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Hermans RA, Storm AE, Kloosterboer SM, Hillegers MH, Koch BC, Dierckx B, de Winter BC. Therapeutic Drug Monitoring to Optimize Risperidone Treatment in Children with Autism Spectrum Disorder. Ther Drug Monit 2024; 46:259-264. [PMID: 38019457 PMCID: PMC10930352 DOI: 10.1097/ftd.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Risperidone is an atypical antipsychotic drug used to treat irritability and aggression in children and adolescents with autism spectrum disorder. In an earlier study, the sum trough concentration of risperidone and its metabolite (9-hydroxyrisperidone) was positively correlated with weight gain and effectiveness. The aim of this study was to determine the therapeutic window for risperidone sum trough concentrations that balances weight gain with treatment effectiveness in this population. In addition, the effect of therapeutic drug monitoring (TDM) on treatment optimization was simulated. METHODS In a retrospective cohort (n = 24 children), the target window for risperidone leading to the least increase in body mass index z-scores while retaining effectiveness as measured by the irritability subscale of the Aberrant Behavior Checklist was determined using receiver operating curve analysis. This target range was used to simulate the effect of TDM using a population PK model implemented in the software platform InsightRX. Dosing advice was based on plasma trough concentrations and the dose administered at 12 weeks to simulate whether more children would be on target at 24 weeks after the start of treatment. RESULTS A risperidone sum trough target range of 3.5-7.0 mcg/L would minimize increase in body mass index z-score and optimize effectiveness. Dosing advice using TDM and a population PK model would lead to a larger proportion of children achieving the target concentration range (62.5% versus 16.7%). CONCLUSIONS TDM may be a useful tool for optimizing risperidone treatment in children and adolescents with autism spectrum disorder.
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Affiliation(s)
- Rebecca A. Hermans
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alaya E.M. Storm
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
| | - Sanne M. Kloosterboer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
| | - Manon H.J. Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Birgit C.P. Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Brenda C.M. de Winter
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands; and
- Rotterdam Clinical Pharmacometrics Group, Erasmus University Medical Center, Rotterdam, the Netherlands
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Tan L, Kluivers AC, Cruz-López EO, Broekhuizen M, Chen Z, Neuman RI, Schoenmakers S, Ruijgrok L, van de Velde D, de Winter BC, van den Bogaerdt AJ, Lu X, Danser AJ, Verdonk K. Statins Prevent the Deleterious Consequences of Placental Chemerin Upregulation in Preeclampsia. Hypertension 2024; 81:861-875. [PMID: 38361240 PMCID: PMC10956680 DOI: 10.1161/hypertensionaha.123.22457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Chemerin, an inflammatory adipokine, is upregulated in preeclampsia, and its placental overexpression results in preeclampsia-like symptoms in mice. Statins may lower chemerin. METHODS Chemerin was determined in a prospective cohort study in women suspected of preeclampsia and evaluated as a predictor versus the sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio. Chemerin release was studied in perfused placentas and placental explants with or without the statins pravastatin and fluvastatin. We also addressed statin placental passage and the effects of chemerin in chorionic plate arteries. RESULTS Serum chemerin was elevated in women with preeclampsia, and its addition to a predictive model yielded significant effects on top of the sFlt-1/PlGF ratio to predict preeclampsia and its fetal complications. Perfused placentas and explants of preeclamptic women released more chemerin and sFlt-1 and less PlGF than those of healthy pregnant women. Statins reversed this. Both statins entered the fetal compartment, and the fetal/maternal concentration ratio of pravastatin was twice that of fluvastatin. Chemerin constricted plate arteries, and this was blocked by a chemerin receptor antagonist and pravastatin. Chemerin did not potentiate endothelin-1 in chorionic plate arteries. In explants, statins upregulated low-density lipoprotein receptor expression, which relies on the same transcription factor as chemerin, and NO release. CONCLUSIONS Chemerin is a biomarker for preeclampsia, and statins both prevent its placental upregulation and effects, in an NO and low-density lipoprotein receptor-dependent manner. Combined with their capacity to improve the sFlt-1/PlGF ratio, this offers an attractive mechanism by which statins may prevent or treat preeclampsia.
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Affiliation(s)
- Lunbo Tan
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.T., A.C.M.K., E.O.C.-L., M.B., R.I.N., A.H.J.D., K.V.), Erasmus MC, Rotterdam, the Netherlands
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, China (L.T., X.L.)
| | - Ans C.M. Kluivers
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.T., A.C.M.K., E.O.C.-L., M.B., R.I.N., A.H.J.D., K.V.), Erasmus MC, Rotterdam, the Netherlands
- Department of Obstetrics and Gynecology (A.C.M.K., R.I.N., S.S.), Erasmus MC, Rotterdam, the Netherlands
| | - Edwyn O. Cruz-López
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.T., A.C.M.K., E.O.C.-L., M.B., R.I.N., A.H.J.D., K.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Michelle Broekhuizen
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.T., A.C.M.K., E.O.C.-L., M.B., R.I.N., A.H.J.D., K.V.), Erasmus MC, Rotterdam, the Netherlands
- Division of Neonatology, Department of Neonatal and Pediatric Intensive Care (M.B.), Erasmus MC, Rotterdam, the Netherlands
| | - Zhongli Chen
- Department of Internal Medicine, Academic Center for Thyroid Diseases (Z.C.), Erasmus MC, Rotterdam, the Netherlands
| | - Rugina I. Neuman
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.T., A.C.M.K., E.O.C.-L., M.B., R.I.N., A.H.J.D., K.V.), Erasmus MC, Rotterdam, the Netherlands
- Department of Obstetrics and Gynecology (A.C.M.K., R.I.N., S.S.), Erasmus MC, Rotterdam, the Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynecology (A.C.M.K., R.I.N., S.S.), Erasmus MC, Rotterdam, the Netherlands
| | - Liesbeth Ruijgrok
- Department of Hospital Pharmacy (L.R., D.v.d.V., B.C.M.d.W.), Erasmus MC, Rotterdam, the Netherlands
| | - Daan van de Velde
- Department of Hospital Pharmacy (L.R., D.v.d.V., B.C.M.d.W.), Erasmus MC, Rotterdam, the Netherlands
| | - Brenda C.M. de Winter
- Department of Hospital Pharmacy (L.R., D.v.d.V., B.C.M.d.W.), Erasmus MC, Rotterdam, the Netherlands
| | - Antoon J. van den Bogaerdt
- Heart Valve Department, Euro Tissue Bank-Bio Implant Services LIFE (ETB-BISLIFE), Beverwijk, the Netherlands (A.J.v.d.B.)
| | - Xifeng Lu
- Clinical Research Center, The First Affiliated Hospital of Shantou University Medical College, China (L.T., X.L.)
| | - A.H. Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.T., A.C.M.K., E.O.C.-L., M.B., R.I.N., A.H.J.D., K.V.), Erasmus MC, Rotterdam, the Netherlands
| | - Koen Verdonk
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.T., A.C.M.K., E.O.C.-L., M.B., R.I.N., A.H.J.D., K.V.), Erasmus MC, Rotterdam, the Netherlands
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Mulder MB, de Man RA, Kamar N, Durmaz G, de Bruijne J, Vanwolleghem T, Izopet J, Gandia P, van der Eijk AA, van Gelder T, Hesselink DA, de Winter BC. Determining the therapeutic range for ribavirin in transplant recipients with chronic hepatitis E virus infection. J Viral Hepat 2021; 28:431-435. [PMID: 33135238 PMCID: PMC7983011 DOI: 10.1111/jvh.13432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 12/09/2022]
Abstract
The aim of this study was to define the therapeutic range for ribavirin (RBV) in transplant recipients with chronic hepatitis E virus (HEV) infection. In this retrospective multicentre cohort study, data of adult transplant recipients with chronic HEV infection, who had been treated with RBV monotherapy between 01-3-2008 and 01-08-2018, were included. ROC curve analyses were performed, and the half-maximal effective RBV concentration was calculated to determine a representative therapeutic range. In 96 patients, RBV monotherapy for a median of three months resulted in a sustained virologic response in 63.5% of the patients, while 88.5% of the patients developed anaemia. RBV plasma concentrations at steady state were significantly higher in clinical responders compared with clinical non-responders: median 1.96 (IQR 1.81-2.70) versus 0.49 (IQR 0.45-0.73) mg/L, P = .0004. RBV caused a dose-dependent haemoglobin reduction with higher RBV plasma concentrations resulting in more haemoglobin reduction. The therapeutic range for RBV for chronic HEV infection in transplant recipients ranges between 1.8 and 2.3 mg/L.
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Affiliation(s)
- Midas B. Mulder
- Department of Hospital PharmacyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Robert A. de Man
- Department of HepatologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Nassim Kamar
- Department of Nephrology and Organs TransplantationCHU RangueilINSERM U1043IFR–BMTUniversité Paul SabatierToulouseFrance
| | - Gűlcan Durmaz
- Department of Hospital PharmacyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Joep de Bruijne
- Department of GastroenterologyUniversity Medical CenterUtrechtThe Netherlands
| | - Thomas Vanwolleghem
- Department of Gastroenterology and HepatologyUniversity Hospital of AntwerpEdegemBelgium,Laboratory of Experimental Medicine and PediatricsUniversity of AntwerpAntwerpBelgium
| | - Jacques Izopet
- Department of VirologyCHU PurpanINSERM U1043IFR–BMTUniversity Paul SabatierToulouseFrance
| | - Peggy Gandia
- Department of Toxicology CHU PurpanINSERM U1043IFR–BMTUniversity Paul SabatierToulouseFrance
| | | | - Teun van Gelder
- Department of Hospital PharmacyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands,Department of Internal MedicineDivision of Nephrology and TransplantationErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Dennis A. Hesselink
- Department of Internal MedicineDivision of Nephrology and TransplantationErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Brenda C.M. de Winter
- Department of Hospital PharmacyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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Francke MI, de Winter BC, Elens L, Lloberas N, Hesselink DA. The pharmacogenetics of tacrolimus and its implications for personalized therapy in kidney transplant recipients. Expert Review of Precision Medicine and Drug Development 2020. [DOI: 10.1080/23808993.2020.1776107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Marith I. Francke
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Brenda C.M. de Winter
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laure Elens
- Louvain Drug Research Institute, Université Catholique De Louvain, Louvain, Belgium
| | - Nuria Lloberas
- Department of Nephrology, IDIBELL, Hospital Universitari Di Bellvitge, University of Barcelona, Barcelona, Spain
| | - Dennis A. Hesselink
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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