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These paradigm shifts are being informed by new approaches for dose measurement.
This had no effect on our comparison of the different approaches for dose reconstruction but absolutely needs to be considered for accurate dose reconstruction and comparison with acceptable daily intakes.
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Pharmacokinetic/pharmacodynamic (PK/PD) modeling is the dominant approach for dose and dosing regimen selection in drug discovery and development.
However, the current empirical and trial-and-error approach for dose escalation often results in a lengthy titration process and is not strictly implemented in many clinics.
A validated approach for dose adjustment is not currently available.
Suggestions are provided here for an alternative PK-PD approach for dose finding which, if validated, may improve and accelerate dose finding and so avoid systematic underprescribing and thus underdosing.
Therefore, a rational approach for dose selection that considers both safety and efficacy should precede the standard PK study, especially for drugs with renal excretion and low therapeutic range.
An alternative approach for dosing meal-time insulin in type 1 diabetes, the food insulin index (FII), recently has been shown to be better than carbohydrate counting in estimating the optimal doses required to cover high-carbohydrate meals (22).
Recommendations included better links between the risk management question and risk assessment design, more explicit account of uncertainty and variability and a harmonized approach for dose-response assessment [ 3].
Sponsors have used different MABEL approaches for FIH dose selection.
The approach used for dose and risk assessment from potential exposure of accidental releases and their comparison with acceptance criteria are presented.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com