Individualized Patient Care Through Model-Informed Precision Dosing: Reflections on Training Future Practitioners

Prior to his passing, Dr. Roger Jelliffe, expressed the need for educating future physicians and clinical pharmacists on the availability of computer-based tools to support dose optimization in patients in stable or unstable physiological states. His perspectives were to be captured in a commentary...

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Veröffentlicht in:The AAPS journal 2022-11, Vol.24 (6), p.117, Article 117
Hauptverfasser: Jelliffe, Roger, Liu, Jiang, Drusano, George L., Martinez, Marilyn N.
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container_issue 6
container_start_page 117
container_title The AAPS journal
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creator Jelliffe, Roger
Liu, Jiang
Drusano, George L.
Martinez, Marilyn N.
description Prior to his passing, Dr. Roger Jelliffe, expressed the need for educating future physicians and clinical pharmacists on the availability of computer-based tools to support dose optimization in patients in stable or unstable physiological states. His perspectives were to be captured in a commentary for the AAPS J with a focus on incorporating population pharmacokinetic (PK)/pharmacodynamic (PD) models that are designed to hit the therapeutic target with maximal precision. Unfortunately, knowing that he would be unable to complete this project, Dr. Jelliffe requested that a manuscript conveying his concerns be completed upon his passing. With this in mind, this final installment of the AAPS J theme issue titled “Alternative Perspectives for Evaluating Drug Exposure Characteristics in a Population — Avoiding Analysis Pitfalls and Pigeonholes” is an effort to honor Dr. Jelliffe’s request, conveying his concerns and the need to incorporate modeling and simulation into the training of physicians and clinical pharmacists. Accordingly, Dr. Jelliffe’s perspectives have been integrated with those of the other three co-authors on the following topics: the clinical utility of population PK models; the role of multiple model (MM) dosage regimens to identify an optimal dose for an individual; tools for determining dosing regimens in renal dialysis patients (or undergoing other therapies that modulate renal clearance); methods to analyze and track drug PK in acutely ill patients presenting with high inter-occasion variability; implementation of a 2-cycle approach to minimize the duration between blood samples taken to estimate the changing PK in an acutely ill patient and for the generation of therapeutic decisions in advance for each dosing cycle based on an analysis of the previous cycle; and the importance of expressing therapeutic drug monitoring results as 1/variance rather than as the coefficient of variation. Examples showcase why, irrespective of the overall approach, the combination of therapeutic drug monitoring and computer-informed precision dosing is indispensable for maximizing the likelihood of achieving the target drug concentrations in the individual patient.
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subjects Analysis
Biochemistry
Biomedical and Life Sciences
Biomedicine
Biotechnology
Care and treatment
Commentary
Drug Monitoring - methods
Education, Medical
Education, Pharmacy
Health aspects
Humans
Medical colleges
Models, Biological
Patient Care - methods
Patients
Pharmacists
Pharmacology/Toxicology
Pharmacy
Physiological aspects
Precision Medicine - methods
Simulation Training
Theme: Alternative Perspectives for Evaluating Drug Exposure Characteristics in a Population – Avoiding Analysis Pitfalls and Pigeon Holes
Training
title Individualized Patient Care Through Model-Informed Precision Dosing: Reflections on Training Future Practitioners
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