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安全人体首剂最大安全起始剂量的估算附录

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2024年2月21日发(作者:烟欣可)

①使用相同的系数将mg/kg剂量换算成mg/m2剂量:其具体的使用见附录B公式(i)mg/m

2

= km × mg/kg,即动物km×动物剂量(mg/kg)=人km×人剂量mg/kg,也就是将剂量标准化到体表面积后,人的剂量等于动物的剂量。

②在公式HED=animal dose in mg/kg×(animal weight in kg/human weight in kg)0.33中动物剂量换算为HED的换算系数为(animal weight in kg/human weight in kg)0.33。

③表1第4列数值上=动物km /人km。

④我们可以推理出动物km /人km =(animal weight in kg/human weight in kg)0.33。

⑤也就是说动物km /人km或(animal weight in kg/human weight in kg)0.33都是这里的“换算系数conversion factor”。

⑥而这里的“除数”在数值上=人km /动物km,也是表1中的第3列。

⑦标准值:根据附录B,当人的体重为60 kg,表3第2列被认为是动物标准体重,使用公式(animal weight in kg/human weight in kg)0.33计算出的换算系数是这里的标准值。

⑧很广泛的体重范围:当人的体重为60 kg,在附录B表3第3列的动物体重范围,使用公式(animal weight in kg/human weight in kg)0.33计算出的换算系数在标准值的±20%内,这个微小的差异与毒理学试验中两倍以上的剂量间隔相比,可忽略不计。

⑨那么当人的体重范围也在变化时,对换算系数的影响如何呢?附录B表4列出了人体重在50-80 kg范围变化时,在第B列的动物体重范围内,使用公式(animal weight in

kg/human weight in kg)0.33计算出的换算系数极值,分别见C列和D列,极值与标准值的差异见F列。对于60 kg人体重,换算系数在标准值±20%的动物体重范围见G列。

⑩如果你还是觉得对体重的范围比较纠结,附录B表5给出了不同人体重对应的不同大鼠体重下,使用公式(animal weight in kg/human weight in kg)0.33计算的换算系数,用阴影强调了在标准值±10%和±20%的大鼠和人体重。

⑪其实,不管动物体重和人体重如何变化,(animal weight in kg/human weight in kg)0.33这个公式才是计算换算系数的根本。

⑫这个换算系数是否适用于动物试验任何种属的换算?我们最常见的动物的体表面积=体形系数×体重2/3,感觉在这里是没有考虑体型系数的影响,由于Freireich et al(1966)的文献无法下载到,所以,这里的体表面积是否=W2/3,就不得而知。

以上内容由摘自药学英语公众号,已获得作者本人批准。

V. STEP 2: HUMAN EQUIVALENT DOSE CALCULATION

V.第2步:人体等效剂量的计算

A. Conversion Based on Body Surface Area

A.根据体表面积换算

After the NOAELs in the relevant animal studies have been determined, they are converted to

HEDs. A decision should be made regarding the most appropriate method for extrapolating the

animal dose to the equivalent human dose. Toxic endpoints for therapeutics administered

systemically to animals, such as the MTD, are usually assumed to scale well between species

when doses are normalized to body surface area (i.e., mg/m

2) (EPA 1992; Lowe and Davis 1998).

The basis for this assumption lies primarily with the work of Freireich et al. (1966) and Schein et

al. (1970). These investigators reported that, for antineoplastic drugs, doses lethal to 10 percent of

rodents (LD 10 s) and MTDs in nonrodents both correlated with the human MTD when the doses

were normalized to the same administration schedule and expressed as mg/m 2. Despite the

subsequent analyses showing that the MTDs for this set of drugs scale best between species when

doses are normalized to W 0.75 rather than W

0.67 (inherent in body surface area normalization)

(Travis and White 1988; Watanabe et al. 1992), normalization to body surface area has remained a

widespread practice for estimating an HED based on an animal dose.

相关动物中的NOAEL被确定之后,应当将NOAEL换算成HED,应确定将动物剂量外推到人体等效剂量最适合的方法。如果将剂量标准化为体表面积(即mg/m2),在动物中全身给药的药物的毒性终点,如MTD,通常被认为在不同动物之间有很好的换算关系(EPA1992;Lowe and Davis1998)。这一假设主要是根据Freireich et al(1966)和Schein et

al(1970)的研究结果做出的。上述研究者报告,对于抗肿瘤药物,如果剂量标准化为相同的给药方案并以mg/m2表示,则致使10%啮齿类动物死亡的剂量(LD10)和非啮齿类动物的MTD均与人MTD有很好的相关性。尽管随后的分析显示当剂量标准化为W0.75而不是W0.67(固有的体表面积标准化系数)时,不同动物之间该类药物MTD的换算(Travis and

White 1988;Watanabe et al.1992)是最好的,但体表面积标准化仍然是根据动物剂量估计HED的普遍接受的做法。

An analysis of the affect of the allometric exponent on the conversion of an animal dose to the

HED was conducted (see Appendix A). Based on this analysis and on the fact that correcting for

body surface area increases clinical trial safety by resulting in a more conservative starting dose

estimate, it was concluded that the approach of converting NOAEL doses to an HED based on

body surface area correction factors (i.e., W 0.67) should be maintained for selecting starting doses

for initial studies in adult healthy volunteers. Nonetheless, use of a different dose normalization

approach, such as directly equating the human dose to the NOAEL in mg/kg, may be appropriate

in some circumstances. Deviations from the body surface area approach, when describing the

conversion of animal dose to HED, should be justified. The basis for justifying direct mg/kg

conversion and examples in which other normalization methods are appropriate are described in

the following subsection.

一项研究分析了类比指数对动物剂量换算为HED的影响(见附录A)。根据此分析结果,又考虑到校正体表面积可导致更保守的起始剂量估计值从而提高临床安全性这一事实,可以得出如下结论,即:在成年健康志愿者首次临床研究中,应将基于体表面积换算系数(即W0.67)把NOAEL剂量换算为HED这一方法始终用于起始剂量的选择。尽管如此,在某些情况下,使用不同的剂量标准化方法可能是恰当的。例如:直接将人体剂量等同于以mg/kg表示的NOAEL。当把动物剂量换算为HED时不使用体表面积换算的方法时,应当提供充分的理由说明所用方法的合理性。以下一节介绍了直接以mg/kg剂量换算的依据,以及其它标准化方法也适用的实例。

Although normalization to body surface area is an appropriate method for extrapolating doses

between species, consistent factors for converting doses from mg/kg to mg/m

2 have not always

been used. Given that body surface area normalization provides a reasonable approach for

estimating an HED, the factors used for converting doses for each species should be standardized.

Since body surface area varies with W

0.67, the conversion factors are dependent on the weight of

the animals in the studies. However, analyses conducted to address the effect of body weight on

the actual BSA-CF demonstrated that a standard factor provides a reasonable estimate of the HED

over a broad range of human and animal weights (see Appendix B). The conversion factors and

divisors shown in Table 1 are therefore recommended as the standard values to be used for

interspecies dose conversions for NOAELs. (These factors may also be applied when comparing

safety margins for other toxicity endpoints (e.g., reproductive toxicity and carcinogenicity) when

other data for comparison (i.e., AUCs) are unavailable or are otherwise inappropriate for

comparison.)

Table1:Conversion of Animal Doses to Human Equivalent Doses Based on Body Surface Area

Species

To Convert

Animal Dose in

mg/kg to Dose in

mg/m², Multiply

by km

37

25

3

5

6

7

8

12

20

12

6

7

20

27

35

To Convert Animal Dose in mg/kg

to HED

a in mg/kg, Either:

Divide

Animal Dose By

——

——

12.3

7.4

6.2

5.3

4.6

3.1

1.8

3.1

6.2

5.3

1.8

1.4

1.1

Multiply

Animal Dose By

——

——

0.08

0.13

0.16

0.19

0.22

0.32

0.54

0.32

0.16

0.19

0.54

0.73

0.95

Human

Child (20 kg)

b

Mouse

Hamster

Rat

Ferret

Guinea pig

Rabbit

Dog

Primates:

Monkeys

c

Marmoset

Squirrel monkey

Baboon

Micro-pig

Mini-pig

a.Assumes 60 kg human. For species not listed or for weights outside the standard ranges, HED

can be calculated from the following formula:

HED = animal dose in mg/kg x (animal weight in kg/human weight in kg) 0.33.

b. This km value is provided for reference only since healthy children will rarely be volunteers

for phase 1 trials.

c. For example, cynomolgus, rhesus, and stumptail.

虽然按体表面积标准化是不同动物间外推剂量的一种恰当的方法,但并不总是使用相同的系数将mg/kg剂量换算成mg/m2剂量。假设体表面积标准化是估计HED的一种合理的方法,那么对于每个动物种属而言用于剂量换算的系数应当标准化。由于体表面积随W0.67而变化,因此换算系数取决于所研究的动物的体重。然而,为说明体重对实际BSA-CF影响而进行的分析显示,一个标准系数可以在人和动物很广泛的体重范围内提供一个合理的HED估计值(见附录B)。因此表1中显示的换算系数和除数被推荐为不同动物间NOAEL剂量换算的标准值。(当没有其他数据(如AUC)供比较或者其他数据不适合比较时,这些换算系数也适用比较其他毒性终点[例如生殖毒性和致癌性]的安全性阈值。)

表1: 根据体表面积将动物剂量换算为人体等效剂量

种属

将mg/kg表示的动物

剂量换算成mg/m2的

剂量,乘以km

37

25

3

5

6

7

8

12

20

12

6

7

20

27

35

将mg/kg表示的动物

剂量换算成mg/kg表示的

HEDa,则

将动物剂量除以 或将动物剂量乘以

——

——

0.08

0.13

0.16

0.19

0.22

0.32

0.54

0.32

0.16

0.19

0.54

0.73

0.95

——

——

12.3

7.4

6.2

5.3

4.6

3.1

1.8

3.1

6.2

5.3

1.8

1.4

1.1

儿童(20kg)b

小鼠

仓鼠

大鼠

白鼬

豚鼠

灵长类:

猴c

狨猴

松鼠猴

狒狒

微型猪

小型猪

a.假定人体重为60kg。对于未列出的种属重或体重超出标准范围的种属,HED可以按照以下公式计算:

HED=动物剂量(mg/kg)×(动物体重kg/人体重kg)0.33

b提供这一km值仅作为参考,因为健康儿童罕有成为I期试验的志愿者

c例如短尾猴、恒河猴和桩尾猴(stumptail)

2024年2月21日发(作者:烟欣可)

①使用相同的系数将mg/kg剂量换算成mg/m2剂量:其具体的使用见附录B公式(i)mg/m

2

= km × mg/kg,即动物km×动物剂量(mg/kg)=人km×人剂量mg/kg,也就是将剂量标准化到体表面积后,人的剂量等于动物的剂量。

②在公式HED=animal dose in mg/kg×(animal weight in kg/human weight in kg)0.33中动物剂量换算为HED的换算系数为(animal weight in kg/human weight in kg)0.33。

③表1第4列数值上=动物km /人km。

④我们可以推理出动物km /人km =(animal weight in kg/human weight in kg)0.33。

⑤也就是说动物km /人km或(animal weight in kg/human weight in kg)0.33都是这里的“换算系数conversion factor”。

⑥而这里的“除数”在数值上=人km /动物km,也是表1中的第3列。

⑦标准值:根据附录B,当人的体重为60 kg,表3第2列被认为是动物标准体重,使用公式(animal weight in kg/human weight in kg)0.33计算出的换算系数是这里的标准值。

⑧很广泛的体重范围:当人的体重为60 kg,在附录B表3第3列的动物体重范围,使用公式(animal weight in kg/human weight in kg)0.33计算出的换算系数在标准值的±20%内,这个微小的差异与毒理学试验中两倍以上的剂量间隔相比,可忽略不计。

⑨那么当人的体重范围也在变化时,对换算系数的影响如何呢?附录B表4列出了人体重在50-80 kg范围变化时,在第B列的动物体重范围内,使用公式(animal weight in

kg/human weight in kg)0.33计算出的换算系数极值,分别见C列和D列,极值与标准值的差异见F列。对于60 kg人体重,换算系数在标准值±20%的动物体重范围见G列。

⑩如果你还是觉得对体重的范围比较纠结,附录B表5给出了不同人体重对应的不同大鼠体重下,使用公式(animal weight in kg/human weight in kg)0.33计算的换算系数,用阴影强调了在标准值±10%和±20%的大鼠和人体重。

⑪其实,不管动物体重和人体重如何变化,(animal weight in kg/human weight in kg)0.33这个公式才是计算换算系数的根本。

⑫这个换算系数是否适用于动物试验任何种属的换算?我们最常见的动物的体表面积=体形系数×体重2/3,感觉在这里是没有考虑体型系数的影响,由于Freireich et al(1966)的文献无法下载到,所以,这里的体表面积是否=W2/3,就不得而知。

以上内容由摘自药学英语公众号,已获得作者本人批准。

V. STEP 2: HUMAN EQUIVALENT DOSE CALCULATION

V.第2步:人体等效剂量的计算

A. Conversion Based on Body Surface Area

A.根据体表面积换算

After the NOAELs in the relevant animal studies have been determined, they are converted to

HEDs. A decision should be made regarding the most appropriate method for extrapolating the

animal dose to the equivalent human dose. Toxic endpoints for therapeutics administered

systemically to animals, such as the MTD, are usually assumed to scale well between species

when doses are normalized to body surface area (i.e., mg/m

2) (EPA 1992; Lowe and Davis 1998).

The basis for this assumption lies primarily with the work of Freireich et al. (1966) and Schein et

al. (1970). These investigators reported that, for antineoplastic drugs, doses lethal to 10 percent of

rodents (LD 10 s) and MTDs in nonrodents both correlated with the human MTD when the doses

were normalized to the same administration schedule and expressed as mg/m 2. Despite the

subsequent analyses showing that the MTDs for this set of drugs scale best between species when

doses are normalized to W 0.75 rather than W

0.67 (inherent in body surface area normalization)

(Travis and White 1988; Watanabe et al. 1992), normalization to body surface area has remained a

widespread practice for estimating an HED based on an animal dose.

相关动物中的NOAEL被确定之后,应当将NOAEL换算成HED,应确定将动物剂量外推到人体等效剂量最适合的方法。如果将剂量标准化为体表面积(即mg/m2),在动物中全身给药的药物的毒性终点,如MTD,通常被认为在不同动物之间有很好的换算关系(EPA1992;Lowe and Davis1998)。这一假设主要是根据Freireich et al(1966)和Schein et

al(1970)的研究结果做出的。上述研究者报告,对于抗肿瘤药物,如果剂量标准化为相同的给药方案并以mg/m2表示,则致使10%啮齿类动物死亡的剂量(LD10)和非啮齿类动物的MTD均与人MTD有很好的相关性。尽管随后的分析显示当剂量标准化为W0.75而不是W0.67(固有的体表面积标准化系数)时,不同动物之间该类药物MTD的换算(Travis and

White 1988;Watanabe et al.1992)是最好的,但体表面积标准化仍然是根据动物剂量估计HED的普遍接受的做法。

An analysis of the affect of the allometric exponent on the conversion of an animal dose to the

HED was conducted (see Appendix A). Based on this analysis and on the fact that correcting for

body surface area increases clinical trial safety by resulting in a more conservative starting dose

estimate, it was concluded that the approach of converting NOAEL doses to an HED based on

body surface area correction factors (i.e., W 0.67) should be maintained for selecting starting doses

for initial studies in adult healthy volunteers. Nonetheless, use of a different dose normalization

approach, such as directly equating the human dose to the NOAEL in mg/kg, may be appropriate

in some circumstances. Deviations from the body surface area approach, when describing the

conversion of animal dose to HED, should be justified. The basis for justifying direct mg/kg

conversion and examples in which other normalization methods are appropriate are described in

the following subsection.

一项研究分析了类比指数对动物剂量换算为HED的影响(见附录A)。根据此分析结果,又考虑到校正体表面积可导致更保守的起始剂量估计值从而提高临床安全性这一事实,可以得出如下结论,即:在成年健康志愿者首次临床研究中,应将基于体表面积换算系数(即W0.67)把NOAEL剂量换算为HED这一方法始终用于起始剂量的选择。尽管如此,在某些情况下,使用不同的剂量标准化方法可能是恰当的。例如:直接将人体剂量等同于以mg/kg表示的NOAEL。当把动物剂量换算为HED时不使用体表面积换算的方法时,应当提供充分的理由说明所用方法的合理性。以下一节介绍了直接以mg/kg剂量换算的依据,以及其它标准化方法也适用的实例。

Although normalization to body surface area is an appropriate method for extrapolating doses

between species, consistent factors for converting doses from mg/kg to mg/m

2 have not always

been used. Given that body surface area normalization provides a reasonable approach for

estimating an HED, the factors used for converting doses for each species should be standardized.

Since body surface area varies with W

0.67, the conversion factors are dependent on the weight of

the animals in the studies. However, analyses conducted to address the effect of body weight on

the actual BSA-CF demonstrated that a standard factor provides a reasonable estimate of the HED

over a broad range of human and animal weights (see Appendix B). The conversion factors and

divisors shown in Table 1 are therefore recommended as the standard values to be used for

interspecies dose conversions for NOAELs. (These factors may also be applied when comparing

safety margins for other toxicity endpoints (e.g., reproductive toxicity and carcinogenicity) when

other data for comparison (i.e., AUCs) are unavailable or are otherwise inappropriate for

comparison.)

Table1:Conversion of Animal Doses to Human Equivalent Doses Based on Body Surface Area

Species

To Convert

Animal Dose in

mg/kg to Dose in

mg/m², Multiply

by km

37

25

3

5

6

7

8

12

20

12

6

7

20

27

35

To Convert Animal Dose in mg/kg

to HED

a in mg/kg, Either:

Divide

Animal Dose By

——

——

12.3

7.4

6.2

5.3

4.6

3.1

1.8

3.1

6.2

5.3

1.8

1.4

1.1

Multiply

Animal Dose By

——

——

0.08

0.13

0.16

0.19

0.22

0.32

0.54

0.32

0.16

0.19

0.54

0.73

0.95

Human

Child (20 kg)

b

Mouse

Hamster

Rat

Ferret

Guinea pig

Rabbit

Dog

Primates:

Monkeys

c

Marmoset

Squirrel monkey

Baboon

Micro-pig

Mini-pig

a.Assumes 60 kg human. For species not listed or for weights outside the standard ranges, HED

can be calculated from the following formula:

HED = animal dose in mg/kg x (animal weight in kg/human weight in kg) 0.33.

b. This km value is provided for reference only since healthy children will rarely be volunteers

for phase 1 trials.

c. For example, cynomolgus, rhesus, and stumptail.

虽然按体表面积标准化是不同动物间外推剂量的一种恰当的方法,但并不总是使用相同的系数将mg/kg剂量换算成mg/m2剂量。假设体表面积标准化是估计HED的一种合理的方法,那么对于每个动物种属而言用于剂量换算的系数应当标准化。由于体表面积随W0.67而变化,因此换算系数取决于所研究的动物的体重。然而,为说明体重对实际BSA-CF影响而进行的分析显示,一个标准系数可以在人和动物很广泛的体重范围内提供一个合理的HED估计值(见附录B)。因此表1中显示的换算系数和除数被推荐为不同动物间NOAEL剂量换算的标准值。(当没有其他数据(如AUC)供比较或者其他数据不适合比较时,这些换算系数也适用比较其他毒性终点[例如生殖毒性和致癌性]的安全性阈值。)

表1: 根据体表面积将动物剂量换算为人体等效剂量

种属

将mg/kg表示的动物

剂量换算成mg/m2的

剂量,乘以km

37

25

3

5

6

7

8

12

20

12

6

7

20

27

35

将mg/kg表示的动物

剂量换算成mg/kg表示的

HEDa,则

将动物剂量除以 或将动物剂量乘以

——

——

0.08

0.13

0.16

0.19

0.22

0.32

0.54

0.32

0.16

0.19

0.54

0.73

0.95

——

——

12.3

7.4

6.2

5.3

4.6

3.1

1.8

3.1

6.2

5.3

1.8

1.4

1.1

儿童(20kg)b

小鼠

仓鼠

大鼠

白鼬

豚鼠

灵长类:

猴c

狨猴

松鼠猴

狒狒

微型猪

小型猪

a.假定人体重为60kg。对于未列出的种属重或体重超出标准范围的种属,HED可以按照以下公式计算:

HED=动物剂量(mg/kg)×(动物体重kg/人体重kg)0.33

b提供这一km值仅作为参考,因为健康儿童罕有成为I期试验的志愿者

c例如短尾猴、恒河猴和桩尾猴(stumptail)

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