Pharmacokinetics noncompartmental

Limitations of Noncompartmental Pharmacokinetic Analysis of Biotech Drugs... 

A basic assumption related to both methods of analysis is that the elimination of drug from the body is exclusively from the sampling compartment (i. e., blood/ plasma), and that rate constants are first order. However, when some or all of the elimination occurs outside the sampling compartment - that is, in the peripheral or tissue compartment(s) - these types of analysis are prone to error in the estimation of Vss, but not CL. In compartmental modeling, the error is related to the fact that no longer do the exponents accurately reflect the inter-compartmental and elimination (micro) rate constants. This model mis specification will result in an error that is related to the relative magnitudes of the distribution rate constants and the peripheral elimination rate constant. However, less widely understood is the fact that this model mis specification will also result in errors in noncompartmental pharmacokinetic analysis. 

Lacey, L.F., O Keene, O.N., Pritchard, J.F., and Bye, A. Common noncompartmental pharmacokinetic variables Are they normally and log-normally distributed Journal of Biopharmaceutical Statistics 1997 7 171-178. 

Noncompartmental pharmacokinetics has been developed as an alternative to data-intensive compartmental and physiologic models. While the latter techniques are useful in pharmacokinetic predictions if sufficient data are available, drugs with complex distribution and elimination may be difficult to properly model without additional experimental data. The noncompartmental techniques do not rely on specific distribution characteristics of a drug and therefore become useful when data are limited. 

Analysis of most (perhaps 65%) pharmacokinetic data from clinical trials starts and stops with noncompartmental analysis (NCA). NCA usually includes calculating the area under the curve (AUC) of concentration versus time, or under the first-moment curve (AUMC, from a graph of concentration multiplied by time versus time). Calculation of AUC and AUMC facilitates simple calculations for some standard pharmacokinetic parameters and collapses measurements made at several sampling times into a single number representing exposure. The approach makes few assumptions, has few parameters, and allows fairly rigorous statistical description of exposure and how it is affected by dose. An exposure response model may be created. With respect to descriptive dimensions these dose-exposure and exposure-response models... 

EA Nuesch. Noncompartmental approaches in pharmacokinetics using moments. Drug Metab Rev 15 103-131, 1984. 

Two classical methods used in the analysis of pharmacokinetic data are the fitting of sums of exponential functions (2- and 3-compartment mammillary models) to plasma and/or tissue data, and less frequently, the fitting of arbitrary polynomial functions to the data (noncompartmental analysis). 

Noncompartmental analysis is limited in that it is not descriptive or predictive concentrations must be interpolated from data. The appeal of noncompartmental analysis is that the shape of the blood concentration-versus-time curve is not assumed to be represented by an exponential function and, therefore, estimates of metabolic and pharmacokinetic parameters are not biased by this assumption. In order to minimize errors in parameter estimates that are introduced by interpolation, a large number of data points that adequately define the concentration-versus-tie curve are needed. 

P. Veng-Pedersen. Noncompartmentally based pharmacokinetic modeling. Adv. Drug Deliv. Rev. 48 265-300, 2001. 

In pharmaceutical research and drug development, noncompartmental analysis is normally the first and standard approach used to analyze pharmacokinetic data. The aim is to characterize the disposition of the drug in each individual, based on available concentration-time data. The assessment of pharmacokinetic parameters relies on a minimum set of assumptions, namely that drug elimination occurs exclusively from the sampling compartment, and that the drug follows linear pharmacokinetics that is, drug disposition is characterized by first-order processes (see Chapter 7). Calculations of pharmacokinetic parameters with this approach are usually based on statistical moments, namely the area under the concentration-time profile (area under the zero moment curve, AUC) and the area under the first moment curve (AUMC), as well as the terminal elimination rate constant (Xz) for extrapolation of AUC and AUMC beyond the measured data. Other pharmacokinetic parameters such as half-life (t1/2), clearance (CL), and volume of distribution (V) can then be derived. 

An assumption concerning the number of compartments is, by nature, not required. For reliable results and precise parameter estimates, however, a relatively large number of data points per individual are required. Phase 1 studies of mAbs usually provide sufficient data for a noncompartmental analysis, but the assumption of linear pharmacokinetics is not valid for most mAbs. This prerequisite, however, was frequently neglected during the early years of therapeutic mAh development, and an overall estimate for CL, for example, was frequently reported in the literature. In dose-escalating studies, however, the concentration-time plots of the raw data clearly indicate that the slope of the terminal phase is not parallel for the different doses, but increases with increasing dose (Fig. 3.10). As a result, the listing of different clearance values for different doses can be found. For example, the clearance of trastuzumab was reported to be 88.3 mL/h for a 10-mg dose, 34.3 mL/h for a 50-mg dose, 25.0 mL/h for a 100-mg dose, 19.0 mL/h for a 250-mg dose, and 16.7 mL/h for a 300-mg dose. 

Despite these limitations, even today noncompartmental analysis approaches are sometimes the only way in which pharmacokinetic data of mAbs are analyzed. Especially for the mechanistic understanding of the behavior of mAbs in the body, a noncompartmental analysis cannot be recommended. 

In contrast to noncompartmental analysis, in compartmental analysis a decision on the number of compartments must be made. For mAbs, the standard compartment model is illustrated in Fig. 3.11. It comprises two compartments, the central and peripheral compartment, with volumes VI and V2, respectively. Both compartments exchange antibody molecules with specific first-order rate constants. The input into (if IV infusion) and elimination from the central compartment are zero-order and first-order processes, respectively. Hence, this disposition model characterizes linear pharmacokinetics. For each compartment a differential equation describing the change in antibody amount per time can be established. For... 

Traditionally, linear pharmacokinetic analysis has used the n-compartment mammillary model to define drug disposition as a sum of exponentials, with the number of compartments being elucidated by the number of exponential terms. More recently, noncompartmental analysis has eliminated the need for defining the rate constants for these exponential terms (except for the terminal rate constant, Xz, in instances when extrapolation is necessary), allowing the determination of clearance (CL) and volume of distribution at steady-state (Vss) based on geometrically estimated Area Under the Curves (AUCs) and Area Under the Moment Curves (AUMCs). Numerous papers and texts have discussed the values and limitations of each method of analysis, with most concluding the choice of method resides in the richness of the data set. 

From previous chapters it is clear that the evaluation. of pharmacokinetic parameters is an essential part of understanding how drugs function in the body. To estimate these parameters studies are undertaken in which transient data are collected. These studies can be conducted in animals at the preclinical level, through all stages of clinical trials, and can be data rich or sparse. No matter what the situation, there must be some common means by which to communicate the results of the experiments. Pharmacokinetic parameters serve this purpose. Thus, in the field of pharmacokinetics, the definitions and formulas for the parameters must be agreed upon, and the methods used to calculate them understood. This understanding includes assumptions and domains of validity, for the utility of the parameter values depends upon them. This chapter focuses on the assumptions and domains of validity for the two commonly used methods — noncompartmental and compartmental analysis. Compartmental models have been presented in earlier chapters. This chapter expands upon this, and presents a comparison of the two methods. 

The quantitative parameters require not only a mathematical formalism but also data from which to estimate them. As noted, the two most common methods used for pharmacokinetic estimation are noncompartmental and compartmental analysis. A comparison of the two methods has been given by Gillespie (1). Comparisons regarding the two methodologies as applied to metabolic studies have been provided by DiStefano III (2) and Cobelli and Toffolo (3). Coveil et al. (4) have made an extensive theoretical comparison of the two methods. 

Using the definition of pharmacokinetics given in terms of spatial and temporal distributions, one can easily progress to a description of the underlying assumptions and mathematics of noncompartmental and compartmental analysis, and, from there, proceed to the processes involved in estimating the pharmacokinetic parameters. This will permit a better understanding of the domain of validity of noncompartmental vs compartmental parameter estimation. 

The pharmacokinetic parameters descriptive of the system are as follows (although these definitions apply to both noncompartmental and compartmental models, some modification will be needed for two accessible pool models as well as compartmental models) ... 

Moments of a function will play an essential role in estimating specific pharmacokinetic parameters. The modern use of moments in the analysis of pharmacokinetic data and the notions of noncompartmental or integral equation analysis can be traced to Yamaoka et al. (10), although these authors correctly point out that the formulas were known since the late 1930s. 

The notions of linearity and time invariance will be discussed in more detail later.) For a formal derivation of these equations/ the reader is referred to Weiss (11)/ Coveil ef al. (A), or Cobelli et al. (12). An understanding of the derivations is absolutely essential to understanding the domain of validity of the pharmacokinetic parameters obtained by noncompartmental methods/ no matter what method of evaluating the integrals or extrapolations is employed. 

If one has pharmacokinetic data and knows that the situation calls for nonlinear kinetics, then compartmental models, no matter how difficult to postulate, are really required. Noncompartmental models cannot deal with the time-varying situation. 

This discussion will rely heavily on the following sources. First, the publications of DiStefano and Landaw (22, 23) deal with issues related to compartmental versus single accessible pool noncompartmental models. Second, Cobelli and Toffolo (3) discuss the two accessible pool noncompartmental model. Finally, Coveil et al. (4) provide the theory to demonstrate the link between noncompartmental and compartmental models in estimating the pharmacokinetic parameters. 

Suppose one has a set of pharmacokinetic data. The question is how to obtain information from the data related to the disposition of the drug in question. DiStefano and Landaw (22) deal with this question by making the distinction between models of data and models of system. Understanding this distinction is useful in understanding the differences between compartmental and noncompartmental models. 

As discussed, the noncompartmental model divides the system into two components an accessible pool and nonaccessible pools. The kinetics of the nonacces-sible pools are lumped into the recirculation-exchange arrows. From this, as has been discussed, we can estimate pharmacokinetic parameters describing the accessible pool and system. 

In conclusion, noncompartmental models and linear, constant-coefficient models have different domains of validity. When the domains are identical, then the pharmacokinetic parameters estimated by either method should, in theory, be equal. If they are not, then differences are due to the methods used to estimate them. 

Gillespie WR. Noncompartmental versus compart-mental modeling in clinical pharmacokinetics. Clin Pharmacokinet 1991 20 253-62. 

---