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Bandeira LC, Pinto L, Carneiro CM. Pharmacometrics: The Already-Present Future of Precision Pharmacology. Ther Innov Regul Sci 2023; 57:57-69. [PMID: 35984633 DOI: 10.1007/s43441-022-00439-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023]
Abstract
The use of mathematical modeling to represent, analyze, make predictions or providing information on data obtained in drug research and development has made pharmacometrics an area of great prominence and importance. The main purpose of pharmacometrics is to provide information relevant to the search for efficacy and safety improvements in pharmacotherapy. Regulatory agencies have adopted pharmacometrics analysis to justify their regulatory decisions, making those decisions more efficient. Demand for specialists trained in the field is therefore growing. In this review, we describe the meaning, history, and development of pharmacometrics, analyzing the challenges faced in the training of professionals. Examples of applications in current use, perspectives for the future, and the importance of pharmacometrics for the development and growth of precision pharmacology are also presented.
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Affiliation(s)
- Lorena Cera Bandeira
- Laboratory of Immunopathology, Nucleus of Biological Sciences Research, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | - Leonardo Pinto
- Laboratory of Immunopathology, Nucleus of Biological Sciences Research, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Cláudia Martins Carneiro
- Laboratory of Immunopathology, Nucleus of Biological Sciences Research, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
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Burtchell J, Fetty K, Miller K, Minden K, Kantor D. Two Sides to Every Story: Perspectives from Four Patients and a Healthcare Professional on Multiple Sclerosis Disease Progression. Neurol Ther 2019; 8:185-205. [PMID: 31273563 PMCID: PMC6858896 DOI: 10.1007/s40120-019-0141-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Indexed: 02/07/2023] Open
Abstract
Abstract Multiple sclerosis (MS) is a chronic progressive disease and many patients transition from an initial relapsing–remitting course to a secondary progressive pattern. Accurate classification of disease status is critical to ensure that patients are treated appropriately and kept informed of their prognosis. Consensus terms defining the different forms of MS are available but were developed primarily for healthcare professionals (HCPs) and may be of limited value to patients. This article provides direct insights from four patients with MS, at different points in their disease trajectory, regarding their understanding of, and attitudes toward, MS progression. We also examine the utility of the current classification systems from the perspectives of patients and HCPs. Responses collected during in-depth, structured interviews and questionnaires portrayed the difficulties patients face accepting their MS diagnosis and treatment, revealed how understanding of the term “disease progression” varies considerably, and highlighted the challenges surrounding the period of transition to secondary progressive MS (SPMS). The terms describing different MS types were considered confusing and can make patients feel “compartmentalized” or “labeled”. Patients also struggled to relate these terms to their reality of living with MS, were reluctant to discuss progression with their HCPs, and feared being diagnosed with SPMS owing to concerns about treatment access. These insights highlight the need to develop patient-friendly language to describe MS progression; it may also be preferable for HCPs to describe MS as a disease spectrum in discussions with their patients. Funding Novartis Pharmaceuticals Corporation. Plain Language Summary Plain language summary available for this article.
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Affiliation(s)
- Jeri Burtchell
- HealthiVibe, LLC, Arlington, VA, USA.,Partners in Research, East Palatka, FL, USA
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3
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Novakovic A, Thorsted A, Schindler E, Jönsson S, Munafo A, Karlsson M. Pharmacometric Analysis of the Relationship Between Absolute Lymphocyte Count and Expanded Disability Status Scale and Relapse Rate, Efficacy End Points, in Multiple Sclerosis Trials. J Clin Pharmacol 2018; 58:1284-1294. [DOI: 10.1002/jcph.1136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/20/2018] [Indexed: 11/11/2022]
Affiliation(s)
- A.M. Novakovic
- Department of Pharmaceutical Biosciences; Uppsala University; Uppsala Sweden
- Current affiliation: Pharmacometry; Merck KGaA; Darmstadt Germany
| | - A. Thorsted
- Department of Pharmaceutical Biosciences; Uppsala University; Uppsala Sweden
| | - E. Schindler
- Department of Pharmaceutical Biosciences; Uppsala University; Uppsala Sweden
| | - S. Jönsson
- Department of Pharmaceutical Biosciences; Uppsala University; Uppsala Sweden
| | - A. Munafo
- Merck Institute for Pharmacometrics, Lausanne, Switzerland (part of Merck Serono S.A. Coinsins, Switzerland; an affiliate of Merck KGaA; Darmstadt Germany)
| | - M.O. Karlsson
- Department of Pharmaceutical Biosciences; Uppsala University; Uppsala Sweden
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Comi G, Hartung HP, Kurukulasuriya NC, Greenberg SJ, Scaramozza M. Cladribine tablets for the treatment of relapsing–remitting multiple sclerosis. Expert Opin Pharmacother 2012; 14:123-36. [DOI: 10.1517/14656566.2013.754012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Holland NJ, Schneider DM, Rapp R, Kalb RC. Meeting the needs of people with primary progressive multiple sclerosis, their families, and the health-care community. Int J MS Care 2011; 13:65-74. [PMID: 24453707 PMCID: PMC3882958 DOI: 10.7224/1537-2073-13.2.65] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although major advances have been made in delaying or preventing progression for the relapsing forms of multiple sclerosis (MS), little progress has been made to date in disease management for primary progressive MS (PPMS). Treatment strategies are largely focused on managing the symptoms of the disease and providing counseling and other forms of psychosocial support. The nurse plays a major role in managing these patients. This article summarizes a collaborative effort by the National Multiple Sclerosis Society and the Multiple Sclerosis Association of America to analyze the needs of this patient population and respond with programs that will meet those needs. This approach to developing a needs assessment is broadly applicable to other patient populations.
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Affiliation(s)
- Nancy J Holland
- Hastings-on-Hudson, NY, USA (NJH); DiaMed, LLC/DiaMedica Publishing, New York, NY, USA (DS); Multiple Sclerosis Association of America, Cherry Hill, NJ, USA (RR); and National Multiple Sclerosis Society, New York, NY, USA (RCK)
| | - Diana M Schneider
- Hastings-on-Hudson, NY, USA (NJH); DiaMed, LLC/DiaMedica Publishing, New York, NY, USA (DS); Multiple Sclerosis Association of America, Cherry Hill, NJ, USA (RR); and National Multiple Sclerosis Society, New York, NY, USA (RCK)
| | - Robert Rapp
- Hastings-on-Hudson, NY, USA (NJH); DiaMed, LLC/DiaMedica Publishing, New York, NY, USA (DS); Multiple Sclerosis Association of America, Cherry Hill, NJ, USA (RR); and National Multiple Sclerosis Society, New York, NY, USA (RCK)
| | - Rosalind C Kalb
- Hastings-on-Hudson, NY, USA (NJH); DiaMed, LLC/DiaMedica Publishing, New York, NY, USA (DS); Multiple Sclerosis Association of America, Cherry Hill, NJ, USA (RR); and National Multiple Sclerosis Society, New York, NY, USA (RCK)
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6
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Abstract
Autophagy is emerging as a central regulator of cellular health and disease and, in the central nervous system (CNS), this homeostatic process appears to influence synaptic growth and plasticity. Herein, we review the evidence that dysregulation of autophagy may contribute to several neurodegenerative diseases of the CNS. Up-regulation of autophagy may prevent, delay or ameliorate at least some of these disorders, and - based on recent findings from our laboratory - we speculate that this goal may be achieved using a safe, simple and inexpensive approach.
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Affiliation(s)
- Mehrdad Alirezaei
- Department of Immunology and Microbial Science, SP30-2110, The Scripps Research Institute, 10550 N. Torrey Pines Rd, La Jolla, CA 92037, USA
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Update on inflammation, neurodegeneration, and immunoregulation in multiple sclerosis: therapeutic implications. Clin Neuropharmacol 2009; 32:121-32. [PMID: 19483479 DOI: 10.1097/wnf.0b013e3181880359] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory, demyelinating, and neurodegenerative disease of the central nervous system of uncertain etiology. There is consensus that a dysregulated immune system plays a critical role in the pathogenesis of MS; therefore, we aim to summarize current hypotheses concerning the complex cellular and molecular interactions involved in the immunopathology of MS. Although CD4+ T lymphocytes have long been implicated in the immunopathology of MS, the role of other T-cell subtypes has been recognized. CD4+ and CD8+ cells have been isolated from different locations within MS lesions and gamma/delta T cells have been isolated from early MS lesions. The prevalent dogma has been that CD4+ TH1 cells release cytokines and mediators of inflammation that may cause tissue damage, although CD4+ TH2 cells may be involved in modulation of these effects. Recent evidence, however, suggests that additional T-cell subsets play a prominent role in MS immunopathology: TH17 cells, CD8+ effector T cells, and CD4+CD25+ regulatory T cells. In addition, laboratory and clinical data are accumulating on the prominent role of B lymphocytes and antigen-presenting cells in MS pathogenesis. On the basis of these observations, new therapeutic approaches for MS will need to focus on resetting multiple components of the immune system.
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Multiple sclerosis therapy: historical and future perspectives. Curr Opin Neurol 2009. [DOI: 10.1097/01.wco.0000347400.31774.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kalanie H, Kholghie Y, Shamsai GR, Ghorbani M. Opticospinal multiple sclerosis in Iran. J Neurol Sci 2008; 276:130-2. [PMID: 18962726 DOI: 10.1016/j.jns.2008.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 09/15/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
Clinical course, magnetic resonance imaging (MRI) findings and cerebrospinal fluid data (CSF) on 20 patients among 520 with clinically definite multiple sclerosis (MS) according to the criteria of Poser et al., with opticospinal clinical presentation above 5 years and mean disease duration of 8+/-4.4 years were reviewed. The prevalence rate was 3.8%. The clinical course was relapsing-remitting (RR) for all patients. The mean age of onset was 24+/-8.2 years. The gender ratio was 2.3:1 female:male. First clinical presentation was spinal signs in 12 (60%), optic neuritis in 7 (35%) and simultaneous involvement of both eyes in 1 (5%) patient. No transverse myelitis (TM), sustained severe optic neuritis (SSON) or minor brain stem signs were recorded. No conversion to conventional MS (CMS) or secondary progressive MS (SPMS) was identified during the study period and no case had positive family history for the disease. The yearly number of attacks was 0.66+/-0.84, with mean Kurtzke expanded disability status scale (EDSS) of 2.5+/-1.2. All patients had 1 to 5 hemispheral T2 lesions in brain MRI, non-fulfilled Barkhof criteria for brain lesions. All had preventricular and 14 (70%) had juxtacortical lesions. None had gadolinium T1 enhanced lesions. No involvement of the brainstem or cerebellar structures was detected. Fifteen had 1 cervical lesion, five had 2 and four had 1 concomitant thoracic cord signal, all extending below three vertebral segments in sagittal planes with peripheral white matter location on the axial planes. Spinal fluid contained normal cell and protein with negative oligoclonal bands (OB).
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Affiliation(s)
- Hossein Kalanie
- Department of Neurology, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
PURPOSE OF REVIEW Although multiple sclerosis is considered the prototype of a primary autoimmune disease in the central nervous system, there is emerging evidence that primary oligodendrocyte dysfunctions can suffice to trigger a secondary immune response in the nervous system. This short review focuses on the possible primary role of oligodendrocytes in axon loss and inflammatory demyelination. RECENT FINDINGS The analysis of natural and engineered mouse mutants has provided unexpected insight into oligodendrocyte function beyond that of axonal myelination for rapid impulse propagation. Specifically, mutations in some genes thought to be required for myelin assembly revealed an additional role of oligodendrocytes in supporting long-term axonal function and survival. Other mutations have been reported that cause both central nervous system demyelination and neuroinflammation, with pathological features known from human leukodystrophy patients. In human multiple sclerosis, demyelination leads invariably to axon loss, but the underling pathomechanisms may not be restricted to that of a primary immune-mediated disorder. SUMMARY Collectively, experimental and pathological findings point to a primary role of myelinating glia in long-term axonal support and suggest that defects of lipid metabolism in oligodendrocytes contribute to inflammatory myelin diseases.
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