Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck & Co., Inc., Kenilworth, NJ, USA.
J Pharmacokinet Pharmacodyn. 2018 Jun;45(3):355-364. doi: 10.1007/s10928-018-9571-3. Epub 2018 Jan 20.
Cardiovascular disease remains a significant global health burden, and development of cardiovascular drugs in the current regulatory environment often demands large and expensive cardiovascular outcome trials. Thus, the use of quantitative pharmacometric approaches which can help enable early Go/No Go decision making, ensure appropriate dose selection, and increase the likelihood of successful clinical trials, have become increasingly important to help reduce the risk of failed cardiovascular outcomes studies. In addition, cardiovascular safety is an important consideration for many drug development programs, whether or not the drug is designed to treat cardiovascular disease; modeling and simulation approaches also have utility in assessing risk in this area. Herein, examples of modeling and simulation applied at various stages of drug development, spanning from the discovery stage through late-stage clinical development, for cardiovascular programs are presented. Examples of how modeling approaches have been utilized in early development programs across various therapeutic areas to help inform strategies to mitigate the risk of cardiovascular-related adverse events, such as QTc prolongation and changes in blood pressure, are also presented. These examples demonstrate how more informed drug development decisions can be enabled by modeling and simulation approaches in the cardiovascular area.
心血管疾病仍然是全球重大的健康负担,在当前的监管环境下开发心血管药物通常需要进行大规模且昂贵的心血管结局试验。因此,使用定量药理学方法可以帮助早期做出是否继续进行的决策,确保选择适当的剂量,并提高临床试验成功的可能性,这对于降低心血管结局研究失败的风险变得越来越重要。此外,心血管安全性是许多药物开发项目的重要考虑因素,无论药物是否旨在治疗心血管疾病;建模和模拟方法在评估该领域的风险方面也具有实用性。本文介绍了在药物开发的各个阶段(从发现阶段到后期临床开发)应用于心血管项目的建模和模拟示例。还介绍了在各个治疗领域的早期开发计划中如何利用建模方法来帮助制定策略以降低与心血管相关的不良事件(如 QTc 延长和血压变化)风险的示例。这些示例展示了如何通过心血管领域的建模和模拟方法来做出更明智的药物开发决策。