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Duan Y, Yang X, Zhang M, Qi X, Jin Y, Wang Z, Chen L. Adaptive Dosage Strategy of Levetiracetam in Chinese Epileptic Patients: Focus on Pregnant Women. J Pharm Sci 2024; 113:1385-1394. [PMID: 38176454 DOI: 10.1016/j.xphs.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024]
Abstract
There is presently no efficient dose individualization strategy for the use of antiseizure medications in epileptic pregnant patients. This study aimed to develop a population pharmacokinetics model for levetiracetam and propose a tailored adaptive individualized dosage strategy for epileptic pregnant patients. A total of 322 levetiracetam plasma concentrations from 238 patients with epilepsy were included, including 216 women with epilepsy (20.83% of whom were pregnant). The levetiracetam plasma concentration was measured using a validated ultra-performance liquid chromatography-tandem mass spectrometry assay, and the data were modeled using a nonlinear mixed-effects model. The resultant model served as the basis for simulating the dosage adjustment strategy. A one-compartment model with first-order elimination best described the pharmacokinetic data of levetiracetam. The apparent clearance (CL/F) was 3.43 L/h (95% CI 3.30-3.56) and the apparent volume of distribution was 43.7 L (95% CI 40.4-47.0) for a typical individual of 57.2 kg. Pregnancy and body weight were found to be significant covariates of CL/F of levetiracetam. The recommended regimen of levetiracetam could be predicted by the population pharmacokinetic model based on body weight, gestational age, and the daily dose of levetiracetam taken before pregnancy.
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Affiliation(s)
- Yifei Duan
- Department of Neurology, West China Hospital, Sichuan University
| | - Ximeng Yang
- Department of Neurology, West China Hospital, Sichuan University
| | - Mengyu Zhang
- Department of Neurology, West China Hospital, Sichuan University; Clinical Trial Center, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University
| | - Xiaohui Qi
- Department of Neurology, West China Hospital, Sichuan University; Clinical Trial Center, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University
| | - Ying Jin
- Department of Neurology, West China Hospital, Sichuan University; Clinical Trial Center, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University
| | - Zhenlei Wang
- Department of Neurology, West China Hospital, Sichuan University; Clinical Trial Center, NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, West China Hospital, Sichuan University.
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University.
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Zhao J, Yan D, Li Y, Xu X, Li F, Zhang S, Jin J, Qiu F. Simultaneous determination of 11 oral targeted antineoplastic drugs and 2 active metabolites by LC-MS/MS in human plasma and its application to therapeutic drug monitoring in cancer patients. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1237:124100. [PMID: 38547701 DOI: 10.1016/j.jchromb.2024.124100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024]
Abstract
Interindividual exposure differences have been identified in oral targeted antineoplastic drugs (OADs) owing to the pharmacogenetic background of the patients and their susceptibility to multiple factors, resulting in insufficient efficacy or adverse effects. Therapeutic drug monitoring (TDM) can prevent sub-optimal concentrations of OADs and improve their clinical treatment. This study aimed to develop and validate an LC-MS/MS method for the simultaneous quantification of 11 OADs (gefitinib, imatinib, lenvatinib, regorafenib, everolimus, osimertinib, sunitinib, tamoxifen, lapatinib, fruquintinib and sorafenib) and 2 active metabolites (N-desethyl sunitinib and Z-endoxifen) in human plasma. Protein precipitation was used to extract OADs from the plasma samples. Chromatographic separation was performed using an Eclipse XDB-C18 (4.6 × 150 mm, 5 μm) column with a gradient elution of the mobile phase composed of 2 mM ammonium acetate with 0.1 % formic acid in water (solvent A) and methanol (solvent B) at a flow rate of 0.8 mL/min. Mass analysis was performed using positive ion mode electrospray ionization in multiple-reaction monitoring mode. The developed method was validated following FDA bioanalytical guidelines. The calibration curves were linear over the range of 2-400 ng/mL for gefitinib, imatinib, lenvatinib, regorafenib, and everolimus; 1-200 ng/mL for osimertinib, sunitinib, N-desethyl sunitinib, tamoxifen, and Z-endoxifen; and 5-1000 ng/mL for lapatinib, fruquintinib, and sorafenib, with all coefficients of correlation above 0.99. The intra- and inter-day imprecision was below 12.81 %. This method was successfully applied to the routine TDM of gefitinib, lenvatinib, regorafenib, osimertinib, fruquintinib, and sorafenib to optimize the dosage regimens.
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Affiliation(s)
- Jing Zhao
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China
| | - Dongming Yan
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China
| | - Yue Li
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China
| | - Xiaoqing Xu
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China
| | - Fengling Li
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China
| | - Shuang Zhang
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China
| | - Jingyi Jin
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China.
| | - Furong Qiu
- Laboratory of Clinical Pharmacokinetics, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201213, China.
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Biard L, Andrillon A, Silva RB, Lee SM. Dose optimization for cancer treatments with considerations for late-onset toxicities. Clin Trials 2024:17407745231221152. [PMID: 38591582 DOI: 10.1177/17407745231221152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Given that novel anticancer therapies have different toxicity profiles and mechanisms of action, it is important to reconsider the current approaches for dose selection. In an effort to move away from considering the maximum tolerated dose as the optimal dose, the Food and Drug Administration Project Optimus points to the need of incorporating long-term toxicity evaluation, given that many of these novel agents lead to late-onset or cumulative toxicities and there are no guidelines on how to handle them. Numerous methods have been proposed to handle late-onset toxicities in dose-finding clinical trials. A summary and comparison of these methods are provided. Moreover, using PI3K inhibitors as a case study, we show how late-onset toxicity can be integrated into the dose-optimization strategy using current available approaches. We illustrate a re-design of this trial to compare the approach to those that only consider early toxicity outcomes and disregard late-onset toxicities. We also provide proposals going forward for dose optimization in early development of novel anticancer agents with considerations for late-onset toxicities.
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Affiliation(s)
- Lucie Biard
- INSERM U1153 Team ECSTRRA, Université Paris Cité, Paris, France
| | - Anaïs Andrillon
- INSERM U1153 Team ECSTRRA, Université Paris Cité, Paris, France
- Department of Statistical Methodology, Saryga, Tournus, France
| | - Rebecca B Silva
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Shing M Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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Trancart M, Hanak AS, Dambrune C, Madi M, Voros C, Baati R, Calas AG. No-observed-adverse-effect-level (NOAEL) assessment as an optimized dose of cholinesterase reactivators for the treatment of exposure to warfare nerve agents in mice. Chem Biol Interact 2024; 392:110929. [PMID: 38417730 DOI: 10.1016/j.cbi.2024.110929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Despite the international convention on the prohibition of chemical weapons ratified in 1997, the threat of conflicts and terrorist attacks involving such weapons still exists. Among these, organophosphorus-nerve agents (OPs) inhibit cholinesterases (ChE) causing cholinergic syndrome. The reactivation of these enzymes is therefore essential to protect the poisoned people. However, these reactivating molecules, mainly named oximes, have major drawbacks with limited efficacy against some OPs and a non-negligible ChE inhibitor potential if administered at an inadequate dose, an effect that they are precisely supposed to mitigate. As a result, this project focused on assessing therapeutic efficacy, in mice, up to the NOAEL dose, the maximum dose of oxime that does not induce any observable toxic effect. NOAEL doses of HI-6 DMS, a reference oxime, and JDS364. HCl, a candidate reactivator, were assessed using dual-chamber plethysmography, with respiratory ventilation impairment as a toxicity criterion. Time-course modeling parameters and pharmacodynamic profiles, reflecting the interaction between the oxime and circulating ChE, were evaluated for treatments at their NOAEL and higher doses. Finally, the therapeutic potential against OPs poisoning was determined through the assessment of protective indices. For JDS364. HCl, the NOAEL dose corresponds to the smallest dose inducing the most significant therapeutic effect without causing any abnormality in ChE activity. In contrast, for HI-6 DMS, its therapeutic benefit was observed at doses higher than its NOAEL, leading to alterations in respiratory function. These alterations could not be directly correlated with ChE inhibition and had no adverse effects on survival. They are potentially attributed to the stimulation of non-enzymatic cholinergic targets by HI-6 DMS. Thus, the NOAEL appears to be an optimal dose for evaluating the efficacy of oximes, particularly when it can be linked to respiratory alterations effectively resulting from ChE inhibition.
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Affiliation(s)
- Marilène Trancart
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, Brétigny-sur-Orge, France
| | - Anne-Sophie Hanak
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, Brétigny-sur-Orge, France
| | - Chloé Dambrune
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, Brétigny-sur-Orge, France; Ecole de Chimie Polymère et Matériaux ECPM, Université de Strasbourg, ICPEES UMR CNRS 7515, 25, Rue Becquerel, F-67087, Strasbourg, France
| | - Méliati Madi
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, Brétigny-sur-Orge, France
| | - Camille Voros
- Ecole de Chimie Polymère et Matériaux ECPM, Université de Strasbourg, ICPEES UMR CNRS 7515, 25, Rue Becquerel, F-67087, Strasbourg, France
| | - Rachid Baati
- Ecole de Chimie Polymère et Matériaux ECPM, Université de Strasbourg, ICPEES UMR CNRS 7515, 25, Rue Becquerel, F-67087, Strasbourg, France
| | - André-Guilhem Calas
- French Armed Forces Biomedical Research Institute, CBRN Defense Division, Toxicology and Chemical Risks Department, Brétigny-sur-Orge, France.
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Chardon A, Udrescu C, Beneux A, Ruffion A, Horn S, Lapierre A, Chapet O. Erectile function preservation after radiotherapy using a dose-optimization approach on sexual structures for localized prostate cancer. Cancer Radiother 2024; 28:182-187. [PMID: 38599939 DOI: 10.1016/j.canrad.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 04/12/2024]
Abstract
PURPOSE Erectile function preservation is an important quality of life factor in patients treated for prostate cancer. A dose-optimization approach on sexual structures was developed and evaluated to limit erectile dysfunction after radiotherapy. MATERIALS AND METHODS Twenty-three men with localized prostate cancer and no erectile dysfunction were enrolled in the study. All patients received a prescription dose between 76 and 78Gy. Computed tomography/magnetic resonance image registration was used to delineate the prostatic volume and the sexual structures: internal pudendal arteries (IPA), penile bulb and corpus cavernosum. Erectile function was evaluated using the 5-items International Index of Erectile Function (IIEF-5) score every 6 months during the 2 years after radiotherapy and once a year afterwards. No erectile dysfunction, mild erectile dysfunction and severe erectile dysfunction were defined if the IIEF-5 scores were 20-25, 17-19 and < 17, respectively. RESULTS The mean follow-up was 4.5 years. The mean age of the patients was 66.3 years. At 2 years, 67% of the patients had no erectile dysfunction, 11% had mild erectile dysfunction and 22% had severe erectile dysfunction. No significant difference was found between the patients with and without erectile dysfunction (IIEF-5≥20 and IIEF-5<20, respectively) for any of the parameters: dosimetric values (internal pudendal arteries, penile bulb, corpus cavernosum), age, comorbidity and smoking status. The biochemical-relapse free survival was 100% at 2 years. CONCLUSION This approach with dose-optimization on sexual structures for localized prostate cancer found excellent results on erectile function preservation after radiotherapy, with 78% of the patients with no or mild erectile dysfunction at 2 years.
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Affiliation(s)
- A Chardon
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - C Udrescu
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - A Beneux
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Ruffion
- Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France; Department of Urology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - S Horn
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - A Lapierre
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France
| | - O Chapet
- Department of Radiotherapy-Oncology, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69100 Villeurbanne, France.
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Cadavid L, Karout L, Kalra MK, Morgado F, Londoño MA, Pérez L, Galeano M, Montaño M, Wesley L, Almanza J, Pacheco W, Gómez L, Moscatelli A, Muglia V, Kiipper F, Lucena R, Bernardo M, Ugas C. Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead. Pediatr Radiol 2024; 54:457-467. [PMID: 37227466 DOI: 10.1007/s00247-023-05676-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023]
Abstract
We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.
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Affiliation(s)
- Lina Cadavid
- Department of Radiology, Hospital Pablo Tobón Uribe, Calle 78B#69-240, Medellín, Antioquia, 050034, Colombia.
| | - Lina Karout
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Flavio Morgado
- Pontificie Universidade Católica de São Paulo, São Paulo, Brazil
| | - María Antonieta Londoño
- Universidad Nacional de Colombia/Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Lizbeth Pérez
- Department of Radiology, Clinica alemana de Santiago - Universidad del Desarrollo, Santiago de Chile, Chile
| | - Monica Galeano
- Department of Radiology, Hospital del Niño Prof Dr. Ramón Exeni, La Matanza provincia de Buenos Aires, Argentina
| | - Mario Montaño
- Department of Radiology, Hospital Santa Cruz C.P.S, Santa Cruz de la Sierra, Bolivia
| | - Lavinia Wesley
- Department of Radiology, Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panamá
| | - Judith Almanza
- Department of Radiology, Salud Digna., Ciudad de México, México
| | - Walter Pacheco
- Department of Radiology, Maria Hospital, Pediatric Specialties, Tegucigalpa, Honduras
| | - Lucia Gómez
- Department of Radiology, Hospital Metropolitano, Quito, Ecuador
| | | | - Valdair Muglia
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Monica Bernardo
- Pontifícia Universidade Católica de São Paulo, Hospital Miguel Soeiro, Sorocaba, Brazil
| | - Carlos Ugas
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Lima, Perú
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Lau C, Mohmaed Ali MI, Lin L, van Balen DEM, Jacobs BAW, Nuijen B, Smeenk RM, Steeghs N, Huitema ADR. Impact of bariatric surgery on oral anticancer drugs: an analysis of real-world data. Cancer Chemother Pharmacol 2024:10.1007/s00280-024-04640-0. [PMID: 38427065 DOI: 10.1007/s00280-024-04640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The number of patients with bariatric surgery who receive oral anticancer drugs is rising. Bariatric surgery may affect the absorption of oral anticancer drugs. Strikingly, no specific drug dosing recommendations are available. We aim to provide practical recommendations on the application of oral anticancer drugs in patients who underwent bariatric surgery. METHODS Patients with any kind of bariatric surgery were extracted retrospectively in a comprehensive cancer center. In addition, a flowchart was proposed to assess the risk of inadequate exposure to oral anticancer drugs in patients who underwent bariatric surgery. Subsequently, the flowchart was evaluated retrospectively using routine Therapeutic drug monitoring (TDM) samples. RESULTS In our analysis, 571 cancer patients (0.4% of 140.000 treated or referred patients) had previous bariatric surgery. Of these patients, 78 unique patients received 152 oral anticancer drugs equaling an overall number of 30 unique drugs. The 30 different prescribed oral anticancer drugs were categorized as low risk (13%), medium risk (67%), and high risk (20%) of underdosing. TDM plasma samples of 25 patients (82 samples) were available, of which 21 samples post-bariatric surgery (25%) were below the target value. CONCLUSIONS The proposed flowchart can support optimizing the treatment with orally administered anticancer drugs in patients who underwent bariatric surgery. We recommend performing TDM in drugs that belong to BCS classes II, III, or IV. If more risk factors are present in BCS classes II or IV, a priori switches to other drugs may be advised. In specific cases, higher dosages can be provided from the start (e.g., tamoxifen).
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Affiliation(s)
- Cedric Lau
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Department of Clinical Pharmacy, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands.
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Ma Ida Mohmaed Ali
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lishi Lin
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Dorieke E M van Balen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Bart A W Jacobs
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Bastiaan Nuijen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Robert M Smeenk
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - Neeltje Steeghs
- Division of Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Division of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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8
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Gendy JM, Nomura N, Stuart JN, Blumenthal G. US FDA's Dose Optimization Postmarketing Requirements and Commitments of Oncology Approvals and the Impact on Product Labels from 2010 to 2022: An Emerging Landscape from Traditional to Novel Therapies. Ther Innov Regul Sci 2024; 58:380-386. [PMID: 38182940 PMCID: PMC10850176 DOI: 10.1007/s43441-023-00606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Dose optimization is a focal point of many US Food and Drug Administration (FDA) drug approvals. We sought to understand the impact of the FDA's Postmarketing Commitments/Postmarketing Requirements (PMCs/PMRs) on dose optimization and prescriber labeling for oncology drugs. METHODS Publicly available information was aggregated for all FDA oncology drug approvals between January 1, 2010, and December 31, 2022. Study completion dates were compared to product labeling before and after PMC/PMR fulfillment dates to evaluate labeling changes associated with dose-related PMCs/PMRs. Data were analyzed individually (2010-2015 and 2016-2022) due to differences in available information. RESULTS From 2010 to 2015, 14 of 42 (33.3%) new molecular entities (NMEs) had dose-related PMCs/PMRs, with 6 of 14 (42.9%) resulting in a relevant label change. From 2016 to 2022, of the 314 new or supplemental applications approved, 21 had dose-related PMCs/PMRs (6.7%), which trended upward over time; 71.4% of dose-related PMCs/PMRs were NMEs. Kinase inhibitors (KIs) and antibody/peptide drug conjugates (ADCs/PDCs) were the most affected drug classes. Ten of the 21 approvals with dose-related PMCs/PMRs fulfilled their dosing PMCs/PMRs, and 3 of the 10 (30%) had relevant label changes. CONCLUSION Most dose-related PMRs/PMCs were issued for NMEs. Of these, KIs and ADCs/PDCs were highly represented, reflecting their novelty and greater uncertainty around their safety profile. PMC/PMR issuance broadly increased over time. With the implementation of the FDA's Project Optimus in 2021, it remains to be seen whether fewer dose-related PMCs/PMRs emerge in future due to enhanced dose optimization in the premarketing setting.
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Affiliation(s)
- Joseph M Gendy
- Global Regulatory Affairs, Merck & Co., Inc., 126 E. Lincoln Avenue, Rahway, NJ, 07065, USA.
| | - Naomi Nomura
- Global Regulatory Affairs, Merck & Co., Inc., 126 E. Lincoln Avenue, Rahway, NJ, 07065, USA
| | - Jeffrey N Stuart
- Global Regulatory Affairs, Merck & Co., Inc., 126 E. Lincoln Avenue, Rahway, NJ, 07065, USA
| | - Gideon Blumenthal
- Global Regulatory Affairs, Merck & Co., Inc., 126 E. Lincoln Avenue, Rahway, NJ, 07065, USA
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Maués J, Loeser A, Cowden J, Johnson S, Carlson M, Lee S. The patient perspective on dose optimization for anticancer treatments: A new era of cancer drug dosing-Challenging the "more is better" dogma. Clin Trials 2024:17407745241232428. [PMID: 38385314 DOI: 10.1177/17407745241232428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
The Patient-Centered Dosing Initiative, a patient-led effort advocating for a paradigm shift in determining cancer drug dosing strategies, pioneers a departure from traditional oncology drug dosing practices. Historically, oncology drug dosing relies on identifying the maximum tolerated dose through phase 1 dose escalation methodology, favoring higher dosing for greater efficacy, often leading to higher toxicity. However, this approach is not universally applicable, especially for newer treatments like targeted therapies and immunotherapies. Patient-Centered Dosing Initiative challenges this "more is better" ethos, particularly as metastatic breast cancer patients themselves, as they not only seek longevity but also a high quality of life since most metastatic breast cancer patients stay on treatment for the rest of their lives. Surveying 1221 metastatic breast cancer patients and 119 oncologists revealed an evident need for flexible dosing strategies, advocating personalized care discussions based on patient attributes. The survey results also demonstrated an openness toward flexible dosing and a willingness from both patients and clinicians to discuss dosing as part of their care. Patient-centered dosing emphasizes dialogue between clinicians and patients, delving into treatment efficacy-toxicity trade-offs. Similarly, clinical trial advocacy for multiple dosing regimens encourages adaptive strategies, moving away from strict adherence to maximum tolerated dose, supported by recent research in optimizing drug dosages. Recognizing the efficacy-effectiveness gap between clinical trials and real-world practice, Patient-Centered Dosing Initiative underscores the necessity for patient-centered dosing strategies. A focus on individual patient attributes aligns with initiatives like Project Optimus and Project Renewal, aiming to optimize drug dosages for improved treatment outcomes at both the pre- and post-approval phases. Patient-Centered Dosing Initiative's efforts extend to patient education, providing tools to initiate dosage-related conversations with physicians. In addition, it emphasizes physician-patient dialogues and post-marketing studies as essential in determining optimal dosing and refining drug regimens. A dose-finding paradigm prioritizing drug safety, tolerability, and efficacy benefits all stakeholders, reducing emergency care needs and missed treatments for patients, aligning with oncologists' and patients' shared goals. Importantly, it represents a win-win scenario across healthcare sectors. In summary, the Patient-Centered Dosing Initiative drives transformative changes in cancer drug dosing, emphasizing patient well-being and personalized care, aiming to enhance treatment outcomes and optimize oncology drug delivery.
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Affiliation(s)
- Julia Maués
- Patient-Centered Dosing Initiative (PCDI), Metastatic Breast Cancer Alliance, New York, NY, USA
| | - Anne Loeser
- Patient-Centered Dosing Initiative (PCDI), Metastatic Breast Cancer Alliance, New York, NY, USA
| | - Janice Cowden
- Patient-Centered Dosing Initiative (PCDI), Metastatic Breast Cancer Alliance, New York, NY, USA
| | - Sheila Johnson
- Patient-Centered Dosing Initiative (PCDI), Metastatic Breast Cancer Alliance, New York, NY, USA
| | - Martha Carlson
- Patient-Centered Dosing Initiative (PCDI), Metastatic Breast Cancer Alliance, New York, NY, USA
| | - Shing Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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Wang J, Mei Y, Liang S, Li SC, Chen C, Nie G, Tuo YL, Sun D, Wang Y. How to handle a missed or delayed dose of lacosamide in pediatric patients with epilepsy? a mode-informed individual dosing. Epilepsy Behav 2024; 151:109601. [PMID: 38194771 DOI: 10.1016/j.yebeh.2023.109601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
This study aims to investigate the effects on the pharmacokinetic (PK) of lacosamide (LCM), and to guide the individual dosing regimens for children and ones with poor medication adherence. Population PK research was performed based on 164 plasma samples of 113 pediatric patients aged from 1.75 to 14.42 years old. The PK characteristic of LCM was developed by a one-compartment model with first-order elimination. The typical value of apparent clearance (CL) and apparent volume of distribution (Vd) was 1.91 L·h-1 and 56.53 L respectively. In the final model, the variability of CL was significantly associated with the body surface area (BSA) and elevated uric acid (UA) level. In contrast, the impact of some prevalent anti-seizure medicines, such as valproic acid, levetiracetam, oxcarbazepine, lamotrigine, and perampanel, and gene polymorphisms of Cytochrome P450 (CYP)2C19, ATP-binding cassette (ABC)B1, and ABCC2 had no clinical significance on the PK parameters of LCM. BSA-based dosing regimen of LCM was provided according to Monte Carlo simulation approach; while the dosage should reduce half in patients with an UA level of more than 400 μmol·L-1 comparing with an UA level of 100 μmol·L-1. Individualize remedial doses of about 0.5- to 1.5-fold of regular doses were recommended in six common scenarios of missed or delayed doses, that depended on the delayed time. In current study, the population PK model of LCM in children with epilepsy was developed successfully. The BSA-based dosing regimen and individualized remedial strategy were recommended to guarantee the precise administration of LCM.
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Affiliation(s)
- Jun Wang
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yan Mei
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Song Liang
- Department of Children's Rehabilitation, the Third People's Hospital of Hubei Province, Wuhan, China
| | - Si-Chan Li
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Chen Chen
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Gang Nie
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ya-Li Tuo
- Department of Clinical Pharmacy, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
| | - Yang Wang
- Drug Clinical Trial Agency Office, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
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Kantarjian HM, Jabbour EJ, Lipton JH, Castagnetti F, Brümmendorf TH. A Review of the Therapeutic Role of Bosutinib in Chronic Myeloid Leukemia. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00022-3. [PMID: 38278737 DOI: 10.1016/j.clml.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
The development of the BCR::ABL1 tyrosine kinase inhibitors (TKIs) has transformed Philadelphia chromosome (Ph)-positive chronic myeloid leukemia (CML) from a fatal disease to an often-indolent illness that, when managed effectively, can restore a life expectancy close to that of the normal population. Bosutinib is a second-generation TKI approved for adults with Ph-positive CML in chronic phase, accelerated phase, or blast phase that is resistant or intolerant to prior therapy, and for newly diagnosed Ph-positive chronic phase CML. This review details the efficacy of bosutinib for the treatment of CML in the first- and second-line settings, as well as in third- and later-line settings for high-risk patients resistant or intolerant to at least 2 TKIs. It also outlines bosutinib studies that provide evidence for dose-optimization strategies that can be used to improve efficacy and effectively manage adverse events. The studies that provide evidence for specific patient populations benefiting particularly from bosutinib dose-optimization strategies are also discussed. The well-established, long-term side-effect profile and the potential to make dose adjustments with bosutinib make it an appropriate treatment option for patients with CML. Bosutinib has demonstrated a positive impact on health-related quality of life and an important role in the long-term treatment of patients with CML.
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Affiliation(s)
- Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey H Lipton
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Fausto Castagnetti
- Institute of Hematology 'L. and A. Seràgnoli,' IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany; Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), Cologne, Germany
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12
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Haddad L, Saleme H, Howarth N, Tack D. Reject Analysis in Digital Radiography and Computed Tomography: A Belgian Imaging Department Case Study. J Belg Soc Radiol 2023; 107:100. [PMID: 38144871 PMCID: PMC10742225 DOI: 10.5334/jbsr.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/25/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Reject analysis is usually performed in digital radiography (DR) for quality assurance. Data for computed tomography (CT) rejects remains sparse. The aim of this study is to help provide a straightforward benchmark for reject analysis of both DR and CT. Materials and methods This retrospective observational study included 107,277 DR and 20,659 CT during 18 months in a tertiary care center. Rejected acquisitions were retrieved by Dose Archiving and Communication System (DACS). The DR and CT reject analysis included reject rates, reasons for rejection and supplementary radiation dose associated with these rejects. Results 8,904 rejected DR and 514 rejected CT were retrieved. The DR reject rate was 8.3% whereas the CT reject rate was 2.5%. The cumulative effective dose (ED) of DR rejects was 377.3 mSv while the cumulative ED of CT rejects was 1267.4 mSv. The major reason for rejects was positioning for both DR (61%) and CT (44%). Conclusion This study helps constitute a simple reproducible method to analyze both DR and CT rejects simultaneously. Although CT rejects are less often monitored than DR rejects, the radiation dose associated with CT rejects is much higher, which emphasizes the need to systematically monitor both DR and CT rejects. Investigating the reasons and the most frequently rejected examinations gives an opportunity for improvement of imaging techniques in cooperation with technologists.
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Affiliation(s)
| | - Hanna Saleme
- Department of Radiology, Epicura La Madeleine, Rue Maria Thomée, 1, 7800 Ath, Belgium
| | - Nigel Howarth
- Department of Radiology, Hislanden –Clinique des Grangettes, 7 Chemin des Grangettes, 1224 Chênes-Bougeries, Switzerland
| | - Denis Tack
- Department of Radiology, Epicura La Madeleine, Rue Maria Thomée, 1, 7800 Ath, Belgium
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Oliveira Bernardo M, Karout L, Morgado F, Ebrahimian S, Sarmet Santos A, Amorim C, Muniz Filho H, Moscatelli A, Francisco Muglia V, Schroeder H, Moulin Sales D, Gandolpho Henschel R, Giovanni Valese B, Kiipper F, Cesar Cavalcanti P, Lucena R, Jornada T, de Paula V, Zago M, Varella R, Anes M, Márcio Alves Pinheiro A, Claúdio de Moura Carvalho L, Santana de Melo Tapajos J, Antonio de Almeida F, Applegate K, Paulo G, Roberto Costa P. Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study. Eur J Radiol 2023; 169:111191. [PMID: 37976761 DOI: 10.1016/j.ejrad.2023.111191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.
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Affiliation(s)
| | - Lina Karout
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Shadi Ebrahimian
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA.
| | | | - Clarissa Amorim
- Complexo Hospitalar de Niterói, Niterói, Rio de Janeiro, Brazil.
| | | | | | - Valdair Francisco Muglia
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Henrique Schroeder
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | | | | | | | | | | | - Ronaldo Lucena
- Unimed Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tiago Jornada
- Hospital das Clínicas de Recife, Recife, Pernambuco, Brazil.
| | - Valnir de Paula
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcel Zago
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ricardo Varella
- Hospital Unimed de Vitória, Vitória, Espírito Santo, Brazil.
| | - Mauricio Anes
- Hospital das Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | | | | | - Kimberly Applegate
- University of Kentucky College of Medicine, Department of Radiology, Lexington, KY, USA.
| | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde do Instituto Politécnico de Coimbra, Coimbra, Portugal.
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Klingler S, Biel P, Tschanz M, Schulze R. CBCTs in a Swiss university dental clinic: a retrospective evaluation over 5 years with emphasis on radiation protection criteria. Clin Oral Investig 2023; 27:5627-5636. [PMID: 37522991 PMCID: PMC10492752 DOI: 10.1007/s00784-023-05184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To retrospectively evaluate all cone-beam computed tomography (CBCT) scans acquired from 2017 to 2022 in a Swiss university dental clinic with particular emphasis on radiation protection aspects. MATERIAL AND METHODS Radiological databases at the dental clinic of the University of Bern, Switzerland, were explored using a self-developed search algorithm. Data of all acquired CBCT from 01.01.2017 to 27.06.2022 were screened. Exposure parameters (exposure time, exposure angle, milliampere (mA), kilovoltage (kV), field of view (FOV) size), dose area product (DAP), age, and sex of the patient were recorded anonymously. The collected data were analyzed mainly descriptively. Correlations measured the statistical relationships between the variables. RESULTS A total of 10,348 CBCT datasets were analyzed. Patient age ranged from 5 to 96 years (mean: 49.4 years, SD: 21.6 years). The number of CBCTs in patients under 25 years was around 20% each year. In total, 10,313 (99.7%) CBCTs were acquired in small to medium FOV (FOV up to 10 cm of height), and 35 (0.3%) in large FOV (height > 10 cm). DAPs of small FOVs were 518.3 ± 233.2 mGycm2 (mean ± SD), of medium FOV 1233 ± 502.2 mGycm2, and of large FOV 2189 ± 368.7 mGycm2. DAP (ρ = 0.4048, p < 0.0001) and kV (ρ = 0.0210, p = 0.0327) correlated positively with age. Reduced scan angle correlated with young age (rpb 0.2729, p < 0.001). mA did not correlate with age (p = 0.3685). CONCLUSIONS This study demonstrates that certain well-known radiation protection aspects as the reduction of FOV, mA, kV, and scan angle were only partly considered. CLINICAL RELEVANCE Known radiation protection aspects, especially in young patients, should be fully applied in regular clinical practice.
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Affiliation(s)
- Samuel Klingler
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - Philippe Biel
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Moses Tschanz
- Information Technology (IT) Group, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Ralf Schulze
- Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
- Division of Oral Diagnostic Sciences, Department of Oral Surgery and Stomatology and Oral Diagnostics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Bai JP, Wang J, Zhang Y, Wang L, Jiang X. Quantitative Systems Pharmacology for Rare Disease Drug Development. J Pharm Sci 2023; 112:2313-2320. [PMID: 37422281 DOI: 10.1016/j.xphs.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
Though hundreds of drugs have been approved by the US Food and Drug Administration (FDA) for treating various rare diseases, most rare diseases still lack FDA-approved therapeutics. To identify the opportunities for developing therapies for these diseases, the challenges of demonstrating the efficacy and safety of a drug for treating a rare disease are highlighted herein. Quantitative systems pharmacology (QSP) has increasingly been used to inform drug development; our analysis of QSP submissions received by FDA showed that there were 121 submissions as of 2022, for informing rare disease drug development across development phases and therapeutic areas. Examples of published models for inborn errors of metabolism, non-malignant hematological disorders, and hematological malignancies were briefly reviewed to shed light on use of QSP in drug discovery and development for rare diseases. Advances in biomedical research and computational technologies can potentially enable QSP simulation of the natural history of a rare disease in the context of its clinical presentation and genetic heterogeneity. With this function, QSP may be used to conduct in-silico trials to overcome some of the challenges in rare disease drug development. QSP may play an increasingly important role in facilitating development of safe and effective drugs for treating rare diseases with unmet medical needs.
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Affiliation(s)
- Jane Pf Bai
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Jie Wang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Yifei Zhang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Lingshan Wang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Xiling Jiang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
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Lāce E, Mohammadian R, Āboltiņš A, Sosārs D, Apine I. Trade-off between the radiation parameters and image quality using iterative reconstruction techniques in head computed tomography: a phantom study. Acta Radiol 2023; 64:2618-2626. [PMID: 37469141 DOI: 10.1177/02841851231185347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Iterative reconstruction techniques (IRTs) are commonly used in computed tomography (CT) and help to reduce image noise. PURPOSE To determine the minimum radiation dose while preserving image quality in head CT using IRTs. MATERIAL AND METHODS The anthropomorphic phantom was used to scan nine head CT image series with varied radiation parameters. CT dose parameters, including volume CT dose index (CTDIvol [in mGy]) and dose length product (DLP [in mGy/cm]), were recorded for each scan series. Different noise levels (iDoseL1-6) were used in IRT reconstructions for soft and bone tissues. In total, 15 measurements were taken from five regions of interest (ROI) with an area of 10 mm2. The signal-to-noise ratio (SNR) and noise values obtained at different ROIs were compared among various reconstruction methods with repeated measures of statistical analysis. RESULTS In the head CT scan, applying IRT iDoseL5 had the lowest noise and highest SNR for soft tissue (P < 0.05), and increased iDose can decrease CT dose by 54.6% without compromising image quality. While for bone tissue reconstruction, no clear association was found between the level of iDose and noise. However, when CTDIvol is >20 mGy, iDoseL4 is slightly superior to other reconstruction methods (P < 0.065). CONCLUSION Using IRTs in head CTs reduces radiation dose while maintaining image quality. IDoseL5 provided optimal balance for soft tissue.
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Affiliation(s)
- Elīza Lāce
- Department of Radiology, Riga Stradin's University, Riga, Latvia
| | - Reza Mohammadian
- Department of Radiology, Riga Stradin's University, Riga, Latvia
| | - Ainārs Āboltiņš
- Department of Radiology, Children's Clinical University Hospital, Riga, Latvia
| | - Dāvis Sosārs
- Department of Radiology, Children's Clinical University Hospital, Riga, Latvia
| | - Ilze Apine
- Department of Radiology, Riga Stradin's University, Riga, Latvia
- Department of Radiology, Children's Clinical University Hospital, Riga, Latvia
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Yu Z, Wu L, Bunn V, Li Q, Lin J. Evolution of Phase II Oncology Trial Design: from Single Arm to Master Protocol. Ther Innov Regul Sci 2023; 57:823-838. [PMID: 36871111 DOI: 10.1007/s43441-023-00500-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023]
Abstract
The recent development of novel anticancer treatments with diverse mechanisms of action has accelerated the detection of treatment candidates tremendously. The rapidly changing drug development landscapes and the high failure rates in Phase III trials both underscore the importance of more efficient and robust phase II designs. The goals of phase II oncology studies are to explore the preliminary efficacy and toxicity of the investigational product and to inform future drug development strategies such as go/no-go decisions for phase III development, or dose/indication selection. These complex purposes of phase II oncology designs call for efficient, flexible, and easy-to-implement clinical trial designs. Therefore, innovative adaptive study designs with the potential of improving the efficiency of the study, protecting patients, and improving the quality of information gained from trials have been commonly used in Phase II oncology studies. Although the value of adaptive clinical trial methods in early phase drug development is generally well accepted, there is no comprehensive review and guidance on adaptive design methods and their best practice for phase II oncology trials. In this paper, we review the recent development and evolution of phase II oncology design, including frequentist multistage design, Bayesian continuous monitoring, master protocol design, and innovative design methods for randomized phase II studies. The practical considerations and the implementation of these complex design methods are also discussed.
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Affiliation(s)
- Ziji Yu
- , 95 Hayden Ave, Lexington, MA, 02421, USA.
- Takeda Pharmaceuticals, Lexington, USA.
| | - Liwen Wu
- Takeda Pharmaceuticals, Lexington, USA
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Liu Y, Xu L, Wang X, Wu L, Cai R, Li L, Zheng Q. Optimization of secukinumab dose regimens in patients with moderate-to-severe plaque psoriasis via exposure-response modeling. Expert Rev Clin Pharmacol 2023; 16:999-1008. [PMID: 37710355 DOI: 10.1080/17512433.2023.2259300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Further dose optimization is required for patients with moderate-to-severe plaque psoriasis who do not benefit from the approved secukinumab dose regimen. This study aimed to develop an exposure-response model for secukinumab to recommend dose regimens for patients of different body weights. METHODS We searched the PubMed and Cochrane Library databases for randomized controlled trials using PASI 75 and PASI 90 response rates as primary outcomes. A model-based meta-analysis was developed to quantitatively analyze the distribution of six secukinumab dose regimens in patients weighing 50-120 kg. RESULTS Sixteen trials involving 6,197 subjects were included in the analysis. The established model accurately described the time-course characteristics of PASI 75 and PASI 90 response rates over 52 weeks. Simulations indicated that maintenance doses could be reduced to 150 mg every 4 weeks and to 150 mg every 3 weeks for patients weighing 50 and 60 kg, respectively. In contrast, maintenance doses of 300 mg every 3 weeks should be selected for patients weighing 120 kg. Patients weighing 70-110 kg remained on approved maintenance doses of 300 mg every 4 weeks. CONCLUSIONS Based on patient body weights, the exposure-response model recommends efficacious and economical dose regimens for patients with moderate-to-severe plaque psoriasis.
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Affiliation(s)
- Yixiao Liu
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ling Xu
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinrui Wang
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lijuan Wu
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ruifen Cai
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lujin Li
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Mohammed Ali A, Al-Murshedi S. Low-cost chest paediatric phantom for dose optimisation: construction and validation. Radiologia (Engl Ed) 2023; 65:327-337. [PMID: 37516486 DOI: 10.1016/j.rxeng.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/05/2022] [Indexed: 07/31/2023]
Abstract
INTRODUCTION AND OBJECTIVES In order to perform chest dose optimisation studies, the imaging phantom should be adequate for image quality evaluation. Since high-end phantoms are cost prohibitive, there is a need for a low-cost construction method with fairly available tissue substitutes. MATERIALS AND METHODS Theoretical calculations of radiological characteristics were performed for each of lung, cortical bone and soft tissues in order to choose appropriate substitute, then, cork, P.V.C. (Polyvinyl chloride) and water were chosen, respectively. Validation included, firstly, measuring CT Hounsfield Units (HU) of a real patient's tissues then compared against their corresponding anatomies in the constructed phantom. Secondly, Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values were acquired in this study to evaluate the quality of images generated from the constructed phantom, then, compare their trends with a valid phantom under different exposure parameters (kVp and mAs). RESULTS From theoretical calculations, the percentage differences showed high accuracy of tissue substitutes when simulating real patient tissues; P.V.C. was ≥5.78%, cork was ≥4.46% and water ≥5%. The percentage difference (CT HU) between lung and cortical bone and their equivalent tissue substitutes were 10.44% and 0.53%-3.17%, respectively. Strong positive correlations were found for SNR when changing both kVp (0.79) and mAs (0.65). While the correlation strength of CNR values were found to be moderate when changing both kVp (0.58) and mAs (0.53). CONCLUSIONS Our low-cost phantom approved through CT HU that their materials replicate the radiological characteristics of real one-year-old child while SNR and SNR correlations confirmed its applicability in imaging and optimisation studies.
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Affiliation(s)
- A Mohammed Ali
- Department of Radiological Techniques, College of Health and Medical Technology, Al-Zahraa University for Women, Karbala, Iraq; Department of medical physics, College of Applied Medical Sciences, University of Kerbala, 56001 Karbala, Iraq.
| | - S Al-Murshedi
- Department of Radiological Techniques, College of Health and Medical Technology, Al-Zahraa University for Women, Karbala, Iraq
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20
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Shin Y, Chae D, Park K. Development of a population pharmacokinetic model and optimal dosing regimen of leflunomide in Korean population. Eur J Pharm Sci 2023; 184:106402. [PMID: 36754259 DOI: 10.1016/j.ejps.2023.106402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE Leflunomide is an immunosuppressive drug indicated for the treatment of rheumatoid arthritis (RA). While the pharmacokinetics (PK) of its active metabolite A771726 reportedly show large interindividual variability, no efficient dose individualization strategy is currently available. The goal of this work was to develop a population PK model for A771726 and propose an optimal individualized dosing strategy. METHODS A771726 plasma concentration data were collected from 50 healthy male volunteers participating in two leflunomide PK studies given a single oral dose of 40 mg. Concentrations were elevated in low body weight (WT) subjects and showed multiple peaks. Thus, A771726 PK modeling was conducted incorporating allometry scaling and enterohepatic circulation (EHC). For dose optimization, simulating a set of 1000 virtual subjects from the developed model and dividing the subjects into 5 groups with WT of 50, 60, 70, 80, 90 kg, respectively, the optimal dose was explored that achieves the drug concentration most similar to the target, which was defined as the concentration for the 70 kg subject treated with the current standard dosage regimen (the loading dose of 100 mg QD for 3 days, followed by the maintenance dose of 20 mg QD). RESULTS The data were best described by a two compartment model with first order absorption incorporating EHC with the bile released into the intestine. None of the covariates tested was found to be significant other than WT used in allometry. Simulation showed that the optimal loading dose increased by 15 mg for every 10 kg increment in WT while the optimal maintenance dose was 15 and 25 mg for 50 and 90 kg groups, respectively, and the same (= 20 mg) for the others. Large concentration differences from the target observed in low and high WT groups disappeared when optimal doses were given. CONCLUSIONS This work demonstrates the importance of a population PK model-based dose optimization approach in maintaining drug therapeutic concentrations in leflunomide treatment.
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Affiliation(s)
- Yesong Shin
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Korea; Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Dongwoo Chae
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Kyungsoo Park
- Department of Pharmacology, Yonsei University College of Medicine, Seoul 03722, Korea.
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21
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Soltantabar P, Lon HK, Parivar K, Wang DD, Elmeliegy M. Optimizing benefit/risk in oncology: Review of post-marketing dose optimization and reflections on the road ahead. Crit Rev Oncol Hematol 2023; 182:103913. [PMID: 36681205 DOI: 10.1016/j.critrevonc.2023.103913] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Oncology therapies shifted from chemotherapy to molecularly targeted agents and finally to the era of immune-oncology agents. In contrast to cytotoxic agents, molecularly targeted agents are more selective, exhibit a wider therapeutic window, and may maximally modulate tumor growth at doses lower than the maximum tolerated dose (MTD). However, first-in-patient oncology studies for molecularly targeted agents continued to evaluate escalating doses using limited number of patients per dose cohort assessing dose-limiting toxicities to identify the MTD which is commonly selected for further development adopting a 'more is better' approach that led to several post-marketing requirement (PMR) studies to evaluate alternative, typically lower, doses or dosing frequencies to optimize the benefit-risk profile. In this review, post-marketing dose optimization efforts were reviewed including those required by a regulatory pathway or voluntarily conducted by the sponsor to improve efficacy, safety, or method of administration. Lessons learned and future implications from this deep dive review are discussed considering the evolving regulatory landscape on dose optimization for oncology compounds.
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Affiliation(s)
| | - Hoi-Kei Lon
- Global Product Development, Pfizer Inc, San Diego, CA, USA
| | | | - Diane D Wang
- Global Product Development, Pfizer Inc, San Diego, CA, USA
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22
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Cairns KA, Abbott IJ, Dooley MJ, Peleg AY, Peel TN, Udy AA. The impact of daptomycin therapeutic drug monitoring on clinical outcomes: a systematic review. Int J Antimicrob Agents 2023; 61:106712. [PMID: 36640849 DOI: 10.1016/j.ijantimicag.2023.106712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/25/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
AIM Daptomycin therapeutic drug monitoring (TDM) is a potentially valuable intervention for a relatively new drug. The aim of this study was to determine whether daptomycin TDM, including dose adjustment where necessary, improves the clinical outcomes of adult patients with Gram-positive infections. METHODS A systematic review of English-language studies in MEDLINE (Ovid MEDLINE and Epub Ahead of Print, In-process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions), EMBASE via OVID, Cochrane Central Register of Controlled Trials via the OVID platform, Scopus and Web of Science online databases was performed and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There was no discrimination on study type or time of publication. STUDY SELECTION Adults (age ≥18 years) with a Gram-positive infection requiring treatment with daptomycin who received TDM, with subsequent reporting of serum concentrations and dose adjustment where necessary, were included. RESULTS In total, 2869 studies were identified, of which nine met the inclusion criteria. No studies of daptomycin TDM including a relevant control arm have been published to date. All of the included studies were single-arm observational cohort studies. Broad heterogeneity was observed between the studies in terms of included pathogens, infection types, daptomycin TDM practices, reported clinical outcomes, and reporting of potential confounders. CONCLUSIONS No studies exploring the efficacy of routine daptomycin TDM on patient-centred outcomes in comparison with fixed dosing regimens have been published to date. This represents a key knowledge gap as opposed to an inherent lack of efficacy. Further well-designed, comparative studies are required to determine the role of daptomycin TDM in patients with Gram-positive infections.
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Affiliation(s)
- Kelly A Cairns
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia; Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
| | - Iain J Abbott
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia; Microbiology Unit, Alfred Health, Melbourne, VIC, Australia
| | - Michael J Dooley
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia; Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia; Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Trisha N Peel
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
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Bachmann F, Koch G, Bauer RJ, Steffens B, Szinnai G, Pfister M, Schropp J. Computing optimal drug dosing with OptiDose: implementation in NONMEM. J Pharmacokinet Pharmacodyn 2023; 50:173-188. [PMID: 36707456 DOI: 10.1007/s10928-022-09840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023]
Abstract
Determining a drug dosing recommendation with a PKPD model can be a laborious and complex task. Recently, an optimal dosing algorithm (OptiDose) was developed to compute the optimal doses for any pharmacometrics/PKPD model for a given dosing scenario. In the present work, we reformulate the underlying optimal control problem and elaborate how to solve it with standard commands in the software NONMEM. To demonstrate the potential of the OptiDose implementation in NONMEM, four relevant but substantially different optimal dosing tasks are solved. In addition, the impact of different dosing scenarios as well as the choice of the therapeutic goal on the computed optimal doses are discussed.
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Affiliation(s)
- Freya Bachmann
- Department of Mathematics and Statistics, University of Konstanz, PO Box 195, 78457, Konstanz, Germany
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland.
| | | | - Britta Steffens
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland.,Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland.,Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Johannes Schropp
- Department of Mathematics and Statistics, University of Konstanz, PO Box 195, 78457, Konstanz, Germany
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24
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Kumsa MJ, Nguse TM, Ambessa HB, Gele TT, Fantaye WG, Dellie ST. Establishment of local diagnostic reference levels for common adult CT examinations: a multicenter survey in Addis Ababa. BMC Med Imaging 2023; 23:6. [PMID: 36624411 PMCID: PMC9830915 DOI: 10.1186/s12880-023-00963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In medical imaging, a computed tomography (CT) scanner is a major source of ionizing radiation. All medical radiation exposures should be justified and optimized to meet the clinical diagnosis. Thus, to avoid unnecessary radiation doses for patients, diagnostic reference levels (DRLs) have been used. The DRLs are used to identify unusually high radiation doses during CT procedures, which are not appropriate for the clinical diagnosis. It has been successfully implemented in Europe, Canada, Australia, the United States, several industrialized countries, and a few underdeveloped countries. The present study aimed to establish DRLs for the head, chest, and abdominopelvic (AP) CT procedures in Addis Ababa, Ethiopia. METHODS A pilot study identified the most frequent CT examinations in the city. At the time of the pilot, eighteen CT scan facilities were identified as having functioning CT scanners. Then, on nine CT facilities (50% of functional CT scanners), a prospective analysis of volume CT dose index (CTDIvol) and dose length product (DLP) was performed. We collected data for 838 adult patients' head, chest, and AP CT examinations. SPSS version 25 was used to compute the median values of the DLP and CTDIvol dose indicators. The rounded 75th percentile of CTDIvol and DLP median values were used to define the DRLs. The results are compared to DRL data from the local, regional, and international levels. RESULT The proposed DRLs using CTDIvol (mGy) are 53, 13, and 16 for the head, chest, and AP examinations respectively, while the DLP (mGy.cm) for the respective examinations were 1210, 635, and 822 mGy.cm. CONCLUSION Baseline CT DRLs figures for the most frequently performed in Addis Ababa were provided. The discrepancies in dose between CT facilities and as well as between identical scanners suggests a large potential for dose optimization of examinations. This can be actually achieved through appropriate training of CT technologists and continuous dose audits.
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Affiliation(s)
- Marema Jebessa Kumsa
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teklehaimanot Mezgebe Nguse
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Haleluya Biredaw Ambessa
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Tefera Gele
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemu Geteye Fantaye
- grid.7123.70000 0001 1250 5688Department of Medical Radiologic Technology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seife Teferi Dellie
- grid.7123.70000 0001 1250 5688Department of Radiology, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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25
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Umezawa Y, Sasaki K. Dose optimization of tyrosine kinase inhibitor therapy in chronic myeloid leukemia. Int J Hematol 2023; 117:24-9. [PMID: 36087226 DOI: 10.1007/s12185-022-03431-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
The therapeutic outcomes of chronic myeloid leukemia (CML) have improved dramatically since tyrosine kinase inhibitors (TKIs) became available in clinical practice. Life expectancy of patients with CML is now close to that of the general population. Patients with CML who achieve sustained deep molecular response may discontinue TKI therapy. However, most patients still require TKI therapy for long periods without sustained deep molecular response. Given the awareness of increased incidence of arterial occlusive events in patients on TKI therapy, the optimal TKI selection should be based on age, comorbidities, risk classification, and goals of treatment. Dose optimization of TKI therapy reduces the incidence of adverse events while maintaining efficacy in CML.
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26
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Zhang P, Li XN, Lu K, Wu C. A 2-in-1 adaptive design to seamlessly expand a selected dose from a phase 2 trial to a phase 3 trial for oncology drug development. Contemp Clin Trials 2022; 122:106931. [PMID: 36174958 DOI: 10.1016/j.cct.2022.106931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/10/2022] [Accepted: 09/17/2022] [Indexed: 01/27/2023]
Abstract
In oncology, dose-finding studies are largely performed only in Phase I clinical trials and the maximum tolerated dose (MTD), a dose initially developed for systemic chemotherapies, is by default selected for the Phase 3 confirmatory trial. With the advent of anti-cancer therapies such as molecular targeted agents and immunotherapies, a paradigm shift is underway from the use of conventional MTD approaches to improved dose selection strategies for oncology programs. In response to this new challenge, new study designs are needed to optimize dose selection while still bring life-changing new therapies to patients as soon as possible. In this paper, we propose a 2-in-1 adaptive design starting with a Phase 2 trial with randomized evaluation of multiple doses and only select one dose to expand to a Phase 3 trial if efficacy evidence is observed based on an interim evaluation. The lowest dose will be selected if multiple doses show promising efficacy unless the higher dose demonstrates a more compelling treatment effect, and study will be seamlessly expanded to a Phase 3 trial with the selected dose with patients enrolled in the Phase 2 portion also used for the statistical inference in the Phase 3 portion. The overall Type I error can be controlled under a mild assumption. Simulation studies are conducted to confirm the control of Type I error and to demonstrate the desirable operating characteristics of the proposed design.
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27
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Funahashi M, Kashiyama K, Nakamura T, Shiraishi J. Utilization of upper and lower limits of exposure index in clinical digital radiography. Radiol Phys Technol 2022. [PMID: 36036873 DOI: 10.1007/s12194-022-00674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
In many digital X-ray imaging systems, although air kerma on a surface of each detector is used, a standardized dose index called an exposure index (EI) has been proposed by the IEC, which is expected to be utilized for dose management. In clinical practices, EI is effectively utilized using a deviation index (DI), which is a deviation between a target EI (EIT) set for each imaging region and an EIT of the acquired image. However, an important issue in clinical uses of EI is a suppression of excessive doses. It is difficult to achieve a reliable reduction in exposure doses by indicating DI. In this study, physical image characteristics of detectors, visual detectability by charts, and observer experiments using a chest phantom were examined to determine upper (DImax) and lower (DImin) limits of the EIT and DI to achieve a reliable dose reduction in chest examinations. As the result, the tolerance ranges indicated by DImax and DImin, which were set based on the results of physical and visual evaluations, proved to be almost consistent with the distribution of EI values in 735 clinical images taken with a photo-timer control in real clinical practices.
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28
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Upadhyay SK, Chauhan PK. Optimization of eco-friendly amendments as sustainable asset for salt-tolerant plant growth-promoting bacteria mediated maize (Zea Mays L.) plant growth, Na uptake reduction and saline soil restoration. Environ Res 2022; 211:113081. [PMID: 35304115 DOI: 10.1016/j.envres.2022.113081] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/05/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
Soil salinity is progressively affecting global agriculture area, and act as a brutal environmental factor for the productivity of plants, therefore, sustainable remediation of the saline soil is urgently required. In this study, we tested the effectiveness of PM (poultry manure), SMS (spent mushroom substrate), and CD (cow dung) for the recovery of salt soil and the optimization of the productivity of the maize plant. PM and SMS showed the valuable source of OC, N, P, K as the CD. The HCA analysis showed that 47% of the bacterial population from PM, SMS, and CD survived at 6% NaCl (w/v), which had PGP attributes such as IAA, P-solubilizers, and siderophore activity. The results from pot experiments of plant growth and PCA analysis of bacterial PGP attributes reveled re formulation of PM, SMS, and CD, which were further optimized at the saline field level. T-2 treated plant increased their shoot length, chlorophyll content, reducing sugar, nitrogen, phosphorus, and potassium levels significantly after 30 and 60 days, followed by T-4 and T-3 as the control. A significant (P < 0.01) increase in particle density and decrease in bulk density was observed for all combinations treated (T-2 to T-7). A two-year field study revealed that the T-2 combination increased 43% OC, 57% N, 66% P, 48% K, 32% DHA, 76% PPO in the soil than the control after 60 days. T2-combination decreased ≈50% of Na content in root and shoot, and increased 27% of maize crop yield. The dose of 10% PM + 10% SMS can significantly induce the growth of maize plants and the restoration of saline soil health.
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Affiliation(s)
- Sudhir K Upadhyay
- Department of Environmental Science, V.B.S. Purvanchal University, Jaunpur, 222003, India.
| | - Prabhat K Chauhan
- Department of Environmental Science, V.B.S. Purvanchal University, Jaunpur, 222003, India
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Chatigny PY, Bélanger C, Poulin É, Beaulieu L. Catheters and dose optimization using a modified CVT algorithm and multi-criteria optimization in prostate HDR brachytherapy. Med Phys 2022; 49:6575-6587. [PMID: 35892205 DOI: 10.1002/mp.15878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/08/2022] [Accepted: 06/24/2022] [Indexed: 11/07/2022] Open
Abstract
Currently, in HDR brachytherapy planning, the catheter's positions are often selected by the planner which involves the planner's experience. The catheters are then inserted using a template which helps to guide the catheters. For certain applications, it is of interest to choose the optimal location and number of catheters needed for dose coverage and potential decrease of the treatment's toxicity. Hence, it is of great importance to develop patient-specific algorithms for catheters and dose optimization. A modified Centroidal Voronoi tessellation (CVT) algorithm is implemented and merged with a GPU-based multi-criteria optimization algorithm (gMCO). The CVT algorithm optimizes the catheters' positions, and the gMCO algorithm optimizes the dwell times and dwell positions. The CVT algorithm can be used simultaneously for insertion with or without a template. Some improvements to the CVT algorithm are presented such as a new way of considering the area that needs to be covered. One hundred and eight previously treated prostates HDR cases using real-time ultrasound (US) are used to evaluate the different optimization procedures. The plan robustness is evaluated using two types of errors; deviations (random) in the insertion and deviation (systematic) in the reconstruction of the catheters. Using gMCO on clinically inserted catheter increases the acceptance rate by 37% for RTOG criteria. Our results show that all the patients respect RTOG criteria with 11 catheters using CVT+gMCO with a template of 5 mm. The number of catheters needed for all patients to respect RTOG criteria with the freehand technique is 10 catheters using CVT+gMCO. When deviations are introduced, using a template, the acceptance rate goes to 85% with 3 mm deviations using 11 catheters. This decrease is less significant when the number of catheters is higher, decreasing by less than 5% with a 3 mm deviation using 13 catheters or more. In conclusion, it is feasible to decrease the number of catheters needed to treat most patients. Some cases still need a high number of catheters to reach the plan's criteria. Using gMCO allows an increase in the plan quality while using CVT reduces the number of catheters. A higher number of catheters equates to plans that are more robust to deviations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Philippe Y Chatigny
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada.,Service de physique médicale et de radioprotection, Centre intégré de cancérologie, CHU de Québec-Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada
| | - Cédric Bélanger
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada.,Service de physique médicale et de radioprotection, Centre intégré de cancérologie, CHU de Québec-Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada
| | - Éric Poulin
- Service de physique médicale et de radioprotection, Centre intégré de cancérologie, CHU de Québec-Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada
| | - Luc Beaulieu
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada.,Service de physique médicale et de radioprotection, Centre intégré de cancérologie, CHU de Québec-Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada
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30
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Lei Y, Huang Z, Huang Q, Pei F, Huang W. Dose optimization of intravenous dexamethasone for total knee arthroplasty: when two is not better than one. Arch Orthop Trauma Surg 2022; 142:665-672. [PMID: 33743063 DOI: 10.1007/s00402-021-03859-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The optimal dose regimen of dexamethasone in total knee arthroplasty (TKA) has not been determined. This study was performed to evaluate the impact of a single preoperative high-dose dexamethasone compared with two perioperative low-dose dexamethasone in TKA. MATERIALS AND METHODS We prospectively studied three regimens on dexamethasone: no dexamethasone (A), a single preoperative dose of 20-mg dexamethasone (B), and two perioperative doses of 10-mg dexamethasone (C). The primary outcome was postoperative pain level. The incidence of postoperative nausea and vomiting (PONV), use of analgesic and antiemetic rescue, interleukin-6 (IL-6) and C-reactive protein (CRP) levels, range of motion (ROM), and complications were also compared. RESULTS The dynamic pain scores and CRP and IL-6 levels were significantly lower for Group B compared to Groups A and C on postoperative days 1 and 2 (POD 1 and 2). Such differences were also detected between Groups C and A. Besides, the pain scores at rest were significantly lower in Groups B and C than in Group A on POD 1 and 2. Patients in Groups B and C had a lower incidence of PONV, reduced use of analgesic and antiemetic rescue, and improved ROM than in Group A. No complications occurred in any group. CONCLUSION Dexamethasone in TKA provides short-term advantages in analgesic, antiemetic and anti-inflammatory effects. Besides, regarding the effects of pain and inflammatory control on POD 1 and 2, a single preoperative high dose of 20-mg dexamethasone was more effective than two perioperative low doses of 10-mg dexamethasone. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Yiting Lei
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China
| | - Zeyu Huang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China
| | - Qiang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China.
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Al-Humairi A, Ip RHL, Spuur K, Zheng X, Huang B. Visual grading experiments and optimization in CBCT dental implantology imaging: preliminary application of integrated visual grading regression. Radiat Environ Biophys 2022; 61:133-145. [PMID: 34988606 DOI: 10.1007/s00411-021-00959-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 11/13/2021] [Indexed: 06/14/2023]
Abstract
This study uses a general formulation of integrated visual grading regression (IVGR) and applies it to cone beam computed tomography (CBCT) scan data related to anatomical landmarks for dental implantology. The aim was to assess and predict a minimum acceptable dose for diagnostic imaging and reporting. A skull phantom was imaged with a CBCT unit at various diagnostic exposures. Key anatomical landmarks within the images were independently reviewed by three trained observers. Each provided an overall image quality score. Statistical analysis was carried out to examine the acceptability of the images taken, using an IVGR analysis that was formulized as a three-stage protocol including defining an integrated score, development of an ordinal regression, and investigation of the possibility for dose reduction through estimated parameters. For a unit increase in the logarithm of radiation dose, the odds ratio that the integrated score for an image assessed by observers being rated in a higher category was 3.940 (95% confidence interval: 1.016-15.280). When assessed by the observers, the minimum dose required to achieve a 75% probability for an image to be classified as at least acceptable was 1346.91 mGy·cm2 dose area product (DAP), a 31% reduction compared to the 1962 mGy·cm2 DAP default dosage of the CBCT unit. The kappa values of the intra and inter-observer reliability indicated moderate agreements, while a discrepancy among observers was also identified because each, as expected, perceived visibility differently. The results of this work demonstrate the IVGR's predictive value of dose saving in the effort to reduce dose to patients while maintaining reportable diagnostic image quality.
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Affiliation(s)
- Ahmed Al-Humairi
- School of Dentistry, The University of Queensland, Herston, QLD, Australia.
| | - Ryan H L Ip
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Kelly Spuur
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Xiaoming Zheng
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Boyen Huang
- Department of Primary Dental Care, University of Minnesota School of Dentistry, Minneapolis, MN, USA
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Olanow CW, Stocchi F, Peckham EL, De Pandis MF, Sciarappa K, Navia B. Dose optimization of apomorphine sublingual film for treating "OFF" episodes in Parkinson's disease. Parkinsonism Relat Disord 2021; 93:27-30. [PMID: 34763305 DOI: 10.1016/j.parkreldis.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Apomorphine sublingual film is approved for the "on-demand" treatment of "OFF" episodes in Parkinson's disease (PD). Patients must undergo dose titration to determine their most effective and tolerable dose. We assessed whether higher doses than those that provide an initial "ON" response could yield more effective treatment. METHODS Patients with PD were assessed in the "OFF" state and the apomorphine sublingual film dose was titrated to a level that provided a tolerable "ON" response. The dose was then increased by up to two dose levels, if tolerated. A comparison in the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III scores was made following administration of the dose that provided the initial "ON" response and following the higher dose. Treatment-emergent adverse events were also reported. RESULTS Thirty-five patients were titrated to higher apomorphine sublingual film doses than those that provided an initial "ON" response. A mean improvement in MDS-UPDRS Part III score was observed compared with the initial dose of 5.6 points (P = 0.034), 4.4 points (P = 0.009), and 3.7 points (P = 0.018) at 30, 60, and 90 min postdose, respectively. Adverse events were mild or moderate and resolved with dose reduction without concomitant treatment. CONCLUSION Higher doses of apomorphine sublingual film than those initially perceived to provide an "ON" response can be tolerated and provide additional improvement in motor function in many patients.
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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Radiation dose to nurses, cardiologists, and patients during coronary angiography: a comparison of femoral and radial access. Eur J Cardiovasc Nurs 2021; 21:325-331. [PMID: 34718509 DOI: 10.1093/eurjcn/zvab096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/26/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to radiation during fluoroscopically guided cardiac procedures is a cause for concern for both the patient and staff. AIMS This study sought to compare the occupational and patient radiation dose during femoral and radially accessed invasive coronary angiography (CA). METHODS AND RESULTS Occupational dose (µSv) was measured at the left temple of the cardiologist (n = 17), scrub (n = 27), and circulator nurse (n = 27) during 761 femoral and 671 radially accessed diagnostic coronary angiograms and percutaneous coronary intervention (PCI) procedures. Patient dose parameters of dose area product (DAP) (Gy.cm2) and air kerma (AK) (Gy) were also measured. Coronary angiography performed via the radial artery is associated with greater mean dose to the cardiologist, with the exception of procedures including only PCI. Results demonstrated that scrub nurses are exposed to higher mean doses than the cardiologist when using femoral access and similar doses during radial cases. Both AK and DAP were associated with a higher average dose for femoral PCI than radial, with DAP being significantly higher. CONCLUSIONS Awareness of factors that increase the dose to staff and patients is vital to inform and improve practice. This study has demonstrated that access route during diagnostic CA and PCI influences both patient and staff dose. Radiation dose to in-room staff other than the fluoroscopic operator should be a focus of future research. In addition, all staff present during X-ray guided procedures should be provided with radiation education and adopt dose minimization strategies to reduce occupational exposures.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD 4120 Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Centre for Biomedical Technologies (CBT), Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,QMIR Berghofer Medical Research Institute, 200 Herston Road, Herston, QLD 4006 Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
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Kaur N, Pandey A, Shafiq N, Gupta A, Das R, Singh H, Ahluwalia J, Malhotra S. Genetic and Nongenetic Determinants of Variable Warfarin Dose Requirements: A Report from North India. Public Health Genomics 2021; 25:1-9. [PMID: 34673650 PMCID: PMC10233675 DOI: 10.1159/000519462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Warfarin is widely used and will continue to be prescribed especially in developing countries due to its low cost. Given the huge patient load requiring anticoagulation, there is a need to develop strategies to optimize warfarin therapy for ensuring safe and effective anticoagulation. In the present work, we aimed at elucidating the association of genetic and nongenetic variables with warfarin dose requirement in patients attending the cardiovascular clinic in a tertiary care center of North India. METHODS This was a prospective study conducted over 1 year. Patient demographic and clinical details were captured in customized case record forms. Genotyping was done using the polymerase chain reaction-restriction fragment length polymorphism method. Pharmacogenetic influence of CYP2C9 (rs1799853 and rs1057910) and VKORC1 (rs9923231) variant alleles was studied. The association of genetic and nongenetic factors with warfarin dose was quantified using a stepwise multivariate linear regression model. RESULTS Two hundred and forty patients were screened. Data from 82 eligible patients were used for quantifying the association of genetic and nongenetic factors with warfarin dose. A descriptive model based on CYP2C9*3 (rs1057910) and VKORC1 (rs9923231) variant alleles and BMI was developed. The model explains nearly half of the interindividual variation in warfarin dose requirement. CONCLUSION The model explains nearly half of the interindividual variation in warfarin dose in patients with atrial fibrillation and or requiring valve replacement.
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Affiliation(s)
- Navjot Kaur
- Department of Pharmacology, VMMC & Safdarjung Hospital, New Delhi, India
- Clinical Pharmacology Resident, Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Avaneesh Pandey
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reena Das
- Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harkant Singh
- Department of CTVS, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Alnaaimi M, Alduaij M, Algaily M, Shanawey F, Mohammedzein T, Alkandri F, Shaban M, Alenezi S. NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR NUCLEAR MEDICINE IN KUWAIT. J Nucl Med Technol 2021; 50:54-59. [PMID: 34583955 DOI: 10.2967/jnmt.121.262175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnostic reference level (DRL) is an optimization tool of patients exposure used to evaluate and provide guidance for radiation doses in medical imaging. In the past few decades, there has been a global increase in the number of diagnostic imaging procedures, including nuclear medicine procedures, and consequently the patient radiation exposure. This has encouraged international and national healthcare organizations to take actions and keep up with such changes to meet the expectations of an increasing use of ionizing radiation in medicine. The DRL in Kuwait was established by investigating the administered activity of radiopharmaceuticals and computed tomography (CT) radiation doses in hybrid imaging systems. The DRL were determined based on the 75th percentile of radiopharmaceuticals administered activity distribution as recommended by the international commission on radiation protection (ICRP). This study presents the establishment process and results of the first national DRLs for nuclear medicine procedures in Kuwait as a way to optimize radiation exposure. The DRLs determined in Kuwait are in good agreement with other published DRLs in Europe, Japan, Korea, Australia and the US.
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Affiliation(s)
| | | | | | | | | | | | - Mohamed Shaban
- Radiation Protection Department, Ministry of Health, Kuwait
| | - Saud Alenezi
- Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Kuwait
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Wang B, Warden AR, Ding X. The optimization of combinatorial drug therapies: Strategies and laboratorial platforms. Drug Discov Today 2021; 26:2646-2659. [PMID: 34332097 DOI: 10.1016/j.drudis.2021.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/19/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022]
Abstract
Designing optimal combinatorial drug therapies is challenging, because the drug interactions depend not only on the drugs involved, but also on their doses. With recent advances, combinatorial drug therapy is closer than ever to clinical application. Herein, we summarize approaches and advances over the past decade for identifying and optimizing drug combination therapies, with innovations across research fields, covering physical laboratory platforms for combination screening to computational models and algorithms designed for synergism prediction and optimization. By comparing different types of approach, we detail a three-step workflow that could maximize the overall optimization efficiency, thus enabling the application of personalized optimization of combinatorial drug therapy.
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Affiliation(s)
- Boqian Wang
- Institute for Personalized Medicine, State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, PR China
| | - Antony R Warden
- Institute for Personalized Medicine, State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, PR China
| | - Xianting Ding
- Institute for Personalized Medicine, State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, PR China.
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Kim YH, Kang P, Cho CK, Jung EH, Park HJ, Lee YJ, Bae JW, Jang CG, Lee SY. Physiologically based pharmacokinetic (PBPK) modeling for prediction of celecoxib pharmacokinetics according to CYP2C9 genetic polymorphism. Arch Pharm Res 2021; 44:713-24. [PMID: 34304363 DOI: 10.1007/s12272-021-01346-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022]
Abstract
Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) and a representative selective cyclooxygenase (COX)-2 inhibitor, which is commonly prescribed for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute pain, and primary dysmenorrhea. It is mainly metabolized by CYP2C9 and partly by CYP3A4 after oral administration. Many studies reported that CYP2C9 genetic polymorphism has significant effects on the pharmacokinetics of celecoxib and the occurrence of adverse drug reactions. The aim of this study was to develop a physiologically based pharmacokinetic (PBPK) model of celecoxib according to CYP2C9 genetic polymorphism for personalized pharmacotherapy. Initially, a clinical pharmacokinetic study was conducted where a single dose (200 mg) of celecoxib was administered to 39 healthy Korean subjects with CYP2C9*1/*1 or CYP2C9*1/*3 genotypes to obtain data for PBPK development. Based on the conducted pharmacokinetic study and a previous pharmacokinetic study involving subjects with CYP2C9*1/*13 and CYP2C9*3/*3 genotype, PBPK model for celecoxib was developed. A PBPK model for CYP2C9*1/*1 genotype group was developed and then scaled to other genotype groups (CYP2C9*1/*3, CYP2C9*1/*13 and CYP2C9*3/*3). After model development, model validation was performed with comparison of five pharmacokinetic studies. As a result, the developed PBPK model of celecoxib successfully described the pharmacokinetics of each CYP2C9 genotype group and its predicted values were within the acceptance criterion. Additionally, all the predicted values were within two-fold error range in comparison to the previous pharmacokinetic studies. This study demonstrates the possibility of determining the appropriate dosage of celecoxib for each individual through the PBPK modeling with CYP2C9 genomic information. This approach could contribute to the reduction of adverse drug reactions of celecoxib and enable precision medicine.
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Cox CPW, van Assema DME, Verburg FA, Brabander T, Konijnenberg M, Segbers M. A dedicated paediatric [ 18F]FDG PET/CT dosage regimen. EJNMMI Res 2021; 11:65. [PMID: 34279735 PMCID: PMC8289942 DOI: 10.1186/s13550-021-00812-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The role of 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) in children is still expanding. Dedicated paediatric dosage regimens are needed to keep the radiation dose as low as reasonably achievable and reduce the risk of radiation-induced carcinogenesis. The aim of this study is to investigate the relation between patient-dependent parameters and [18F]FDG PET image quality in order to propose a dedicated paediatric dose regimen. METHODS In this retrospective analysis, 102 children and 85 adults were included that underwent a diagnostic [18F]FDG PET/CT scan. The image quality of the PET scans was measured by the signal-to-noise ratio (SNR) in the liver. The SNR liver was normalized (SNRnorm) for administered activity and acquisition time to apply curve fitting with body weight, body length, body mass index, body weight/body length and body surface area. Curve fitting was performed with two power fits, a nonlinear two-parameter model α p-d and a linear single-parameter model α p-0.5. The fit parameters of the preferred model were combined with a user preferred SNR to obtain at least moderate or good image quality for the dosage regimen proposal. RESULTS Body weight demonstrated the highest coefficient of determination for the nonlinear (R2 = 0.81) and linear (R2 = 0.80) models. The nonlinear model was preferred by the Akaike's corrected information criterion. We decided to use a SNR of 6.5, based on the expert opinion of three nuclear medicine physicians. Comparison with the quadratic adult protocol confirmed the need for different dosage regimens for both patient groups. In this study, the amount of administered activity can be considerably reduced in comparison with the current paediatric guidelines. CONCLUSION Body weight has the strongest relation with [18F]FDG PET image quality in children. The proposed nonlinear dosage regimen based on body mass will provide a constant and clinical sufficient image quality with a significant reduction of the effective dose compared to the current guidelines. A dedicated paediatric dosage regimen is necessary, as a universal dosing regimen for paediatric and adult is not feasible.
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Affiliation(s)
- Christina P W Cox
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Postbus, 2040 3000 CA, Rotterdam, The Netherlands.
| | - Daniëlle M E van Assema
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Postbus, 2040 3000 CA, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Postbus, 2040 3000 CA, Rotterdam, The Netherlands
| | - Tessa Brabander
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Postbus, 2040 3000 CA, Rotterdam, The Netherlands
| | - Mark Konijnenberg
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Postbus, 2040 3000 CA, Rotterdam, The Netherlands
| | - Marcel Segbers
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Postbus, 2040 3000 CA, Rotterdam, The Netherlands
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Xiao J, Yu H, Sui X, Hu Y, Cao Y, Liu G, Zhang Y, Hu P, Wang Y, Li C, Xu B, Shi H. Can the BMI-based dose regimen be used to reduce injection activity and to obtain a constant image quality in oncological patients by 18F-FDG total-body PET/CT imaging? Eur J Nucl Med Mol Imaging 2021. [PMID: 34185138 DOI: 10.1007/s00259-021-05462-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE PET image quality is influenced by the patient size according to the current guideline. The study aimed to propose an optimized dose regimen to yield a constant image quality independent of patient habitus to meet the clinical needs. METHODS A first patient cohort of 78 consecutive oncological patients (59.7 ± 13.7 years) who underwent a total-body PET/CT scan were retrospectively enrolled to develop the regimen. The patients were randomly distributed in four body mass index (BMI) groups according to the World Health Organization (WHO) criteria. The liver SNR (signal-to-noise ratio, SNRL) was obtained by manually drawing regions of interest (ROIs) and normalized (SNRnorm) by the product of injected activity and acquisition time. Fits of SNRnorm against different patient-dependent parameters were performed to determine the best correlating parameter and fit method. A qualitative assessment on image quality was performed using a 5-point Likert scale to determine the acceptable threshold of SNRL. Thus, an optimized regimen was proposed and validated by a second patient cohort consisted of prospectively enrolled 38 oncological patients. RESULTS The linear fit showed SNRnorm had the strongest correlation (R2 = 0.69) with the BMI than other patient-dependent parameters and fit method. The qualitative assessment indicated a SNRL value of 14.0 as an acceptable threshold to achieve sufficient image quality. The optimized dose regimen was determined as a quadratic relation with BMI: injected activity (MBq) = 39.2 (MBq)/(- 0.03*BMI + 1.49)2. In the validation study, the SNRL no longer decreased with the increase of BMI. There was no significant difference of the image quality regarding the value of SNRL between different BMI groups (p > 0.05). In addition, the injected activity was reduced by 75.6 ± 2.9%, 72.1 ± 4.0%, 67.1 ± 4.4%, and 64.8 ± 3.5% compared with the first cohort for the four BMI groups, respectively. CONCLUSION The study proposed a quadratic relation between the 18F-FDG injected activity and the patient's BMI for total-body 18F-FDG PET imaging. In this regimen, the image quality can maintain in a constant level independent of patient habitus and meet the clinical requirement with a reduced injected activity.
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Hirt D, Oualha M, Pasquiers B, Blanot S, Rubinstazjn R, Glorion C, Messaoudi SE, Drummond D, Lopez V, Toubiana J, Béranger A, Boujaafar S, Zheng Y, Capito C, Winter S, Léger PL, Berthaud R, Gana I, Foissac F, Tréluyer JM, Bouazza N, Benaboud S. Population pharmacokinetics of intravenous and oral ciprofloxacin in children to optimize dosing regimens. Eur J Clin Pharmacol 2021; 77:1687-1695. [PMID: 34160669 DOI: 10.1007/s00228-021-03174-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to characterize pharmacokinetics of intravenous and oral ciprofloxacin in children to optimize dosing scheme. METHODS Children treated with ciprofloxacin were included. Pharmacokinetics were described using non-linear mixed-effect modelling and validated with an external dataset. Monte Carlo simulations investigated dosing regimens to achieve a target AUC0-24 h/MIC ratio ≥ 125. RESULTS A total of 189 children (492 concentrations) were included. A two-compartment model with first-order absorption and elimination best described the data. An allometric model was used to describe bodyweight (BW) influence, and effects of estimated glomerular filtration rate (eGFR) and age were significant on ciprofloxacin clearance. CONCLUSION The recommended IV dose of 10 mg/kg q8h, not exceeding 400 mg q8h, would achieve AUC0-24 h to successfully treat bacteria with MICs ≤ 0.25 (e.g. Salmonella, Escherichia coli, Proteus, Haemophilus, Enterobacter, and Klebsiella). A dose increase to 600 mg q8h in children > 40 kg and to 15 mg/kg q8h (max 400 mg q8h, max 600 mg q8h if augmented renal clearance, i.e., eGFR > 200 mL/min/1.73 m2) in children < 40 kg would be needed for the strains with highest MIC (16% of Pseudomonas aeruginosa and 47% of Staphylococcus aureus). The oral recommended dose of 20 mg/kg q12h (not exceeding 750 mg) would cover bacteria with MICs ≤ 0.125 but may be insufficient for bacteria with higher MIC and a dose increase according bodyweight and eGFR would be needed. These doses should be prospectively confirmed, and a therapeutic drug monitoring could be used to refine them individually.
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Affiliation(s)
- D Hirt
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France. .,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France. .,INSERM, U1018, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - M Oualha
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Réanimation et Surveillance Continue Médico-Chirurgicales Pédiatriques, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - B Pasquiers
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France
| | - S Blanot
- Service de Neurochirurgie, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - R Rubinstazjn
- Service de Réanimation Chirurgicale Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - C Glorion
- Service de Chirurgie Orthopédique et Traumatologie Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - S El Messaoudi
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France
| | - D Drummond
- Service de Pneumologie Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - V Lopez
- Service de Réanimation Cardiaque Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - J Toubiana
- Service de Pédiatrie Générale - Équipe Mobile D'infectiologie, Hôpital Necker Enfants Malades, AP-HP, Université de Paris, 149 Rue de Sèvres, 75015, Paris, France
| | - A Béranger
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Réanimation et Surveillance Continue Médico-Chirurgicales Pédiatriques, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Sana Boujaafar
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Yi Zheng
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Carmen Capito
- Service de Chirurgie Viscérale et Urologique Pédiatriques, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - S Winter
- Service d'hématologie, Immunologie et Rhumatologie Pédiatrique Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - P L Léger
- Service de Réanimation Pédiatrique, Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France
| | - R Berthaud
- Service de Néphrologie Pédiatrique, Hôpital Necker Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - Inès Gana
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - F Foissac
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - J M Tréluyer
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - N Bouazza
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Unite de Recherche Clinique Paris Descartes Necker Cochin, AP-HP, 89 rue d'Assas, 75014, Paris, France.,CIC-1419 Inserm, Cochin-Necker, 149 Rue de Sèvres, 75015, Paris, France
| | - S Benaboud
- EA7323, Evaluation des Thérapeutiques et Pharmacologie Périnatale et Pédiatrique, Université de Paris, 89 rue d'Assas, 75014, Paris, France.,Service de Pharmacologie Clinique, AP-HP, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
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Badhan RKS, Gittins R. Precision dosing of methadone during pregnancy: A pharmacokinetics virtual clinical trials study. J Subst Abuse Treat 2021; 130:108521. [PMID: 34118695 DOI: 10.1016/j.jsat.2021.108521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/05/2021] [Accepted: 05/28/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Methadone use for the management of opioid dependency during pregnancy is commonplace. Methadone levels are altered during pregnancy due to changes in maternal physiology. Despite this, a paucity of data exist regarding the most appropriate optimal dosing regimens during pregnancy. METHODS This study applied a pharmacokinetic modeling approach to examine gestational changes in R- and S-methadone concentrations in maternal plasma and fetal (cord) blood. This study did so to derive a theoretical optimal dosing regimen during pregnancy, and to identify the impact of Cytochromes P450 (CYP) 2B6 and 2C19 polymorphisms on methadone maternal and fetal pharmacokinetics. RESULTS The study noted significant decreases in maternal R- and S-methadone plasma concentrations during gestation, with concomitant increases in fetal levels. At a dose of 90 mg once daily, 75% (R-) and 94% (S-) of maternal methadone trough levels were below the lower therapeutic window at term (week 40). The developed optimal dosing regimen escalated doses to 110 mg by week 5, followed by 10 mg increments every 5 weeks up to a maximum of 180 mg once daily near term. This increase resulted in 27% (R-) and 11% (S-) of subjects with trough levels below the lower therapeutic window at term. CYP2B6 poor metabolizers (PM) and either CYP2C19 extensive metabolizers (EM), PM, or ultra-rapid (UM) metabolizer phenotypes demonstrated statistically significant increases in concentrations when compared to their matched CYP2B6 EM counterparts. CONCLUSIONS Specific and gestation-dependent dose titrations are required during pregnancy to reduce the risks associated with illicit drug use and to maintain fetal safety.
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Deevband MR, Rahmani F, Ebrahimi Bardar M, Ghorbani M. Optimization of dose and image quality in pediatrics chest digital radiography. J Med Imaging Radiat Sci 2021; 52:443-449. [PMID: 34052183 DOI: 10.1016/j.jmir.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/20/2021] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In this study, pediatric chest digital radiography (DR) is evaluated in response to the high volume of chest DR examinations and high radiosensitivity of children and young adults. The aim of the study is to optimize irradiation parameters in chest DR to have dose as low as reasonably achievable (ALARA) and simultaneously obtain improved or preserved image quality. MATERIALS AND METHODS Homogeneous phantoms in terms of density, dimensions, and composition were constructed to produce equivalent chest phantoms with less than 5% error for the 5-10 and 10-15-year-old age groups. The modulation transfer function (MTF), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured for both the reference and new conditions for the two age groups. RESULTS The results indicate that for the 5-10 year old age group, the optimized technique was 75 kVp and 6.3 mAs, in which the dose reduced 10% and the SNR and CNR increased by 0.4% and 6%, respectively, compared to the reference condition. For the 10-15-year-old age group, the 85 kVp and 5 mAs was close to the optimum condition, in which the dose reduced 37% and the SNR and CNR increased by 16% and 4%, respectively, compared to the reference condition. CONCLUSION The introduced optimized conditions in this study are accompanied by lower dose and higher SNR and CNR; therefore, they can be proposed as guides for optimization in clinical practice for pediatric chest digital radiography.
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Affiliation(s)
- Mohammad Reza Deevband
- Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Rahmani
- Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Ebrahimi Bardar
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahdi Ghorbani
- Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Soeny K, Bogacka B, Jones B. Model based dose personalization in clinical trials. Comput Methods Programs Biomed 2021; 201:105957. [PMID: 33588339 DOI: 10.1016/j.cmpb.2021.105957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Personalized medicine is an important area of medical research which consists of designing therapies specifically for a patient or a group of patients. For drugs having a narrow therapeutic index or for vulnerable patients, methods such as therapeutic drug monitoring are used in a hospital setting to ensure that the blood concentration of the drug is maintained within a pre-decided range. However, such methods can not be used for drugs which are still in the developmental phase since, generally, insufficient information is available about the pharmacokinetic behaviour of the drug. METHODS In this paper, we present a new methodology for explicit optimization of dose regimens during the course of the pharmacokinetic studies such that the resultant blood concentration of the drug in each subject is maintained around a desired target concentration or within a target range. RESULTS We demonstrate that our algorithm is able to achieve the clinical objective of PK estimation while simultaneously individualizing the dose to every subject in the trial. Our algorithm computes dose regimens that, on average, have a relative efficiency of 97% with a standard deviation of less than 5%. The results show that the algorithm can be relied upon to ensure that the subjects in the trial are minimally over- and under-exposed to the test therapy. CONCLUSIONS The proposed methodology can assist in ensuring correct dosing to each subject in a clinical trial so that each subject receives only the intended exposure to the drug while simultaneously estimating the PK profile of the drug. Our methodology can also be applied in randomized concentration-controlled trials where maintenance of the target concentration in the subjects is a fundamental requirement for conducting these trials.
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Affiliation(s)
- Kabir Soeny
- School of Mathematical Sciences, Queen Mary University of London, UK.
| | - Barbara Bogacka
- School of Mathematical Sciences, Queen Mary University of London, UK
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Guðjónsdóttir J, Paalsson KE, Sveinsdóttir GP. Are the target exposure index and deviation index used efficiently? Radiography (Lond) 2021; 27:903-907. [PMID: 33707050 DOI: 10.1016/j.radi.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Exposure index (EI) is important to evaluate correct exposure in radiography and thus important for image quality. The purpose of this study was to evaluate whether the target exposure index (EIT) and deviation index (DI) were used efficiently. METHODS Radiography departments in Iceland, using <10 years old equipment, were invited to participate. For each x-ray unit, admin users were asked about the use of EIT and data was gathered on EIT for five body parts (BP); lumbar spine, chest, hip, knee and hand. For each of the five BP, 100 examinations from the past year were selected randomly (or all, if < 100). The EI from one predefined view was recorded and the corresponding DI calculated. RESULTS A total of ten x-ray units, from four manufacturers and located at eight departments, were included in the study. The departments involved are comprised of a university hospital, smaller hospitals, and miscellaneous private departments. Two departments (25%) had not set EIT, five (62.5%) used default values and only one had revised EIT values. In four departments (50%) radiographers favored "acceptable EI range" over DI. The mean EI was significantly different (p < 0.05) from the EIT in the majority of the five BP, in four out of the six departments that had defined EIT. In total 30% of images from all departments combined had DI outside the range of -3.0 < DI < +3.0. The standard deviation of DI was from 1.4 to 2.7. CONCLUSION The study shows that the EIT and DI are not used efficiently, regardless of equipment vendor or department characteristics. IMPLICATIONS FOR PRACTICE Current recommendations on targeting the mean DI of 0 need to be reinforced. Theoretical knowledge and training need to be improved.
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Affiliation(s)
- J Guðjónsdóttir
- University of Iceland, Faculty of Medicine, Radiography, Stapa við Hringbraut 31, 101 Reykjavík, Iceland; Icelandic Radiation Safety Authority, Rauðarárstígur 10, 105 Reykjavík, Iceland.
| | - K E Paalsson
- Landspítali - the National University Hospital of Iceland, 101 Reykjavík, Iceland
| | - G P Sveinsdóttir
- University of Iceland, Faculty of Medicine, Radiography, Stapa við Hringbraut 31, 101 Reykjavík, Iceland.
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Elbakary N, Ouanes S, Riaz S, Abdallah O, Mahran I, Al-Khuzaei N, Eltorki Y. Prevalence, median time, and associated factors with the likelihood of initial antidepressant change: a cross-sectional study in Qatar. BMC Psychiatry 2021; 21:115. [PMID: 33618690 PMCID: PMC7898448 DOI: 10.1186/s12888-021-03099-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4-12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. METHODS This was a retrospective study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using several cox regression models. RESULTS A total of 487 patients met the inclusion criteria of the study, 431 (88%) of them had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44-53%]) had their IAD changed less than or equal to 30 days. The median time to IAD change was 43 days with 95% CI [33.2-52.7]. The factors statistically associated with higher hazard of IAD change were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. CONCLUSIONS Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. Our findings offered some clues to help clinicians identify the high-risk predictors of short survival and subsequent failure of IAD.
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Affiliation(s)
- Nervana Elbakary
- Department of Pharmacy, Mental Health Services, Hamad Medical Corporation, Doha, Qatar.
| | - Sami Ouanes
- grid.413548.f0000 0004 0571 546XMedical Department, Mental Health Services Hamad Medical Corporation, Doha, Qatar
| | - Sadaf Riaz
- grid.413548.f0000 0004 0571 546XDepartment of Pharmacy, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Oraib Abdallah
- grid.413548.f0000 0004 0571 546XDepartment of Pharmacy, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Islam Mahran
- grid.413548.f0000 0004 0571 546XDepartment of Pharmacy, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Noriya Al-Khuzaei
- grid.413548.f0000 0004 0571 546XDepartment of Pharmacy, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Yassin Eltorki
- grid.413548.f0000 0004 0571 546XDepartment of Pharmacy, Mental Health Services, Hamad Medical Corporation, Doha, Qatar
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Yeung AWK, Harper B, Zhang C, Neelakantan P, Bornstein MM. Do different cone beam computed tomography exposure protocols influence subjective image quality prior to and after root canal treatment? Clin Oral Investig 2020; 25:2119-2127. [PMID: 32840680 PMCID: PMC7966640 DOI: 10.1007/s00784-020-03524-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
Objectives The current study aimed to evaluate different CBCT exposure protocols and influencing factors affecting the subjective image quality of scans taken for endodontic indications. Materials and methods Twelve extracted teeth, comprising of two sets of maxillary molars, premolars, canines and incisors, mandibular premolars, and molars, were endodontically treated, and either received a fiber or metal post. The teeth were scanned by CBCT imaging before and after root canal treatment, and after post insertion. Each scan was performed thrice, using an ultra low dose (ULD), standard (SM), and high-resolution mode (HR), respectively. Twelve observers—4 endodontists, 4 periodontists, and 4 radiologists—assessed the subjective image quality using visual analogue scales (VAS). Potential influencing factors were evaluated including acquisition mode, observer specialty, stage of treatment, type of post, and type of tooth, using one-way ANOVA and T test. Results Teeth scanned with the ULD had the highest average VAS score (72.5), followed by HR (70.2), and SM (69.0) for values pooled from all teeth and observers. CBCT acquisition mode was not a significant influencing factor on the VAS scores. Observer specialty, stage of treatment, type of post, and type of tooth were significant influencing factors. Conclusions Based on the present in vitro data, a low-dose CBCT mode seems not to negatively affect the perception of image quality. Clinical relevance The findings from this in vitro study demonstrate that a low-dose CBCT mode might have potential for diagnostics prior to or following endodontic treatment.
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Affiliation(s)
- Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Basak Harper
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chengfei Zhang
- Endodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Prasanna Neelakantan
- Endodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Michael M Bornstein
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland.
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Abstract
Purpose of Review For patients with chronic phase chronic myeloid leukemia (CP-CML), there is an increasing focus on personalization of therapy with dose modifications of tyrosine kinase inhibitors (TKIs) to reduce side effects and maintain efficacy. Dose reductions are also being considered in clinical trials prior to treatment-free remission (TFR) attempts. Recent Findings Recent retrospective analyses of large clinical trials show that dose modification/reduction is safe. Efficacy is generally maintained and side effects are improved. Clinical trials such as DESTINY have demonstrated that dose reduction is safe for patients in deep molecular remission and may be considered prior to a TFR attempt. Summary Dose modifications are widely used to prevent and manage the toxicities of TKIs. With adequate monitoring, dose optimization is safe, reduces side effects, and improves quality-of-life for patients. Clinical trials of dose optimization are currently recruiting across all approved TKIs and will lead to further personalization of therapy for CP-CML patients in the future.
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Chaivichacharn P, Avihingsanon A, Manosuthi W, Ubolyam S, Tongkobpetch S, Shotelersuk V, Punyawudho B. Dosage Optimization of Efavirenz Based on a Population Pharmacokinetic-Pharmacogenetic Model of HIV-infected Patients in Thailand. Clin Ther 2020; 42:1234-1245. [PMID: 32451120 DOI: 10.1016/j.clinthera.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE Efavirenz exhibits high interindividual variability in plasma concentrations, leading to unpredictable efficacy and toxicity. Polymorphism of CYP2B6 516G > T has been found to predominantly contribute to efavirenz variability. However, dosage recommendations incorporating CYP2B6 516G > T polymorphism have not been investigated in the Thai population. This study aimed to develop a population model of the pharmacokinetic properties of efavirenz, and to investigate the impact of patients' characteristics and CYP2B6 516G > T polymorphism on the pharmacokinetic properties of efavirenz. Model-based simulations were performed to provide genotype-based dosage optimization in a Thai population. METHODS Plasma efavirenz concentrations measured at 12 h post-dose in 360 Thai HIV-infected patients with and without tuberculosis were analyzed by the nonlinear mixed-effects modeling approach. A 1-compartment model with first-order absorption and elimination was used for describing the pharmacokinetic properties of efavirenz. FINDINGS The allele frequency of CYP2B6 516G > T was 34.17%. The efavirenz oral clearance were 11.9, 8.0, and 2.8 L/h in patients weighing 57 kg and having the CYP2B6 516 GG, 516 GT, and 516 TT genotypes, respectively. The use of rifampicin increased efavirenz oral clearance by 28%. The results from the simulations suggest that efavirenz dosages of 400, 300, and 100 mg once daily in Thai HIV mono-infected patients, and 800, 600, and 200 mg once daily in HIV/tuberculosis co-infected patients carrying CYP2B6 516 GG, 516 GT, and 516 TT, respectively. IMPLICATION The results from this study provide a rationale for efavirenz dose adjustment based on CYP2B6 516G > T polymorphism in Thai HIV-infected patients, which could help to improve treatment outcomes in this population. ClinicalTrials.gov identifier: NCT01138267.
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Affiliation(s)
- Piyawat Chaivichacharn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Mueang Nonthaburi, Thailand
| | | | - Siraprapa Tongkobpetch
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Baralee Punyawudho
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
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Ter Voert EEGW, Svirydenka H, Müller J, Becker AS, Balaz M, Efthymiou V, Maushart CI, Gashi G, Wolfrum C, Betz MJ, Burger IA. Low-dose 18F-FDG TOF-PET/MR for accurate quantification of brown adipose tissue in healthy volunteers. EJNMMI Res 2020; 10:5. [PMID: 31974702 PMCID: PMC6977803 DOI: 10.1186/s13550-020-0592-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Positron emission tomography (PET) is increasingly applied for in vivo brown adipose tissue (BAT) research in healthy volunteers. To limit the radiation exposure, the injected 18F-FDG tracer dose should be as low as possible. With simultaneous PET/MR imaging, the radiation exposure due to computed tomography (CT) can be avoided, but more importantly, the PET acquisition time can often be increased to match the more extensive magnetic resonance (MR) imaging protocol. The potential gain in detected coincidence counts, due to the longer acquisition time, can then be applied to decrease the injected tracer dose. The aim of this study was to investigate the minimal 18F-FDG dose for a 10-min time-of-flight (TOF) PET/MR acquisition that would still allow accurate quantification of supraclavicular BAT volume and activity. Methods Twenty datasets from 13 volunteers were retrospectively included from a prospective clinical study. PET emission datasets were modified to simulate step-wise reductions of the original 75 MBq injected dose. The resulting PET images were visually and quantitatively assessed and compared to a 4-min reference scan. For the visual assessment, the image quality and artifacts were scored using a 5-point and a 3-point Likert scale. For the quantitative analysis, image noise and artifacts, BAT metabolic activity, BAT metabolic volume (BMV), and total BAT glycolysis (TBG) were investigated. Results The visual assessment showed still good image quality for the 35%, 30%, and 25% activity reconstructions with no artifacts. Quantitatively, the background noise was similar to the reference for the 35% and 30% activity reconstructions and the artifacts started to increase significantly in the 25% and lower activity reconstructions. There was no significant difference in supraclavicular BAT metabolic activity, BMV, and TBG between the reference and the 35% to 20% activity reconstructions. Conclusions This study indicates that when the PET acquisition time is matched to the 10-min MRI protocol, the injected 18F-FDG tracer dose can be reduced to approximately 19 MBq (25%) while maintaining image quality and accurate supraclavicular BAT quantification. This could decrease the effective dose from 1.4 mSv to 0.36 mSv.
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Affiliation(s)
- Edwin E G W Ter Voert
- Department of Nuclear Medicine, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland. .,University of Zurich, Rämistrasse 71, 8006, Zürich, Switzerland.
| | - Hanna Svirydenka
- Department of Nuclear Medicine, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.,Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Julian Müller
- Department of Nuclear Medicine, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Anton S Becker
- Department of Health Sciences and Technology, Institute of Food, Nutrition and Health, ETH Zürich, Schorenstrasse 16, 8603, Schwerzenbach, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Miroslav Balaz
- Department of Health Sciences and Technology, Institute of Food, Nutrition and Health, ETH Zürich, Schorenstrasse 16, 8603, Schwerzenbach, Switzerland
| | - Vissarion Efthymiou
- Department of Health Sciences and Technology, Institute of Food, Nutrition and Health, ETH Zürich, Schorenstrasse 16, 8603, Schwerzenbach, Switzerland
| | - Claudia Irene Maushart
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Gani Gashi
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Christian Wolfrum
- Department of Health Sciences and Technology, Institute of Food, Nutrition and Health, ETH Zürich, Schorenstrasse 16, 8603, Schwerzenbach, Switzerland
| | - Matthias J Betz
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.,Department of Nuclear Medicine, Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland
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Huang L, Maan MK, Xu D, Bakr Shabbir MA, Dai M, Yuan Z. Pharmacokinetic-pharmacodynamic modeling of cyadox against Escherichia coli in swine. Microb Pathog 2019; 135:103650. [PMID: 31376503 DOI: 10.1016/j.micpath.2019.103650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lingli Huang
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Muhammad Kashif Maan
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Dongting Xu
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Muhammad Abu Bakr Shabbir
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Menghong Dai
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China
| | - Zonghui Yuan
- National Reference Laboratory of Veterinary Drug Residues/ MAO Key Laboratory for the Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, 430070, PR China.
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