在IIa期肺结核试验中使用多维细菌负载建模的多维细菌负载建模来确定暴露-反应关系的权力
Simon E Koele1, Thomas P C Dorlo2, Caryn M Upton3
1Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen, The Netherlands.
CPT: pharmacometrics & systems pharmacology
|December 16, 2023
概括
在结核病 (TB) 临床试验中确定暴露-反应关系至关重要. 时间到阳性 (TTP) 标记器为药理动力学-药理动力学 (PK-PD) 建模提供了比殖民地形成单位 (CFU) 更大的功率,特别是在结合数据或不平衡设计的情况下.
科学领域:
- 药理动力学和药理动力学
- 临床试验设计 临床试验设计
- 传染病建模 传染病建模
背景情况:
- 在结核病 (TB) 临床试验IIa阶段中,准确识别暴露-反应关系对于有效的剂量选择和随后的研究设计至关重要.
- 提高药理动力学-药理动力学 (PK-PD) 模型在识别这些关系方面的功率的最佳反应标记仍然不清楚.
研究的目的:
- 评估和比较不同响应标志物的力量,特别是殖民地形成单位 (CFU) 和时间到阳性 (TTP),在确定结核病药物的PK-PD建模框架内的暴露-响应关系.
- 评估数据分析策略,包括结合CFU和TTP数据以及不平衡的研究设计对检测这些关系的能力的影响.
主要方法:
- 对四种假设的结核病药物进行CFU和TTP测量的模拟,在14天内具有不同的活性概况.
- 使用CFU,TTP或组合CFU + TTP数据确定暴露-反应关系的统计能力的确定.
- 在平衡和不平衡 (最低/最高剂量组中的25/60名参与者) 两种研究设计下对功率的评估,共有60名参与者.
主要成果:
- 对于具有中度杀菌活性的结核病药物,无论使用哪种标志物,识别暴露-反应关系的能力始终很低 (<59%).
- 与CFU数据相比,对TTP数据的分析表明功率显著更高 (增加1.9%至29.4%).
- 对CFU和TTP数据的综合分析显示,功率平均有4.2%的轻微改善. 不平衡的设计比平衡的设计提高了16%的功率.
- 为了达到中高活性药物的80%功率,CFU的样本大小为136,TTP的样本大小为72,CFU+TTP数据的样本大小为68.
结论:
- 对于表现出中度杀菌活性或缓慢开始作用的结核病药物,建立暴露-反应关系的能力是有限的.
- 在确定这些关系时,PK-PD模型中,时间到阳性 (TTP) 成为比殖民地形成单位 (CFU) 更强大的响应标志物.
- 对CFU和TTP数据的综合分析,或实施不平衡剂量组研究设计,可以在统计能力方面逐步改善.
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