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Practical Therapeutic Drug Management in HIV‐Infected Patients: Use of Population Pharmacokinetic Models Supplemented by Individualized Bayesian Dose Optimization
Author(s) -
Neely Michael,
Jelliffe Roger
Publication year - 2008
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1177/0091270008321789
Subject(s) - dosing , medicine , drug , pharmacokinetics , therapeutic index , therapeutic drug monitoring , intensive care medicine , population , drug delivery , pharmacology , environmental health , chemistry , organic chemistry
Individualized, model‐based, target‐oriented optimal concentration‐controlled dosing of HIV medications can be beneficial to patients for whom there are limited dosing guidelines, such as children, adolescents, or patients with altered physiologic function. Barriers to this approach include lack of training, expertise, and access to appropriate software to assist the clinician. The authors present 4 illustrative clinical cases of HIV‐infected patients whose therapy was optimized using population pharmacokinetic models (here generated from published studies) and supplemented by individualized Bayesian adaptive control of dosage regimens as implemented in the MM‐USCPACK software. These 4 cases illustrate how clinicians can maximize therapeutic success in (1) patients with reduced drug clearance, (2) young adolescents transitioning to adult physiology, (3) patients with dose‐dependent toxicity, and (4) adolescents with limited therapeutic options.