Comprehensive Approaches to Precision
Dosing
Systemic exposure to a drug may be closely related to outcome as well as
side effects, but it would be naïve to think that exposure is the only
parameter that we should focus on optimizing. As previously mentioned,
there are other ways a drug’s effect can be monitored and other
parameters may modulate the relationship between systemic exposure and
effect. Thus, an ideal precision dosing approach goes far beyond the use
of TDM reference ranges, TDM software, or even PKPD software with
population models and Bayesian forecasting. In reality, we need to be
able to monitor, aggregate, and derive conclusions from thousands of
data points, and continually adjust treatment recommendations as new
data points are collected. This calls for machine learning and
artificial intelligence approaches that have started to make their mark
on some areas of medicine, although not yet in precision dosing. Current
and future technology will make this a reality and help bridge the gap
between clinical studies and real-world patient
care.40