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Soeorg H, Sverrisdóttir E, Andersen M, Lund TM, Sessa M. Artificial Neural Network vs. Pharmacometric Model for Population Prediction of Plasma Concentration in Real-World Data: A Case Study on Valproic Acid. Clin Pharmacol Ther 2022; 111:1278-1285. [PMID: 35263452 DOI: 10.1002/cpt.2577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/01/2022] [Indexed: 11/08/2022]
Abstract
We compared the predictive performance of an artificial neural network to traditional pharmacometric modeling for population prediction of plasma concentrations of valproate in real-world data. We included individuals aged 65 years or older with epilepsy who redeemed their first prescription of valproate after the diagnosis of epilepsy and had at least one valproate plasma concentration measured. A long short-term memory neural network (LSTM) was developed using the training data set to fit the LSTM and the test data set to validate the model. Predictions from the LSTM were compared with those obtained from the population predictions from a pharmacometric model by Birnbaum et al. which had the best predictive performance for population predictions of valproate concentrations in Danish databases. We used the cutoff of ± 20 mg/L of prediction error to define good predictions. A total of 1,252 individuals were included in the study. The LSTM fitted using the training data set had poor predictive performance in the test data set, but better than that of the pharmacometric model. The proportion of individuals with at least one predicted concentration within ± 20 mg/L of observed concentration was largest in case of the LSTM (64.4%, 95% confidence interval (CI): 58.4-70.2%) compared with the pharmacometric model by Birnbaum et al. (49.8%, 95% CI: 47.0-52.6%). LSTM shows better predictive performance to predict valproate plasma concentrations compared with a traditional pharmacometric model in the investigated setting with real-world data in older patients with epilepsy where information on exact timepoints for both dosing and plasma concentration measurement are missing.
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Affiliation(s)
- Hiie Soeorg
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Pharmacometrics Research Group, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Eva Sverrisdóttir
- Pharmacometrics Research Group, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Trine Meldgaard Lund
- Pharmacometrics Research Group, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Maurizio Sessa
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Macrolide Treatment Failure due to Drug–Drug Interactions: Real-World Evidence to Evaluate a Pharmacological Hypothesis. Pharmaceutics 2022; 14:pharmaceutics14040704. [PMID: 35456537 PMCID: PMC9031623 DOI: 10.3390/pharmaceutics14040704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 02/01/2023] Open
Abstract
Macrolide antibiotics have received criticism concerning their use and risk of treatment failure. Nevertheless, they are an important class of antibiotics and are frequently used in clinical practice for treating a variety of infections. This study sought to utilize pharmacoepidemiology methods and pharmacology principles to estimate the risk of macrolide treatment failure and quantify the influence of their pharmacokinetics on the risk of treatment failure, using clinically reported drug–drug interaction data. Using a large, commercial claims database (2006–2015), inclusion and exclusion criteria were applied to create a cohort of patients who received a macrolide for three common acute infections. Furthermore, an additional analysis examining only bacterial pneumonia events treated with macrolides was conducted. These criteria were formulated specifically to ensure treatment failure would not be expected nor influenced by intrinsic or extrinsic factors. Treatment failure rates were 6% within the common acute infections and 8% in the bacterial pneumonia populations. Regression results indicated that macrolide AUC changes greater than 50% had a significant effect on treatment failure risk, particularly for azithromycin. In fact, our results show that decreased or increased exposure change can influence failure risk, by 35% or 12%, respectively, for the acute infection scenarios. The bacterial pneumonia results were less significant with respect to the regression analyses. This integration of pharmacoepidemiology and clinical pharmacology provides a framework for utilizing real-world data to provide insight into pharmacokinetic mechanisms and support future study development related to antibiotic treatments.
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Soeorg H, Sverrisdóttir E, Andersen M, Lund TM, Sessa M. The PHARMACOM-EPI Framework for Integrating Pharmacometric Modelling Into Pharmacoepidemiological Research Using Real-World Data: Application to Assess Death Associated With Valproate. Clin Pharmacol Ther 2021; 111:840-856. [PMID: 34860420 DOI: 10.1002/cpt.2502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023]
Abstract
In pharmacoepidemiology, it is usually expected that the observed association should be directly or indirectly related to the pharmacological effects of the drug/s under investigation. Pharmacological effects are, in turn, strongly connected to the pharmacokinetic and pharmacodynamic properties of a drug, which can be characterized and investigated using pharmacometric models. Recently, the use of pharmacometrics has been proposed to provide pharmacological substantiation of pharmacoepidemiological findings derived from real-world data. However, validated frameworks suggesting how to combine these two disciplines for the aforementioned purpose are missing. Therefore, we propose PHARMACOM-EPI, a framework that provides a structured approach on how to identify, characterize, and apply pharmacometric models with practical details on how to choose software, format dataset, handle missing covariates/dosing data, how to perform the external evaluation of pharmacometric models in real-world data, and how to provide pharmacological substantiation of pharmacoepidemiological findings. PHARMACOM-EPI was tested in a proof-of-concept study to pharmacologically substantiate death associated with valproate use in the Danish population aged ≥ 65 years. Pharmacological substantiation of death during a follow-up period of 1 year showed that in all individuals who died (n = 169) individual predictions were within the subtherapeutic range compared with 52.8% of those who did not die (n = 1,084). Of individuals who died, 66.3% (n = 112) had a cause of death possibly related to valproate and 33.7% (n = 57) with well-defined cause of death unlikely related to valproate. This proof-of-concept study showed that PHARMACOM-EPI was able to provide pharmacological substantiation for death associated with valproate use in the study population.
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Affiliation(s)
- Hiie Soeorg
- Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark.,Department of Drug Design and Pharmacology, Pharmacometrics Research Group, University of Copenhagen, Copenhagen, Denmark
| | - Eva Sverrisdóttir
- Department of Drug Design and Pharmacology, Pharmacometrics Research Group, University of Copenhagen, Copenhagen, Denmark
| | - Morten Andersen
- Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, Pharmacometrics Research Group, University of Copenhagen, Copenhagen, Denmark
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
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Srinivasan M, White A, Lott J, Williamson T, Kong SX, Plouffe L. Quantifying the economic burden of unintended pregnancies due to drug–drug interactions with hormonal contraceptives from the United States payer perspective. Gates Open Res 2021; 5:171. [DOI: 10.12688/gatesopenres.13430.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background: In the United States of America (USA), nearly 10 million women use oral contraceptives (OCs). Concomitant administration of certain medications can result in contraceptive failure, and consequently unintended pregnancies due to drug–drug interactions (DDIs). The objective of this analysis was to estimate the economic impact of unintended pregnancies due to DDIs among women of reproductive age using an OC alone or in combination with an enzyme inducer co-medication in the USA from a payer perspective. Methods: A Markov model using a cohort of 1,000 reproductive-age women was developed to estimate costs due to contraceptive failure for OC alone versus OC with concomitant enzyme inducer drugs. All women were assumed to begin an initial state, continuing until experiencing an unintended pregnancy. Unintended pregnancies could result in birth, induced abortion, spontaneous abortion, or ectopic pregnancy. The cohort was analyzed over a time horizon of 1 year with a cycle length of 1 month. Estimates of costs and probabilities of unintended pregnancy outcomes were obtained from the literature. Probabilities from the Markov cohort trace was used to estimate number of pregnancy outcomes. Results: On average, enzyme inducers resulted in 20 additional unintended pregnancies with additional unadjusted and adjusted costs median (range) of USD136,304 (USD57,436–USD320,093) and USD65,146 (USD28,491–USD162,635), respectively. The major component of the direct cost is attributed to the cost of births. Considering the full range of events, DDIs with enzyme inducers could result in 16–25 additional unintended pregnancies and total unadjusted and adjusted costs ranging between USD46,041 to USD399,121 and USD22,839 to USD202,788 respectively. Conclusion: The direct costs associated with unintended pregnancies due to DDIs may be substantial and are potentially avoidable. Greater awareness of DDI risk with oral contraceptives among payers, physicians, pharmacists and patients may reduce unintended pregnancies in at-risk populations.
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Srinivasan M, White A, Chaturvedula A, Vozmediano V, Schmidt S, Plouffe L, Wingate LT. Incorporating Pharmacometrics into Pharmacoeconomic Models: Applications from Drug Development. PHARMACOECONOMICS 2020; 38:1031-1042. [PMID: 32734572 PMCID: PMC7578131 DOI: 10.1007/s40273-020-00944-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Pharmacometrics is the science of quantifying the relationship between the pharmacokinetics and pharmacodynamics of drugs in combination with disease models and trial information to aid in drug development and dosing optimization for clinical practice. Considering the variability in the dose-concentration-effect relationship of drugs, an opportunity exists in linking pharmacokinetic and pharmacodynamic model-based estimates with pharmacoeconomic models. This link may provide early estimates of the cost effectiveness of drug therapies, thus informing late-stage drug development, pricing, and reimbursement decisions. Published case studies have demonstrated how integrated pharmacokinetic-pharmacodynamic-pharmacoeconomic models can complement traditional pharmacoeconomic analyses by identifying the impact of specific patient sub-groups, dose, dosing schedules, and adherence on the cost effectiveness of drugs, thus providing a mechanistic basis to predict the economic value of new drugs. Greater collaboration between the pharmacoeconomics and pharmacometrics community can enable methodological improvements in pharmacokinetic-pharmacodynamic-pharmacoeconomic models to support drug development.
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Affiliation(s)
- Meenakshi Srinivasan
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Annesha White
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Ayyappa Chaturvedula
- University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Valvanera Vozmediano
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
| | - Stephan Schmidt
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
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Wang CY, Pham PN, Kim S, Lingineni K, Schmidt S, Diaby V, Brown J. Predicting Cost-Effectiveness of Generic vs. Brand Dabigatran Using Pharmacometric Estimates Among Patients with Atrial Fibrillation in the United States. Clin Transl Sci 2020; 13:352-361. [PMID: 32053288 PMCID: PMC7070788 DOI: 10.1111/cts.12719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 11/30/2022] Open
Abstract
Generic entry of newer anticoagulants is expected to decrease the costs of atrial fibrillation management. However, when making switches between brand and generic medications, bioequivalence concerns are possible. The objectives of this study were to predict and compare the lifetime cost‐effectiveness of brand dabigatran with hypothetical future generics. Markov microsimulations were modified to predict the lifetime costs and quality‐adjusted life years of patients on either brand or generic dabigatran from a US private payer perspective. Event rates for generics were predicted using previously developed pharmacokinetic‐pharmacodynamic models. The analyses showed that generic dabigatran with lower‐than‐brand systemic exposure were dominant. Meanwhile, generic dabigatran with extremely high systemic exposure was not cost‐effective compared with the brand reference. Cost‐effectiveness of generic medications cannot always be assumed as shown in this example. Combined use of pharmacometric and pharmacoeconomic models can assist in decision making between brand and generic pharmacotherapies.
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Affiliation(s)
- Ching-Yu Wang
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation & Safety, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Phuong N Pham
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation & Safety, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Sarah Kim
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, University of Florida College of Pharmacy, Orlando, Florida, USA
| | - Karthik Lingineni
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, University of Florida College of Pharmacy, Orlando, Florida, USA
| | - Stephan Schmidt
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, University of Florida College of Pharmacy, Orlando, Florida, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation & Safety, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Joshua Brown
- Department of Pharmaceutical Outcomes and Policy, Center for Drug Evaluation & Safety, University of Florida College of Pharmacy, Gainesville, Florida, USA
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Bai JP, Musante CJ, Petanceska S, Zhang L, Zhao L, Zhao P. American Society for Clinical Pharmacology and Therapeutics 2019 Annual Meeting Pre-Conferences. CPT Pharmacometrics Syst Pharmacol 2019; 8:333-335. [PMID: 31087531 PMCID: PMC6617844 DOI: 10.1002/psp4.12424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jane P.F. Bai
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMarylandUSA
| | - Cynthia J. Musante
- Quantitative Systems PharmacologyEarly Clinical Development, Pfizer IncCambridgeMassachusettsUSA
| | - Suzana Petanceska
- Division of NeuroscienceNational Institute on Aging at the National Institutes of HealthBethesdaMarylandUSA
| | - Lei Zhang
- Office of Research and StandardsOffice of Generic DrugsCenter for Drug Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMarylandUSA
| | - Liang Zhao
- Office of Research and StandardsOffice of Generic DrugsCenter for Drug Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMarylandUSA
| | - Ping Zhao
- Bill & Melinda Gates FoundationSeattleWashingtonUSA
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