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The s.c. administration provides benefits over i.v. injections. The objective of the study was to support the first\u2010in\u2010pediatric dose selection for s.c. MarzAA to treat episodic bleeding episodes in children up through 11\u2009years in a registrational phase III trial. Assuming the same exposure\u2010response relationship as in adults, an exposure matching strategy was used with a population pharmacokinetics model. A sensitivity analysis evaluating the impact of doubling in absorption rate and age\u2010dependent allometric exponents on dose selection was performed. Subsequently, the probability of trial success, defined as the number of successful trials for a given pediatric dose divided by the number of simulated trials (<jats:italic>n<\/jats:italic>\u2009=\u20091000) was studied. A successful trial was defined as outcome where four, three, or two out of 24 pediatric subjects per trial were allowed to fall outside the adult exposures after s.c. administration of 60\u2009\u03bcg\/kg. A dose of 60\u2009\u03bcg\/kg in children with HA\/HB was supported by the clinical trial simulations to match exposures in adults. The sensitivity analyses further supported selection of the 60\u2009\u03bcg\/kg dose level in all age groups. Moreover, the probability of trial success evaluations given a plausible design confirmed the potential of a 60\u2009\u03bcg\/kg dose level. Taken together, this work demonstrates the utility of model\u2010informed drug development and could be helpful for other pediatric development programs for rare diseases.<\/jats:p>","DOI":"10.1002\/psp4.12967","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T09:44:55Z","timestamp":1681292695000},"page":"977-987","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Model\u2010informed pediatric dose selection of marzeptacog alfa (activated): An exposure matching strategy"],"prefix":"10.1002","volume":"12","author":[{"given":"Alan","family":"Faraj","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Biosciences Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7247-1360","authenticated-orcid":false,"given":"Rob C.","family":"van Wijk","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Biosciences Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Neuman","sequence":"additional","affiliation":[{"name":"Catalyst Biosciences  South San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shraddha","family":"Desai","sequence":"additional","affiliation":[{"name":"Catalyst Biosciences  South San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant E.","family":"Blouse","sequence":"additional","affiliation":[{"name":"Catalyst Biosciences  South San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Knudsen","sequence":"additional","affiliation":[{"name":"Catalyst Biosciences  South San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3424-9686","authenticated-orcid":false,"given":"Ulrika S. 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