ArticleClinical pharmacology and therapeutics2022
Use of Real-World Data and Physiologically-Based Pharmacokinetic Modeling to Characterize Enoxaparin Disposition in Children With Obesity.
Article in Clinical pharmacology and therapeutics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- American Society of Hematology/International Society on Thrombosis and Haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients.Blood advances · 2025Guideline
- Update on antithrombotic therapy and body mass: a clinical consensus statement of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and the European Society of Cardiology Working Group on Thrombosis.European heart journal. Cardiovascular pharmacotherapy · 2024Pooled it
- A Review of Virtual Twins in Physiologically-Based Pharmacokinetic Modeling and Simulation.Clinical pharmacology and therapeutics · 2026Review
- Innovative strategies for anti-fibrotic drugs discovery from traditional Chinese medicine.Chinese herbal medicines · 2026Review
- Optimizing Venous Thromboembolism Prophylaxis in Burn Patients Using Enoxaparin Through PBPK Modeling.CPT: pharmacometrics & systems pharmacology · 2026Article
- Dosing Strategies for High-Alert Medications in Obese Pediatric Patients: A Systematic Review.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Obesity and Pharmacokinetic Variability: Implications for Cardiovascular Therapeutics.European cardiology · 2026Review
- Physiologically-Based Pharmacokinetic Modeling to Support Pediatric Clinical Development: An IQ Working Group Perspective on the Current Status and Challenges.CPT: pharmacometrics & systems pharmacology · 2026Review
- Pharmacokinetics and Childhood Obesity: Pathophysiological Basis and Challenges in Choosing the Ideal Body Size Descriptor.Pharmaceuticals (Basel, Switzerland) · 2025Review
- Applications of PBPK Models to Predict Tissue Residues and Extralabel Withdrawal Times of Drugs in Food Animals: Perspectives from the Food Animal Residue Avoidance Databank (FARAD) Program.The AAPS journal · 2025Review
- Leveraging In Silico and Artificial Intelligence Models to Advance Drug Disposition and Response Predictions Across the Lifespan.Clinical and translational science · 2025Review
- Physiologically Based Pharmacokinetic Modeling of Antibiotics in Children: Perspectives on Model-Informed Precision Dosing.Antibiotics (Basel, Switzerland) · 2025Review
- Pharmacokinetics of Dexamethasone in Children and Adolescents with Obesity.Journal of clinical pharmacology · 2024Article
- Physiologically-based pharmacokinetic modeling of pantoprazole to evaluate the role of CYP2C19 genetic variation and obesity in the pediatric population.CPT: pharmacometrics & systems pharmacology · 2024Article
- Characterizing Enoxaparin's Population Pharmacokinetics to Guide Dose Individualization in the Pediatric Population.Clinical pharmacokinetics · 2024Article
- Virtual twins for model-informed precision dosing of clozapine in patients with treatment-resistant schizophrenia.CPT: pharmacometrics & systems pharmacology · 2024Article
- Anti-Obesity and Anti-Inflammatory Synergistic Effects of Green Tea Catechins and Citrus β-Cryptoxanthin Ingestion in Obese Mice.International journal of molecular sciences · 2023Article
- Perioperative Acetaminophen Dosing in Obese Children.Children (Basel, Switzerland) · 2023Review
- Predicting the correct dose in children: Role of computational Pediatric Physiological-based pharmacokinetics modeling tools.CPT: pharmacometrics & systems pharmacology · 2023Review
- Integrating real-world data to accelerate and guide drug development: A clinical pharmacology perspective.Clinical and translational science · 2022Review
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 3 countries.
Funding
Abstract
Dosing guidance for children with obesity is often unknown despite the fact that nearly 20% of US children are classified as obese. Enoxaparin, a commonly prescribed low-molecular-weight heparin, is dosed based on body weight irrespective of obesity status to achieve maximum concentration within a narrow therapeutic or prophylactic target range. However, whether children with and without obesity experience equivalent enoxaparin exposure remains unclear. To address this clinical question, 2,825 anti-activated factor X (anti-Xa) surrogate concentrations were collected from the electronic health records of 596 children, including those with obesity. Using linear mixed-effects regression models, we observed that 4-hour anti-Xa concentrations were statistically significantly different in children with and without obesity, even for children with the same absolute dose (P = 0.004). To further mechanistically explore obesity-associated differences in anti-Xa concentration, a pediatric physiologically-based pharmacokinetic (PBPK) model was developed in adults, and then scaled to children with and without obesity. This PBPK model incorporated binding of enoxaparin to antithrombin to form anti-Xa and elimination via heparinase-mediated metabolism and glomerular filtration. Following scaling, the PBPK model predicted real-world pediatric concentrations well, with an average fold error (standard deviation of the fold error) of 0.82 (0.23) and 0.87 (0.26) in children with and without obesity, respectively. PBPK model simulations revealed that children with obesity have at most 20% higher 4-hour anti-Xa concentrations under recommended, total body weight-based dosing compared to children without obesity owing to reduced weight-normalized clearance. Enoxaparin exposure was better matched across age groups and obesity status using fat-free mass weight-based dosing.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.