Thromb Haemost 1998; 80(01): 109-113
DOI: 10.1055/s-0037-1615148
Rapid Communication
Schattauer GmbH

Population Pharmacokinetics of Recombinant Factor VIIa in Volunteers Anticoagulated with Acenocoumarol

Pascal Girard
1   Clinical Pharmacology Unit, EA 643 University Claude Bernard, Hôpital Cardiologique, Lyon, France
,
Patrice Nony
1   Clinical Pharmacology Unit, EA 643 University Claude Bernard, Hôpital Cardiologique, Lyon, France
,
Elisabeth Erhardtsen
2   NOVO Nordisk, Gentofte, Denmark
,
Sylvie Delair
1   Clinical Pharmacology Unit, EA 643 University Claude Bernard, Hôpital Cardiologique, Lyon, France
,
Patrick Ffrench
3   Laboratoire d’Hématologie et d’Hémostase, Hôpital Cardiologique, Lyon, France
,
Marc Dechavanne
3   Laboratoire d’Hématologie et d’Hémostase, Hôpital Cardiologique, Lyon, France
,
Jean-Pierre Boissel
1   Clinical Pharmacology Unit, EA 643 University Claude Bernard, Hôpital Cardiologique, Lyon, France
› Author Affiliations
Further Information

Publication History

Received 07 May 1997

Accepted after resubmission 18 February 1998

Publication Date:
08 December 2017 (online)

Summary

This study establishes a population PK model for FVII clotting activity (FVII:C) after injection of recombinant activated factor VII (rFVIIa) to healthy volunteers. Twenty eight volunteers, anticoagulated with acenocoumarol, received one or two rFVIIa injections, with dose ranging from 5 to 320 μg/kg. The FVII:C kinetic was fitted to a 2 compartment model, with continuous “endogenous perfusion” mimicking endogenous activity. Estimated clearance was 2.4 l/h (20% inter-individual variability and 9% inter-period variability). The volume of distribution at steady-state appeared to be significantly dose dependent: 78 ml/kg for doses ≤20 μg/kg and 88 ml/kg for doses >20 μg/kg respectively, with 16% inter-individual variability. The dose producing 50% of the maximum drop of INR was estimated to be 2.2 μg/kg. The model will be used to better define the dosage regimen for future clinical developments.

 
  • References

  • 1 Joist JH. Hemostatic abnormalities in liver disease. In: Hemostasis and Thrombosis. Colman RW, Hirsh J, Marder VJ, Salzman EW. eds. JB Lippencott Cie; Philadelphia: 1994. pp. 906-20.
  • 2 Talstad I. Which coagulation factors interfere with the one-stage prothrombin time?. Haemostasis 1993; 23: 19-25.
  • 3 Kelly DA, Summerfield JA. Hemostasis in liver disease. Seminars in liver disease 1987; 7: 182-91.
  • 4 Van der Meer FJ, Rosendaal FR, Vandenbroucke JP, Briet E. Bleeding complications in oral anticoagulant therapy. An analysis of risk factors. Arch Intern Med 1993; 153: 1557-62.
  • 5 Ten Cate H, Bauer KA, Levi M, Edgington TS, Sublett RD, Barzegar S, Kass BL, Rosenberg RD. The activation of factor X and prothrombin by recombinant factor VIIa in vivo is mediated by tissue factor. J Clin Invest 1993; 92: 1207-12.
  • 6 Diness V, Lund-Hansen T, Hedner U. Effect of recombinant human FVIIA on warfarin-induced bleeding in rats. Thrombosis Res 1990; 59: 921-9.
  • 7 Brinkhous KM, Hedner U, Garris JB, Diness V, Read MS. Effect of recombinant factor VIIa on the hemostatic defect in dogs with hemophilia A, hemophilia B, and von Willebrand disease. Proc Natl Acad Sci USA 1989; 86: 1382-6.
  • 8 Hedner U, Glazer S, Pingel K, Alberts KA, Blomback M, Schulman S, Johnsson H. Successful use of recombinant factor VIIa in patient with severe haemophilia A during synovectomy [letter]. Lancet 1988; 2: 1193.
  • 9 Macik BG, Hohneker J, Roberts HR, Griffin AM. Use of recombinant activated factor VII for treatment of a retropharyngeal hemorrhage in a hemophilic patient with a high titer inhibitor. Am J Hematol 1989; 32: 232-4.
  • 10 Bech RM, Anderson PM, Glazer S, Hedner U. Recombinant factor VIIa for the treatment of congenital factor VII deficient patients. Thromb Haemost 1995; 73: 983.
  • 11 Ffrench P, Nony P, Erhardtsen E. et al. Dose effect of recombinant factor VIIa in healthy subjects pre-treated with acenocoumarol. Thromb Haemost 1995; 73: 984.
  • 12 Erhardtsen E, Nony P, French P. et al. Further safety information on the use of factor VIIa in acenocoumarol treated volunteers: a phase I study. Blood 1994; 84 (Suppl. 01) 76.
  • 13 Hansen LL, Nielsen FE, Hedner U. Validation of a method for determination of recombinant FVIIa coagulation activity in plasma using a one stage clotting assay. Thromb Haemost 1993; 69: 865.
  • 14 Fair DS. Quantitation of factor VII in the plasma of normal and warfarin-treated individuals by radioimmunoassay. Blood 1983; 62: 784-91.
  • 15 Yuh L, Beal SL, Davidian M, Harrison F, Hester A, Kowalski K, Vonesh E, Wolfinger R. Population pharmacokinetic/pharmacodynamic methodology and applications: a bibliography. Biometrics 1994; 50: 566-75.
  • 16 Beal SL, Sheiner LB. NONMEM User’s Guide, Part I. San Francisco: University of California at San Francisco; 1992
  • 17 Karlsson MO, Sheiner LB. The importance of modeling interoccasion variability in population pharmacokinetic analyses. J Pharmacokinet Biopharm 1993; 21: 735-50.
  • 18 Boeckmann AJ, Sheiner LB, Beal SL. NONMEM User’s Guide, Part V. Introductory Guide. San Francisco: University of California at San Francisco; 1992
  • 19 Lindley CM, Sawyer WT, Macik BG, Lusher J, Harrison JF, Baird-Cox K, Birch K, Glazer S, Roberts HR. Pharmacokinetics and pharmacodynamics of recombinant factor VIIa. Clin Pharmacol Ther 1994; 55: 638-48.