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Deprecated: Implicit conversion from float 209.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Aerosol+Med+Pulm+Drug+Deliv 2014 ; 27 (3): 178-84 Nephropedia Template TP
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Lung Deposition and Pharmacokinetics of Nebulized Cyclosporine in Lung Transplant Patients #MMPMID23668548
Corcoran T; Niven R; Verret W; Dilly S; Johnson B
J Aerosol Med Pulm Drug Deliv 2014[Jun]; 27 (3): 178-84 PMID23668548show ga
Background: Inhaled cyclosporine (CsA) is being investigated as a prophylaxis for lung transplant rejection. Lung deposition and systemic exposure of nebulized CsA in lung transplant patients was evaluated as part of the Phase 3 cyclosporine inhalation solution (CIS) trial (CYCLIST).Methods: Ten patients received 300?mg of CIS (62.5?mg/mL CsA in propylene glycol) admixed with 148?MBq of Tc-DTPA (technetium-99m bound to diethylenetriaminepentaacetic acid) administered using a Sidestream® disposable jet nebulizer. Deposition was assessed using a dual-headed gamma camera. Blood samples were collected over a 24-hr time period after aerosol dosing and analyzed for CsA levels. A pharmacokinetic analysis of the resulting blood concentration versus time profiles was performed.Results: The average total deposited dose was 53.7±12.7?mg. Average pulmonary dose was 31.8±16.3?mg, and stomach dose averaged 15.5±11.1?mg. Device performance was consistent, with breathing maneuvers influencing dose variation. Predose coaching with five of 10 patients reduced stomach deposition (22.6±11.2 vs. 8.3±5.2?mg; p=0.03). Blood concentrations declined quickly from a maximum of 372±140?ng/mL to 15.3±9.7?ng/mL at 24?hr post dose. Levels of AUC(0?24) [area under the concentration vs. time curve from 0 to 24?hr] averaged 1,493±746?ng hr/mL. On a three times per week dose regimen, this represents <5% of the weekly systemic exposure of twice per day oral administration.Conclusions: Substantial doses of CsA can be delivered to the lungs of lung transplant patients by inhaled aerosol. Systemic levels are small relative to typical oral CsA administration.