In Clinical Pharmacokinetics Stein Schalkwijk, Rob ter Heine, Angela Colbers and David Burger, described the feasibility to reduce the efavirenz dose in HIV-positive pregnant women to minimize treatment costs and limit toxicity.
BackgroundReducing the dose of efavirenz can improve safety, reduce costs, and increase access for patients with HIV infection. According to the World Health Organization, a similar dosing strategy for all patient populations is desirable for universal roll-out; however, it remains unknown whether the 400 mg daily dose is adequate during pregnancy.
MethodsWe developed a mechanistic population pharmacokinetic model using pooled data from women included in seven studies (1968 samples, 774 collected during pregnancy). Total and free efavirenz exposure (AUC24 and C12) were predicted for 400 (reduced) and 600 mg (standard) doses in both pregnant and non-pregnant women.
ResultsUsing a 400 mg dose, the median efavirenz total AUC24 and C12 during the third trimester of pregnancy were 91 and 87% of values among non-pregnant women, respectively. Furthermore, the median free efavirenz C12 and AUC24 were predicted to increase during pregnancy by 11 and 15%, respectively.
ConclusionsIt was predicted that reduced-dose efavirenz provides adequate exposure during pregnancy. These findings warrant prospective confirmation.
Stein Schalkwijk, Rob ter Heine, Angela Colbers and David Burger are members within the theme Infectious diseases and global health.
A Mechanism-Based Population Pharmacokinetic Analysis Assessing the Feasibility of Efavirenz Dose Reduction to 400 mg in Pregnant Women. Schalkwijk S, Ter Heine R, Colbers AC, Huitema ADR, Denti P, Dooley KE, Capparelli E, Best BM, Cressey TR, Greupink R, Russel FGM, Mirochnick M, Burger DM. Clin Pharmacokinet. 2018 Mar 8. doi: 10.1007/s40262-018-0642-9.
Related news items
What can we learn from rural Tanzanian food?23 December 2021
What we eat affects our bodies. A diet high in plant based products and low in fat offers health benefits and prevents lifestyle diseases, such as cardiovascular disease. This is what Quirijn de Mast shows based on his research in Africa.read more
New anti-inflammatory drugs increase risk of fungal infection22 November 2021
Investigators at the Department of Internal Medicine / Infectious Diseases and Dermatology demonstrate worldwide side effects of certain so-called biologics using four different research approachesread more
Freezer Challenge by Teun Bousema13 April 2021
13 research groups, 1280 boxes discarded, 26% less energy consumption, and two winners. Watch our short video with the results of the Radboud Freezer Challenge. It is safe, and you can do it anytime. Warm up your freezers to cool down the planet!read more
Save the date for Radboud New Frontiers 2018: Betere zorg, netwerkzorg?17 January 2018
After standard care, standardized care, and personalized care, network care will be care 4.0. But how exactly do you do that? Should we create new structures for it or is it just a matter of trust and ability to step back?read more
Save the date for Radboud New Frontiers 2018: Big data, better healthcare?17 January 2018
How is big data influencing healthcare and healthcare research? How will it help us and what are the limitations? The first day of the 12th edition of the Radboud New Frontiers symposium, on 1 November 2018, will give you all the answers (and raises new questions).read more