为什么是最大耐受剂量？
Why maximum tolerated dose?
机构信息
Division of Psychiatry, Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia.
Department of General Medicine, Royal Adelaide Hospital, Adelaide, South Australia.
出版信息
Br J Clin Pharmacol. 2019 Oct;85(10):2213-2217. doi: 10.1111/bcp.14032. Epub 2019 Jul 22.
Abstract
A long-established approach to the pharmacological treatment of disease has been to start low and go slow. However, clinicians often prescribe up to maximum tolerated dose (MTD), especially when treating acute and more severe disease, without evidence to show that MTD is more likely to improve outcomes. Cardiovascular guidelines for some indications advocate MTD even in prevention, for example hypercholesterolaemia, without compelling evidence of better outcomes. This review explores the origins and potential problems of prescribing medications at MTD. Oral effective dose 50 (ED50) may be a useful guide for balancing efficacy and safety.
摘要
长期以来，治疗疾病的药理学方法一直是从低剂量开始，逐渐增加剂量。然而，临床医生经常开出最大耐受剂量（MTD）的药物，尤其是在治疗急性和更严重的疾病时，而没有证据表明 MTD 更有可能改善治疗效果。对于某些适应症，心血管指南甚至主张在预防中使用 MTD，例如高胆固醇血症，尽管没有更好的结果的有力证据。本综述探讨了在 MTD 下开处方的起源和潜在问题。口服有效剂量 50（ED50）可能是平衡疗效和安全性的有用指南。
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