This article represents the first in a series of tutorials on model evaluation in nonlinear mixed effect models (NLMEMs), from the International Society of Pharmacometrics (ISoP) Model Evaluation Group. Numerous tools are available for evaluation of NLMEM, with a particular emphasis on visual assessment. This first basic tutorial focuses on presenting graphical evaluation tools of NLMEM for continuous data. It illustrates graphs for correct or misspecified models, discusses their pros and cons, and recalls the definition of metrics used.

PurposeThis work investigates improved utilization of ADAS-cog data (the primary outcome in Alzheimer’s disease (AD) trials of mild and moderate AD) by combining pharmacometric modeling and item response theory (IRT).MethodsA baseline IRT model characterizing the ADAS-cog was built based on data from 2,744 individuals. Pharmacometric methods were used to extend the baseline IRT model to describe longitudinal ADAS-cog scores from an 18-month clinical study with 322 patients. Sensitivity of the ADAS-cog items in different patient populations as well as the power to detect a drug effect in relation to total score based methods were assessed with the IRT based model.ResultsIRT analysis was able to describe both total and item level baseline ADAS-cog data. Longitudinal data were also well described. Differences in the information content of the item level components could be quantitatively characterized and ranked for mild cognitively impairment and mild AD populations. Based on clinical trial simulations with a theoretical drug effect, the IRT method demonstrated a significantly higher power to detect drug effect compared to the traditional method of analysis.ConclusionA combined framework of IRT and pharmacometric modeling permits a more effective and precise analysis than total score based methods and therefore increases the value of ADAS-cog data.Electronic supplementary materialThe online version of this article (doi:10.1007/s11095-014-1315-5) contains supplementary material, which is available to authorized users.

Estimation methods for nonlinear mixed-effects modelling have considerably improved over the last decades. Nowadays, several algorithms implemented in different software are used. The present study aimed at comparing their performance for dose-response models. Eight scenarios were considered using a sigmoid E(max) model, with varying sigmoidicity and residual error models. One hundred simulated datasets for each scenario were generated. One hundred individuals with observations at four doses constituted the rich design and at two doses, the sparse design. Nine parametric approaches for maximum likelihood estimation were studied: first-order conditional estimation (FOCE) in NONMEM and R, LAPLACE in NONMEM and SAS, adaptive Gaussian quadrature (AGQ) in SAS, and stochastic approximation expectation maximization (SAEM) in NONMEM and MONOLIX (both SAEM approaches with default and modified settings). All approaches started first from initial estimates set to the true values and second, using altered values. Results were examined through relative root mean squared error (RRMSE) of the estimates. With true initial conditions, full completion rate was obtained with all approaches except FOCE in R. Runtimes were shortest with FOCE and LAPLACE and longest with AGQ. Under the rich design, all approaches performed well except FOCE in R. When starting from altered initial conditions, AGQ, and then FOCE in NONMEM, LAPLACE in SAS, and SAEM in NONMEM and MONOLIX with tuned settings, consistently displayed lower RRMSE than the other approaches. For standard dose-response models analyzed through mixed-effects models, differences were identified in the performance of estimation methods available in current software, giving material to modellers to identify suitable approaches based on an accuracy-versus-runtime trade-off.

Abstract.In the current work, we present the methodology for development of an Item Response Theory model within a non-linear mixed effects framework to characterize the longitudinal changes of the Movement Disorder Society (sponsored revision) of Unified Parkinson's Disease Rating Scale (MDS-UPDRS) endpoint in Parkinson's disease (PD). The data were obtained from Parkinson's Progression Markers Initiative database and included 163,070 observations up to 48 months from 430 subjects belonging to De Novo PD cohort. The probability of obtaining a score, reported for each of the items in the questionnaire, was modeled as a function of the subject's disability. Initially, a single latent variable model was explored to characterize the disease progression over time. However, based on the understanding of the questionnaire set-up and the results of a residuals-based diagnostic tool, a three latent variable model with a mixture implementation was able to adequately describe longitudinal changes not only at the total score level but also at each individual item level. The linear progression rates obtained for the patient-reported items and the non-sided items were similar, each of which roughly take about 50 months for a typical subject to progress linearly from the baseline by one standard deviation. However for the sided items, it was found that the better side deteriorates quicker than the disabled side. This study presents a framework for analyzing MDS-UPDRS data, which can be adapted to more traditional UPDRS data collected in PD clinical trials and result in more efficient designs and analyses of such studies.

The number of counts (events) per unit of time is a discrete response variable that is generally analyzed with the Poisson distribution (PS) model. The PS model makes two assumptions: the mean number of counts (lambda) is assumed equal to the variance, and counts occurring in non-overlapping intervals are assumed independent. However, many counting outcomes show greater variability than predicted by the PS model, a phenomenon called overdispersion. The purpose of this study was to implement and explore, in the population context, different distribution models accounting for overdispersion and Markov patterns in the analysis of count data. Daily seizures count data obtained from 551 subjects during the 12-week screening phase of a double-blind, placebo-controlled, parallel-group multicenter study performed in epileptic patients with medically refractory partial seizures, were used in the current investigation. The following distribution models were fitted to the data: PS, Zero-Inflated PS (ZIP), Negative Binomial (NB), and Zero-Inflated Negative Binomial (ZINB) models. Markovian features were introduced estimating different lambdas and overdispersion parameters depending on whether the previous day was a seizure or a non-seizure day. All analyses were performed with NONMEM VI. All models were successfully implemented and all overdispersed models improved the fit with respect to the PS model. The NB model resulted in the best description of the data. The inclusion of Markovian features in lambda and in the overdispersion parameter improved the fit significantly (P < 0.001). The plot of the variance versus mean daily seizure count profiles, and the number of transitions, are suggested as model performance tools reflecting the capability to handle overdispersion and Markovian features, respectively.

The lack of a common exchange format for mathematical models in pharmacometrics has been a long-standing problem. Such a format has the potential to increase productivity and analysis quality, simplify the handling of complex workflows, ensure reproducibility of research, and facilitate the reuse of existing model resources. Pharmacometrics Markup Language (PharmML), currently under development by the Drug Disease Model Resources (DDMoRe) consortium, is intended to become an exchange standard in pharmacometrics by providing means to encode models, trial designs, and modeling steps.

Count data, or number of events per time interval, are discrete data arising from repeated time to event observations. Their mean count, or piecewise constant event rate, can be evaluated by discrete probability distributions from the Poisson model family. Clinical trial data characterization often involves population count analysis. This tutorial presents the basics and diagnostics of count modeling and simulation in the context of pharmacometrics. Consideration is given to overdispersion, underdispersion, autocorrelation, and inhomogeneity.

Neutropenia and febrile neutropenia (FN) are serious side effects of cytotoxic chemotherapy which may be alleviated with the administration of recombinant granulocyte colony-stimulating factor (GCSF) derivatives, such as pegfilgrastim (PG) which increases absolute neutrophil count (ANC). In this work, a population pharmacokinetic-pharmacodynamic (PKPD) model was developed based on data obtained from healthy volunteers receiving multiple administrations of PG. The developed model was a bidirectional PKPD model, where PG stimulated the proliferation, maturation, and margination of neutrophils and where circulating neutrophils in turn increased the elimination of PG. Simulations from the developed model show disproportionate changes in response with changes in dose. A dose increase of 10% from the 6 mg therapeutic dose taken as a reference leads to area under the curve (AUC) increases of ~50 and ~5% for PK and PD, respectively. A full random effects covariate model showed that little of the parameter variability could be explained by sex, age, body size, and race. As a consequence, little of the secondary parameter variability (C and AUC of PG and ANC) could be explained by these covariates.