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Pharmacokinetics of Lenalidomide in Subjects With Various Degrees of Renal Impairment and in Subjects on Hemodialysis

From Celgene Corporation, Summit, New Jersey.

The present study investigated the effect of renal impairment and hemodialysis on the pharmacokinetics of lenalidomide following a single 25-mg oral dose in 30 subjects aged 39 to 76 years. A single 25-mg dose was well tolerated by renally impaired subjects. Renal impairment did not alter the oral absorption, protein binding, or nonrenal elimination of lenalidomide. Mean urinary recovery of unchanged lenalidomide was 84% of the dose in subjects with normal renal function (creatinine clearance [CL_Cr] > 80 mL/min), and it declined to 69%, 38%, and 43% in subjects with mild (50 CL_Cr 80 mL/min), moderate (30 CL_Cr < 50 mL/min), and severe (CL_Cr < 30 mL/min) renal impairment, respectively. The differences in pharmacokinetic parameters between normal renal function and mild renal impairment were minor to modest (11%-32%). As renal impairment progressed to moderate, severe, or end-stage renal disease, total and renal lenalidomide clearance decreased drastically, area under the concentration-time curve increased by approximately 185% to 420%, and t was prolonged by approximately 6 to 12 hours. A 4-hour hemodialysis removed 31% of lenalidomide in the body. Therefore, lenalidomide dose adjustments should be considered for patients with CL_Cr < 50 mL/min, and the recommendations are given for the starting doses.

Key Words: Lenalidomide • pharmacokinetics • renal impairment • hemodialysis

Address for correspondence: Nianhang Chen, Celgene Corporation, 86 Morris Avenue, Summit, NJ 07091; e-mail: nchen{at}celgene.com.

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