Physiologically based pharmacokinetic modeling to predict OAT3-mediated drug-drug interactions of meropenem in varying stages of chronic kidney disease

This study aimed to predict OAT3-mediated meropenem DDIs in varying stages of CKD using physiologically based pharmacokinetic (PBPK) models. Meropenem DDI model was performed with OAT3 perpetrators probenecid (strong inhibitor), piperacillin (moderate inhibitor) and acyclovir (weak inhibitor). Firstly, whole-body PBPK models were developed for meropenem and piperacillin in healthy adults with PK-Sim®. Then the models were translated to patients with varying stages of CKD by accounting for changes in eGFR, kidney volume, kidney blood flow, hematocrit, gastric emptying time, small intestinal transit time, OAT transport function and non-renal clearance. Subsequently, meropenem DDI model was verified by comparing the model simulation results of the interaction between meropenem and probenecid with the observational data from clinical studies. Finally, pharmacokinetics of meropenem under co-administration of piperacillin and acyclovir were predicted through simulations with the virtual population in varying stages of CKD. The developed PBPK models of meropenem and piperacillin adequately described the pharmacokinetic characteristics in healthy adults and in adults with varying stages of CKD. The predicted AUC ratio of meropenem co-administered with probenecid to meropenem given alone was within 1.5-fold of the observed clinical data. The predicted steady-state AUC values of meropenem in healthy adults co-administered with probenecid, piperacillin or acyclovir were 1.593-fold (95% CI, 1.436-1.6244), 1.031-fold (95% CI, 1.017-1.045) and 1.005-fold (95% CI, 1.004-1.005), respectively, as compared to the AUC of meropenem given alone. And all predicted probenecid-meropenem, piperacillin-meropenem and acyclovir-meropenem DDI AUC ratios were decreased in renal impairment. Our presented meropenem DDI model demonstrated that patients with CKD may be less vulnerable to OAT3-mediated DDIs compared with healthy adults. However, further clinical DDI studies are required to verify our prediction results. PBPK analysis provided a quantitative basis for guiding the clinical application of meropenem combined with OAT3 inhibitor in varying stages of CKD.