Effect of plasmapheresis on drug pharmacokinetics in children: a structured review of the current literature

Abstract

Introduction In this structured review, we present a structured overview on the effect of plasmapheresis on pharmacokinetics (PK) of drugs in children. Furthermore, we intended to analyse if, based on the changed PK, evidence-based drug dosing regimens for drugs at therapeutic dosages in this population have been developed. Methods A structured literature search assessing drug PK/exposure in children undergoing plasmapheresis was conducted in EMBASE and PubMed on 23 March 2023. Studies were labelled as relevant when data on PK/exposure after plasmapheresis in patients younger than 18 years-old was reported. Extracted parameters included patient characteristics, plasmapheresis related characteristics and PK/exposure related parameters. Results Twenty-six studies were identified, 96% being case reports. PK/exposure data for eighteen drugs in children undergoing plasmapheresis were included, 69% of the studies reported significant change in drug exposure after plasmapheresis. In 38% of the studies plasmapheresis was used in combination with drugs at therapeutic dosages, with no significant drug removal. No evidence-based drug dosing regimen for drugs at therapeutic dosages in children undergoing plasmapheresis have been developed. However, the usefulness of plasmapheresis in drug poisoning has been demonstrated, in case reports, for 31% of the overdosages. Conclusions This structured review shows that a very limited number of studies have been performed on the PK/exposure of drugs in children undergoing plasmapheresis. Furthermore, it became clear that predicting the risk of drug removal by plasmapheresis based on theoretical (drug properties or PK) criteria for adults is not always applicable to children.