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Hospital precision dosing is increasing

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Artificial intelligence (AI) and emerging technologies are bringing exciting changes to hospitals and healthcare systems. With the technological advancements of recent years, healthcare organizations are increasingly adopting digital healthcare solutions to improve patient care. Clinical Decision Support (CDS) platforms, for example, are being used by providers to optimize treatment and help ensure that drugs work as intended. Precision dosing CDS platforms incorporate artificial intelligence to give hospitals the ability to reduce medication errors, raise quality of care, and increase cost savings in 2021 and beyond.

Precision dosing specific to hospital environments

Precision dosing is defined as the process of individualizing medication doses taking into account patient-specific factors, such as demographics, clinical characteristics, and genetic data. Precision dosing CDS platforms are critical tools for reducing adverse drug events (ADE), which are some of the most costly medical complications and add more than $ 30 billion a year to the US healthcare system. ADEs also result in 1.3 million trips to the emergency department annually. according to him Centers for Disease Control and Prevention. Ultimately, adverse adverse effects cause numerous negative effects effects for patients, including longer hospital stays, more emergency department visits, and higher rates of admission and readmission.

Many patients are at risk for ADE because drugs are typically developed with the average patient in mind. The drugs are often studied in a few thousand patients during a clinical development program. As a result, many types of patients are not adequately studied in clinical trials, including geriatric patients, pediatric patients, and those with end-organ dysfunction. This has later implications, as once the drug is approved, it is generally administered more widely in patient populations that are not well characterized in clinical trials. These groups of patients are at increased risk of experiencing poor clinical outcomes. In fact, the FDA has reported that drugs in a variety of therapeutic areas are only effective in 25% to 62% of patients. Precision dosing has the ability to address both of these issues through individualized dosing.

Precision dosing is especially beneficial for drugs with a narrow therapeutic window (that is, drugs with a toxic dose very close to the minimum dose necessary for the drug to be effective). The approach may also be beneficial for drugs with high inter-patient variability in response to drugs. Key therapeutic areas for precision dosing include infectious diseases, oncology, blood and bone marrow transplantation, solid organ transplantation, and inflammatory bowel disease. For example, precision dosing has worked well in individualizing dosing for vancomycin, an antibiotic prescribed for bacterial infections that can cause acute kidney damage if the dose is too high, leading to longer hospital stays and higher costs.

Today, hospital physicians and pharmacists are incorporating precision dosing into their clinical practices to ensure that patients receive the correct dose of complicated drugs, from intravenous antibiotics to chemotherapy. Hospital physicians can access precision dosing guidance through an integrated EHR application that is integrated into their clinical workflow, or through separate web-based applications.

Modern precision dosing support platforms employ pharmacology and machine learning models, operating on patient-specific data (including demographic, clinical, laboratory, and genetic information) to help clinicians understand a patient’s individual drug profile. to guide dosing decisions. The goal is to ensure that each patient receives the correct dose at the correct time. Precision dosing can be applied to numerous medications and improve patient outcomes by ensuring that the patient receives the maximum effective dose while reducing the likelihood of an adverse drug event.

What does 2021 hold for us and beyond?
We see healthcare continue its shift from a fixed dosing mindset to one that embraces individualized dosing, as artificial intelligence and machine learning advance and precision dosing technology becomes more available at the point of care. We also expect to see an increase in precise dosing and monitoring of specialty drugs, as well as in conditioning regimens for gene therapy and cell therapy.

Individualized treatment at the point of care with precision dosing and drug monitoring is also gaining momentum in the tailwinds of the recently revised vancomycin dosing consensus. guidelines. The new guidelines call for a change in vancomycin monitoring based only on trough serum levels at area under the curve (AUC) guided dosing with the help of Bayesian dosing software, adapting to different regimens and changes in the physiology of each patient. during therapy courses.

In addition to precision dosing at the point of care, we will see increased utility during the drug development process. Biopharmaceutical companies are increasingly incorporating precision dosing into clinical trials and are motivated to combine precision dosing with new drugs used to treat rare and common diseases in order to maximize the efficacy of new therapies. This means that once the drug has been approved, clinicians can benefit from the immediate availability of a CDS tool that helps determine an individualized dosage regimen for the newly approved drug.

At the same time, hospitals and larger healthcare systems can also benefit from the ability to tailor drug models to their specific patient populations. Currently, precision dosing platforms use pharmacokinetic models derived from general population data to guide dosing decisions. A healthcare system with a patient population that does not closely resemble the general population on which a model is based may find the dosing regimens suggested by these models to be less accurate, potentially increasing the time it takes for patients to achieve. an exposure to a target drug.

In the near future, provider organizations will be able to use retrospective data from their patient populations to develop a custom predictive model unique to their patient demographics, enabling more accurate dosing across their populations. Using more accurate and population-specific precision dosing models will help organizations improve quality of care and reduce costs as they increasingly move toward value-based care and value-based contracting. risk.

As AI moves to more areas of healthcare delivery, precision medicine will be redefined and its benefits will be extended to more patients. Precision medicine will no longer just mean the selection of drugs targeting patients with a specific genomic profile, an approach that, in oncology, is believed to benefit only ~ 5% of cancer patients. Precision medicine will grow to include individualized dosing of a wide range of drugs that are already widely used in many therapeutic areas. Precision medicine, including precision dosing, not only has positive implications for the patient, but also promises to improve hospital and healthcare system operating business models, reduce payer costs, and enhance clinical research and development. of medications.

Photo: Stas_V, Getty Images

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