Claiming desmopressin therapeutic equivalence in children requires pediatric data: a population PKPD analysis

Eur J Clin Pharmacol. 2018 Mar;74(3):297-305. doi: 10.1007/s00228-017-2386-0. Epub 2017 Dec 3.

Abstract

Purpose: For a new formulation of a drug, only pharmacokinetic bioequivalence with the original formulation has to be demonstrated in healthy, young adults. However, "children are not small adults," and to guarantee a safe and effective treatment, age-adapted drug development is required. Desmopressin, a vasopressin analogue prescribed for nocturnal enuresis in children, was studied as an example formulation first developed in adults and then extrapolated to a pediatric indication.

Methods: Population pharmacokinetic and pharmacodynamic modeling was used to analyze previously published desmopressin data of 18 children suffering from nocturnal enuresis. The main objective was the comparison of the therapeutic equivalence of two desmopressin formulations: tablet and lyophilisate. The measurements for pharmacokinetics and pharmacodynamics were respectively plasma desmopressin concentration and urine osmolality and diuresis.

Results: The half maximal inhibitory concentration for inhibition of urine production was 0.7 pg/mL lower for the lyophilisate than for the tablet. The effect of formulation on the half maximal inhibitory concentration seems to suggest that the 120-μg lyophilisate has a more pronounced effect on the urine volume and osmolality than the 200-μg tablet, even when the same exposure is achieved.

Conclusions: A new indirect response model for desmopressin was constructed and validated, using a previously built pharmacokinetic model and additional pharmacodynamic data. In order to draw solid conclusions regarding the efficacy and safety of desmopressin in children, pharmacokinetics and pharmacodynamics data should be analyzed together. This study adds proof to potential differences in pediatric and adult pharmacokinetic and pharmacodynamic properties of desmopressin and exemplifies the need for pediatric clinical trials, not only for every new drug but also for every new formulation.

Keywords: 1-Deamino-8-D-arginine vasopressin (dDAVP); Bioequivalence; Children; Lyophilisate; PKPD modeling; Tablet.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Equivalence Trial
  • Validation Study

MeSH terms

  • Administration, Sublingual
  • Adolescent
  • Age Factors
  • Antidiuretic Agents / administration & dosage*
  • Antidiuretic Agents / blood
  • Antidiuretic Agents / pharmacokinetics
  • Antidiuretic Agents / therapeutic use
  • Child
  • Cross-Over Studies
  • Deamino Arginine Vasopressin / administration & dosage*
  • Deamino Arginine Vasopressin / blood
  • Deamino Arginine Vasopressin / pharmacokinetics
  • Deamino Arginine Vasopressin / therapeutic use
  • Drug Compounding*
  • Female
  • Freeze Drying
  • Humans
  • Kidney Concentrating Ability / drug effects
  • Male
  • Models, Biological*
  • Needs Assessment
  • Nocturnal Enuresis / blood
  • Nocturnal Enuresis / drug therapy*
  • Nocturnal Enuresis / urine
  • Osmolar Concentration
  • Pilot Projects
  • Tablets
  • Urinalysis

Substances

  • Antidiuretic Agents
  • Tablets
  • Deamino Arginine Vasopressin