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European journal of clinical pharmacology
Dec, 2021;77 (12): 1909-1917.

External evaluation of published population pharmacokinetic models of polymyxin B.

Ya-Qian Li, Kai-Feng Chen, Jun-Jie Ding, Hong-Yi Tan, Nan Yang, Ya-Qi Lin, Cui-Fang Wu, Yue-Liang Xie, Guo-Ping Yang, Jing-Jing Liu, Qi Pei
Author Information
  1. Ya-Qian Li: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  2. Kai-Feng Chen: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  3. Jun-Jie Ding: Center for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
  4. Hong-Yi Tan: Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  5. Nan Yang: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  6. Ya-Qi Lin: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  7. Cui-Fang Wu: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  8. Yue-Liang Xie: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  9. Guo-Ping Yang: Center for Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
  10. Jing-Jing Liu: Department of Intensive Medicine, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China. Liujj@126.com.
  11. Qi Pei: Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China. peiqi1028@126.com. ORCID
PMID: 34342716 DOI: 10.1007/s00228-021-03193-y

Abstract

OBJECTIVES: Several population pharmacokinetics (popPK) models for polymyxin B have been constructed to optimize therapeutic regimens. However, their predictive performance remains unclear when extrapolated to different clinical centers. Therefore, this study aimed to evaluate the predictive ability of polymyxin B popPK models.
METHODS: A literature search was conducted, and the predictive performance was determined for each selected model using an independent dataset of 20 patients (92 concentrations) from the Third Xiangya Hospital. Prediction- and simulation-based diagnostics were used to evaluate model predictability. The influence of prior information was assessed using Bayesian forecasting.
RESULTS: Eight published studies were evaluated. In prediction-based diagnostics, the prediction error within ± 30% was over 50% in two models. In simulation-based diagnostics, the prediction- and variability-corrected visual predictive check (pvcVPC) showed satisfactory predictivity in three models, while the normalized prediction distribution error (NPDE) tests indicated model misspecification in all models. Bayesian forecasting demonstrated a substantially improvement in the model predictability even with one prior observation.
CONCLUSION: Not all published models were satisfactory in prediction- and simulation-based diagnostics; however, Bayesian forecasting improved the predictability considerably with priors, which can be applied to guide polymyxin B dosing recommendations and adjustments for clinicians.

Keywords

External evaluation Polymyxin B Population pharmacokinetics

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MeSH Term

Bayes Theorem
Humans
Immunosuppressive Agents
Models, Biological
Polymyxin B

Chemicals

Immunosuppressive Agents
Polymyxin B
Journal Article

Word Cloud

Created with Highcharts 10.0.0modelsBpolymyxinpredictivemodeldiagnosticssimulation-basedpredictabilityBayesianforecastingpublishedpopulationpharmacokineticspopPKperformanceevaluateusingpriorpredictionerrorprediction-satisfactoryExternalevaluationOBJECTIVES:SeveralconstructedoptimizetherapeuticregimensHoweverremainsunclearextrapolateddifferentclinicalcentersThereforestudyaimedabilityMETHODS:literaturesearchconducteddeterminedselectedindependentdataset20patients92concentrationsThirdXiangyaHospitalPrediction-usedinfluenceinformationassessedRESULTS:Eightstudiesevaluatedprediction-basedwithin ± 30%50%twovariability-correctedvisualcheckpvcVPCshowedpredictivitythreenormalizeddistributionNPDEtestsindicatedmisspecificationdemonstratedsubstantiallyimprovementevenoneobservationCONCLUSION:howeverimprovedconsiderablypriorscanappliedguidedosingrecommendationsadjustmentsclinicianspharmacokineticPolymyxinPopulation

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