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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of pharmacokinetics and pharmacodynamics 17 (1989), S. 47-66 
    ISSN: 1573-8744
    Keywords: theophyliine ; population analysis ; methylxanthines ; neonatal apnea ; kinetics ; NONMEM
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The population pharmacokinetics of theophylline were evaluated using 391 theophylline serum concentration measurements from 108 neonates and young infants (postnatal age 0–26 weeks), who received theophylline for the treatment of neonatal apnea. A one-compartment pharmacokinetic model with first-order elimination was used, with intravenous aminophylline and oral theophylline administration modeled as zero-order infusions. The effect of a variety of developmental and demographic factors on clearance (CL) and volume (V) were investigated. Hypothesis testing to evaluate potentially significant factors produced a final model in which clearance was based on weight (kg) raised to an exponential power and postnatal age (weeks), with CL (ml/hr)=17.5 (weight)1.28 + 1.17 (postnatal age). Clearance was reduced by 12% for patients receiving parenteral nutrition. Volume of distribution in this population was adequately described using only weight, with V (L)=0.858 L/kg. Bioavailability of orally administered drug was not significantly less than unity. Interindividual variability in clearance was modest, with a coefficient of variation for clearance of 16%. An estimate of interindividual variability in volume could not be obtained. As a measure of residual variability in theophylline serum concentrations, the coefficients of variation for theophylline serum concentrations of 5.0, 10.0, and 13.0 mg/L were found to be approximately, 25, 12, and 9%, respectively. The identification of influential patient factors and the quantification of their influence on theophylline disposition allow for a priori estimates of theophylline pharmacokinetic parameters in these patients.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-8744
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Summary The results of this study document the safety of co-administering alprazolam at doses up to 4 mg per day to patients already receiving imipramine. Although a pharmacokinetic interaction was observed by both a traditional analysis approach and a population analysis approach resulting in a significant increase in imipramine and desipramine plasma concentrations, no adverse pharmacodynamic effects were found in behavioral measurements or the incidence and severity of side effects. The ability of population pharmacokinetic analysis to provide insight in interpreting the results obtained from the traditional pharmacokinetic evaluation provide further support for the use of performing population pharmacokinetic analysis of data collected during clinical studies.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Journal of pharmacokinetics and pharmacodynamics 19 (1991), S. 87-112 
    ISSN: 1573-8744
    Keywords: population pharmacokinetics ; NONMEM ; simulations ; bias ; standard error ; confidence intervals ; monoexponential model ; clinical trials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract In a simulation study of the estimation of population pharmacokinetic parameters, including fixed and random effects, the estimates and confidence intervals produced by NONMEM were evaluated. Data were simulated according to a monoexponential model with a wide range of design and statistical parameters, under both steady state (SS) and nonSS conditions. Within the range of values for population parameters commonly encountered in research and clinical settings, NONMEM produced parameter estimates for CL, V, σCL,and σe which exhibit relatively small biases. As the range of variability increases, these biases became larger and more variable. An important exception was bias in the estimate for σv which was large even when the underlying variability was small. NONMEM standard error estimates are appropriate as estimates of standard deviation when the underlying variability is small. Except in the case of CL,standard error estimates tend to deteriorate as underlying variability increases. An examination of confidence interval coverage indicates that caution should be exercised when the usual 95% confidence intervals are used for hypothesis testing. Finally, simulationbased corrections of point and interval estimates are possible but corrections must be performed on a casebycase basis.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of pharmacokinetics and pharmacodynamics 20 (1992), S. 295-313 
    ISSN: 1573-8744
    Keywords: population pharmacokinetics ; NONMEM ; simulations ; hypothesis testing ; confidence intervals ; likelihood ratio test ; power ; monoexponential model ; clinical trials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract In a simulation study of inference on population pharmacokinetic parameters, two methods of performing tests of hypotheses comparing two populations using NONMEM were evaluated. These two methods are the test based upon 95% confidence intervals and the likelihood ratio test. Data were simulated according to a monoexponential model and, in that context, power curves for each test were generated for (i)the ratio of mean clearance and (ii)the ratio of the population standard deviations of clearance. To generate the power curves, a range of these parameters was employed; other pharmacokinetic parameters were selected to reflect the variability typically present in a Phase II clinical trial. For tests comparing the means, the confidence interval tests had approximately the same power as the likelihood ratio tests and were consistently more faithful to the nominal level of significance. For comparison of the standard deviations, and when the volume of information available was relatively small, however, the likelihood ratio test was more able to detect differences between the two groups. These results were then compared to results on parameter estimation in order to gain insight into the question of power. As an example, the nonnormality of estimates of the ratio of standard deviations plays an important role in explaining the low power for the confidence interval tests. We conclude that, except for the situation of modeling standard deviations with only sparse information, NONMEM produces tests of significance that are effective at detecting clinically significant differences between two populations.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of pharmacokinetics and pharmacodynamics 19 (1991), S. 25S 
    ISSN: 1573-8744
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Summary The analysis of observational data using a mixed effect model is more complex than the traditional approach to pharmacokinetic parameter estimation. Structural and statistical models must be explicitly formulated and implemented within the computer program NONMEM. This presents some unique challenges in the selection and evaluation of alternative models for the evaluation of interindividual and residual variability.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Journal of pharmacokinetics and pharmacodynamics 19 (1991), S. 37S 
    ISSN: 1573-8744
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Summary Results have been presented that demonstrate the ability to conduct population pharmacokinetic analysis as a component of clinical efficacy and safety trials. This method of analysis offers the potential to determine the pharmacokinetics of a drug in the actual patients receiving medication and to evaluate relationships between pharmacokinetics and drug action. However, active involvement in the protocol design, and data collection process are required to ensure the quality of the resultant data set.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Journal of pharmacokinetics and pharmacodynamics 19 (1991), S. 11S 
    ISSN: 1573-8744
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Summary In spite of the vast amount of data generated during the new drug development process, much remains to be learned about the pharmacokinetics of a drug once it is released on the market. The ethical and logistical problems which arise during an experimental pharmacokinetic study frequently prevent the study of elderly, pediatric, or critically ill patients. The recognition of these limitations by scientists and regulators have prompted a desire to extract the maximum amount of information from data available during Phase III and Phase IV clinical trials and, in addition, to use information generated during the routine clinical care of patients. Mixed effect model analysis allows one to overcome the problems of analyzing observational data to obtain accurate and precise estimates of population pharmacokinetic parameters. Use of this approach expands the methodologies available to the data analyst and opens up a number of data sources which can now be considered for analysis.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1573-904X
    Keywords: population pharmacokinetics ; tirilazad ; subarachnoid hemorrage ; gender effect ; enzyme induction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Purpose. Data collected during Phase I and II in the development of tirilazad were pooled and analyzed using nonlinear mixed effects models to assess covariates which might affect tirilazad pharmacokinetics. Methods. Four single dose and five multiple dose studies in normal volunteers were combined with two multiple dose studies performed in patients with subarachnoid hemorrhage (SAH) to identify factors related to intersubject variability in clearance (CL) and central compartment volume (Vc). Data from 253 subjects, which consisted of 7,219 tirilazad concentrations, were analyzed. The effects of weight, gender, patient versus volunteer status, and phenytoin use were evaluated. Results. Relative to male volunteers not receiving concomitant phenytoin, significant effects on clearance included: a 46% increase in volunteers receiving phenytoin, and an 82% increase in clearance associated with SAH patients (all of whom received phenytoin). Significant effects on Vc were: a 26% increase for female volunteers not receiving phenytoin, a 12% decrease for volunteers receiving concomitant phenytoin, a 152% increase for male SAH patients, and a 270% increase for female SAH patients. Incorporating patient covariate effects substantially reduced the interindividual variability (from 27.9% to 24.7% for clearance and from 48.2% to 37.5% for Vc). Residual variability was estimated at 66% coefficient of variation (CV) in SAH patients and at 22−48% CV over the range of predicted concentrations in normal volunteers. Conclusions. The most important factors affecting tirilazad pharmacokinetics are the administration of phenytoin (increased CL) and SAH (increased Vc and residual variability). The effect of gender on tirilazad pharmacokinetics was modest.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1573-904X
    Keywords: pharmacokinetics ; pharmacodynamic modeling ; NONMEM ; model validation ; cisatracurium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Purpose. The population PK/PD approach was prospectively used to determine the PK/PD of cisatracurium in various subgroups of healthy surgical patients. Methods. Plasma concentration (Cp) and neuromuscular block data from 241 patients in 8 prospectively-designed Phase I−III trials were pooled and analyzed using NONMEM. The analyses included limited Cp-time data randomly collected from 186 patients in efficacy/safety studies and full Cp-time data from 55 patients in pharmacokinetic studies. The effects of covariates on the PK/PD parameters of cisatracurium were evaluated. The time course of neuromuscular block was predicted for various patient subgroups. Results. The population PK/PD model for cisatracurium revealed that anesthesia type, gender, age, creatinine clearance, and presence of obesity were associated with statistically significant (p 〈 0.01) effects on the PK/PD parameters of cisatracurium. These covariates were not associated with any clinically significant changes in the predicted recovery profile of cisatracurium. Slight differences in onset were predicted in patients with renal impairment and patients receiving inhalation anesthesia. Based on the validation procedure, the model appears to be accurate and precise. Conclusions. The prospective incorporation of a population PK/PD strategy into the clinical development of cisatracurium generated information which influenced product labeling and reduced the number of studies needed during development.
    Type of Medium: Electronic Resource
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