Long-Term Predictions of the Therapeutic Equivalence of Daily and Less Than Daily Alendronate Dosing
作者:C. J. Hernandez、G. S. Beaupré、R. Marcus、D. R. Carter
DOI:10.1359/jbmr.2002.17.9.1662
日期:——
Less than daily alendronate dosing has been identified as an attractive alternative to daily dosing for patients and physicians. A recent 2‐year study found bone mineral density (BMD) changes caused by weekly alendronate dosing therapeutically equivalent to that caused by daily dosing. There are no methods that can be used to predict how long therapeutic equivalence will be maintained after the first 2 years of treatment. In addition, it is unclear if dosing less frequently than weekly also might be therapeutically equivalent to daily dosing. In this study we use a computer simulation to develop predictions of the therapeutic equivalence of daily and less than daily dosing over time periods as long as a decade. The computer simulation uses a cell‐based computer model of bone remodeling and a quantitative description of alendronate pharmacokinetics/pharmacodynamics (PK/PD). The analyses suggest that less than daily dosing regimens do not increase BMD as much as daily dosing. However, model predictions suggest that dosing as frequent as weekly still may be therapeutically equivalent to daily dosing over periods as long as 10 years. In addition, the simulations predict dosing less frequently than weekly may be therapeutically equivalent to daily dosing within the first year of treatment but may not be therapeutically equivalent after 10 years. Hypotheses based on these simulations may be useful for determining which dosing regimen may be most attractive for clinical trials.
对患者和医生来说,少于每日一次的阿仑膦酸钠用药已被确定为一种有吸引力的替代每日用药的方法。最近一项为期两年的研究发现,每周服用阿仑膦酸钠所引起的骨矿物质密度(BMD)变化与每天服用阿仑膦酸钠所引起的变化在治疗上是等效的。目前还没有任何方法可以用来预测治疗头两年后治疗效果会维持多久。此外,目前还不清楚少于每周一次的给药频率是否也可能与每日给药具有同等疗效。在本研究中,我们利用计算机模拟来预测每日给药和少于每日给药在长达十年的时间内的治疗等效性。计算机模拟使用了基于细胞的骨重塑计算机模型和阿仑膦酸钠药代动力学/药效学(PK/PD)的定量描述。分析表明,少于每日给药的方案对 BMD 的增加不如每日给药。然而,模型预测表明,在长达 10 年的时间里,每周给药的频率仍可能与每日给药的治疗效果相当。此外,模拟预测在治疗的第一年内,用药频率低于每周一次的治疗效果可能等同于每日用药,但在 10 年后可能就不等同于每日用药了。基于这些模拟的假设可能有助于确定哪种给药方案对临床试验最有吸引力。