Open Access: Optimal dose‐finding for efficacy–safety models

Each week, we select a recently published Open Access article to feature. This week’s article comes from Biometrical Journal and considers an efficacy–safety model to find the optimal dose in the clinical development of drugs. 

The article’s abstract is given below, with the full article available to read here.

Tsirpitzi, R. E., & Miller, F. (2021). Optimal dose‐finding for efficacy–safety modelsBiometrical Journal1– 17

Dose‐finding is an important part of the clinical development of a new drug. The purpose of dose‐finding studies is to determine a suitable dose for future development based on both efficacy and safety. Optimal experimental designs have already been used to determine the design of this kind of studies, however, often that design is focused on efficacy only. We consider an efficacy–safety model, which is a simplified version of the bivariate Emax model. We use here the clinical utility index concept, which provides the desirable balance between efficacy and safety. By maximizing the utility of the patients, we get the estimated dose. This desire leads us to locally urn:x-wiley:03233847:media:bimj2241:bimj2241-math-0001‐optimal designs. An algebraic solution for urn:x-wiley:03233847:media:bimj2241:bimj2241-math-0002‐optimal designs is determined for arbitrary urn:x-wiley:03233847:media:bimj2241:bimj2241-math-0003 vectors using a multivariate version of Elfving’s method. The solution shows that the expected therapeutic index of the drug is a key quantity determining both the number of doses, the doses itself, and their weights in the optimal design. A sequential design is proposed to solve the complication of parameter dependency, and it is illustrated in a simulation study.


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