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The pharmacokinetics of infliximab are highly variable in children with Crohn's disease (CD), and a one-size-fits-all approach to dosing is inadequate.
Until drug assays are routinely available, a personalized approach to dosing should be considered for each patient based on local AMS.
Patients may have an "as needed" approach to dosing, taking doses to treat symptoms or lessen side effects (Dunbar-Jacob and Mortimer-Stephens 2001; Marder 2003; Pound et al. 2005).
Given the sources of beta-lactam pharmacokinetic variability highlighted, Ulldemolins and colleagues suggest a general approach to dosing of patients.
Similarly, the lack of a pharmacokinetic pharmacodynamic relationship for cisplatin may explain why such an approach to dosing has not been established for this drug.
In patients receiving CRRT, there is great variability in antibiotic pharmacokinetics, which complicates an empiric approach to dosing and suggests the need for therapeutic drug monitoring.
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Besides, Toutain and Lees thought that the parameters derived from PK/PD modelling may be used as an alternative and preferred approach to dose titration studies for selecting rational dosage regimens (both dose and dosing interval) for further evaluation in clinical trials [ 3].
An alternative approach to dose escalation to increase systemic 4-HPR levels is pharmacological modulation of 4-HPR metabolism.
This has been referred to as a "physiologic approach" to dose selection (vom Saal et al. 1998).
In a conventional approach to dose finding, the doses need to be reduced early in the phase 2 studies to determine which concentration profiles are necessary for cure.
We recommend a flexible, tailor-made approach to dose adjustments based on the severity of observed AEs and responses to changes in dose levels.
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