Thromb Haemost 2020; 120(10): 1407-1416
DOI: 10.1055/s-0040-1714349
Coagulation and Fibrinolysis

Population Pharmacokinetic Modeling of von Willebrand Factor Activity in von Willebrand Disease Patients after Desmopressin Administration

1  Hospital Pharmacy-Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
Jessica M. Heijdra*
2  Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
,
Quincy Kieboom
2  Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
,
Marieke J. H. A. Kruip
3  Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
,
Frank W. G. Leebeek
3  Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
,
Marjon H. Cnossen**
2  Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
,
Ron A. A. Mathôt**
1  Hospital Pharmacy-Clinical Pharmacology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
for the OPTI-CLOT Group› Author Affiliations

Abstract

Objective Most von Willebrand disease (VWD) patients can be treated with desmopressin during bleeding or surgery. Large interpatient variability is observed in von Willebrand factor (VWF) activity levels after desmopressin administration. The aim of this study was to develop a pharmacokinetic (PK) model to describe, quantify, and explain this variability.

Methods Patients with either VWD or low VWF, receiving an intravenous desmopressin test dose of 0.3 µg kg−1, were included. A PK model was derived on the basis of the individual time profiles of VWF activity. Since no VWF was administered, the VWF dose was arbitrarily set to unity. Interpatient variability in bioavailability (F), volume of distribution (V), and clearance (Cl) was estimated.

Results The PK model was developed using 951 VWF activity level measurements from 207 patients diagnosed with a VWD type. Median age was 28 years (range: 5–76), median predose VWF activity was 0.37 IU/mL (range: 0.06–1.13), and median VWF activity response at peak level was 0.64 IU/mL (range: 0.04–4.04). The observed PK profiles were best described using a one-compartment model with allometric scaling. While F increased with age, Cl was dependent on VWD type and sex. Inclusion resulted in a drop in interpatient variability in F and Cl of 81.7 to 60.5% and 92.8 to 76.5%, respectively.

Conclusion A PK model was developed, describing VWF activity versus time profile after desmopressin administration in patients with VWD or low VWF. Interpatient variability in response was quantified and partially explained. This model is a starting point toward more accurate prediction of desmopressin dosing effects in VWD.

Authors' Contributions

N.d.J. wrote the manuscript. J.H. and Q.K. collected the clinical data. N.d.J. and R.M. performed the analyses and developed the empirical population PK model. M.C. supervised data collection. R.M. and M.C. jointly supervised this study, while F.L. and M.K. gave critical guidance. All authors contributed substantially to the critical revision of the manuscript, and approved the final draft.


* Both are first authors.


** Both are last authors.


See [Supplementary Appendix A] for a full list of members of the study group.


Supplementary Material



Publication History

Received: 08 April 2020

Accepted: 05 June 2020

Publication Date:
03 August 2020 (online)

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