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Montepiedra G, Svensson EM, Wong WK, Hooker AC. Optimizing the design of a pharmacokinetic trial to evaluate the dosing scheme of a novel tuberculosis drug in children living with or without HIV. CPT Pharmacometrics Syst Pharmacol 2024; 13:270-280. [PMID: 37946698 PMCID: PMC10864936 DOI: 10.1002/psp4.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
Pharmacokinetic (PK) studies in children are usually small and have ethical constraints due to the medical complexities of drawing blood in this special population. Often, population PK models for the drug(s) of interest are available in adults, and these models can be extended to incorporate the expected deviations seen in children. As a consequence, there is increasing interest in the use of optimal design methodology to design PK sampling schemes in children that maximize information using a small sample size and limited number of sampling times per dosing period. As a case study, we use the novel tuberculosis drug delamanid, and show how applications of optimal design methodology can result in highly efficient and model-robust designs in children for estimating PK parameters using a limited number of sampling measurements. Using developed population PK models based on available data from adults living with and without HIV, and limited data on children without HIV, competing designs for children living with HIV were derived and assessed based on robustness to model uncertainty.
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Affiliation(s)
| | - Elin M. Svensson
- Department of PharmacyRadboud University Medical CenterNijmegenThe Netherlands
- Department of PharmacyUppsala UniversityUppsalaSweden
| | - Weng Kee Wong
- University of California Los AngelesLos AngelesCaliforniaUSA
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Nguyen TT, Lee SB, Kang JJ, Oh SY. Optimal Design of Galvanic Vestibular Stimulation for Patients with Vestibulopathy and Cerebellar Disorders. Brain Sci 2023; 13:1333. [PMID: 37759934 PMCID: PMC10526825 DOI: 10.3390/brainsci13091333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/02/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES Galvanic vestibular stimulation (GVS) has shown positive outcomes in various neurological and psychiatric disorders, such as enhancing postural balance and cognitive functions. In order to expedite the practical application of GVS in clinical settings, our objective was to determine the best GVS parameters for patients with vestibulopathy and cerebellar disorders using optimal design calculation. METHODS A total of 31 patients (26 males, mean age 57.03 ± 14.75 years, age range 22-82 years) with either unilateral or bilateral vestibulopathy (n = 18) or cerebellar ataxia (n = 13) were enrolled in the study. The GVS intervention included three parameters, waveform (sinusoidal, direct current [DC], and noisy), amplitude (0.4, 0.8, and 1.2 mA), and duration of stimulation (5 and 30 min), resulting in a total of 18 GVS intervention modes as input variables. To evaluate the effectiveness of GVS, clinical vertigo and gait assessments were conducted using the Dizziness Visual Analogue Scale (D-VAS), Activities-specific Balance Confidence Scale (ABC), and Scale for Assessment and Rating of Ataxia (SARA) as output variables. Optimal design and local sensitivity analysis were employed to determine the most optimal GVS modes. RESULTS Patients with unilateral vestibulopathy experienced the most favorable results with either noisy or sinusoidal GVS at 0.4 mA amplitude for 30 min, followed by DC GVS at 0.8 mA amplitude for 5 min. Noisy GVS at 0.8 or 0.4 mA amplitude for 30 min demonstrated the most beneficial effects in patients with bilateral vestibulopathy. For patients with cerebellar ataxia, the optimal choices were noisy GVS with 0.8 or 0.4 mA amplitude for 5 or 30 min. CONCLUSIONS This study is the first to utilize design optimization methods to identify the GVS stimulation parameters that are tailored to individual-specific characteristics of dizziness and imbalance. A sensitivity analysis was carried out along with the optimal design to offset the constraints of a limited sample size, resulting in the identification of the most efficient GVS modes for patients suffering from vestibular and cerebellar disorders.
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Affiliation(s)
- Thanh Tin Nguyen
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju 54907, Republic of Korea; (T.T.N.); (J.-J.K.)
- Department of Pharmacology, Hue University of Medicine and Pharmacy, Hue University, Hue 49120, Vietnam
| | - Seung-Beop Lee
- School of International Engineering and Science, Graduate School of Integrated Energy-AI, Jeonbuk National University, Jeonju 54896, Republic of Korea;
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju 54907, Republic of Korea; (T.T.N.); (J.-J.K.)
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju 54907, Republic of Korea; (T.T.N.); (J.-J.K.)
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
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Bauer RJ, Hooker AC, Mentre F. Tutorial for $DESIGN in NONMEM: Clinical trial evaluation and optimization. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:1452-1465. [PMID: 34559958 PMCID: PMC8674001 DOI: 10.1002/psp4.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 12/02/2022]
Abstract
This NONMEM tutorial shows how to evaluate and optimize clinical trial designs, using algorithms developed in design software, such as PopED and PFIM 4.0. Parameter precision and model parameter estimability is obtained by assessing the Fisher Information Matrix (FIM), providing expected model parameter uncertainty. Model parameter identifiability may be uncovered by very large standard errors or inability to invert an FIM. Because evaluation of FIM is more efficient than clinical trial simulation, more designs can be investigated, and the design of a clinical trial can be optimized. This tutorial provides simple and complex pharmacokinetic/pharmacodynamic examples on obtaining optimal sample times, doses, or best division of subjects among design groups. Robust design techniques accounting for likely variability among subjects are also shown. A design evaluator and optimizer within NONMEM allows any control stream first developed for trial design exploration to be subsequently used for estimation of parameters of simulated or clinical data, without transferring the model to another software. Conversely, a model developed in NONMEM could be used for design optimization. In addition, the $DESIGN feature can be used on any model file and dataset combination to retrospectively evaluate the model parameter uncertainty one would expect given that the model generated the data, particularly if outliers of the actual data prevent a reasonable assessment of the variance‐covariance. The NONMEM trial design feature is suitable for standard continuous data, whereas more elaborate trial designs or with noncontinuous data‐types can still be accomplished in optimal design dedicated software like PopED and PFIM.
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Affiliation(s)
- Robert J Bauer
- Pharmacometrics, R&D, ICON Clinical Research, LLC, Gaithersburg, Maryland, USA
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Gao Y, Hennig S, Barras M. Monitoring of Tobramycin Exposure: What is the Best Estimation Method and Sampling Time for Clinical Practice? Clin Pharmacokinet 2020; 58:389-399. [PMID: 30140975 DOI: 10.1007/s40262-018-0707-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this article is to investigate the influence of blood sampling times on tobramycin exposure estimation and clinical decisions and to determine the best sampling times for two estimation methods used for therapeutic drug monitoring. METHODS Adult patients with cystic fibrosis, treated with once-daily intravenous tobramycin, were intensively sampled over one 24-h dosing interval to determine true exposure (AUC0-24). The AUC0-24s were then estimated using both log-linear regression and Bayesian forecasting methods for 21 different sampling time combinations. These were compared to true exposure using relative prediction errors. The differences in subsequent dose recommendations were calculated. RESULTS Twelve patients, with a median (range) age of 25 years (18-36) and weight of 66.5 kg (50.6-76.4) contributed 96 tobramycin concentrations. Five hundred and eighty-eight estimated AUC0-24s were compared to 12 measured true AUC0-24 values. Median relative prediction errors ranged from - 34.7 to 45.5% for the log-linear regression method and from - 14.46 to 11.23% for the Bayesian forecasting method across the 21 sampling combinations. The most unbiased exposure estimation was provided from concentrations sampled at 100/640 min after the start of the infusion using log-linear regression and at 70/160 min using Bayesian forecasting. Subsequent dosing recommendations varied greatly depending on the estimation method and the sampling times used. CONCLUSION Sampling times markedly influence bias in AUC0-24 estimation, leading to greatly varied dose adjustments. The impact of blood sampling times on dosing decisions is reduced when using Bayesian forecasting.
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Affiliation(s)
- Yanhua Gao
- School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Stefanie Hennig
- School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Michael Barras
- School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, 20 Cornwall Street, Woolloongabba, Brisbane, QLD, 4102, Australia
- Princess Alexandra Hospital, Brisbane, QLD, Australia
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Germovsek E, Barker CIS, Sharland M, Standing JF. Pharmacokinetic-Pharmacodynamic Modeling in Pediatric Drug Development, and the Importance of Standardized Scaling of Clearance. Clin Pharmacokinet 2020; 58:39-52. [PMID: 29675639 PMCID: PMC6325987 DOI: 10.1007/s40262-018-0659-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pharmacokinetic/pharmacodynamic (PKPD) modeling is important in the design and conduct of clinical pharmacology research in children. During drug development, PKPD modeling and simulation should underpin rational trial design and facilitate extrapolation to investigate efficacy and safety. The application of PKPD modeling to optimize dosing recommendations and therapeutic drug monitoring is also increasing, and PKPD model-based dose individualization will become a core feature of personalized medicine. Following extensive progress on pediatric PK modeling, a greater emphasis now needs to be placed on PD modeling to understand age-related changes in drug effects. This paper discusses the principles of PKPD modeling in the context of pediatric drug development, summarizing how important PK parameters, such as clearance (CL), are scaled with size and age, and highlights a standardized method for CL scaling in children. One standard scaling method would facilitate comparison of PK parameters across multiple studies, thus increasing the utility of existing PK models and facilitating optimal design of new studies.
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Affiliation(s)
- Eva Germovsek
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Heath, University College London, London, UK. .,Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, PO Box 591, 751 24, Uppsala, Sweden.
| | - Charlotte I S Barker
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Heath, University College London, London, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
| | - Joseph F Standing
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Heath, University College London, London, UK.,Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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Sverdlov O, Ryeznik Y, Wong WK. On Optimal Designs for Clinical Trials: An Updated Review. JOURNAL OF STATISTICAL THEORY AND PRACTICE 2019. [DOI: 10.1007/s42519-019-0073-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brekkan A, Jönsson S, Karlsson MO, Hooker AC. Reduced and optimized trial designs for drugs described by a target mediated drug disposition model. J Pharmacokinet Pharmacodyn 2018; 45:637-647. [PMID: 29948794 PMCID: PMC6061097 DOI: 10.1007/s10928-018-9594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/07/2018] [Indexed: 12/01/2022]
Abstract
Monoclonal antibodies against soluble targets are often rich and include the sampling of multiple analytes over a lengthy period of time. Predictive models built on data obtained in such studies can be useful in all drug development phases. If adequate model predictions can be maintained with a reduced design (e.g. fewer samples or shorter duration) the use of such designs may be advocated. The effect of reducing and optimizing a rich design based on a published study for Omalizumab (OMA) was evaluated as an example. OMA pharmacokinetics were characterized using a target-mediated drug disposition model considering the binding of OMA to free IgE and the subsequent formation of an OMA–IgE complex. The performance of the reduced and optimized designs was evaluated with respect to: efficiency, parameter uncertainty and predictions of free target. It was possible to reduce the number of samples in the study by 30% while still maintaining an efficiency of almost 90%. A reduction in sampling duration by two-thirds resulted in an efficiency of 75%. Omission of any analyte measurement or a reduction of the number of dose levels was detrimental to the efficiency of the designs (efficiency ≤ 51%). However, other metrics were, in some cases, relatively unaffected, showing that multiple metrics may be needed to obtain balanced assessments of design performance.
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Affiliation(s)
- A Brekkan
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden
| | - S Jönsson
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden
| | - M O Karlsson
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden
| | - A C Hooker
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden.
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Llanos-Paez CC, Staatz C, Hennig S. Balancing Antibacterial Efficacy and Reduction in Renal Function to Optimise Initial Gentamicin Dosing in Paediatric Oncology Patients. AAPS JOURNAL 2017; 20:14. [PMID: 29204823 DOI: 10.1208/s12248-017-0173-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
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Bayard DS, Neely M. Experiment design for nonparametric models based on minimizing Bayes Risk: application to voriconazole¹. J Pharmacokinet Pharmacodyn 2016; 44:95-111. [PMID: 27909942 DOI: 10.1007/s10928-016-9498-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/25/2016] [Indexed: 12/01/2022]
Abstract
An experimental design approach is presented for individualized therapy in the special case where the prior information is specified by a nonparametric (NP) population model. Here, a NP model refers to a discrete probability model characterized by a finite set of support points and their associated weights. An important question arises as to how to best design experiments for this type of model. Many experimental design methods are based on Fisher information or other approaches originally developed for parametric models. While such approaches have been used with some success across various applications, it is interesting to note that they largely fail to address the fundamentally discrete nature of the NP model. Specifically, the problem of identifying an individual from a NP prior is more naturally treated as a problem of classification, i.e., to find a support point that best matches the patient's behavior. This paper studies the discrete nature of the NP experiment design problem from a classification point of view. Several new insights are provided including the use of Bayes Risk as an information measure, and new alternative methods for experiment design. One particular method, denoted as MMopt (multiple-model optimal), will be examined in detail and shown to require minimal computation while having distinct advantages compared to existing approaches. Several simulated examples, including a case study involving oral voriconazole in children, are given to demonstrate the usefulness of MMopt in pharmacokinetics applications.
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Affiliation(s)
- David S Bayard
- Laboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Michael Neely
- Laboratory of Applied Pharmacokinetics and Bioinformatics, The Saban Research Institute, Children's Hospital of Los Angeles, Los Angeles, CA, USA. .,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Kristoffersson AN, Friberg LE, Nyberg J. Inter occasion variability in individual optimal design. J Pharmacokinet Pharmacodyn 2015; 42:735-50. [PMID: 26452548 PMCID: PMC4624834 DOI: 10.1007/s10928-015-9449-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/23/2015] [Indexed: 12/24/2022]
Abstract
Inter occasion variability (IOV) is of importance to consider in the development of a design where individual pharmacokinetic or pharmacodynamic parameters are of interest. IOV may adversely affect the precision of maximum a posteriori (MAP) estimated individual parameters, yet the influence of inclusion of IOV in optimal design for estimation of individual parameters has not been investigated. In this work two methods of including IOV in the maximum a posteriori Fisher information matrix (FIMMAP) are evaluated: (i) MAPocc—the IOV is included as a fixed effect deviation per occasion and individual, and (ii) POPocc—the IOV is included as an occasion random effect. Sparse sampling schedules were designed for two test models and compared to a scenario where IOV is ignored, either by omitting known IOV (Omit) or by mimicking a situation where unknown IOV has inflated the IIV (Inflate). Accounting for IOV in the FIMMAP markedly affected the designs compared to ignoring IOV and, as evaluated by stochastic simulation and estimation, resulted in superior precision in the individual parameters. In addition MAPocc and POPocc accurately predicted precision and shrinkage. For the investigated designs, the MAPocc method was on average slightly superior to POPocc and was less computationally intensive.
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Affiliation(s)
- Anders N Kristoffersson
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden.
| | - Lena E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden
| | - Joakim Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 75124, Uppsala, Sweden
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Perera V, Bies RR, Mo G, Dolton MJ, Carr VJ, McLachlan AJ, Day RO, Polasek TM, Forrest A. Optimal sampling of antipsychotic medicines: a pharmacometric approach for clinical practice. Br J Clin Pharmacol 2015; 78:800-14. [PMID: 24773369 DOI: 10.1111/bcp.12410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/19/2014] [Indexed: 11/28/2022] Open
Abstract
AIM To determine optimal sampling strategies to allow the calculation of clinical pharmacokinetic parameters for selected antipsychotic medicines using a pharmacometric approach. METHODS This study utilized previous population pharmacokinetic parameters of the antipsychotic medicines aripiprazole, clozapine, olanzapine, perphenazine, quetiapine, risperidone (including 9-OH risperidone) and ziprasidone. d-optimality was utilized to identify time points which accurately predicted the pharmacokinetic parameters (and expected error) of each drug at steady-state. A standard two stage population approach (STS) with MAP-Bayesian estimation was used to compare area under the concentration-time curves (AUC) generated from sparse optimal time points and rich extensive data. Monte Carlo Simulation (MCS) was used to simulate 1000 patients with population variability in pharmacokinetic parameters. Forward stepwise regression analysis was used to determine the most predictive time points of the AUC for each drug at steady-state. RESULTS Three optimal sampling times were identified for each antipsychotic medicine. For aripiprazole, clozapine, olanzapine, perphenazine, risperidone, 9-OH risperidone, quetiapine and ziprasidone the CV% of the apparent clearance using optimal sampling strategies were 19.5, 8.6, 9.5, 13.5, 12.9, 10.0, 16.0 and 10.7, respectively. Using the MCS and linear regression approach to predict AUC, the recommended sampling windows were 16.5-17.5 h, 10-11 h, 23-24 h, 19-20 h, 16.5-17.5 h, 22.5-23.5 h, 5-6 h and 5.5-6.5 h, respectively. CONCLUSION This analysis provides important sampling information for future population pharmacokinetic studies and clinical studies investigating the pharmacokinetics of antipsychotic medicines.
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Affiliation(s)
- Vidya Perera
- School of Pharmacy and Pharmaceutical Sciences, School of Pharmacy, SUNY at Buffalo, Buffalo, NY, USA; Schizophrenia Research Institute, Sydney, Australia
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Andrews LM, Riva N, de Winter BC, Hesselink DA, de Wildt SN, Cransberg K, van Gelder T. Dosing algorithms for initiation of immunosuppressive drugs in solid organ transplant recipients. Expert Opin Drug Metab Toxicol 2015; 11:921-36. [DOI: 10.1517/17425255.2015.1033397] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Nyberg J, Bazzoli C, Ogungbenro K, Aliev A, Leonov S, Duffull S, Hooker AC, Mentré F. Methods and software tools for design evaluation in population pharmacokinetics-pharmacodynamics studies. Br J Clin Pharmacol 2015; 79:6-17. [PMID: 24548174 PMCID: PMC4294071 DOI: 10.1111/bcp.12352] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/09/2014] [Indexed: 11/26/2022] Open
Abstract
Population pharmacokinetic (PK)-pharmacodynamic (PKPD) models are increasingly used in drug development and in academic research; hence, designing efficient studies is an important task. Following the first theoretical work on optimal design for nonlinear mixed-effects models, this research theme has grown rapidly. There are now several different software tools that implement an evaluation of the Fisher information matrix for population PKPD. We compared and evaluated the following five software tools: PFIM, PkStaMp, PopDes, PopED and POPT. The comparisons were performed using two models, a simple-one compartment warfarin PK model and a more complex PKPD model for pegylated interferon, with data on both concentration and response of viral load of hepatitis C virus. The results of the software were compared in terms of the standard error (SE) values of the parameters predicted from the software and the empirical SE values obtained via replicated clinical trial simulation and estimation. For the warfarin PK model and the pegylated interferon PKPD model, all software gave similar results. Interestingly, it was seen, for all software, that the simpler approximation to the Fisher information matrix, using the block diagonal matrix, provided predicted SE values that were closer to the empirical SE values than when the more complicated approximation was used (the full matrix). For most PKPD models, using any of the available software tools will provide meaningful results, avoiding cumbersome simulation and allowing design optimization.
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Affiliation(s)
- Joakim Nyberg
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - Caroline Bazzoli
- Laboratoire Jean Kuntzmann, Département Statistique, University of GrenobleGrenoble, France
| | - Kay Ogungbenro
- Centre for Applied Pharmacokinetic Research, School of Pharmacy and Pharmaceutical Sciences, University of ManchesterManchester, UK
| | - Alexander Aliev
- Institute for Systems Analysis, Russian Academy of SciencesMoscow, Russia
| | | | | | - Andrew C Hooker
- Department of Pharmaceutical Biosciences, Uppsala UniversityUppsala, Sweden
| | - France Mentré
- INSERM U738 and University Paris DiderotParis, France
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Comparing Dosage Adjustment Methods for Once-Daily Tobramycin in Paediatric and Adolescent Patients with Cystic Fibrosis. Clin Pharmacokinet 2014; 54:409-21. [DOI: 10.1007/s40262-014-0211-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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VÄLITALO P, RANTA VP, HOOKER AC, KOKKI M, KOKKI H. Population pharmacometrics in support of analgesics studies. Acta Anaesthesiol Scand 2014; 58:143-56. [PMID: 24383522 DOI: 10.1111/aas.12253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 12/20/2022]
Abstract
Population pharmacometric modeling is used to explain both population trends as well as the sources and magnitude of variability in pharmacokinetic and pharmacodynamics data; the later, in part, by taking into account patient characteristics such as weight, age, renal function and genetics. The approach is best known for its ability to analyze sparse data, i.e. when only a few measurements have been collected from each subject, but other benefits include its flexibility and the potential to construct more detailed models than those used in the traditional individual curve fitting approach. This review presents the basic concepts of population pharmacokinetic and pharmacodynamic modeling and includes several analgesic drug examples. In addition, the use of these models to design and optimize future studies is discussed. In this context, finding the best design factors, such as the sampling times or the dose, for future studies within pre-defined criteria using a previously constructed population pharmacokinetic model can help researchers acquire clinically meaningful data without wasting resources and unnecessarily exposing vulnerable patient groups to study drugs and additional blood sampling.
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Affiliation(s)
- P. VÄLITALO
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - V.-P. RANTA
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - A. C. HOOKER
- Uppsala University; Department of Pharmaceutical Biosciences; Uppsala Sweden
| | - M. KOKKI
- School of Medicine; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Department of Anesthesia and Operative Services; Kuopio Finland
| | - H. KOKKI
- School of Medicine; University of Eastern Finland; Kuopio Finland
- Kuopio University Hospital; Department of Anesthesia and Operative Services; Kuopio Finland
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Nyberg J, Ueckert S, Strömberg EA, Hennig S, Karlsson MO, Hooker AC. PopED: an extended, parallelized, nonlinear mixed effects models optimal design tool. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 108:789-805. [PMID: 22640817 DOI: 10.1016/j.cmpb.2012.05.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 05/01/2012] [Accepted: 05/03/2012] [Indexed: 06/01/2023]
Abstract
Several developments have facilitated the practical application and increased the general use of optimal design for nonlinear mixed effects models. These developments include new methodology for utilizing advanced pharmacometric models, faster optimization algorithms and user friendly software tools. In this paper we present the extension of the optimal design software PopED, which incorporates many of these recent advances into an easily useable enhanced GUI. Furthermore, we present new solutions to problems related to the design of experiments such as: faster and more robust FIM calculations and optimizations, optimizing over cost/utility functions and diagnostic tools and plots to evaluate design performance. Examples for; (i) Group size optimization and efficiency translation, (ii) Cost/constraint optimization, (iii) Optimizations with different FIM approximations and (iv) optimization with parallel computing demonstrate the new features in PopED and underline the potential use of this tool when designing experiments.
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Affiliation(s)
- Joakim Nyberg
- The Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Faculty of Pharmacy, Uppsala University, P.O. Box 591, SE-751 24 Uppsala, Sweden
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