O. Yin, K. Baron, J. Mondick
Jun 1, 2022
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HemaSphere
Abstract
Background: Background: Mitapivat (AG-348) is a first-in-class, oral, small molecule, allosteric activator of the red blood cell pyruvate kinase (PK) enzyme (PKR). The positive benefit-risk profile of mitapivat has been demonstrated in two recently completed phase 3 studies in adults with PK deficiency who are not regularly transfused (ACTIVATE, NCT03548220) or regularly transfused (ACTIVATE-T, NCT03559699). Currently, two phase 3 studies are being initiated to evaluate the efficacy and safety of mitapivat in pediatric subjects aged 1 to <18 years (yrs) with PK deficiency who are not regularly transfused (ACTIVATE-Kids, NCT05144256) or regularly transfused (ACTIVATE-KidsT, NCT05175105). Aims: Aims: Conduct a pharmacometrics analysis to support the mitapivat dose selection in the phase 3 studies in pediatric subjects. Methods: Methods: A three compartment population pharmacokinetic model with allometrically scaled parameters (clearances and volume of distribution) was applied. Dose simulations were conducted for various age subsets and body weight ranges using data from the National Health and Nutrition Examination Survey (NHANES) database. For subjects aged 1 to <2 yrs, in addition to allometric scaling, maturation factors (Salem F et al. Clin Pharmacokinet. 2014;53:625–36. Salem F et al. Clin Pharmacokinet. 2015;54:671) accounting for changes in cytochrome P450 (CYP) 3A activity were implemented. This approach Summary/Conclusion: Summary/Conclusion: Population pharmacokinetic modeling and simulation was utilized to identify candidate doses for evaluation in mitapivat pediatric phase 3 studies. The selected doses for each pediatric age subset and body weight range are projected to provide mitapivat AUC similar to that achieved in adults receiving the recommended clinical dose.