Computer-controlled administration of cardiovascular drugs

Optimizing drug development in oncology by clinical trial simulation: Why and how?

In therapeutic research, the safety and efficacy of pharmaceutical products are necessarily tested on humans via clinical trials after an extensive and expensive preclinical development period. Methodologies such as computer modeling and clinical trial simulation (CTS) might represent a valuable option to reduce animal and human assays. The relevance of these methods is well recognized in pharmacokinetics and pharmacodynamics from the preclinical phase to postmarketing. However, they are barely used and are poorly regarded for drug approval, despite Food and Drug Administration and European Medicines Agency recommendations. The generalization of CTS could be greatly facilitated by the availability of software for modeling biological systems, by clinical trial studies and hospital databases. Data sharing and data merging raise legal, policy and technical issues that will need to be addressed. Development of future molecules will have to use CTS for faster development and thus enable better patient management. Drug activity modeling coupled with disease modeling, optimal use of medical data and increased computing speed should allow this leap forward. The realization of CTS requires not only bioinformatics tools to allow interconnection and global integration of all clinical data but also a universal legal framework to protect the privacy of every patient. While recognizing that CTS can never replace 'real-life' trials, they should be implemented in future drug development schemes to provide quantitative support for decision-making. This in silico medicine opens the way to the P4 medicine: predictive, preventive, personalized and participatory.

Computer-controlled heart rate increase by isoproterenol infusion: mathematical modeling of the system

The purpose of this study was mathematical modeling of the heart rate (HR) response to isoproterenol (Iso) infusion. We developed a computerized system for the controlled increase of HR by Iso, based on a modified proportional-integral controller. HR was measured in conscious, freely moving rats. We found that the steady-state HR can be described as a hyperbolic power function of the steady-state Iso flow rate. This dependence was coupled with a first-order difference equation to form a pharmacodynamic model that reliably describes the relationship between HR and Iso flow for any arbitrary form of Iso flow function. In simulation studies, we showed that the model continued to follow the HR curve from real-time experiments far beyond the initial "learning interval" from which its parameters were calculated. Our results suggest that the predictive ability and the simplicity of calculating the parameters render this pharmacodynamic model appropriate for use within future advanced, model-based, adaptive control systems and as a part of larger cardiovascular models.

Optimal pharmacokinetic delivery of infused drugs: application to the treatment of cardiac arrhythmias

A common clinical goal of infusing drugs is to attain therapeutic steady-state concentrations as rapidly as possible. The desire is to closely approximate a step function in plasma concentration of the therapeutic agent. We have developed a novel approach to achieve this goal by using the principles of systems and compartmental analyses. The approach is to build a pharmacokinetic model for the disposition of the drug and then calculate backwards from the desired output function to derive the optimal input infusion function. We applied this technique to the infusion of Lidocaine, an antiarrhythmic agent which is often difficult to control. An optimal infusion function, used to drive a servo-controlled infusion pump, was derived to closely approximate a step-function response of drug levels. The efficacy of this infusion function was verified experimentally in dogs.