Validation of a Physiological Based Pharmacokinetic Model by the Study of Paracetamol Distribution in the Brain Compartments in Brain Injured Patients

Brain Injured Patients Clinical Trial

Official title:

Validation of a Physiological Based Pharmacokinetic Model by the Study of Paracetamol Distribution in the Brain Compartments in Brain Injured Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03223506
• Other study ID #: PB-PK BRAIN
• Status: Completed
• Phase: Phase 1
• Start date: March 23, 2013
• Est. completion date: December 31, 2017

Study information

• Verified date: October 2017
• Source: Poitiers University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Brain is composed of several anatomical compartments separated by physiological barriers allowing the maintenance of homeostasis. Furthermore, brain-barriers restrain the diffusion of some drugs in cerebro spinal fluid (CSF) and in extracellular fluid (ECF) of brain tissue, making the development and optimization of dosing regimen of new drugs difficult. Most dosing regimen are determined from the plasma concentration because target site concentrations are difficult to obtain in the brain, hence making the prediction of the therapeutic effect, the adverse effect and the toxicity of a brain- diffused drug difficult. Although quantitative and qualitative differences exist in the processes governing pharmacokinetic (PK) in CSF and brain tissue, CSF is considered as the best surrogate of drugs penetration in the human brain.

A study previously published has evaluated in rats the cerebral distribution of paracetamol, used as a marker of passive diffusion in the ECF by microdialysis in the striatum and in the CSF by microdialysis in the ventricular lateralis and the cistern magna. Authors chose paracetamol, as it has the property to diffuse passively and rapidly in the central nervous system allowing the exclusive description of the relationship between the different compartments of the brain. This study has first revealed an unexpected important difference between the distribution profiles obtained in ECF and CSF. Based on these results, authors developed a physiologically based PK model (PBPK) to describe their results and thereby offering the possibility to perform interspecies simulations to predict central nervous system (CNS) distribution of paracetamol in human. In this study, authors used this model to perform pharmaceutical extrapolations between species converting data from animal to human by replacing obtained data from clinical past studies describing paracetamol distribution in the CSF and in plasma.

Microdialysis allows determination of free extracellular concentrations of drug in different tissues and also in brain. Our research team, INSERM U1070, has several past experiences with studies involving micro-dialysis to study the distribution of antibiotic in tissue in both animal and human including cerebral tissue in rat and human. Recommendation from the scholar society suggests that brain injured patients should benefit from a multimodal monitoring to optimize their care and brain perfusion. This invasive multimodal monitoring consists of measuring the intracranial pressure, the oxygen tissue-pressure, the estimation of the cerebral blood flow-rate by cranial Doppler as well as the monitoring of cerebral ischemic parameters by microdialysis. We also prevent systemic cerebral aggression among which, hyperthermia, explaining the prescription of paracetamol among a large number of brain injured patients. Furthermore setting up of an external ventricular draining (EVD) to treat an intra cranial hypertension is usually necessary to allow the continuous flow of the excess of CSF in the brain ventricle.

Few studies carried on human has aimed at comparing the distribution of drugs in both the CSF and the brain extracellular fluid though it is established that the brain barriers differ in their permeability as well as the drug's concentrations are different between brain compartments. Thus by mean of monitoring through microdialysis and/or through therapeutic EVD, required by brain-injured patients, we aim in our study to explore the pharmacokinetic of paracetamol in the brain ECF, the CSF and the plasma and to validate in man the PBPK developed in rat.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 17
• Est. completion date: December 31, 2017
• Est. primary completion date: December 31, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Brain injured patient

• Age = 18 ans

• Patient with a brain microdialysis monitoring and/or an external ventricular drainage

• Patient receiving paracetamol for clinical purpose

Exclusion Criteria:

• Paracetamol allergy

• Liver failure

Related Conditions & MeSH terms

• Brain Injured Patients

Intervention

Drug:
• Paracetamol

Locations

Country	Name	City	State
France	CHU de Poitiers	Poitiers

Sponsors (1)

Lead Sponsor	Collaborator
Poitiers University Hospital

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Area under the curve of paracetamol in the CSF, ECF and plasma.		24 months
Secondary	Area under the curve ratio of plasmatic of paracetamol between 2 administrations		30 months
Secondary	Area under the curve ratio of free cerebral concentration (CSF and ECF) of paracetamol between 2 administrations		30 months
Secondary	Maximum concentration of paracetamol in cerebro spinal fluid		30 months
Secondary	Maximum concentration of paracetamol in extra cellular fluid		30 months
Secondary	Minimum concentration of paracetamol in cerebro spinal fluid		30 months
Secondary	Minimum concentration of paracetamol in extra cellular fluid		30 months
Secondary	Elimination half life of paracetamol in cerebro spinal fluid		30 months
Secondary	Elimination half life of paracetamol in extra cellular fluid		30 months
Secondary	Minimum plasma concentration		30 months
Secondary	Volume of distribution		30 months
Secondary	Clearance of paracetamol		30 months
Secondary	Maximum plasma concentration		30 months
Secondary	Elimination half life of paracetamol		30 months