PHARMACODYNAMICS OF VARIABLE PATIENT COMPLIANCE - IMPLICATIONS FOR PHARMACEUTICAL VALUE

Authors
Citation
J. Urquhart, PHARMACODYNAMICS OF VARIABLE PATIENT COMPLIANCE - IMPLICATIONS FOR PHARMACEUTICAL VALUE, Advanced drug delivery reviews, 33(3), 1998, pp. 207-219
Citations number
36
Categorie Soggetti
Pharmacology & Pharmacy
ISSN journal
0169409X
Volume
33
Issue
3
Year of publication
1998
Pages
207 - 219
Database
ISI
SICI code
0169-409X(1998)33:3<207:POVPC->2.0.ZU;2-U
Abstract
Pharmaceutical value, a multidimensional factor that includes proven e fficacy, is now crucial to market success. A key parameter of value is reliability in use, determined by the several sources of variance in drug response, e.g. the Harter-Peck model, based on linear pharmacomet rics of theophylline, whose dose-response has an estimated 80% coeffic ient of variation, due mainly to variable pharmacokinetics and non-com pliance. The main forms of non-compliance are multiday intervals betwe en doses, the impact of which is difficult to assess because too littl e is known of the time-course of drug actions after dosing stops ('off -responses'). Omeprazole, the best-selling drug, is an exception, and its off-response data reveal markedly non-linear pharmacodynamics that appear to filter most of the variance that a linear model passes, pro jecting a big gain in reliability. The impact of variable compliance i s attenuated by 'forgiveness', the post-dose duration of effective act ion (4-5 days for omeprazole) minus its recommended dosing interval. ( C) 1998 Elsevier Science B.V. All rights reserved.