Applied Concepts in PBPK Modeling: How to Build a PBPK/PD Model.

The aim of this tutorial is to introduce the fundamental concepts of physiologically based pharmacokinetic/pharmacodynamic (PBPK/PD) modeling with a special focus on their practical implementation in a typical PBPK model building workflow. To illustrate basic steps in PBPK model building, a PBPK model for ciprofloxacin will be constructed and coupled to a pharmacodynamic model to simulate the antibacterial activity of ciprofloxacin treatment.

Generating Virtual Patients by Multivariate and Discrete Re-Sampling Techniques.

PURPOSE: Clinical Trial Simulations (CTS) are a valuable tool for decision-making during drug development. However, to obtain realistic simulation scenarios, the patients included in the CTS must be representative of the target population. This is particularly important when covariate effects exist that may affect the outcome of a trial. The objective of our investigation was to evaluate and compare CTS results using re-sampling from a population pool and multivariate distributions to simulate patient covariates. METHODS: COPD was selected as paradigm disease for the purposes of our analysis, FEV1 was used as response measure and the effects of a hypothetical intervention were evaluated in different populations in order to assess the predictive performance of the two methods. RESULTS: Our results show that the multivariate distribution method produces realistic covariate correlations, comparable to the real population. Moreover, it allows simulation of patient characteristics beyond the limits of inclusion and exclusion criteria in historical protocols. CONCLUSION: Both methods, discrete resampling and multivariate distribution generate realistic pools of virtual patients. However the use of a multivariate distribution enable more flexible simulation scenarios since it is not necessarily bound to the existing covariate combinations in the available clinical data sets.

Prediction of disease progression, treatment response and dropout in chronic obstructive pulmonary disease (COPD).

PURPOSE: Drug development in chronic obstructive pulmonary disease (COPD) has been characterised by unacceptably high failure rates. In addition to the poor sensitivity in forced expiratory volume in one second (FEV1), numerous causes are known to contribute to this phenomenon, which can be clustered into drug-, disease- and design-related factors. Here we present a model-based approach to describe disease progression, treatment response and dropout in clinical trials with COPD patients. METHODS: Data from six phase II trials lasting up to 6 months were used. Disease progression (trough FEV1 measurements) was modelled by a time-varying function, whilst the treatment effect was described by an indirect response model. A time-to-event model was used for dropout RESULTS: All relevant parameters were characterised with acceptable precision. Two parameters were necessary to model the dropout patterns, which was found to be partly linked to the treatment failure. Disease severity at baseline, previous use of corticosteroids, gender and height were significant covariates on disease baseline whereas disease severity and reversibility to salbutamol/salmeterol were significant covariates on Emax for salmeterol active arm. CONCLUSION: Incorporation of the various interacting factors into a single model will offer the basis for patient enrichment and improved dose rationale in COPD.

Concentration and surface of absorption: concepts and applications to gastrointestinal patches delivery.

Gastrointestinal patches represent a novel multiparticulate drug delivery system able to increase the intestinal absorption of drugs with poor bioavailability. The number of patches to administer is a critical issue since it is related to the surface and drug concentration at the absorption site. The objective of this article is to evaluate the effect of the number of administered patches on the final absorption of leuprolide, a peptide chosen as model drug, assuming complete adhesion of all the devices to the intestinal membrane. The same dose of leuprolide was encapsulated into 2, 4 and 6 patches; the resulting intestinal absorption profiles were measured with the Ussing chamber ex vivo experimental setup and compared between them. The results showed that varying the number of patches, the final absorption does not present statistically significant changes, indicating that changes in concentration are balanced by change in absorption surface. These experimental findings can also be explained considering the equation that links the drug flow to surface and concentration at the absorption site, showing that the drug flow is related only to the geometry of each individual patch.

Characterization of chitosan thiolation and application to thiol quantification onto nanoparticle surface.

The objective of the present work was to establish a simple and appropriated method for the quantification of thiol groups standing on the surface of core-shell nanoparticles elaborated with poly(isobutyl cyanoacrylates) and thiolated chitosan. A critical analysis of the widely used Ellman's method for the determination of thiol groups in various compounds was made. The reduced solubility of the thiolated polymer at the optimal pH of the Ellman's assay (pH 8-8.5) made difficult the accessibility of the Ellman's reagent to thiol groups in the cross-linked polymer. Furthermore, the lack of stability of the Ellman's reaction with time lead to the conclusion that the Ellman's method was of limited value to evaluate thiol groups in thiolated polymers like thiolated chitosan. An alternative and very simple thiol quantification method was developed on the bases of the classical iodine titration. The new method allowed the determination of thiol groups in small amount of samples at acidic pH, and the monitoring of the thiol determination kinetic with time. It was successfully applied to the quantification of active thiol groups on the surface of poly(isobutyl cyanoacrylates) nanoparticles coated with thiol chitosan.

Information campaign planned for Kyrgyzstan.

PIP: It is tradition in Kyrgyzstan to have large families. Siblings, however, are born soon after each other, causing serious health problems and sometimes death for the mothers and newborn infants. After the country gained independence in 1991, the government introduced a program to reduce maternal and infant mortality by increasing the use of family planning. The program has already met with some success; between 1991 and 1996, the level of contraceptive use among reproductive-age women increased from almost 22% to almost 33%. However, while the level of family planning practice has increased, the range of methods used remains limited to IUD and abortion. Other methods constitute only a small percentage of contraceptives used, and use of modern methods such as oral contraceptive pills is concentrated in the capital city of Bishkek. This continued dependence upon IUD and abortion has been attributed to a lack of information among both service providers and the public about the range of methods available. AVSC is involved in several efforts to increase the level of related awareness. There is also an urgent need in the country for family planning education materials. With funding from the UN Population Fund, AVSC is working with the Kyrgyzstan Ministry of Health and the Republican Health Education Center on an IEC campaign, to be launched in fall 1998, with the aim of teaching the public about contraception to increase birth spacing and prevent unintended pregnancies.^ieng