title: Compliance-guided therapy : a new insight into the potential role of clinical pharmacologists.
abstract: OBJECTIVE
  In the field of drug noncompliance, we investigated an original approach that could give the prescribing physician, in collaboration with a clinical pharmacologist, an active role. The aim here is for the prescribing physician to take compliance into account so as to provide an optimised prescription (choice of molecule prescribed and its rhythm of administration) adapted to each patient. The example considered is that of oral anticoagulant treatment prescribed long-term.
  
  
  METHODS
  In order to investigate the choice of the best molecule and treatment regimen for a given noncompliance pattern, we performed an in silico study with two oral anticoagulant agents, warfarin and acenocoumarol, each taken in one or two daily doses. Three linked models were used: the first model generated specific noncompliance patterns, the second model described the pharmacokinetics of oral anticoagulant agents and the third model summarised the pharmacokinetic-pharmacodynamic relations.
  
  
  RESULTS
  Considering different patterns of noncompliance (including timing errors in drug intake and the phenomenon of drug holidays) and comparing warfarin with acenocoumarol, we identified different situations in which one agent (prescribed once or twice daily) could clearly minimise both the thromboembolic and haemorrhagic risks. However, for some specific noncompliance patterns, the choice of the optimal therapy should also be guided by the basal individual thromboembolic and haemorrhagic risks.
  
  
  CONCLUSIONS
  Individualisation of drug therapy involves both drug dose and drug choice. In addition to the classical approach (i.e. drug level measurements, enzyme assays and even genetic sequence data), our study suggests that compliance-guided therapy may represent a potential, evolving way for the individualisation of prescriptions.
authors.affiliation: Clinical Pharmacology Department, Cardiovascular Hospital, Lyon 69003, France.
authors.forename: Alexia
authors.initials: A
authors.lastname: Blesius
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chabaud
authors.forename: Michel
authors.initials: M
authors.lastname: Cucherat
authors.forename: Patrick
authors.initials: P
authors.lastname: Mismetti
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Boissel
authors.forename: Patrice
authors.initials: P
authors.lastname: Nony
mesh_terms: D006801:Humans; D008954:Models, Biological; D010349:Patient Compliance; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010599:Pharmacokinetics; D010601:Pharmacology, Clinical; D017410:Practice Guidelines as Topic
chemical_list: D004364:Pharmaceutical Preparations