Development of a sufficient design for estimation of fluconazole pharmacokinetics in people with HIV infection.
OBJECTIVE
To assess an optimal design that is sufficient to gain precise estimates of the pharmacokinetic (PK) parameters for fluconazole in people with HIV infection.


METHODS
Two studies were identified, the first in healthy volunteers and the second in HIV patients. The investigators (J.F.R. and S.B.D.) were blinded to the second study results. The healthy volunteer study was modelled and a design was found to estimate the PK parameters. The design was evaluated by comparison of the standard errors of the parameters and the predictive performance of the optimal design. The predictive performance was assessed by comparing model predictions against observed concentrations for two models. The first model, termed 'sufficient design', was developed from data extracted from the HIV study that corresponded to the optimal design. The second model, termed 'HIV outcome model', by modelling all the data from the HIV study.


RESULTS
An optimal design HIV study was developed which had considerably fewer blood samples and dosing arms compared with the actual HIV study. The optimized design performed as well as the actual HIV study in terms of parameter precision. The performance of the design, described as the precision (mg l(-1))(2) (95% confidence interval) of the predicted concentrations to the actual concentrations for the 'sufficient design' and 'HIV outcome model' models were: 0.63 (0.40, 0.87) and 0.56 (0.32, 0.79), respectively.


CONCLUSIONS
This study demonstrates how data from healthy volunteers can be utilized via optimal design methodology to design a successful study in the target population.
Roos
Juliana F
JF
School of Pharmacy, University of Queensland, Brisbane, Australia.
Kirkpatrick
Carl M J
CM
Tett
Susan E
SE
McLachlan
Andrew J
AJ
Duffull
Stephen B
SB
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002986:Clinical Trials as Topic / Q000379:methods; D003198:Computer Simulation / Q000191:economics; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D015725:Fluconazole / Q000008:administration & dosage / Q000493:pharmacokinetics*; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D008954:Models, Biological; D011237:Predictive Value of Tests; D019562:Viral Load
D019380:Anti-HIV Agents; D015725:Fluconazole