Pharmacodynamic analysis of sparse data from concentration- and effect-controlled clinical trials guided by a pilot...

The purpose of this investigation was to explore, by computer simulation, the utility of two different clinical trial designs with sparse sampling (three concentration--effect measurements per subject) for population pharmacodynamic studies when the targeted drug concentration or effect measurements are determined by application of optimal sampling theory based on the results of a preceding, data-intensive pilot study. The two design paradigms were concentration-controlled and pharmacologic effect-controlled randomized clinical trials, respectively. The drug concentration--pharmacologic effect relationship was assumed to be describable by the Hill (sigmoid Emax) equation without hysteresis. Intersubject variability was represented by coefficients of variation of 30, 40, and 30% for Emax, EC50, and gamma, respectively. Random controller imprecision and measurement errors were included. Concentration and effect data for 100 subjects were generated by Monte Carlo simulation (ADAPT II), and pharmacodynamic parameter values were obtained by iterative two-stage analysis. These were then used to predict effect intensities over a range of drug concentrations, and the results were compared with those obtained by use of the true parameter values. Concentration- and effect-controlled trial designs were simulated in two forms: unconstrained and constrained with respect to the highest allowed targeted drug concentration or effect intensity. It was found that both types of unconstrained trials yielded good and comparable parameter estimates whereas the constrained trials (which are clinically more realistic) yielded more biased and imprecise estimates of individual pharmacodynamic parameters. Nevertheless, use of the latter to determine the effect intensities produced by different drug concentrations yielded good estimates but only in the range covered by the targeted concentration or effect measurements. For concentration-controlled trials it appears essential that the individuals in the pilot group and the clinical study group be drawn from the same population. Effect-controlled trials gave good results even when the pilot group was not representative of the population (e.g., for an aberrant subpopulation).