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      Tutorial on model selection and validation of model input into precision dosing software for model‐informed precision dosing

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          Abstract

          There has been rising interest in using model‐informed precision dosing to provide personalized medicine to patients at the bedside. This methodology utilizes population pharmacokinetic models, measured drug concentrations from individual patients, pharmacodynamic biomarkers, and Bayesian estimation to estimate pharmacokinetic parameters and predict concentration‐time profiles in individual patients. Using these individualized parameter estimates and simulated drug exposure, dosing recommendations can be generated to maximize target attainment to improve beneficial effect and minimize toxicity. However, the accuracy of the output from this evaluation is highly dependent on the population pharmacokinetic model selected. This tutorial provides a comprehensive approach to evaluating, selecting, and validating a model for input and implementation into a model‐informed precision dosing program. A step‐by‐step outline to validate successful implementation into a precision dosing tool is described using the clinical software platforms Edsim++ and MwPharm++ as examples.

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          Most cited references68

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          A new initiative on precision medicine.

          President Obama has announced a research initiative that aims to accelerate progress toward a new era of precision medicine, with a near-term focus on cancers and a longer-term aim to generate knowledge applicable to the whole range of health and disease.
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            Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists

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              Accurate detection of outliers and subpopulations with Pmetrics, a nonparametric and parametric pharmacometric modeling and simulation package for R.

              Nonparametric population modeling algorithms have a theoretical superiority over parametric methods to detect pharmacokinetic and pharmacodynamic subgroups and outliers within a study population. The authors created "Pmetrics," a new Windows and Unix R software package that updates the older MM-USCPACK software for nonparametric and parametric population modeling and simulation of pharmacokinetic and pharmacodynamic systems. The parametric iterative 2-stage Bayesian and the nonparametric adaptive grid (NPAG) approaches in Pmetrics were used to fit a simulated population with bimodal elimination (Kel) and unimodal volume of distribution (Vd), plus an extreme outlier, for a 1-compartment model of an intravenous drug. The true means (SD) for Kel and Vd in the population sample were 0.19 (0.17) and 102 (22.3), respectively. Those found by NPAG were 0.19 (0.16) and 104 (22.6). The iterative 2-stage Bayesian estimated them to be 0.18 (0.16) and 104 (24.4). However, given the bimodality of Kel, no subject had a value near the mean for the population. Only NPAG was able to accurately detect the bimodal distribution for Kel and to find the outlier in both the population model and in the Bayesian posterior parameter estimates. Built on over 3 decades of work, Pmetrics adopts a robust, reliable, and mature nonparametric approach to population modeling, which was better than the parametric method at discovering true pharmacokinetic subgroups and an outlier.
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                Author and article information

                Contributors
                zachary.taylor@cchmc.org
                Journal
                CPT Pharmacometrics Syst Pharmacol
                CPT Pharmacometrics Syst Pharmacol
                10.1002/(ISSN)2163-8306
                PSP4
                CPT: Pharmacometrics & Systems Pharmacology
                John Wiley and Sons Inc. (Hoboken )
                2163-8306
                12 October 2023
                December 2023
                : 12
                : 12 ( doiID: 10.1002/psp4.v12.12 )
                : 1827-1845
                Affiliations
                [ 1 ] Division of Clinical Pharmacology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
                [ 2 ] Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
                [ 3 ] Department of Biomedical Informatics University of Cincinnati College of Medicine Cincinnati Ohio USA
                [ 4 ] Division of Biomedical Informatics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
                [ 5 ] Division of Research in Patient Services Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
                [ 6 ] Division of Critical Care Medicine, Department of Pediatrics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
                [ 7 ] Division of Hematology and Oncology, Department of Pediatrics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
                [ 8 ] Department of Clinical Pharmacy and Pharmacology, University of Groningen University Medical Center Groningen Groningen The Netherlands
                [ 9 ] Medimatics Maastricht The Netherlands
                [ 10 ] Division of Hospital Medicine, Department of Pediatrics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
                Author notes
                [*] [* ] Correspondence

                Zachary L. Taylor, Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 6018, Cincinnati, OH 45229, USA.

                Email: zachary.taylor@ 123456cchmc.org

                Author information
                https://orcid.org/0000-0001-5178-2397
                https://orcid.org/0000-0001-6805-2243
                https://orcid.org/0000-0003-0863-7316
                https://orcid.org/0000-0001-8683-9488
                https://orcid.org/0000-0002-6231-3323
                https://orcid.org/0000-0003-4224-2967
                https://orcid.org/0000-0002-7655-6094
                https://orcid.org/0000-0002-8471-9826
                https://orcid.org/0000-0001-7737-8499
                Article
                PSP413056 PSP-2023-0053
                10.1002/psp4.13056
                10725261
                37771190
                6b302fee-4fb9-41c3-936e-dcb89307bf65
                © 2023 The Authors. CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 18 September 2023
                : 12 March 2023
                : 19 September 2023
                Page count
                Figures: 3, Tables: 5, Pages: 19, Words: 12116
                Funding
                Funded by: National Institute of Child Health and Development T32 Cincinnati Pediatric Clinical Pharmacology Training Program
                Award ID: T32HD069054
                Funded by: National Institute of Mental Health of the National Institutes of Health
                Award ID: F31MH132265
                Categories
                Tutorial
                Tutorial
                Tutorial
                Custom metadata
                2.0
                December 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.6 mode:remove_FC converted:16.12.2023

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