title: A framework for quantifying the influence of adherence and dose individualization.
abstract: A failure to accommodate for a patient's imperfect adherence may result in therapeutic failure. Similarly, failure to accommodate a patient's individual needs via dose individualization may also result in poor patient outcomes. The property of a drug that signifies the likelihood of therapeutic success to imperfect adherence is termed "forgiveness." We introduce an extension to this concept as: (1) a priori forgiveness (forgiveness when dose individualization is not considered) and (2) a posteriori forgiveness (forgiveness when considering dose individualization). We illustrate cases when adherence is of primary importance and in which dose individualization is of primary importance. The concept of a priori forgiveness and a posteriori forgiveness provides a quantitative measure that allows the influence of adherence to be disentangled from dose individualization and could be used to provide clear guidelines about the relative importance of each in clinical practice.
authors.affiliation: School of Pharmacy, University of Otago, Dunedin, New Zealand.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Assawasuwannakit
authors.affiliation: School of Pharmacy, University of Otago, Dunedin, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Braund
authors.affiliation: School of Pharmacy, University of Otago, Dunedin, New Zealand.
authors.forename: S B
authors.initials: SB
authors.lastname: Duffull
mesh_terms: D000069059:Atorvastatin / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D003198:Computer Simulation; D004334:Drug Administration Schedule; D054796:Drug Dosage Calculations; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D055118:Medication Adherence; D015233:Models, Statistical; D009853:Omeprazole / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D054328:Proton Pump Inhibitors; D000069059:Atorvastatin; D009853:Omeprazole