global research on the utilization of population pharmacokinetic model: a bibliometric analysis from 2000 to 2024

Objective

Population pharmacokinetic (PPK) model is capable of identifying the factors that influence the variability of pharmacokinetic (PK) profiles and the degree of their influence, effectively reduces unexplained variability, and demonstrates excellent predictive ability. PPK model has been successfully constructed in several populations for a variety of drugs. However, no study has yet conducted a bibliometric analysis of publications related to the PPK model. This study aims to provide a comprehensive overview of the research progress and hotspots in the field of PPK model research through bibliometric methods.

Methods

A systematic search of the Web of Science database was conducted to collect articles and reviews related to the PPK model between 2000 and 2024. We then analyzed the data using Bibliometrix R package, Microsoft Office Excel, CiteSpace and VOSviewers.

Results

Between 2000 and 2024, we identified a total of 6,125 papers and 128,856 citations. The average annual growth rate of the relevant publications was 10.35%, showing continued growth momentum. These research outputs are concentrated in North America, Western Europe, and East Asia, with USA leading the way with 2,340 publications and having the highest H-index (93) and total citations (54,965). Uppsala University and British Journal of Clinical Pharmacology are the institutions with the highest publication output and the most influential journals, respectively. Most of the funding agencies are from the USA and the subject categories for most publications are Pharmacology Pharmacy. In terms of author contributions, professor Karlsson MO is the leader in the field with 149 publications. In addition, wo found that "critically ill patients," "tacrolimus," "machine learning," "external evaluation," "polymyxin b," "voriconazole," "extracorporeal membrane oxygenation," "dose optimization" and "model-informed precision dosing" are current research hotspots and future research trends.

Conclusion

This study is the first comprehensive overview of the development of PPK model and research hotspots using bibliometric methods. Our findings provide researchers, especially beginners, with insights into the application area of PPK model, helping them to grasp key information in the field.

Real-world performance in therapeutic target attainment of various recommended polymyxin B dose regimens: Secondary data analysis of a prospective multicenter cohort

BACKGROUND

Various population pharmacokinetic studies have suggested controversial optimal dosing regimens for polymyxin B in recent years. The objective of this study was to examine the real-world performance of various dosing regimens in therapeutic target attainment.

METHODS

This is a secondary analysis of a large prospective multicenter cohort (ChiCTR2200056667). Patients were retrospectively included from the cohort, and patient demographic characteristics, polymyxin B dosing regimens and corresponding 24-hour areas under the curve (AUCs) were collected. Patients were categorized into various groups according to the dosage regimens, and the corresponding AUC target attainment was analyzed. The target AUC ratio was defined as 50-100 mg/L·h.

RESULTS

A total of 304 AUC data from 247 patients were included in this study. Only 55.3% of the AUCs were in the range of 50-100 mg/L·h. Differences in subgroups stratified by fixed-dosing regimens, weight-based regimens, and renal function-based dosing regimens. Moreover, the differences among the highest target dose strategies (fixed dose of 50 mg/12 h, weight-adjusted dose of 1-1.25 mg/kg/12 h, and CRRT unadjusted dose) were also insignificant.

CONCLUSION

No polymyxin B dosing strategy is superior in terms of target attainment, which highlights the importance of TDM in the clinical application of polymyxin B.

Population pharmacokinetics of colistin sulfate in patients on continuous veno-venous hemodiafiltration

OBJECTIVE

The aim of this study is to establish a population pharmacokinetic (PK) model for patients undergoing continuous veno-venous hemodiafiltration (CVVHDF) and optimize the dosing regimen of colistin sulfate.

METHODS

A prospective observational study in a single center was conducted on patients who were administrated with colistin sulfate and CVVHDF for at least 48 h. Blood samples were obtained prior to dosing and four to six blood samples (primarily C0.5h, C1h, C2h, C4h, and C6h) after dosing. The blood concentration of colistin sulfate was determined by ultra-high performance liquid chromatography-tandem mass spectrometry assay. The NONMEM program was used to establish the population PK model and perform Monte Carlo simulations. The predictability and stability of the model were internally evaluated by the goodness of fit plots, visual prediction check, and bootstraps.

RESULTS

A total of 86 plasma concentrations from 20 patients were used for population PK modeling. A two-compartment model with first-order linear elimination best described the population PK characteristics of colistin sulfate. Cystatin C (CysC) and body weight (WT) were identified as covariates for clearance (CL). Internal evaluation results showed that the final model had good stability and prediction performance. Monte Carlo simulations showed that only when the body WT was 50 kg with CysC ≥3.07 mg/l, and when the body WT was 65 kg with CysC = 5.11 mg/l, and minimum inhibitory concentration (MIC) = 0.25 mg/l, the target attainment probability (PTA) of the daily dose of 1.5 million U regimen was ≥90%. All treatment regimens fail to achieve the target PTA when MIC = 1 mg/l.

CONCLUSIONS

With the decrease of CysC levels and the increase of WT, the dose of colistin sulfate may need to be increased. It may be prudent for colistin sulfate to consider an initial dose doubling and subsequent maintenance dosing regimen of 200-225 million unit daily, administered in 2-3 divided doses, to attain PTA standard. This study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn) (trial registration number ChiCTR2300072191).