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Most dose investigation studies are clinical trials (83 of 97) that evaluate a single dosing rule.
For this approach to be pertinent there should be a high degree of confidence in the proposed dosing rule.
Finding an appropriate dosing rule for a new medicine is crucial if its benefits are to be properly evaluated.
A comprehensive comparison to other systems is hampered by the lack of rigorous reports on CPOE dosing rule development in the formal literature.
Otherwise, if it is found to be inadequate, the findings of a single arm PK study can be extrapolated to inform selection of an alternative dosing rule only under strong assumptions, i.e. assumptions that have far reaching clinical consequences yet are supported by limited evidence, in this case dose proportionality.
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Dr Pam Brown, a GP from Swansea, said many patients stopped taking their therapy because osteoporosis was often symptom-free and the strict dosing rules and side-effects made taking it difficult.
Efficacy trials give an opportunity for proposed dosing rules to be assessed against clinical outcomes.
Of the 18 fixed dose strategy trials evaluating two or more dosing rules, 14 and four trials planned to compare two and three rules, respectively.
If a PIP stipulated two dose investigation studies to determine dosing rules for the medicine when administered as monotherapy and adjunctive therapy, we extracted information for both.
PK data alone will be used in 33 studies to guide dose selection with most (25/33) determining dosing rules by targeting levels of exposure seen in older subjects.
If relevant data are numerous, the need for a clinical trial in children may be obviated entirely, with dosing rules supported by modelling and simulation (M&S) alone.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com