Model Informed Drug Development for Everolimus Dosing Selection in Pediatric Infant Patients

Everolimus is currently approved in Europe as an adjunctive therapy for patients aged >/= 2 years with tuberous sclerosis complex (TSC)-associated treatment-refractory partial-onset seizures, based on the EXIST-3 study (NCT01713946) results. As TSC-associated seizures can also affect children aged between 6 months and 2 years, a modeling and simulation (M&S) approach was undertaken to extrapolate exposure (Cmin ) after a dose of 6 mg/m(2) , and reduction in seizure frequency (RSF). A physiologically based pharmacokinetic model using Simcyp(R) was developed to predict Cmin in adult and pediatric patients, which was then used by a population pharmacodynamic model and a linear mixed effect model to predict short-term and long-term efficacy in adults (for validation) and in children, respectively. Based on the results of the M&S study, everolimus at the dose of 6 mg/m(2) is anticipated to be an efficacious treatment in children 6 months to 2 years of age (up to 77.8% RSF), with concentrations within the recommended target range.