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A combined pharmacometric analysis of dabigatran etexilate in healthy volunteers and patients with atrial fibrillation or undergoing orthopaedic surgery

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
MicroRNAs in vascular biology:
Metabolism and atherosclerosis

DOI: https://doi.org/10.1160/TH11-09-0656
Issue: 2012: 107/4 (Apr) pp. 601-801
Pages: 775-785

A combined pharmacometric analysis of dabigatran etexilate in healthy volunteers and patients with atrial fibrillation or undergoing orthopaedic surgery

Online Supplementary Material

C. Dansirikul (1), T. Lehr (1), K.-H. Liesenfeld (1), S. Haertter (1), A. Staab (1)

(1) Boehringer Ingelheim Pharma GmbH & Co KG, Translational Medicine, Biberach an der Riss, Germany

Keywords

thrombin inhibitor, dabigatran etexilate, NONMEM, pharmacometrics, population pharmacokinetics / pharmacodynamics

Summary

Dabigatran etexilate is the orally bioavailable pro-drug of dabigatran, a direct thrombin inhibitor. Using data from eight clinical studies in healthy volunteers and patients with non-valvular atrial fibrillation (AF) or undergoing orthopaedic surgery (OS), population pharmacokinetic (PK) and pharmacodynamic (PD) models were developed to investigate whether the PK and PD of dabigatran differ across different populations. In both healthy volunteers (n=80) and patients (n=1,965), the PK of dabigatran was best described by a two-compartment disposition model with first-order absorption and elimination. Renal function was the only covariate shown to have a clinically relevant impact on dabigatran exposure. The patient PK model was successfully applied in predicting exposure observed in the RE-LY trial evaluating dabigatran treatment in patients with non-valvular AF. The relationship between dabigatran plasma concentrations and activated partial thromboplastin time in healthy volunteers and patients (n=762) was best described with a combination of a linear model and a maximum effect (Emax) model, consistent with previous reports. PK/PD relationships were robust across the various populations tested and were not affected by any of the covariates examined. In summary, the PK of dabigatran is sufficiently consistent to allow extrapolation of data generated in healthy volunteers to patients with AF or undergoing OS.

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