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sfrechen committed Feb 5, 2020
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Expand Up @@ -59,9 +59,9 @@ The model was then verified by simulating:
- multiple dose studies
- a food effect study

Details about input data (physicochemical, *in vitro* and clinical) can be found in [Section 2.2](#2.2-Data).
Details about input data (physicochemical, *in vitro* and clinical) can be found in [Section 2.2](#22-Data).

Details about the structural model and its parameters can be found in [Section 2.3](#2.3-Model-Parameters-and-Assumptions).
Details about the structural model and its parameters can be found in [Section 2.3](#23-Model-Parameters-and-Assumptions).


## 2.2 Data
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*** The fraction excretion to feces of unchanged dapagliflozin of 18.90% (see above) was added and distributed proportionally to Dapagliflozin-3-O-glucuronide and Dapagliflozin-2-O-glucuronide under the assumption that the measured fraction of unchanged dapagliflozin resulted from originally glucuronidated metabolites that underwent biliary excretion and subsequent degradation to dapagliflozin by bacterial glucurinodases in feces.

The following table shows the final mass balance data used for model building under the assumption of that unchanged dapagliflozin molecules in feces were originally glucuronides. Please refer to [Section 2.3](#2.3-Model-Parameters-and-Assumptions) for rationale.
The following table shows the final mass balance data used for model building under the assumption of that unchanged dapagliflozin molecules in feces were originally glucuronides. Please refer to [Section 2.3](#23-Model-Parameters-and-Assumptions) for rationale.

| Observer | Value |
| ------------------------------------------------------------ | ---------- |
Expand All @@ -155,7 +155,7 @@ The following studies were used for model verification:
## 2.3 Model Parameters and Assumptions
### 2.3.1 Absorption

Studies including oral applications of dapagliflozin used for model building applied either a capsule or immediate release tablets. They all demonstrated rapid and extensive absorption. The availability of dense data during absorption, data covering a broad range of doses (from 2.5 up to 500 mg, and intravenous pharmacokinetic data ([Boulton 2013](#5-References)) allowed the identification of the *in vivo* intestinal permeability and an effective *in vivo* solubility in this PBPK model (see also [Section 2.3.4](#2.3.4-Automated-Parameter-Identification)).
Studies including oral applications of dapagliflozin used for model building applied either a capsule or immediate release tablets. They all demonstrated rapid and extensive absorption. The availability of dense data during absorption, data covering a broad range of doses (from 2.5 up to 500 mg, and intravenous pharmacokinetic data ([Boulton 2013](#5-References)) allowed the identification of the *in vivo* intestinal permeability and an effective *in vivo* solubility in this PBPK model (see also [Section 2.3.4](#234-Automated-Parameter-Identification)).

During model building, two different "data scenarios" regarding mass balance information were tested:

Expand All @@ -171,15 +171,15 @@ The dissolution of the tablets from Chang *et al.* ([Chang 2015](#5-References))

Dapagliflozin is moderately protein bound (91 %) in plasma ([Kasichayanula 2014](#5-References)). This value was used in this PBPK model. It was assumed that the major binding partner is albumin.

An important parameter influencing the resulting volume of distribution is lipophilicty. The reported experimental logP value of 2.7 ([DrugBank DB06292](#5-References)) served as a starting value. Finally, the model parameters `Lipophilicity` and `logP (veg.oil/water)` were optimized to match best clinical data (see also [Section 2.3.4](#2.3.4-Automated-Parameter-Identification)).
An important parameter influencing the resulting volume of distribution is lipophilicty. The reported experimental logP value of 2.7 ([DrugBank DB06292](#5-References)) served as a starting value. Finally, the model parameters `Lipophilicity` and `logP (veg.oil/water)` were optimized to match best clinical data (see also [Section 2.3.4](#234-Automated-Parameter-Identification)).

After testing the available organ-plasma partition coefficient and cell permeability calculation methods built in PK-Sim, observed clinical data was best described by choosing the partition coefficient calculation by `Rodgers and Rowland` and cellular permeability calculation by `PK-Sim Standard`. The specific organ permeability was also optimized to match best clinical data (see also [Section 2.3.4](#2.3.4-Automated-Parameter-Identification)).
After testing the available organ-plasma partition coefficient and cell permeability calculation methods built in PK-Sim, observed clinical data was best described by choosing the partition coefficient calculation by `Rodgers and Rowland` and cellular permeability calculation by `PK-Sim Standard`. The specific organ permeability was also optimized to match best clinical data (see also [Section 2.3.4](#234-Automated-Parameter-Identification)).

The reported blood to plasma ratio of 0.88 ([Obermeier 2009](#5-References)) was fixed in the model.

### 2.3.3 Metabolism and Elimination

As previously described in [Section 2.2.2](#2.2.2-Clinical-Data), mass balance data ([Kasichayanula 2008](#5-References), [Obermeier 2009](#5-References), [Kasichayanula 2014](#5-References)) indicated that UGT1A9 is predominatly responsible for the metabolism of dapagliflozin to dapagliflozin-3-O-glucuronide. A minor fraction is metabolized via UGT2B7 to dapagliflozin-2-O-glucuronide and via oxidative cyotochrome-P450 enzymes.
As previously described in [Section 2.2.2](#222-Clinical-Data), mass balance data ([Kasichayanula 2008](#5-References), [Obermeier 2009](#5-References), [Kasichayanula 2014](#5-References)) indicated that UGT1A9 is predominatly responsible for the metabolism of dapagliflozin to dapagliflozin-3-O-glucuronide. A minor fraction is metabolized via UGT2B7 to dapagliflozin-2-O-glucuronide and via oxidative cyotochrome-P450 enzymes.

In summary, three metabolic first order routes were implement into the model:

Expand All @@ -190,7 +190,7 @@ In summary, three metabolic first order routes were implement into the model:

Additionally, a renal clearance (assumed to be mainly driven by glomerular filtration) was implemented.

This clearance and excretion pathways were quantified during parameter optimization to best match clinical data (see also [Section 2.2.2](#2.2.2-Clinical-Data), [Section 2.3.1](#2.3.1-Absorption), and [Section 2.3.4](#2.3.4-Automated-Parameter-Identification)).
This clearance and excretion pathways were quantified during parameter optimization to best match clinical data (see also [Section 2.2.2](#222-Clinical-Data), [Section 2.3.1](#231-Absorption), and [Section 2.3.4](#234-Automated-Parameter-Identification)).

### 2.3.4 Automated Parameter Identification

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The next sections show:

1. the final model parameters for the building blocks: [Section 3.1](#3.1-Final-Input-Parameters).
2. the overall goodness of fit: [Section 3.2](#3.2-Diagnostics-Plots).
3. simulated vs. observed concentration-time profiles for the clinical studies used for model building and for model verification: [Section 3.3](#3.3-Concentration-Time-Profiles).
1. the final model parameters for the building blocks: [Section 3.1](#31-Final-Input-Parameters).
2. the overall goodness of fit: [Section 3.2](#32-Diagnostics-Plots).
3. simulated vs. observed concentration-time profiles for the clinical studies used for model building and for model verification: [Section 3.3](#33-Concentration-Time-Profiles).


## 3.1 Final input parameters
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Use as suspension | Yes | |

## 3.2 Diagnostics Plots
Below you find the goodness-of-fit visual diagnostic plots for the PBPK model performance of all data used presented in [Section 2.2.2](#2.2.2-Clinical-Data).
Below you find the goodness-of-fit visual diagnostic plots for the PBPK model performance of all data used presented in [Section 2.2.2](#222-Clinical-Data).

The first plot shows simulated versus observed plasma concentrations, the second weighted residuals versus time.

Expand All @@ -329,7 +329,7 @@ The first plot shows simulated versus observed plasma concentrations, the second
GMFE = 1.222396

## 3.3 Concentration-Time Profiles
Simulated versus observed concentration-time profiles of all data listed in [Section 2.2.2](#2.2.2-Clinical-Data) are presented below.
Simulated versus observed concentration-time profiles of all data listed in [Section 2.2.2](#222-Clinical-Data) are presented below.


### 3.3.1 Model Building
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