TY - JOUR
T1 - Pharmacokinetic study (phase I−II) of a new dobutamine formulation in preterm infants immediately after birth
AU - Neocirculation Consortium
AU - Pellicer, Adelina
AU - Fernández, Ramón
AU - Jullien, Vincent
AU - Gleeson, Clare
AU - Bravo, María Carmen
AU - Ortego, Paloma López
AU - Sánchez, Laura
AU - Ybarra, Marta
AU - Rojas-Anaya, Héctor
AU - Cabañas, Fernando
AU - Koch, Armin
AU - Smith, Andrea
AU - Rabe, Heike
AU - Amess, Philip
AU - Aiton, Neil
AU - Crook, David
AU - Fernandez-Alvarez, Ramon
AU - Mahoney, Liam
AU - Rabe, Heike
AU - Ramsay, Rebecca
AU - Rojas-Anaya, Héctor
AU - Kouman, Sonia Sobowiec
AU - Jullien, Vincent
AU - Le Saux, Thomas
AU - Pons, Gerard
AU - Zohar, Sarah
AU - Biertz, Frank
AU - Brinkhaus, Marjan
AU - Koch, Armin
AU - Smith, Andrea
AU - Ziert, Yvonne
AU - Lopez Heredia, Jon
AU - López Herrera, Maria Cruz
AU - Mielgo, Victoria
AU - Göpel, Wolfgang
AU - Härtel, Christoph
AU - Kotidis, Charalampos
AU - Turner, Mark
AU - Weindling, Michael
AU - Roll, Claudia
AU - Bravo, Maria Carmen C.
AU - Cabañas, Fernando
AU - López-Ortego, Paloma
AU - Pavía, Marta
AU - Pellicer, Adelina
AU - Gleeson, Clare
AU - Bryson, Simon
AU - Matyas, Melinda
AU - Zaharie, Gabriela
AU - Bokodi, Géza
N1 - Publisher Copyright:
© 2020, International Pediatric Research Foundation, Inc.
PY - 2021/3
Y1 - 2021/3
N2 - Background: Dobutamine is particularly suited to treatment of haemodynamic insufficiency caused by increased peripheral vascular resistance and myocardial dysfunction in the preterm infant. Knowledge of the elimination half-life is essential to estimate the steady state when its efficacy/safety can be evaluated. Methods: Analysis of pharmacokinetic data in ten preterm newborns treated with a new neonatal formulation of dobutamine (IMP) after screening for haemodynamic insufficiency within the first 72 h from birth. Blood samples were withdrawn at the end of IMP infusion and at a random time after the end of infusion (5 min, 15 min, 45 min, 2 h and 6 h). IMP concentration in each sample was measured by ultra-high performance liquid chromatography with electrochemical detection. Results: Median duration of IMP infusion was 37.7 h (IQR 21.2). Calculated IMP half-life ranged between 3.06 and 36.1 min (median 10.6 min), leading to a time to reach the steady-state concentration between 15 min and >2 h. Adverse events were not related to IMP. Conclusions: The wide variability in dobutamine metabolism in preterm infants requires awareness about the risk of under- or overtreatment. A delay of up to 3 h might be required before drawing blood samples to evaluate the effective dose. Impact: Small trials suggest dobutamine as the optimal drug in the preterm infant with haemodynamic insufficiency after birth.Age-related differences in drug pharmacokinetics may result in suboptimal treatments.The lack of formal studies in preterms results in inadequate data on efficacy and safety.This study provides data on the variability of the elimination half-life of dobutamine in the very preterm infant during transitional circulation.There is a wide variation in the time to reach the plasma concentration corresponding to steady state, the moment when its efficacy/safety can be reliably evaluated.This information is crucial for planning future trials on cardiovascular support.
AB - Background: Dobutamine is particularly suited to treatment of haemodynamic insufficiency caused by increased peripheral vascular resistance and myocardial dysfunction in the preterm infant. Knowledge of the elimination half-life is essential to estimate the steady state when its efficacy/safety can be evaluated. Methods: Analysis of pharmacokinetic data in ten preterm newborns treated with a new neonatal formulation of dobutamine (IMP) after screening for haemodynamic insufficiency within the first 72 h from birth. Blood samples were withdrawn at the end of IMP infusion and at a random time after the end of infusion (5 min, 15 min, 45 min, 2 h and 6 h). IMP concentration in each sample was measured by ultra-high performance liquid chromatography with electrochemical detection. Results: Median duration of IMP infusion was 37.7 h (IQR 21.2). Calculated IMP half-life ranged between 3.06 and 36.1 min (median 10.6 min), leading to a time to reach the steady-state concentration between 15 min and >2 h. Adverse events were not related to IMP. Conclusions: The wide variability in dobutamine metabolism in preterm infants requires awareness about the risk of under- or overtreatment. A delay of up to 3 h might be required before drawing blood samples to evaluate the effective dose. Impact: Small trials suggest dobutamine as the optimal drug in the preterm infant with haemodynamic insufficiency after birth.Age-related differences in drug pharmacokinetics may result in suboptimal treatments.The lack of formal studies in preterms results in inadequate data on efficacy and safety.This study provides data on the variability of the elimination half-life of dobutamine in the very preterm infant during transitional circulation.There is a wide variation in the time to reach the plasma concentration corresponding to steady state, the moment when its efficacy/safety can be reliably evaluated.This information is crucial for planning future trials on cardiovascular support.
UR - http://www.scopus.com/inward/record.url?scp=85087318220&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/e92513d0-a9dc-3d40-bec1-9f88083a2cdd/
U2 - 10.1038/s41390-020-1009-0
DO - 10.1038/s41390-020-1009-0
M3 - Journal articles
C2 - 32610341
AN - SCOPUS:85087318220
SN - 0031-3998
VL - 89
SP - 981
EP - 986
JO - Pediatric Research
JF - Pediatric Research
IS - 4
ER -