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cific group of nonlinearmixed effect models that have been developed todescribe exposure–effect relationships within the absence ofdrug concentration measurements. This approach isvery helpful if drug elimination from the biophase is therate-limiting Cabozantinib step in drug disposition. The approach is,nevertheless, not suitable for extrapolating data across differentscenariosfor which noobservations are available.The availability of population PK and PKPD models offersan significant opportunity as a study optimisation tool. These models can also be used to support prediction andextrapolation of data across unique age-groups, dosingregimens and formulations or delivery forms. Moreover, population models could enableextrapolation of long-term efficacy and Cabozantinib safety based onshort-term pharmacokinetic and treatment response data.
M&S and biomarkersA biological marker or biomarker is defined as a characteristicthat is objectively measured and evaluated as an indicator ofnormal biological or pathogenic processes or pharmacologicalresponses Capecitabine to a therapeutic intervention. Biomarkerscan be directly measured or derived by model-basedapproaches and expressed as model parameters. In drugdiscovery and drug development a validated biomarker mayfacilitate decision-making, supporting the prediction oftreatment response as well as guide dose adjustment. Ifvalidated accordingly for sensitivity, specificity and clinicalrelevance, biomarkers can also be used as surrogateendpoints. In this context, model-based analysis ofbiomarker data can contribute to validation procedures andenable comprehensive sensitivity analysis, with a clearunderstanding of the sensitivity and specificity rates.
NSCLC The availability ofbiomarkers could also be a determinant within the progression of aclinical trial when the clinical outcome is delayed or difficultto quantify in short-term studies.Another significant advantage of model-based approaches isthat they allow access to functional components and structuresof a biological system that cannot be identified experimentally.The best example of such a concept is the quantification ofinsulin sensitivity, as defined by the insulin sensitivity index.The loss in insulin sensitivity because of diabetes progressioncannot be measured direct from insulin and glucose levels inplasma; it is derived from a model. In addition, M&S provideinsight into how drug treatments could alter disease.
Clinical Capecitabine trial simulationIn contrast to meta-analysis, clinical trial simulationenables the assessment of the impact of a range of designcharacteristics on the statistical power to detect a treatmenteffect prior to exposing patients to an experimental drug. Ina field where most clinical trials have a conservative design,this methodology offers a unique opportunity to evaluateinnovative designs. Rather than performing power calculationsthat only take sample size and endpoint variabilityinto account, CTS allows calculation of power taking intoaccount a multitude of other factors.In general, CTS utilises two types of models. First, adrug–actionmodel is considered, which comprisespharmacokinetic and pharmacodynamic factors. In chronicdiseases the model also accounts for disease progression.
Unfortunately, the lack of knowledge about the mechanismsunderlying treatment response in many therapeutic indicationshas prevented the development of mechanistic PKPD models.Hence, examples often refer to standard statistical models,such as e.g. the mixed model for repeated measures. Such statistical models have nevertheless a downsidein that they often do not incorporate concentration–effectrelationships Cabozantinib and therefore do not allow for inferences aboutage-related differences in pharmacokinetics, as is the case forpaediatric populations. Second, CTS requires a trial executionmodel. These models simulate other significant aspects of thetrial, such as dropout, compliance and protocol deviations. In this manner, one can determine all possibleoutcomes under candidate trial designs, allowing such trialdesigns to be compared in a strictly quantitative manner.
Thusfar, very few examples exist in which relevant design factorshave been evaluated prospectively as part of the planning of apaediatric trial.It is also significant to stress that CTS allows investigation offactors that cannot be scrutinised by meta-analysis or empiricaldesign. First, designs which have not been implemented cannotbe included in a meta-analysis. Capecitabine Second, it is difficult to separatethe influence of multiple design factors, whereas CTS allowsevaluation of a single factor at a time. Although meta-analysesmay provide valuable information about differences in patientpopulations and treatment response, it is unfortunate that manyinvestigators consider overall publication review sufficient togather evidence on the role of design factors, as often suggestedin the discussion of meta-analysis results.If simulated data is to be exchangeable with actualpatient data, it is imperative that not only model parametersare unbiased, but that estim