Pharmacokinetic/Pharmacodynamic Modelling to Describe the Cholesterol Lowering Effect of Rosuvastatin in People Living with HIV
Perrine Courlet, Monia Guidi, Susana Alves Saldanha, Felix Stader, Anna Traytel, Matthias Cavassini, Marcel Stoeckle, Thierry Buclin, Catia Marzolini, Laurent A Decosterd, Chantal Csajka, and the Swiss HIV Cohort Study, Perrine Courlet, Monia Guidi, Susana Alves Saldanha, Felix Stader, Anna Traytel, Matthias Cavassini, Marcel Stoeckle, Thierry Buclin, Catia Marzolini, Laurent A Decosterd, Chantal Csajka, and the Swiss HIV Cohort Study
Abstract
Background: Rosuvastatin is a lipid-lowering agent widely prescribed in people living with HIV, which is actively transported into the liver, making it a potential victim of drug-drug interactions with antiretroviral agents.
Objectives: The aims of this study were to characterise the pharmacokinetic profile of rosuvastatin and to describe the relationship between rosuvastatin concentrations and non-high-density lipoprotein (HDL)-cholesterol levels in people living with HIV.
Methods: A population pharmacokinetic model (NONMEM) was developed to quantify the influence of demographics, clinical characteristics and comedications on rosuvastatin pharmacokinetics. This model was combined with an indirect effect model to describe non-HDL-cholesterol measurements.
Results: A two-compartment model with sequential zero- and first-order absorption best fitted the 154 rosuvastatin concentrations provided by 65 people living with HIV. None of the tested covariates significantly influenced rosuvastatin pharmacokinetics. A total of 403 non-HDL cholesterol values were available for pharmacokinetic-pharmacodynamic modelling. Baseline non-HDL cholesterol decreased by 14% and increased by 12% with etravirine and antiretroviral drugs with a known impact on the lipid profile (i.e. protease inhibitors, efavirenz, cobicistat), respectively. The baseline value was surprisingly 43% lower in people living with HIV aged 80 years compared with those aged 40 years. Simulations based on the covariate-free model predicted that, under standard rosuvastatin dosages of 5 mg and 20 mg once daily, 31% and 64% of people living with HIV would achieve non-HDL-cholesterol targets, respectively.
Conclusions: The high between-subject variability that characterises both rosuvastatin pharmacokinetic and pharmacodynamic profiles remained unexplained after the inclusion of usual covariates. Considering its limited potential for drug-drug interactions with antiretroviral agents and its potent lipid-lowering effect, rosuvastatin prescription appears safe and effective in people living with HIV with hypercholesterolaemia.
Clinical trial registration no: NCT03515772.
Conflict of interest statement
Perrine Courlet, Laurent A. Decosterd, Susana Alves Saldanha, Felix Stader, Anna Traytel, Matthias Cavassini, Thierry Buclin, Chantal Csajka and Monia Guidi have no conflict of interest to declare. Marcel Stoeckle got fee’s for advisory boards from Gilead, MSD, ViiV, Janssen-Cilag, Sandoz and Mepha, as well as grants for conferences from Gilead and MSD, yet unrelated to the present study. Catia Marzolini received a research grant from Gilead and speaker honoraria for her institution from MSD.
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References
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