Dose Prediction for Repurposing Nitazoxanide in SARS-CoV-2 Treatment or
Chemoprophylaxis
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
has been declared a global pandemic and urgent treatment and prevention
strategies are needed. Nitazoxanide, an anthelmintic drug has been shown
to exhibit in vitro activity against SARS-CoV-2. The present study used
physiologically-based pharmacokinetic (PBPK) modelling to inform optimal
doses of nitazoxanide capable of maintaining plasma and lung tizoxanide
exposures above the reported nitazoxanide SARS-CoV-2 EC90. Methods: A
whole-body PBPK model was validated against available pharmacokinetic
data for healthy individuals receiving single and multiple doses between
500–4000 mg with and without food. The validated model was used to
predict doses expected to maintain tizoxanide plasma and lung
concentrations above the nitazoxanide EC90 in >90% of the
simulated population. PopDes was used to estimate an optimal sparse
sampling strategy for future clinical trials. Results: The PBPK model
was successfully validated against the reported human pharmacokinetics.
The model predicted optimal doses of 1200 mg QID, 1600 mg TID, 2900 mg
BID in the fasted state and 700 mg QID, 900 mg TID and 1400 mg BID when
given with food. For BID regimens an optimal sparse sampling strategy of
0.25, 1, 3 and 12h post dose was estimated. Conclusion: The PBPK model
predicted tizoxanide concentrations within doses of nitazoxanide already
given to humans previously. The reported dosing strategies provide a
rational basis for design of clinical trials with nitazoxanide for the
treatment or prevention of SARS-CoV-2 infection.