Neely Michael, Jelliffe Roger
Laboratory of Applied Pharmacokinetics, Keck School of Medicine, University of Southern California, Los Angeles, USA.
J Clin Pharmacol. 2008 Sep;48(9):1081-91. doi: 10.1177/0091270008321789. Epub 2008 Jul 17.
Individualized, model-based, target-oriented optimal concentration-controlled dosing of HIV medications can be beneficial to patients for whom there are limited dosing guidelines, such as children, adolescents, or patients with altered physiologic function. Barriers to this approach include lack of training, expertise, and access to appropriate software to assist the clinician. The authors present 4 illustrative clinical cases of HIV-infected patients whose therapy was optimized using population pharmacokinetic models (here generated from published studies) and supplemented by individualized Bayesian adaptive control of dosage regimens as implemented in the MM-USCPACK software. These 4 cases illustrate how clinicians can maximize therapeutic success in (1) patients with reduced drug clearance, (2) young adolescents transitioning to adult physiology, (3) patients with dose-dependent toxicity, and (4) adolescents with limited therapeutic options.
针对人类免疫缺陷病毒（HIV）药物进行个体化、基于模型、目标导向的最佳浓度控制给药，对于那些给药指南有限的患者，如儿童、青少年或生理功能改变的患者可能有益。这种方法的障碍包括缺乏培训、专业知识以及获取适当软件以协助临床医生。作者介绍了4例HIV感染患者的典型临床病例，这些患者的治疗通过群体药代动力学模型（此处根据已发表的研究生成）进行优化，并辅以MM-USCPACK软件中实施的个体化贝叶斯剂量方案自适应控制。这4个病例说明了临床医生如何在以下情况中实现治疗成功最大化：（1）药物清除率降低的患者；（2）向成人生理状态转变的青少年；（3）具有剂量依赖性毒性反应的患者；（4）治疗选择有限的青少年。
