Biology subjects

Augustin, D.

Publications and source records attributed to Augustin, D..

3 recordsLinked to original sources

bioRxiv2023

Simulating clinical trials for model-informed precision dosing: Using warfarin treatment as a use case

Treatment response variability across patients is a common phenomenon in clinical practice. For many drugs this inter-individual variability does not require much (if any) individualisation of dosing strategies. However, for some drugs, including chemotherapies and some monoclonal antibody treatments, individualisation of dosages are needed to avoid harmful adverse events. Model-informed precision dosing (MIPD) is an emerging approach to guide the individualisation of dosing regimens of otherwise difficult-to-administer drugs. Several MIPD approaches have been suggested to predict dosing strategies, including regression, reinforcement learning (RL) and pharmacokinetic and pharmacodynamic (PKPD) modelling. A unified framework to study the strengths and limitations of these approaches is missing. We develop a framework to simulate clinical MIPD trials, providing a cost and time efficient way to test different MIPD approaches. Central for our framework is a clinical trial model that emulates the complexities in clinical practice that challenge successful treatment individualisation. We demonstrate this framework using warfarin treatment as a use case and investigate three popular MIPD methods: 1. neural network regression; 2. deep RL; and 3. PKPD modelling. We find that the PKPD model individualises warfarin dosing regimens with the highest success rate and the highest efficiency: 75.1% of the individuals display INRs inside the therapeutic range at the end of the simulated trial; and the median time in the therapeutic range (TTR) is 74 %. In comparison, the regression model and the deep RL model have success rates of 47.9% and 65.8 %, and median TTRs of 45 % and 68 %. We also find that the MIPD models can attain different degrees of individualisation: the Regression model individualises dosing regimens up to variability explained by covariates; the Deep RL model and the PKPD model individualise dosing regimens accounting also for additional variation using monitoring data. However, the Deep RL model focusses on control of the treatment response, while the PKPD model uses the data also to further the individualisation of predictions.

pharmacology and toxicology↗

bioRxiv2022

Filter inference: A scalable nonlinear mixed effects inference approach for snapshot time series data

Variability is an intrinsic property of biological systems and is often at the heart of their complex behaviour. Examples range from cell-to-cell variability in cell signalling pathways to variability in the response to treatment across patients. A popular approach to model and understand this variability is nonlinear mixed effects (NLME) modelling. However, estimating the parameters of NLME models from measurements quickly becomes computationally expensive as the number of measured individuals grows, making NLME inference intractable for datasets with thousands of measured individuals. This shortcoming is particularly limiting for snapshot datasets, common e.g. in cell biology, where high-throughput measurement techniques provide large numbers of single cell measurements. We extend earlier work by Hasenauer et al (2011) to introduce a novel approach for the estimation of NLME model parameters from snapshot measurements, which we call filter inference. Filter inference is a new variant of approximate Bayesian computation, with dominant computational costs that do not increase with the number of measured individuals, making efficient inferences from snapshot measurements possible. Filter inference also scales well with the number of model parameters, using state-of-the-art gradient-based MCMC algorithms, such as the No-U-Turn Sampler (NUTS). We demonstrate the properties of filter inference using examples from early cancer growth modelling and from epidermal growth factor signalling pathway modelling. Author summaryNonlinear mixed effects (NLME) models are widely used to model differences between individuals in a population. In pharmacology, for example, they are used to model the treatment response variability across patients, and in cell biology they are used to model the cell-to-cell variability in cell signalling pathways. However, NLME models introduce parameters, which typically need to be estimated from data. This estimation becomes computationally intractable when the number of measured individuals - be they patients or cells - is too large. But, the more individuals are measured in a population, the better the variability can be understood. This is especially true when individuals are measured only once. Such snapshot measurements are particularly common in cell biology, where high-throughput measurement techniques provide large numbers of single cell measurements. In clinical pharmacology, datasets consisting of many snapshot measurements are less common but are easier and cheaper to obtain than detailed time series measurements across patients. Our approach can be used to estimate the parameters of NLME models from snapshot time series data with thousands of measured individuals.

bioinformatics↗

bioRxiv2022

Treatment response prediction: Is model selection unreliable?

Quantitative modelling has become an essential part of the drug development pipeline. In particular, pharmacokinetic and pharmacodynamic models are used to predict treatment responses in order to optimise clinical trials and assess the safety and efficacy of dosing regimens across patients. It is therefore crucial that treatment response predictions are reliable. However, the data available to fit models are often limited, which can leave considerable uncertainty about the best model to use. Common practice is to select the model that is most consistent with the observed data based on the Akaike information criterion (AIC). Another popular approach is to average the predictions across the subset of models consistent with the data. In this article, we argue that both approaches can lead to unreliable predictions, as treatment responses typically display nonlinear dynamics, so models can be consistent with the observed dynamics, whilst predicting incorrect treatment responses. This is especially the case when predicting treatment responses for either times or dosing regimens that go beyond the observed dynamics. Across a range of experiments on both real laboratory data and synthetically derived data on Neisseria gonorrhoeae response to ciprofloxacin, we show that probabilistic averaging of models results in more reliable treatment response predictions.

systems biology↗