Physiologically-based pharmacokinetic and pharmacodynamic (PBPK/PD)
modeling as a tool for antiviral drug dose regimens for COVID-19
Abstract
Background and Purpose: Ritonavir-boosted lopinavir and chloroquine were
withdrawn for COVID-19 treatment according to WHO recommendation.
However, lopinavir is still being used for COVID-19 treatment in a
clinical practice guideline without supportive evidence. We demonstrated
the utility of physiologically-based pharmacokinetic
(PBPK)/pharmacodynamic (PD) models to support clinical use of lopinavir
and the withdrawal of chloroquine for COVID-19 treatment. Experimental
approach: The developed whole-body PBPK models were validated against
clinical data. Model validation was performed using acceptable methods.
The inhibitory effect (%E) was calculated to demonstrate drug efficacy.
The recommended drug regimen for COVID-19 was the combination of 400/100
mg lopinavir/ritonavir given twice daily and 300 mg base chloroquine
given twice daily for 14 days. Key Results: This study successfully
developed whole-body PBPK models (AAFEs of 1.2-fold). For patients with
a 70 kg body weight, %E for chloroquine in epithelial lining fluid
(ELF) and bronchial epithelial cells (BEC) were about 2% and 12%,
respectively. The corresponding values for lopinavir were 66% and
87.4%, respectively. With the increased body weight to 90 kg, %E for
lopinavir in BEC dramatically dropped to lower than 60%, while that in
ELF was slightly decreased (86.87%). Conclusion and Implications: The
results support the decision of withdrawing chloroquine and using
lopinavir in asymptomatic (with positive antigen kit test) or mild
COVID-19 cases. In addition, results support the administration of
antiviral drugs within the ten days of infection to prevent treatment
failure.