Effects, safety, and plasma levels of topiroxostat and its metabolites in patients receiving hemodialysis

Characterizing Pharmacokinetic Variability of Topiroxostat in Chinese Population: Insights from a Phase I Randomized Clinical Trial

OBJECTIVE

This Phase I clinical trial aimed to address the knowledge gap regarding topiroxostat's use outside Japan by characterizing its pharmacokinetic profile, safety, and efficacy in healthy Chinese subjects.

METHODS

The trial followed a randomized, open-label, three-dose group design, enrolling 12 healthy participants and administering topiroxostat at three different dose levels. The study utilized NONMEM software for pharmacokinetic analysis, evaluating the impact of demographic and biochemical covariates on drug disposition.

RESULTS

Pharmacokinetic analysis shows the peak drug concentration (Cmax) under a single oral administration of 20, 40, and 80 mg of Topiroxostat, which was found in healthy subjects to be 215.46 ± 94.04 ng/mL, 473.74 ± 319.83 ng/mL and 1009.63 ± 585.98 ng/mL, respectively. The time to peak drug concentration (Tmax) was longer in females (0.79-0.98 h) than in males (0.53-0.93 h). Activated partial thromboplastin time (APTT) and triglycerides (TG) were included as covariates for the typical value of the absorption rate constant (TVKA) in our pharmacokinetic model. The dose (DOSE) was considered a covariate for the typical value of bioavailability (TVF1), and sex (SEX) was considered a covariate for the typical value of clearance (TVCL). The typical population values for topiroxostat included Q/F at 4.91 L/h, KA at 0.657 h-¹, Vc/F at 32.5 L, Vp/F at 30 L, and CL/F at 124 L/h.

CONCLUSION

The trial successfully established the pharmacokinetic parameters of topiroxostat in a Chinese population, confirming its safety and efficacy. The results support the need for individualized dosing strategies and optimize therapeutic outcomes.

Joint Deep-Learning-Enabled Impact of Holistic Care on Line Coagulation in Hemodialysis

In order to investigate the impact of holistic care on line coagulation and safety in hemodialysis and to address limitations of the conventional ultrasound flow vector imaging (VFM) technique, which requires proprietary software to acquire raw Doppler and scatter tracking data, a combined deep-learning-enabled holistic care approach to line coagulation in hemodialysis is proposed. First, velocity along the direction of the sound beam, which is provided by the color Doppler echocardiogram, is obtained as the radial velocity component using a velocity scale. Moreover, the left ventricular wall contour is automatically identified using a U-Net network and the left ventricular wall velocity is calculated as the boundary condition of continuity equation by a retrained PWC-Net model. Likewise, the velocity component of each blood mass in the vertical direction of the sound beam is obtained by solving the continuity equation (i.e. tangential velocity component). Finally, the velocity vector map of cardiac flow field was synthesized and visualized in the flow diagram. For this purpose, sixty patients admitted to receive hemodialysis from February 2019 to June 2020 were randomly divided into two groups of 30 patients where the control group implemented conventional care and the study group implemented all-round care on the basis of conventional care. The nursing effects of both groups were compared. Incidence of pipeline coagulation and complications in the study group were lower than those in the control group and the difference was statistically significant (P < 0.05). The nursing detail score, nursing attitude score, nursing professionalism score, and total satisfaction score in the study group were higher than those in the control group and the difference was statistically significant (P < 0.05). Applying all-round nursing in hemodialysis can effectively reduce the incidence of line coagulation complications and improve the safety of hemodialysis, as well as improve patients' satisfaction with nursing care.