A population pharmacokinetic model of piperaquine in pregnant and non-pregnant women with uncomplicated <it>Plasmodium falciparum</it> malaria in Sudan

• Main Authors: Hoglund Richard M, Adam Ishag, Hanpithakpong Warunee, Ashton Michael, Lindegardh Niklas, Day Nicholas PJ, White Nicholas J, Nosten Francois, Tarning Joel
• Format: Article
• Language: English
• Published: BMC 2012-11-01
• Series: Malaria Journal
• Subjects: Malaria; Piperaquine; Pregnancy; Population pharmacokinetics; Nonlinear mixed-effects modelling
• Online Access: http://www.malariajournal.com/content/11/1/398

<p>Abstract</p> <p>Background</p> <p>Pregnancy is associated with an increased risk of developing a malaria infection and a higher risk of developing severe malaria. The pharmacokinetic properties of many anti-malarials are also altered during pregnancy, often resulting in a decreased drug exposure. Piperaquine is a promising anti-malarial partner drug used in a fixed-dose combination with dihydroartemisinin. The aim of this study was to investigate the population pharmacokinetics of piperaquine in pregnant and non-pregnant Sudanese women with uncomplicated <it>Plasmodium falciparum</it> malaria.</p> <p>Method</p> <p>Symptomatic patients received a standard dose regimen of the fixed dose oral piperaquine-dihydroartemisinin combination treatment. Densely sampled plasma aliquots were collected and analysed using a previously described LC-MS/MS method. Data from 12 pregnant and 12 non-pregnant women were analysed using nonlinear mixed-effects modelling. A Monte Carlo Mapped Power (MCMP) analysis was conducted based on a previously published study to evaluate the power of detecting covariates in this relatively small study.</p> <p>Results</p> <p>A three-compartment disposition model with a transit-absorption model described the observed data well. Body weight was added as an allometric function on all clearance and volume parameters. A statistically significant decrease in estimated terminal piperaquine half-life in pregnant compared with non-pregnant women was found, but there were no differences in post-hoc estimates of total piperaquine exposure. The MCMP analysis indicated a minimum of 13 pregnant and 13 non-pregnant women were required to identify pregnancy as a covariate on relevant pharmacokinetic parameters (80% power and p=0.05). Pregnancy was, therefore, evaluated as a categorical and continuous covariate (i.e. estimate gestational age) in a full covariate approach. Using this approach pregnancy was not associated with any major change in piperaquine elimination clearance. However, a trend of increasing elimination clearance with increasing gestational age could be seen.</p> <p>Conclusions</p> <p>The population pharmacokinetic properties of piperaquine were well described by a three-compartment disposition model in pregnant and non-pregnant women with uncomplicated malaria. The modelling approach showed no major difference in piperaquine exposure between the two groups and data presented here do not warrant a dose adjustment in pregnancy in this vulnerable population.</p>