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A Iliadis

Publications and source records attributed to A Iliadis.

At least 37 records · Page 2Linked to original sources

Nonparametric density estimation applied to population pharmacokinetics.

Kinetic parameters are estimated to assess absorption, distribution, metabolism, and elimination of a drug in a subject. In a group of subjects, pharmacokinetic population studies are developed to describe the variability and to detect particular subsets by establishing the relationships between kinetic parameters and easily measurable subject characteristics, the covariates (age, body weight, etc.). The usually proposed methods are based on linear regression equations relating kinetic parameters to the covariates. We propose to measure these dependencies and describe the interindividual variability through the joint probability density function. This function is estimated by a nonparametric method superposing potential functions or kernels over the sample. In this estimation, the Shannon information theory was applied to determine the number of individuals needed to describe the variability reliably and to screen informative covariates with respect to the kinetic parameters. This approach was used to obtain the nonparametric conditional probability density functions of the kinetic parameters, given the covariates. These functions supplied prior information for a Bayesian estimation. The feasibility of the global approach was illustrated by a simulation in which nonlinear relations link covariates and pharmacokinetic parameters. The performance of this new estimator using covariates was compared with that of the usual Bayesian estimation.

Animals↗

Steady state pharmacokinetics of carbamazepine-phenobarbital interaction in patients with epilepsy.

Two carbamazepine (CBZ) tablet formulations (conventional, CBZ-CO, or controlled release, CBZ-CR) are commonly prescribed in monotherapy or in comedication with phenobarbital (PB) in the treatment of epilepsies. This study compares the pharmacokinetics of CBZ-CO against CBZ-CR in patients with epilepsies chronically treated with CBZ in monotherapy or CBZ-PB in bitherapy, the effect of PB on CBZ-CO and CBZ-CR pharmacokinetic parameters, and the effect of the two formulations of CBZ on PB pharmacokinetic parameters. The absorption rate constant (Ka), apparent steady state volume of distribution (Vdss/F), and apparent total clearance (CL/F) were computed with the APIS software using blood level profiles from 34 patients divided into four groups: patients receiving either CBZ-CO or CBZ-CR in monotherapy, or CBZ-CO or CBZ-CR in comedication with PB. The results show that the lowest dispersion of pharmacokinetic parameters was in patients receiving CBZ-CR in monotherapy. The CBZ formulation alters CBZ Ka, (Vdss/F) and (CL/F) values. CBZ (CL/F) also depends on the treatment (presence or absence of comedication by PB). In patients receiving PB in comedication with CBZ, the formulation of CBZ has no effect on PB pharmacokinetic parameters. These changes may be clinically significant and should be taken into account.

Anticonvulsants↗

Pharmacokinetics and pharmacodynamics of nitrosourea fotemustine: a French cancer centre multicentric study.

The nitrosourea, fotemustine, was given intravenously in 1 h constant-rate infusion to 66 patients in a multicentric study to assess both fotemustine pharmacokinetic behaviour and the pharmacokinetic-pharmacodynamic relationships. Depending on the tumour type treated, two administration and sampling protocols were used: 100 mg/m2/week as a conventional dose (six samples, 44 patients) and 300-500 mg/m2/day as a high dose (10 samples, 22 patients). The 91 time-concentration curves were best described by either a one-(55) or a two-compartment (36) model, and their mean clearance values did not differ significantly (85.3 +/- 6.5 and 101.3 +/- 9.5 l/h, respectively, P = 0.1727). Fotemustine pharmacokinetics were not influenced by repeated treatment (time-independence) nor by dose level (dose-independence). The pharmacodynamic effect observed on white blood cell count was expressed by a logit regression model involving the area under the curve mainly and the total administered dose. White blood cell toxicity could be predicted as a function of the dose for a given patient with a known fotemustine clearance value.

Adult↗

High tibial osteotomy in the treatment of infantile Blount's disease.

The results after high tibial osteotomy (proximal to the tibial tubercle) in 23 tibiae (17 children) with infantile Blount's disease are described. The average age at the time of surgery was 5.3 years and the average follow up 4.5 years. The surgical result was good in the tibiae with Grade A deformity. In cases with Grade B deformity a good result was obtained in 4 tibiae and there was a recurrence of the deformity in 1 case. In Grade C the result was good in 3 tibiae, fair in 1, poor in 3 and there was a recurrence of the deformity in I. In Grade D the result was good in 1 tibia, fair in 1 and there was a recurrence of the deformity in 2 cases. Overall, the less severe the degree of the deformity, the better the postoperative surgical outcome. The authors prefer the high tibial osteotomy because it provides a better correction of the varus deformity, better fixation because of the stabilizing role of the patellar ligament, and the union of the osteotomy is easier due to the cancellous bony structure in the metaphysis.

Bone Diseases↗

Anterior cruciate ligament replacement using part of the patellar tendon as a free graft.

The operative result in 91 patients who had a repair of a ruptured anterior cruciate ligament and replacement with a bone-patellar ligament-bone autogenous graft are analyzed. The average time between initial injury and operation was 2 years. Instability of the knee had been present for 6 months to 6 years and the mean follow up was 4 years. Indications for the intraarticular repair were a positive Pivot shift test and Lachman test and a positive anterior drawer sign at the preoperative examinations while under anesthesia. Seventy percent of the injuries were sports related and the remaining thirty percent injured their knee during work-related activities. Forty-eight percent (44 patients) had an associated meniscal lesion, the majority of which were on the medial side. Eighty percent of the meniscal lesions required partial meniscectomy and 20% were repaired. Eleven percent (10 patients) had an associated chondral lesion while 2 patients had a second degree of chondromalacia of the patella. The results were assessed using the Clancy criteria. Sixty eight percent (62 patients) had an excellent result, 28% (25 patients) very good, and 4 patients fair or good. The Lachman test was negative in 70% of out patients and mildly positive with a firm end point in 30%. The pivot shift test was negative in 71% and mildly positive in 29% of our patients.

Adult↗

Population pharmacokinetics of docetaxel during phase I studies using nonlinear mixed-effect modeling and nonparametric maximum-likelihood estimation.

Docetaxel, a novel anticancer agent, was given to 26 patients by short i.v. infusion (1-2 h) at various dose levels (70-115 mg/m2, the maximum tolerated dose) during 2 phase I studies. Two population analyses, one using NONMEM (nonlinear mixed-effect modeling) and the other using NPML (nonparametric maximum-likelihood), were performed sequentially to determine the structural model; estimate the mean population parameters, including clearance (Cl) and interindividual variability; and find influences of demographic covariates on them. Nine covariates were included in the analyses: age, height, weight, body surface area, sex, performance status, presence of liver metastasis, dose level, and type of formulation. A three-compartment model gave the best fit to the data, and the final NONMEM regression model for Cl was Cl = BSA(Theta1 + Theta02 x AGE), expressing Cl (in liters per hour) directly as a function of body surface area. Only these two covariates were considered in the NPML analysis to confirm the results found by NONMEM. Using NONMEM [for a patient with mean AGE (52.3 years) and mean BSA (1.68 m2)] and NPML, docetaxel Cl was estimated to be 35.6 l/h (21.2 lh-1 m-2) and 37.2 l/h with interpatient coefficients of variations (CVs) of 17.4% and 24.8%, respectively. The intraindividual CV was estimated at 23.8% by NONMEM; the corresponding variability was fixed in NPML in an additive Gaussian variance error model with a 20% CV. Discrepancies were found in the mean volume at steady state (Vss; 83.21 for NPML versus 1241 for NONMEM) and in terminal half-lives, notably the mean t1/2 gamma, which was shorter as determined by NPML (7.89 versus 12.2 h), although the interindividual CV was 89.1% and 62.7% for Vss and t1/2 gamma, respectively. However, the NPML-estimated probability density function (pdf) of t1/2 gamma was bimodal (5 and 11.4 h), probably due to the imbalance of the data. Both analyses suggest a similar magnitude of mean Cl decrease with small BSA and advanced age.

Adult↗

A limited sampling strategy for the study of pirarubicin pharmacokinetics in humans.

Pirarubicin (4'-O-tetrahydropyranyldoxorubicin, THP-Adriamycin) is a new anthracycline antibiotic that has recently been developed because its reduced cardiac toxicity is associated with an antitumour efficacy similar to that of doxorubicin. Pirarubicin is characterised by strong haematological toxicity, which has been shown to be correlated with pharmacokinetic parameters, especially the area under the time-concentration curve. To obtain routine pharmacokinetic evaluations of pirarubicin for dose monitoring we developed a limited sampling strategy relying on three blood samples taken at the end of the infusion and at 12 and 24 h post-infusion. The characteristics of interindividual variability were assessed on the first courses of treatment performed in 18 patients; the model was then validated on 10 independent first courses of treatment performed in 10 other patients. The main pharmacokinetic parameters (half-lives, total volume of distribution, total plasma clearance) were estimated in the test group by maximum-likelihood estimation using all samples and by Bayesian estimation using three samples. The concordance between the two estimates was correct (the bias and precision for clearance were 2.3% and 12.1%, respectively), which shows that this limited sampling strategy can be used in routine drug monitoring.

Adult↗

Dosage regimen calculations with optimal control theory.

In clinical pharmacokinetics, dosage regimen calculation involves determination of either: (1) the drug amount to be administered according to a set time schedule, or (2) the time schedule to be used for appropriate drug amounts. The goal is to guarantee that the time profile of circulating drug levels is between the thresholds of toxicity and efficacy. For the first case, solutions are obtained by using the property of linearity when it holds. Herein, we present several results concerning the second case. The optimal control theory allows determination of switching times between the minimal and maximal input rates in order to ensure the fastest transition from an initial state to the therapeutic levels. Fundamental results are reported and the approach is developed for drugs administered by intravenous infusion. By means of the phase trajectories, general graphical rules are presented to design the optimal control and to determine the reachable areas. A numerical example is given, comparisons of the method with others are attempted and potential developments are pointed out.

Drug Administration Schedule↗

Calculation of individual dosage regimen of cytosine arabinoside (ara-C) based on metabolite levels in leukemic cells.

Patients with acute nonlymphocytic leukemia (ANLL) were treated by continuous infusion of ara-C (100 mg/m2/d x 10 days). During ara-C treatment, cellular arabinofuranosyl cytosine triphosphate (ara-CTP) pharmacokinetics was assessed in the circulating blasts of these patients using a high-performance liquid chromatography (HPLC) and an associated radioimmunoassay. Since a strong correlation was found between achievement of complete remission and cellular ara-CTP levels, we propose a calculation scheme that allows steady-state adjustment of ara-CTP levels during administration of ara-C. To improve the complete remission rate in patients with low ara-CTP levels, we sought optimum ara-C dosing. In order to achieve an optimal therapeutic response, in vivo ara-CTP formation has to be > 50 microM in leukemic cells. Conversely, using the same pharmacokinetic approach, the infusion rate at which to administer ara-C in order to reach in vivo ara-CTP concentration threshold and to achieve complete remission could be calculated for each patient.

Arabinofuranosylcytosine Triphosphate↗

Steady state pharmacokinetics of conventional versus controlled-release carbamazepine in patients with epilepsy.

The purpose of the present study was to compare the pharmacokinetic parameters of two carbamazepine (CBZ) tablet formulations (conventional (CBZ-CO) and controlled-release (CBZ-CR)) in patients with epilepsy receiving the drug as monotherapy or polytherapy. The absorption rate constant (Ka), steady-state volume of distribution (Vdss) and total clearance (CL) were computed with the APIS software using 31 blood level profiles from 23 patients who were divided into four groups: patients receiving CBZ-CO in polytherapy, the same patients switched to CBZ-CR in the same polytherapy conditions, patients receiving CBZ-CO in monotherapy and patients receiving CBZ-CR in monotherapy. The four groups were compared in order to assess the significance of differences in Ka, Vdss, CL and diurnal fluctuations of plasma CBZ concentration. The results show a significant decrease of the Ka in the CBZ-CR groups compared to the CBZ-CO groups, both on monotherapy and on polytherapy. The comparison between the monotherapy and polytherapy groups shows increases of Vdss and CL, both in CBZ-CO and CBZ-CR polytherapy groups. Dispersion of pharmacokinetic data was higher in patients on CBZ-CO; among patients on CBZ-CR, dispersion was lowest in the monotherapy group. Clinical improvement was found in four of eight patients switched from CBZ-CO to CBZ-CR. CBZ-CR is therefore a valuable alternative to CBZ-CO.

Adolescent↗

Simultaneous modelling of mexiletine and hydroxy-methyl-mexiletine data after single- and multiple-dose administration of a sustained-release mexiletine formulation.

The pharmacokinetics of mexiletine and its metabolite hydroxy-methyl-mexiletine have been investigated following single-dose and during multiple-dose administration of a sustained-release form of mexiletine to six post-myocardial infarct patients. Comparison of single-dose and washout pharmacokinetics, after short-term multiple-dose administration, showed significant (p < 0.005), but not systematic, modifications in mexiletine apparent clearance for three patients. Furthermore, for these patients, simulation with both sets of parameters indicated that the steady-state was achieved before washout experiment in two cases. The fraction of mexiletine metabolized to hydroxy-methyl-mexiletine was lower for multiple-dose administration (about 18 per cent) than for the single dose (about 42 per cent). The hydroxy-methyl-mexiletine elimination rate constant was about four times that of mexiletine. Mexiletine clearance could be accounted for by other metabolic pathways. In one patient, hydroxy-methyl-mexiletine was undetectable even during multiple-dose administration, despite a significant increase in mexiletine clearance. However, the observed changes in mexiletine disposition had no therapeutic implications and active plasma levels were achieved by the third day of administration and maintained in the therapeutic range (0.75 to 2 micrograms ml-1) in all patients after a twice daily dosage regimen.

Aged↗

APIS: a software for model identification, simulation and dosage regimen calculations in clinical and experimental pharmacokinetics.

APIS is a software package based on mathematical modelling which provides a reliable approach in optimizing drug therapy. It was designed to assist clinicians in interpreting blood drug levels so that drug therapy may be better and more cost-effective. It is a methodological approach to describe, predict and control the kinetic behaviour of a drug. This software incorporates the principle of Bayesian procedures, i.e. one can use all available patient information (population) to determine patient-specific parameter estimates. These estimates can then be used to design an optimal and individualized drug regimen. APIS is an attractive and useful tool for clinical and experimental pharmacokinetics. APIS may be used on any IBM compatible computer using the Microsoft-Windows environment. The software is menu driven to provide a very user-friendly tool for analysing pharmacokinetic data and for designing dosage regimens.

Amikacin↗

Pharmacokinetics of mitoxantrone in cancer patients treated by high-dose chemotherapy and autologous bone marrow transplantation.

We have studied the pharmacokinetics of mitoxantrone in cancer patients. Two regimens were used: eight women (10 kinetics) received a 10 min i.v. infusion of 12 mg m-2 of mitoxantrone; seven women (seven kinetics) received high-dose mitoxantrone associated to high-dose alkylating agents and underwent autologous bone marrow transplantation (BMT). High-dose mitoxantrone was administered according to two different protocols. The drug was quantified in plasma with an HPLC assay and pharmacokinetic analysis was performed with the APIS software. Mitoxantrone pharmacokinetics were best described by an open two- (six kinetics) or an open three compartment model (11 kinetics). A large interindivual variability was observed in pharmacokinetic parameters. In the first group of patients, mean +/- s.d. values of clearance, half-life and total distribution volume were 21.41 +/- 14.59 1 h-1, 19.83 +/- 23.95 h, 165.89 +/- 134.75 1 respectively. In the high-dose group, these values were 21.68 +/- 7.30 1 h-1, 50.26 +/- 20.62 h, 413.70 +/- 194.81 1 respectively. Results showed that identification through the open 2-compartment model is certainly related to the small number of late time-points. We therefore think that mitoxantrone pharmacokinetics is generally best described by an open 3-compartment model. Clearance values showed that there was no saturation in mitoxantrone elimination, even at the highest doses. Terminal elimination half-life was probably underestimated because of the lack of late time-points in some kinetics. The half-life is long for patients receiving high-dose mitoxantrone (mean value was 50 h) and it would be hazardous to perform BMT too early after mitoxantrone infusion. Mitoxantrone metabolites were detected in the plasma of five patients receiving high-dose mitoxantrone and in one with hepatic impairment.

Adolescent↗

Revision of cemented fixation and cement-bone interface strength.

Interfacial shear strength between poly(methyl methacrylate) (PMMA) bone cement and cancellous bone was measured in bone samples from human proximal femora. Samples were prepared with fresh cement-bone, fresh cement inside a mantle of existing cement and with fresh cement-revised bone surfaces. Push-out tests to measure shear strength caused failure only at bone-cement interfaces; revised bone interfaces were 30 per cent weaker (P < 0.02) than primary interfaces. The clinical relevance is that revision of cemented joint arthroplasties may necessitate removal of components with sound cement-bone fixation. The practice of removing all traces of PMMA cement may not yield the optimal fixation; adhesion of fresh cement to freshly prepared surfaces of the existing cement might also be considered where circumstances are favourable.

Bone Cements↗

Evaluation of Bayesian estimation to discriminate subpopulations of patients with altered pharmacokinetics using fragmentary data: a pilot study with pefloxacin.

Bayesian estimation of individual pefloxacin pharmacokinetic parameters was evaluated in patients with renal (n = 34) or hepatic (n = 16) impairments who participated in experimental pharmacokinetic studies during pefloxacin development. The trials involved singly intravenous dosing (300 to 850 mg as 0.5 to 1h-infusion) and serial pefloxacin plasma level measurements (n = 10-18 over 72-96 h). Bayesian estimation used only 2 measured plasma levels (end of infusion and either 12 hour (BE 12h) or 48 hour (BE 48h) levels) and a priori information obtained in a reference population of healthy volunteers (n = 19). The performance of Bayesian estimation in predicting total plasma clearance (Cl), elimination half-life (t1/2) and steady state volume of distribution (Vss) was evaluated with respect to weighted nonlinear least-square estimates using all the data points and a two-compartment model. Pharmacokinetic parameters (and their inter-individual variability) in patients differed significantly from those of healthy volunteers (e.g. t1/2 of 22 +/- 14 h, range 6-81 h vs. 11 +/- 2 h, range 8-17, p less than 0.001). BE 12h provided biased estimates of Cl and t1/2 (24 and 28% respectively) and poor precision (30 and 53% respectively), Vss being well estimated. The BE 48h estimator had good performance with unsignificant bias (less than 1%) and good precision (extremes 13 and 27% for Cl and t1/2 respectively). Patients with hepatic impairment had the more pronounced pharmacokinetics modifications and could even be discriminated from healthy volunteers using the biased BE 12h estimates. These results suggest that Bayesian estimation is quite robust to the a priori information.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Bayesian estimation of cyclosporine clearance in bone marrow graft.

The dosage regimen of cyclosporine (CsA) can be individualized in patients by means of a test dose (TD) method in the few days before bone marrow graft. To simplify the test dosing protocol, we used a Bayesian estimation (BE) of CsA clearance requiring population data and partial kinetic information for a given patient. In the first part, 42 patients, aged 11-47 years, were given a 2-h infusion of CsA (4 mg.kg-1). CsA concentrations were determined in several blood samples. The obtained concentration-time curves were fitted according to a three-compartment model. Maximum likelihood estimation (MLE) allowed CsA determination of pharmacokinetic parameters. Early population parameters of CsA were determined using 22 TD by a two-stage method. In the remaining 20 patients, individual pharmacokinetic parameters were also computed by BE procedure, taking into account the above determined population parameters and CsA concentration determinations from three blood samples drawn at 5 and 30 min and 3 h after the end of TD infusion. In the second part, 16 patients were used to evaluate performance of BE in directly predicting target concentration values. Finally, early population characteristics were updated on the basis of 42 patients. Statistical comparisons between MLE and BE estimates of CsA clearance and between concentrations predicted after BE and those experimentally obtained showed that three blood CsA determinations allowed accurate clearance estimation and target concentration predictions. The method presented here can be used to calculate an individual CsA dosage regimen in real time, thus improving patient comfort.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Pharmacokinetics of flunitrazepam following single dose oral administration in liver disease patients compared with healthy volunteers.

The pharmacokinetic behaviour of flunitrazepam and its main active metabolite, N-desmethyl flunitrazepam, was investigated in 12 patients with liver disease (cirrhosis or hepatitis) compared to 6 healthy volunteers. A gas-liquid chromatographic method allowing for simultaneous determination of flunitrazepam and N-desmethyl flunitrazepam in plasma samples was developed. The accuracy and the precision near the quantification limit of ca. 1 ng/ml were better than 5%. Plasma levels of flunitrazepam were not significantly altered by hepatic failure, whereas plasma levels of N-desmethyl flunitrazepam were lower in patients than in healthy subjects. Pharmacokinetic parameters did not differ significantly between healthy subjects and liver disease patients: the oral clearance was 3.5 +/- 0.8, 3.5 +/- 1.9 and 4.0 +/- 1.2 ml/min/kg, respectively in healthy subjects, patients with hepatitis and patients with cirrhosis. The apparent elimination half-life was 22 +/- 5 h in healthy subjects, 25 +/- 10 h in patients with hepatitis and 20 +/- 6 h in patients with cirrhosis. However, the expected increase of the drug free fraction during liver disease could decrease the therapeutic and toxic ranges of flunitrazepam in these patients.

Administration, Oral↗

Application of Bayesian estimation for the prediction of an appropriate dosage regimen of amikacin.

A Bayesian approach was developed to determine an amikacin dosage regimen to achieve the desired plasma concentrations for each patient. Statistical characteristics of pharmacokinetic parameters were first evaluated in a group of patients (reference population), which when combined with three individual plasma concentrations of drug led to a Bayesian estimation of individual pharmacokinetic parameters. By using these parameters, an individual dosage regimen was then established to avoid residual and peak amikacin concentrations of up to 3 and 25 micrograms/mL, respectively. In a test group of 33 patients, adapted amikacin dosage regimens ranged from 4 to 43 mg/kg/d, with schedules requiring up to four infusions per day. Infusion time varied from 40 min to 4 h. These differences in drug administration protocol result from the wide interindividual variability of amikacin pharmacokinetic parameters. Performance of the developed methodology was evaluated by computing bias and precision of the estimated total body clearance and of the trough and peak amikacin concentrations that were reached after dosage regimen determinations.

Adolescent↗