Clinical Disclaimer:
This application is intended for research and informational purposes only.
Predictions and estimates may not accurately reflect individual patient circumstances, local patient populations, or institutional practices.
Model performance may vary across clinical settings and patient populations.
This tool is not intended to replace professional clinical judgment, institutional protocols, or medical advice.
All clinical and dosing decisions remain the responsibility of the treating clinician.
Use of this application is at the user’s own risk.
Click each tab below and enter the required values. To define the dosing and concentration measurement times, click the time box and use the calendar to select the date. Then, use the slider below to adjust the time. Do not manually enter the date or time.
The observed drug levels are shown as red circles, and the blue line represents the individual predicted concentrations based on the patient input data. When no individual patient data are available, the brown line represents the population-predicted concentrations, while the thin gray lines represent simulated individual predicted concentrations.
Drug Level Prediction
At Week 2, 6, 14 for each schedule
Maintenance Phase
To estimate the trough level during the maintenance dose, enter the Custom Dose (mg/kg) and select the dosing frequency using the radio buttons. The estimated trough level will be displayed below the buttons.
To determine the appropriate dosing frequency for a specific trough level, enter the desired value in Target Trough.
This application takes as input patient characteristics/dosing schedule and presents both the population expected drug concentrations
as well as a simulated set of drug concentrations that represent randomly generated individuals according to a model-estimated
random effects distribution. These simulated responses give some intuition to how individuals can be expected to
deviate. Additionally, if drug concentrations have been observed, we can use that information to calculate the empirical Bayes
estimate (EBE) for the random effects and plot the individual expected drug concentrations in order to aid therapeutic drug monitoring (TDM). Further, we can specify two alternative dosing schedules and see population, simulated, and individual expected drug concentrations to those schedules.
Resources
The models implemented in this application are all available in the scientific literature.
The infliximab model is published in
Dubinsky 2017 [1].
The code to calculate the EBEs is adapted from the open source TDM software
mrgsolve.
Bibliography
Dubinsky MC, Phan BL, Singh N, Rabizadeh S, Mould DR. Pharmacokinetic Dashboard-Recommended Dosing Is Different than Standard of Care Dosing in Infliximab-Treated Pediatric IBD Patients. AAPS J. 2017 Jan;19(1):215-222. doi: 10.1208/s12248-016-9994-y.
Xu Z, Mould DR, Hu C, Ford J, Keen M, Davis HM, et al. A population-based pharmacokinetic pooled analysis of infliximab in pediatrics. ACCP National Meeting 2012 San Diego CA