title: Understanding and applying pharmacometric modelling and simulation in clinical practice and research.
abstract: Understanding the dose-concentration-effect relationship is a fundamental component of clinical pharmacology. Interpreting data arising from observations of this relationship requires the use of mathematical models; i.e. pharmacokinetic (PK) models to describe the relationship between dose and concentration and pharmacodynamic (PD) models describing the relationship between concentration and effect. Drug development requires several iterations of pharmacometric model-informed learning and confirming. This includes modelling to understand the dose-response in preclinical studies, deriving a safe dose for first-in-man, and the overall analysis of Phase I/II data to optimise the dose for safety and efficacy in Phase III pivotal trials. However, drug development is not the boundary at which PKPD understanding and application stops. PKPD concepts will be useful to anyone involved in the prescribing and administration of medicines for purposes such as determining off-label dosing in special populations, individualising dosing based on a measured biomarker (personalised medicine) and in determining whether lack of efficacy or unexpected toxicity maybe solved by adjusting the dose rather than the drug. In clinical investigator-led study design, PKPD can be used to ensure the optimal dose is used, and crucially to define the expected effect size, thereby ensuring power calculations are based on sound prior information. In the clinical setting the most likely people to hold sufficient expertise to advise on PKPD matters will be the pharmacists and clinical pharmacologists. This paper reviews fundamental PKPD principles and provides some real-world examples of PKPD use in clinical practice and applied clinical research.
authors: Infection, Immunity, Inflammation Section, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH.|Department of Pharmacy, Great Ormond Street Hospital for Children, London, WC1N 3JH.|Paediatric Infectious Diseases Research Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE.
authors: Joseph F
authors: JF
authors: Standing
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D003198:Computer Simulation; D004305:Dose-Response Relationship, Drug; D015195:Drug Design; D006801:Humans; D008954:Models, Biological; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000378:metabolism; D057285:Precision Medicine / Q000379:methods; D012107:Research Design
chemical_list: D015415:Biomarkers; D004364:Pharmaceutical Preparations
keywords: pharmacodynamics; pharmacokinetic-pharmacodynamic modelling; pharmacokinetics