1
|
Goulooze SC, Snelder N, Seelmann A, Horvat-Broecker A, Brinker M, Joseph A, Garmann D, Lippert J, Eissing T. Finerenone Dose-Exposure-Serum Potassium Response Analysis of FIDELIO-DKD Phase III: The Role of Dosing, Titration, and Inclusion Criteria. Clin Pharmacokinet 2022; 61:451-462. [PMID: 34786651 PMCID: PMC8891103 DOI: 10.1007/s40262-021-01083-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Finerenone is a nonsteroidal selective mineralocorticoid receptor antagonist (MRA) that demonstrated efficacy in delaying the progression of chronic kidney disease (CKD) and reducing cardiovascular events in patients with CKD and type 2 diabetes mellitus in FIDELIO-DKD, where 5734 patients were randomized 1:1 to receive either finerenone or placebo, with a median follow-up of 2.6 years. Doses of finerenone 10 or 20 mg once daily were titrated based on (serum) potassium and estimated glomerular filtration rate. The MRA mode of action increases potassium. METHODS Nonlinear mixed-effects population pharmacokinetic/pharmacodynamic models were used to analyze the finerenone dose-exposure-response relationship for potassium in FIDELIO-DKD. Individual time-varying exposures from pharmacokinetic analyses were related to the potassium response via a maximal effect, indirect-response model informed by 148,384 serum potassium measurements. RESULTS Although observed potassium levels decreased with increasing dose (i.e., inverse relation), model-based simulations for a fixed-dose setting (i.e., no dose titration) revealed the intrinsic finerenone dose-exposure-potassium response, with potassium levels increasing in a dose- and exposure-dependent manner, thus explaining the apparent conflict. The potassium limit for inclusion and uptitration from finerenone 10 to 20 mg in FIDELIO-DKD was ≤ 4.8 mmol/L. Modified limits of ≤ 5.0 mmol/L were simulated, resulting in higher hyperkalemia frequencies for both the finerenone and the placebo arms, whereas the relative hyperkalemia risk of a finerenone treatment compared with placebo did not increase. CONCLUSIONS The analyses demonstrated the effectiveness of finerenone dose titration in managing serum potassium and provide a quantitative basis to guide safe clinical use.
Collapse
Affiliation(s)
| | - Nelleke Snelder
- Leiden Experts on Advanced Pharmacokinetics and Pharmacodynamics (LAP&P), Leiden, The Netherlands
| | - Andreas Seelmann
- Bayer AG, Pharmaceuticals R&D, Pharmacometrics, Leverkusen/Wuppertal/Berlin, Germany
| | | | - Meike Brinker
- Bayer AG, Pharmaceuticals R&D, Clinical Development, Wuppertal/Berlin, Germany
| | - Amer Joseph
- Bayer AG, Pharmaceuticals R&D, Clinical Development, Wuppertal/Berlin, Germany
| | - Dirk Garmann
- Bayer AG, Pharmaceuticals R&D, Pharmacometrics, Leverkusen/Wuppertal/Berlin, Germany
| | - Joerg Lippert
- Bayer AG, Pharmaceuticals R&D, Pharmacometrics, Leverkusen/Wuppertal/Berlin, Germany
| | - Thomas Eissing
- Bayer AG, Pharmaceuticals R&D, Pharmacometrics, Leverkusen/Wuppertal/Berlin, Germany.
| |
Collapse
|
2
|
Strik AS, Wang YMC, Ruff LE, Yashar W, Messmer BT, Mould DR. Individualized Dosing of Therapeutic Monoclonal Antibodies-a Changing Treatment Paradigm? AAPS JOURNAL 2018; 20:99. [PMID: 30187153 PMCID: PMC8364290 DOI: 10.1208/s12248-018-0257-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/22/2018] [Indexed: 02/06/2023]
Abstract
The introduction of monoclonal antibodies (mAbs) to the treatment of inflammatory bowel disease (IBD) was an important medical milestone. MAbs have been demonstrated as safe and efficacious treatments of IBD. However, a large percentage of patients either fail to respond initially or lose response to therapy after a period of treatment. Although there are factors associated with poor treatment outcomes in IBD, one cause for treatment failure may be low mAb exposure. Consequently, gastroenterologists have begun using therapeutic drug monitoring (TDM) to guide dose adjustment. However, while beneficial, TDM does not provide sufficient information to effectively adjust doses. The pharmacokinetics (PK) and pharmacodynamics (PD) of mAbs are complex, with numerous factors impacting on mAb PK and PD. The concept of dashboard-guided dosing based on Bayesian PK models allows physicians to combine TDM with factors influencing mAb PK to individualize therapy more effectively. One issue with TDM has been the slow turnaround of assay results, either necessitating an additional clinic visit for a sample or reacting to TDM results at a subsequent, rather than the current, dose. New point-of-care (POC) assays for mAbs are being developed that would potentially allow physicians to determine drug concentration quickly. However, work remains to understand how to determine what target exposure is needed for an individual patient, and whether the combination of POC assays and dashboards presents a safe approach with substantial outcome benefit over the current standard of care.
Collapse
Affiliation(s)
- Anne S Strik
- Academic Medical Center Division of Gastroenterology, Amsterdam, Netherlands
| | - Yow-Ming C Wang
- Therapeutic Biologics Program, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | | | - Diane R Mould
- Projections Research Inc., 535 Springview Lane, Phoenixville, Pennsylvania, 19460, USA.
| |
Collapse
|
3
|
Mould DR, Upton RN, Wojciechowski J, Phan BL, Tse S, Dubinsky MC. Dashboards for Therapeutic Monoclonal Antibodies: Learning and Confirming. AAPS JOURNAL 2018; 20:76. [PMID: 29904814 DOI: 10.1208/s12248-018-0237-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/25/2018] [Indexed: 02/08/2023]
Abstract
Inflammatory diseases (ID) are incurable, progressive diseases. Literature evidence cites increasing incidence of these diseases worldwide. When treatments with chemical immunosuppressive agents fail, patients are often treated with monoclonal antibodies (MAbs). However, MAb failure rates are generally high, with approximately half the patients being discontinued within 4 years, necessitating switching to another MAb. One potential cause of treatment failure is subtherapeutic exposure. Several studies demonstrated associations between trough MAb concentrations and clinical response, supporting the notion that improving drug exposure may result in improved outcomes. MAbs exhibit complex and highly variable pharmacokinetics in ID patients with numerous factors affecting clearance. Bayesian-guided dosing with dashboard systems is a new tool being investigated in the treatment of ID to reduce variability in exposure. Simulations suggest dashboards will be effective at maintaining patients at target troughs. However, when patients are dosed using doses or intervals outside those listed in prescribing information, there is concern that patients may have drug exposures beyond or below the ranges found to be safe and efficacious. This manuscript reviews the rationale behind dashboard development, evaluations of expected performance, and a simulated assessment of MAb exposure with dashboard-based dosing versus dosing based on the prescribing information. We introduce the concept of pharmacologic equivalence-if patients are dosed based on individual pharmacokinetics, the resulting exposure is consistent with exposures achieved using labeled dosing. We further show that dashboard-based dosing results in observed exposures that are generally contained within the range of exposures achieved with labeled dosing.
Collapse
Affiliation(s)
- Diane R Mould
- Projections Research Inc., 535 Springview Lane, Phoenixville, Pennsylvania, 19460, USA.
| | - Richard N Upton
- Projections Research Inc., 535 Springview Lane, Phoenixville, Pennsylvania, 19460, USA.,Australian Centre for Pharmacometrics, University of South Australia, Adelaide, SA, 5000, Australia
| | | | - Becky L Phan
- Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Stacy Tse
- Mount Sinai Hospital, New York, New York, 10029, USA
| | - Marla C Dubinsky
- Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| |
Collapse
|
4
|
Nguyen THT, Mouksassi M, Holford N, Al‐Huniti N, Freedman I, Hooker AC, John J, Karlsson MO, Mould DR, Pérez Ruixo JJ, Plan EL, Savic R, van Hasselt JGC, Weber B, Zhou C, Comets E, Mentré F. Model Evaluation of Continuous Data Pharmacometric Models: Metrics and Graphics. CPT Pharmacometrics Syst Pharmacol 2017; 6:87-109. [PMID: 27884052 PMCID: PMC5321813 DOI: 10.1002/psp4.12161] [Citation(s) in RCA: 245] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 10/10/2016] [Accepted: 11/09/2016] [Indexed: 12/17/2022] Open
Abstract
This article represents the first in a series of tutorials on model evaluation in nonlinear mixed effect models (NLMEMs), from the International Society of Pharmacometrics (ISoP) Model Evaluation Group. Numerous tools are available for evaluation of NLMEM, with a particular emphasis on visual assessment. This first basic tutorial focuses on presenting graphical evaluation tools of NLMEM for continuous data. It illustrates graphs for correct or misspecified models, discusses their pros and cons, and recalls the definition of metrics used.
Collapse
Affiliation(s)
- THT Nguyen
- INSERM, IAME, UMR 1137, Paris, France, Université Paris DiderotSorbonne Paris CitéParisFrance
| | | | - N Holford
- Department of Pharmacology and Clinical PharmacologyUniversity of AucklandAucklandNew Zealand
| | - N Al‐Huniti
- Quantitative Clinical Pharmacology, AstraZenecaWalthamMassachusettsUSA
| | - I Freedman
- Dr Immanuel Freedman Inc.HarleysvillePennsylvaniaUSA
| | - AC Hooker
- Department of Pharmaceutical BiosciencesUppsala UniversityUppsalaSweden
| | - J John
- Center for Drug Evaluation and Research, U.S. Food and Drug AdministrationWashingtonDCUSA
| | - MO Karlsson
- Department of Pharmaceutical BiosciencesUppsala UniversityUppsalaSweden
| | - DR Mould
- Projections Research Inc.PhoenixvillePennsylvaniaUSA
| | - JJ Pérez Ruixo
- The Janssen Pharmaceutical Companies of Johnson & JohnsonBelgium
| | | | - R Savic
- Department of Bioengineering and Therapeutic SciencesUniversity of California – San FranciscoSan FranciscoCaliforniaUSA
| | - JGC van Hasselt
- Division of PharmacologyLeiden Academic Centre for Drug Research, Leiden UniversityLeidenNetherlands
| | - B Weber
- Boehringer Ingelheim Pharmaceuticals, Inc.RidgefieldConnecticutUSA
| | - C Zhou
- GenentechSan FranciscoCaliforniaUSA
| | - E Comets
- INSERM, IAME, UMR 1137, Paris, France, Université Paris DiderotSorbonne Paris CitéParisFrance
- INSERM CIC 1414, Rennes, France, University Rennes‐1RennesFrance
| | - F Mentré
- INSERM, IAME, UMR 1137, Paris, France, Université Paris DiderotSorbonne Paris CitéParisFrance
| | | |
Collapse
|
5
|
García-García I, Hernández-González I, Díaz-Machado A, González-Delgado CA, Pérez-Rodríguez S, García-Vega Y, Campos-Mojena R, Tuero-Iglesias ÁD, Valenzuela-Silva CM, Cruz-Ramírez A, Martín-Trujillo A, Santana-Milián H, López-Saura PA, Bello-Rivero I. Pharmacokinetic and pharmacodynamic characterization of a novel formulation containing co-formulated interferons alpha-2b and gamma in healthy male volunteers. BMC Pharmacol Toxicol 2016; 17:58. [PMID: 27923408 PMCID: PMC5142133 DOI: 10.1186/s40360-016-0103-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background More potent antitumor activity is desired in Interferon (IFN)-treated cancer patients. This could be achieved by combining IFN alpha and IFN gamma. The aim of this work was to characterize the pharmacokinetics and pharmacodynamics of a novel formulation containing a co-formulated combination of IFNs alpha-2b and gamma (CIGB-128-A). Methods A group of nine healthy male subjects received intramuscularly 24.5 × 106 IU of CIGB-128-A. IFN concentrations were evaluated for 48 h. Serum neopterin, beta2-microglobulin (β2M) and 2′–5′ oligoadenylate synthetase (2′–5′ OAS), classical IFN-inducible serum markers, were measured during 192 h by enzyme immunoassay and body temperature was used as pharmacodynamic variable as well. Results Concerning pharmacokinetics, serum IFNs’ profiles were better fitted to a mono-compartmental model with consecutive zero order and first order absorption, one bioavailability value. No interferences by simultaneous administered IFNs were observed in their typical similar systemic profiles. Neopterin and β2M time profiles showed a delay that was efficiently linked to pharmacokinetics by means of a zero order absorption rate constant. Neopterin level was nine-fold higher than initial values, 48 h post-administration, an increment not described before. At this time, mean serum β2M peaked around the double from baseline. Serum concentrations of the enzyme 2′–5′ OAS was still elevated on the 8 day post-injection. The formulation was well tolerated. Most frequent adverse reactions were fever, headache, arthralgia and lymphopenia, mostly mild. Conclusions The administration of co-formulated IFN alpha-2b and IFN gamma likely provides improved pharmacodynamic properties that may be beneficial to treat several malignancies. Trial registration Cuban Public Registry of Clinical Trials RPCEC00000118, May 24, 2011.
Collapse
Affiliation(s)
- Idrian García-García
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba
| | | | - Alina Díaz-Machado
- National Center for Toxicology, "Carlos J. Finlay" University Hospital, Havana, Cuba
| | | | - Sonia Pérez-Rodríguez
- National Center for Toxicology, "Carlos J. Finlay" University Hospital, Havana, Cuba
| | - Yanelda García-Vega
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba
| | - Rosario Campos-Mojena
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba
| | - Ángela D Tuero-Iglesias
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba
| | - Carmen M Valenzuela-Silva
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba
| | - Alieski Cruz-Ramírez
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba
| | - Alis Martín-Trujillo
- National Center for Toxicology, "Carlos J. Finlay" University Hospital, Havana, Cuba
| | - Héctor Santana-Milián
- Development Direction, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Pedro A López-Saura
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba
| | - Iraldo Bello-Rivero
- Clinical Research Direction, Center for Genetic Engineering and Biotechnology, Ave. 134 b/23 and 25, Cubanacán, Playa, P.O. Box 6332, Havana, Cuba.
| | | |
Collapse
|
6
|
Pelletier AL, Nicaise-Roland P. Adalimumab and pharmacokinetics: Impact on the clinical prescription for inflammatory bowel disease. World J Pharmacol 2016; 5:44-50. [DOI: 10.5497/wjp.v5.i1.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/19/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Anti-tumor necrosis factor (TNF) drugs are widely prescribed for inflammatory disease. A loss of response to adalimumab is frequent and the pharmacokinetics of anti-TNF therapy have important implications for patient management. Individual factors such as albumin, body weight, and disease severity based on the C-reactive protein level influence drug metabolism. Adalimumab trough levels are associated with clinical remission. On the other hand, the detection of antibodies is associated with clinical relapse. Immunosuppressive therapy could reduce antibody formation although the clinical impact is not proven. New algorithms are available to provide personalized treatment and adapt the dosage. More data are needed on dose de-escalation.
Collapse
|
7
|
Wu L, Mould DR, Perez Ruixo JJ, Doshi S. Assessment of hemoglobin responsiveness to epoetin alfa in patients on hemodialysis using a population pharmacokinetic pharmacodynamic model. J Clin Pharmacol 2015; 55:1157-66. [PMID: 25907551 DOI: 10.1002/jcph.527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/16/2015] [Indexed: 11/09/2022]
Abstract
A population pharmacokinetic pharmacodynamic (PK/PD) model describing the effect of epoetin alfa on hemoglobin (Hb) response in hemodialysis patients was developed. Epoetin alfa pharmacokinetics was described using a linear 2-compartment model. PK parameter estimates were similar to previously reported values. A maturation-structured cytokinetic model consisting of 5 compartments linked in a catenary fashion by first-order cell transfer rates following a zero-order input process described the Hb time course. The PD model described 2 subpopulations, one whose Hb response reflected epoetin alfa dosing and a second whose response was unrelated to epoetin alfa dosing. Parameter estimates from the PK/PD model were physiologically reasonable and consistent with published reports. Numerical and visual predictive checks using data from 2 studies were performed. The PK and PD of epoetin alfa were well described by the model.
Collapse
|
8
|
Mould DR, Walz AC, Lave T, Gibbs JP, Frame B. Developing Exposure/Response Models for Anticancer Drug Treatment: Special Considerations. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2015. [PMID: 26225225 PMCID: PMC4369756 DOI: 10.1002/psp4.16] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anticancer agents often have a narrow therapeutic index (TI), requiring precise dosing to ensure sufficient exposure for clinical activity while minimizing toxicity. These agents frequently have complex pharmacology, and combination therapy may cause schedule-specific effects and interactions. We review anticancer drug development, showing how integration of modeling and simulation throughout development can inform anticancer dose selection, potentially improving the late-phase success rate. This article has a companion article in Clinical Pharmacology & Therapeutics with practical examples.
Collapse
Affiliation(s)
- D R Mould
- Projections Research Phoenixville, Pennsylvania, USA
| | - A-C Walz
- Roche Pharma Research and Early Development, Modeling & Simulation, Pharmaceutical Sciences, Roche Innovation Center Basel F. Hoffmann-La Roche, Basel, Switzerland
| | - T Lave
- Roche Pharma Research and Early Development, Modeling & Simulation, Pharmaceutical Sciences, Roche Innovation Center Basel F. Hoffmann-La Roche, Basel, Switzerland
| | - J P Gibbs
- Amgen Thousand Oaks, California, USA
| | - B Frame
- Projections Research Phoenixville, Pennsylvania, USA
| |
Collapse
|
9
|
Mould DR, Upton RN, Wojciechowski J. Dashboard systems: implementing pharmacometrics from bench to bedside. AAPS J 2014; 16:925-37. [PMID: 24947898 PMCID: PMC4147040 DOI: 10.1208/s12248-014-9632-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022] Open
Abstract
In recent years, there has been increasing interest in the development of medical decision-support tools, including dashboard systems. Dashboard systems are software packages that integrate information and calculations about therapeutics from multiple components into a single interface for use in the clinical environment. Given the high cost of medical care, and the increasing need to demonstrate positive clinical outcomes for reimbursement, dashboard systems may become an important tool for improving patient outcome, improving clinical efficiency and containing healthcare costs. Similarly the costs associated with drug development are also rising. The use of model-based drug development (MBDD) has been proposed as a tool to streamline this process, facilitating the selection of appropriate doses and making informed go/no-go decisions. However, complete implementation of MBDD has not always been successful owing to a variety of factors, including the resources required to provide timely modeling and simulation updates. The application of dashboard systems in drug development reduces the resource requirement and may expedite updating models as new data are collected, allowing modeling results to be available in a timely fashion. In this paper, we present some background information on dashboard systems and propose the use of these systems both in the clinic and during drug development.
Collapse
Affiliation(s)
- Diane R Mould
- Projections Research Inc, 535 Springview Lane, Phoenixville, Pennsylvania, 19460, USA,
| | | | | |
Collapse
|
10
|
Ravn P, Foster DJR, Kreilgaard M, Christrup L, Werner MU, Secher EL, Skram U, Upton R. Pharmacokinetic-pharmacodynamic modelling of the analgesic and antihyperalgesic effects of morphine after intravenous infusion in human volunteers. Basic Clin Pharmacol Toxicol 2014; 115:257-67. [PMID: 24520987 DOI: 10.1111/bcpt.12213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 01/31/2014] [Indexed: 11/29/2022]
Abstract
Using a modelling approach, this study aimed to (i) examine whether the pharmacodynamics of the analgesic and antihyperalgesic effects of morphine differ; (ii) investigate the influence of demographic, pain sensitivity and genetic (OPRM1) variables on between-subject variability of morphine pharmacokinetics and pharmacodynamics in human experimental pain models. The study was a randomized, double-blind, 5-arm, cross-over, placebo-controlled study. The psychophysical cutaneous pain tests, electrical pain tolerance (EPTo) and secondary hyperalgesia areas (2HA) were studied in 28 healthy individuals (15 males). The subjects were chosen based on a previous trial where 100 subjects rated (VAS) their pain during a heat injury (47°C, 7 min., 12.5 cm(2) ). The 33% lowest- and highest pain-sensitive subjects were offered participation in the present study. A two-compartment linear model with allometric scaling for weight provided the best description of the plasma concentration-time profile of morphine. Changes in the EPTo and 2HA responses with time during the placebo treatment were best described by a linear model and a quadratic model, respectively. The model discrimination process showed clear evidence for adding between-occasion variability (BOV) on baseline and the placebo slope for EPTo and 2HA, respectively. The sensitivity covariate was significant on baseline EPTo values and genetics as a covariate on the placebo slope for 2HA. The analgesic and antihyperalgesic effects of morphine were pharmacologically distinct as the models had different effect site equilibration half-lives and different covariate effects. Morphine had negligible effect on 2HA, but significant effect on EPTo.
Collapse
Affiliation(s)
- Pernille Ravn
- Department of Drug Design and Pharmacology, Faculty of Medicines and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Basic concepts in population modeling, simulation, and model-based drug development: part 3-introduction to pharmacodynamic modeling methods. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2014; 3:e88. [PMID: 24384783 PMCID: PMC3917320 DOI: 10.1038/psp.2013.71] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/22/2013] [Indexed: 12/16/2022]
Abstract
Population pharmacodynamic (PD) models describe the time course of drug effects, relating exposure to response, and providing a more robust understanding of drug action than single assessments. PD models can test alternative dose regimens through simulation, allowing for informed assessment of potential dose regimens and study designs. This is the third paper in a three-part series, providing an introduction into methods for developing and evaluating population PD models. Example files are available in the Supplementary Data.
Collapse
|
12
|
Basic concepts in population modeling, simulation, and model-based drug development-part 2: introduction to pharmacokinetic modeling methods. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2013; 2:e38. [PMID: 23887688 PMCID: PMC3636497 DOI: 10.1038/psp.2013.14] [Citation(s) in RCA: 477] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/18/2013] [Indexed: 12/05/2022]
|