Chapter 25

Bayesian Analysis of Clinical Data

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Bayesian Analysis of Clinical Data

Monitoring drug disposition in patients can be challenging. Drug regimens may not be constant and only a small number of drug concentration sample may be available. Fortunately, the drug registration process requires extensive pharmacokinetic studies. Combining prior population pharmacokinetic data with a few data points from the potient of interest allows for a better understanding of the drug disposition in this patient. Bayesian pharmacokinetic analysis allows the integration of population information with patient data. The parameters of the pharmacokinetic model are adjusted to best-fit both the population and patient data. A different objective function is required to include both of these observations.

Equation 25.4.1 Objective Function for Bayesian Optimization

Note the use of variance instead of weight in this objective function, Equation 25.4.1. Realistic values for the data variance (and thus weight) must be balanced with variance of each population parameter. The inclusion of patient data and population data provides the ability to estimate parameters in the patient for improved drug regimen recommendations.

In this section we will briefly describe how to set up one non-linear regression program, Boomer.

Program Set-up

As an example we can consider a patient given theophylline by IV infusion over 30 minutes. Population values for clearance, CL and V can be found in the text by Evans, Schentag and Jusko, 1992, chapter 13. Values of these parameters vary in patients with various disease states but for a 'normal' patients (70 Kg)) the values in Table 25.4.1 may be used as an example.

Table 25.4.1 Typical Parameter Values

Parameter Mean Value Standard Deviation Variance
V (L) 30.1 4.2 17.6
Clearance (L/hr) 3.61 1.47 2.16

Figure 25.4.1 Another Diagram Illustrating a One Compartment Model with an IV Infusion

After a dose of 1000 mg/hr for 30min (500 mg IV) samples were collected at 1 hr and 9hr after the start of the infusion. These samples were assayed and found to contain 15.6 and 5.8 mg/L, respectively. Assay standard deviations were estimated to be 5% of the value measured. These patient data and the population parameters from Table 25.4.1 were analyzed with Boomer using the Bayesian method. Figure 25.4.2 illustrates the resulting 'best-fit' to these two data points.

Figure 25.4.2 Linear Plot of Concentration versus Time

Analysis Type

The Bayesian method is specified early in the Boomer input stream.

 METHOD OF ANALYSIS

 0) Normal fitting
 1) Bayesian
 2) Simulation only
 3) Iterative Reweighted Least Squares
 4) Simulation with random error
 5) Grid Search

 -5) To perform Monte Carlo run (Only once at the start of BAT file)
 -4) To perform multi-run (End of BAT file only)
 -3) To run random number test subroutine
 -2) To close (or open) .BAT file
 -1) To finish

 Enter choice (-3 to 5) 1

Figure 25.4.3 Specifying the Bayesian Analysis Method

Model Specification

Boomer doesn't include clearance as a parameter type so it must be entered as a type 19 (dummy) parameter. The elimination rate constant kel is specified as CL/V. Since volume (type 18) parameters cannot be specified before rate constants a dummy parameter Vd specified first. The model parameter V is simply set equal to Vd.

 Model and Parameter Definition

  #  Name                    Value       Type From To     Dep  Start Stop

  1) CL                  =   3.613       19    0    0       0    0    0
  2) Vd                  =   29.33       19    0    0       0    0    0
  3) kel                 =  0.1232        2    1    0 7001002    0    0
  4) V                   =   29.33       18    1    1 1002000    0    0
  5) Duration            =  0.5000        0    0    0       0    0    0
  6) k0                  =   1000.        3    0    1       0    0    1

Figure 25.4.4 Model Specification from the .OUT File

Data and Weight Specification

The two data points were entered from the keyboard with the weight specified by equation specifying a 5% standard deviation. A 5% standard deviation translates into a variance of 0.0025 x Observed Value. Thus the 'a' and 'b' values entered are 0.0025 and 2, respectively.

 Weighting function entry for [Theophylline]

 0) Equal weights
 1) Weight by 1/Cp(i)
 2) Weight by 1/Cp(i)^2
 3) Weight by 1/a*Cp(i)^b
 4) Weight by 1/(a + b*Cp(i)^c)
 5) Weight by 1/((a+b*Cp(i)^c)*d^(tn-ti))

 Data weight as a function of Cp(Obs)

 Enter choice (0-5) 3
 Enter a value 0.0025
 Enter b value 2

Figure 25.4.5 Specifying the Weight for the Data Points by Equation

Program Output

Tabular and Statistical

(Section 1)
 ** FINAL OUTPUT FROM Boomer (v3.1.5) **      26 July 2005 ---  2:21:06 pm

 Title:  Bayesian Fit to Data
 Input: From Keyboard
 Output:  To Fig2206.OUT
 Data for [Theophylline]  came from keyboard (or ?.BAT)
 Fitting algorithm: DAMPING-GAUSS/SIMPLEX
 Weighting for [Theophylline]  by 1/a*Cp(Obs )^b
      With a = 0.2500E-02 and b =  2.000
 Bayesian Fitting to data:
 Numerical integration method: 2) Fehlberg RKF45
          with  1 de(s)
 With relative error   0.1000E-03
 With absolute error   0.1000E-03
 DT =   0.1000E-02     PC =   0.1000E-04 Loops =     1
 Damping =     1

(Section 2)
                    ** FINAL PARAMETER VALUES ***

  #  Name                  Value       S.D.       C.V. %  Lower <-Limit-> Upper
              Population mean         S.D.        (Weight)  Weighted residual

  1) CL                     3.6134      0.904E-02  0.25       1.0       10.
                        3.610        1.470        0.6803       0.2309E-02
  2) Vd                     29.330      0.822E-01  0.28       1.0      0.10E+03
                        30.10        4.200        0.2381      -0.1833

 Final WSS =   0.385777E-01 R^2 =    1.000     Corr. Coeff =    1.000
 AIC =   -2.51016     Log likelihood =   1.11     Schwartz Criteria =   -5.12387
 R and R^2 - jp1     1.0000        1.0000
 R and R^2 - jp2     1.0000        1.0000




(Section 3)
 Model and Parameter Definition

  #  Name                    Value       Type From To     Dep  Start Stop

  1) CL                  =   3.613       19    0    0       0    0    0
  2) Vd                  =   29.33       19    0    0       0    0    0
  3) kel                 =  0.1232        2    1    0 7001002    0    0
  4) V                   =   29.33       18    1    1 1002000    0    0
  5) Duration            =  0.5000        0    0    0       0    0    0
  6) k0                  =   1000.        3    0    1       0    0    1

(Section 4)
 Data for [Theophylline]  :-

 DATA #   Time       Observed      Calculated    (Weight)  Weighted residual

     1    0.000       0.00000       0.00000       0.00000       0.00000
     2   0.1250       0.00000       4.22917       0.00000       0.00000
     3   0.2500       0.00000       8.39372       0.00000       0.00000
     4   0.3750       0.00000       12.4946       0.00000       0.00000
     5   0.5000       0.00000       16.5329       0.00000       0.00000
     6   0.7500       0.00000       16.0314       0.00000       0.00000
     7    1.000       15.6000       15.5452       1.28205      0.702675E-01
     8    1.500       0.00000       14.6165       0.00000       0.00000
     9    2.000       0.00000       13.7433       0.00000       0.00000
    10    4.000       0.00000       10.7420       0.00000       0.00000
    11    6.000       0.00000       8.39608       0.00000       0.00000
    12    9.000       5.80000       5.80182       3.44828     -0.625972E-02
    13    12.00       0.00000       4.00914       0.00000       0.00000

     WSS for data set  1 =   0.4977E-02
               R^2 =    1.000     Corr. Coeff. =    1.000
 R and R^2 - jp1     1.0000        1.0000
 R and R^2 - jp2     1.0000        1.0000

Figure 25.4.6 Tabular and Statistical Output

(Section 1) Preliminary Output describing the input/output details, the fitting (optimization) algorithm, integration method and weighting scheme.

(Section 2) Best-fit parameter values with statistical information are provided. The parameter CV values, the WSS, AIC and other values provide information about the model and how well the data have been fit to the model.

(Section 3) The model definition section provides the apportunity to confirm that the model has been described correctly.

(Section 4) The data are provided next as observed x and y values, calculated y values and weight and residual information. The observed data in this table should be checked against the correct values. Systematic differences between observed and calculated values may be detected in this section if the data analysis is incorrect.

Graphical

(Section 1)
Plots of observed (*) and calculated values (+)
           versus time for [Theophylline] . Superimposed points (X)

    16.53      Linear                      16.53      Semi-log
 | +                                     | +
 |  +                                    |  +
 |   X                                   |   X
 |                                       |    +
 |    +                                  |      +
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 |      +                                | +
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 | +                                     |
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 |            +                          |
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 |+                 +                    |+                 +
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 |                           X           |
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 |+                                   +  |                           X
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 |                                       |+
 |X** * *     *     *                 *  |                                    +
 |_____________________________________  |X**_*_*_____*_____*_________________*
    0.000                                  4.009
 0              <-->             12.     0              <-->             12.



















(Section 2)
 Plot of Std Wtd Residuals (X)         Plot of Std Wtd  Residuals (X)
   versus time for [Theophylline]        versus log(calc Cp(i)) for [Theophylline]

    1.290                                  1.290
 |   X                                   |                                  X
 |                                       |
 |                                       |
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 |                                       |
 0XXX=X=X=====X=====X=================X  0XX================X======X==X==XX==XX
 |                           X           |         X
 |                                       |
  -0.1149                                -0.1149
      0.0       <-->             12.          4.0       <-->             17.

Figure 25.3.8 Graphical Output provided by Boomer

(Section 1) A linear and semi-log printer-type plot of the observed and calculated y-values versus the x-values.

(Section 2) Standardized weighted residuals versus x-value or log(calculated y value) are very useful tools for detecting poor model or weighting scheme selection. Any obvious pattern in these plots should be explored as potential evidence of a poor fit to the data. Patterns are not as obvious with a typical Bayesian analysis since there are fewer observed data points.

The Boomer control file used in this analysis is provided here and the complete output file is provided here.


References


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