在儿科用药研发面临巨大挑战的背景下,模型引导的药物研发(model-informed drug development,MIDD)在儿科新药研发中日益受到重视。在指导剂量选择时,MIDD的核心内容包括基于生理的药物动力学(physiologically based pharmacokinetic,PBPK)模型和群体药物动力学(population pharmacokinetic,PopPK)模型的建立和仿真预测。PBPK模型用于开展临床试验前对儿科剂量进行预测,具有从成人PK外推至儿科PK的能力;PopPK模型用于从儿科临床数据中分析得到药物的PK特征,分析影响药物PK行为的关键协变量,指导个体化儿科用药。这两种模型各有优势与不足,需要在儿科新药研发各个阶段进行联合运用,互相补充,共同为儿童各年龄阶段的剂量选择发挥作用。本文以利伐沙班儿科用药研发为例,介绍PBPK模型和PopPK模型在儿科Ⅰ、Ⅱ、Ⅲ期临床试验中设计和验证给药方案的联合应用,为其他儿科用药研发中MIDD的应用提供参考。
In the current study, we established and validated a simple and sensitive liquid chromatography-tandem mass spectrometric method for the determination of 21-hydroxy deflazacort in nude mice plasma, and such a method was applied to a pharmacokinetic study. Using betamethasone as the internal standard, the plasma samples were pre-treated by precipitation with acetonitrile and then analyzed on a reversed-phase C18 column （50 mm×2 mm, 5 μm） with a mobile phase consisting of acetonitrile and 4.0 mM ammonium formate （pH was adjusted to 3.5 with formic acid （40：60, v/v））. The analyte was detected by a triple quadrupole tandem mass spectrometer using electrospray, and multiple reaction monitoring was employed to select 21-hydroxy deflazacort at m/z 400.2/124.0 and betamethasone at m/z 393.3/147.0 in the positive ion mode. The calibration curves were linear （r〉0.99） over the range of 0.5~,00 ng/mL. The intra- and inter-day precisions and accuracies were 4.5%-10.1% and -1.7%-10.7% respectively. This method was successfully applied to a preclinical administered with a single oral dose of 4 mg/kg deflazacort, and its pharmacokinetic study of deflazacort on female nude mice pharmacokinetics was characterized by a two-compartment model with first-order absorption.
It＇s the main trend of the development of international pharmaceutical education to cultivate professionals with the capability of pharmaceutical service by professional degree education. Clinical pharmacy rotation practice, named officially as ＂Advanced clinical pharmacy practice＂ at our school, is specific to our master of pharmacy （M. Pharm） graduate students for clinical pharmacy practice training in multiple clinical departments in hospitals. It is meaningful for the education reform of clinical pharmacy to evaluate the outcome of clinical pharmacy rotation practice. Questionnaire was developed based on the Teaching Guide To Advanced Clinical Pharmacy Practice and its related record forms. The practice outcomes of clinical rotation practice in the first two years for M. Pharm graduate students were assessed using the fuzzy comprehensive evaluation method. Results showed that the teaching effect of clinical pharmacy practice was at the ＂excellent＂ level. The evaluation scores of Grade 2011 and Grade 2012 were 90.60 （excellent） and 91.83 （excellent） respectively, while the overall score was 91.29 （excellent）. Students showed excellent skills and have met the requirements of the teaching guide after practice. There are somethings to improve in clinical rotation practice teaching. This study will provide important information for our school and the nation to achieve teaching reform in M. Pharm education of clinical pharmacy.
