title: A Bayesian approach for dose-escalation in a Phase I clinical trial incorporating pharmacodynamic endpoints.
abstract: Bayesian decision procedures have already been proposed for and implemented in Phase I dose-escalation studies in healthy volunteers. The procedures have been based on pharmacokinetic responses reflecting the concentration of the drug in blood plasma and are conducted to learn about the dose-response relationship while avoiding excessive concentrations. However, in many dose-escalation studies, pharmacodynamic endpoints such as heart rate or blood pressure are observed, and it is these that should be used to control dose-escalation. These endpoints introduce additional complexity into the modeling of the problem relative to pharmacokinetic responses. Firstly, there are responses available following placebo administrations. Secondly, the pharmacodynamic responses are related directly to measurable plasma concentrations, which in turn are related to dose. Motivated by experience of data from a real study conducted in a conventional manner, this paper presents and evaluates a Bayesian procedure devised for the simultaneous monitoring of pharmacodynamic and pharmacokinetic responses. Account is also taken of the incidence of adverse events. Following logarithmic transformations, a linear model is used to relate dose to the pharmacokinetic endpoint and a quadratic model to relate the latter to the pharmacodynamic endpoint. A logistic model is used to relate the pharmacokinetic endpoint to the risk of an adverse event.
authors.affiliation: Medical and Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, UK. j.whitehead@lancaster.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Whitehead
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Zhou
authors.forename: Lisa
authors.initials: L
authors.lastname: Hampson
authors.forename: Edouard
authors.initials: E
authors.lastname: Ledent
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pereira
mesh_terms: D001499:Bayes Theorem; D017321:Clinical Trials, Phase I as Topic / Q000379:methods* / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D023381:Endpoint Determination; D006801:Humans; D016013:Likelihood Functions