The Gravity Probe B mission provided two new quantitative tests of Einstein’s theory of gravity, general relativity (GR), by cryogenic gyroscopes in Earth’s orbit. Data from four gyroscopes gave a geodetic drift-rate of −6601.8 ± 18.3 marc-s yr−1 and a frame-dragging of −37.2 ± 7.2 marc-s yr−1, to be compared with GR predictions of −6606.1 and −39.2 marc-s yr−1 (1 marc-s = 4.848 × 10−9 radians). The present paper introduces the science, engineering, data analysis, and heritage of Gravity Probe B, detailed in the accompanying 20 CQG papers.

Avelumab, a human anti–programmed death ligand 1 immunoglobulin G1 antibody, has shown efficacy and manageable safety in multiple tumors. A two‐compartment population pharmacokinetic model for avelumab incorporating intrinsic and extrinsic covariates and time‐varying clearance ( CL ) was identified based on data from 1,827 patients across three clinical studies. Of 14 tumor types, a decrease in CL over time was more notable in metastatic Merkel cell carcinoma and squamous cell carcinoma of the head and neck, which had maximum decreases of 32.1% and 24.7%, respectively. The magnitude of reduction in CL was higher in responders than in nonresponders. Significant covariate effects of baseline weight, baseline albumin, and sex were identified on both CL and central distribution volume. Significant covariate effects of black/African American race, C‐reactive protein, and immunogenicity were found on CL . None of the covariate or time‐dependent effects were clinically important or warranted dose adjustment.

The pharmacokinetics and pharmacodynamics of the antiretroviral agent etravirine were evaluated in two phase III clinical trials. Pharmacokinetic data were available in 577 patients randomized to receive etravirine. The mean (SD) population-pharmacokinetics-derived area under the concentration-time curve at 12 h (AUC(12 h)) and concentration at 0 h (C(0 h)) were 5,501 (4,544) ng·h/ml and 393 (378) ng/ml, respectively. Hepatitis C coinfection raised etravarine exposure, and concomitant use of tenofovir disoproxil fumarate lowered etravirine exposure, but these changes were not considered clinically relevant. Etravirine apparent oral clearance was not affected by age, weight, sex, race, hepatitis B coinfection status, creatinine clearance, or concomitant use of enfuvirtide. Virologic response (<50 copies/ml) at week 24 was 59% in patients randomized to etravirine vs. 41% in those receiving placebo (P < 0.0001). There was no apparent relationship between etravirine pharmacokinetics and either efficacy or safety. Factors other than the pharmacokinetics of etravirine such as the characteristics of the patients and the disease, as well as characteristics of the treatment regimen, predict virologic response.

AimTo assess the likelihood of a sustained virological response (SVR) vs. the likelihood of anaemia in patients with chronic hepatitis C. MethodsData from 1732 patients treated with peginterferon alfa-2a (40KD) plus ribavirin in two randomized, multinational studies were pooled. Probabilities of SVR and anaemia were modelled using the generalized additive logistic model, with numerous clinical variables considered for entry into the model. Baseline haemoglobin was only considered in the analysis for anaemia. ResultsThe probability of anaemia increased from 6 to 16% as a function of the ribavirin dose kg − 1 (12-16 mg kg − 1 ), whereas the relationship between SVR and ribavirin dose kg − 1 was influenced by hepatitis C virus (HCV) genotype. The probability of an SVR was not influenced by the ribavirin dose kg − 1 in patients with HCV genotype 2 or 3 infection, but increased as a function of ribavirin dose kg − 1 in patients with HCV genotype 1 infection (40-50% increase in probability of SVR for 12-16 mg kg − 1 dose ribavirin increase). The probability of an SVR in patients infected with HCV genotype 1 decreased with increasing HCV RNA level to about 3 million copies ml − 1 , but was relatively independent of increasing HCV RNA level thereafter. In addition, older age, a higher ribavirin apparent oral clearance and cirrhosis had a negative impact on achieving an SVR, but improved with increasing alanine aminotransferase (ALT) quotient. Sex and ribavirin dose kg − 1 were the most important prognostic factors for anaemia, followed by baseline haemoglobin, age, baseline ALT quotient and cirrhosis. ConclusionThis study supports individualizing ribavirin dosages by HCV genotype and body weight, and highlights several clinical variables that influence the likelihood of an SVR compared with anaemia in chronic hepatitis C patients treated with peg interferon alfa-2a (40KD) plus ribavirin.

Avelumab, an anti–programmed death‐ligand 1 monoclonal antibody approved for the treatment of metastatic Merkel cell carcinoma and platinum‐treated urothelial carcinoma, was initially approved with a 10 mg/kg weight‐based dose. We report pharmacokinetic (PK)/pharmacodynamic analyses for avelumab comparing weight‐based dosing and a flat 800 mg dose, developed using data from 1,827 patients enrolled in 3 clinical trials (NCT01772004, NCT01943461, and NCT02155647). PK metrics were simulated for weight‐based and flat‐dosing regimens and summarized by quartiles of weight. Derived exposure metrics were used in simulations of exposure‐safety (various tumors) and exposure‐efficacy (objective responses; Merkel cell or urothelial carcinoma). Flat dosing was predicted to provide similar exposure to weight‐based dosing, with slightly lower variability. Exposure‐safety and exposure‐efficacy simulations suggested similar benefit:risk profiles for the two dosing regimens. These pharmacometric analyses provided the basis for the US Food and Drug Administration approval of a flat dose of avelumab 800 mg every 2 weeks in approved indications.

AimA population pharmacokinetic analysis was performed using plasma concentration data ( n = 7025) from 380 patients to examine the relationship between ribavirin dose and its pharmacokinetics. MethodsRibavirin pharmacokinetics were described by a three-compar tment model with sequential zero-order and a first-order absorption processes. Interoccasion variability and food effects were included. ResultsLean body weight (range 41-91 kg) was the only covariate with a clinically significant influence on ribavirin pharmacokinetics, affecting clearance (15.3-23.9 l h − 1 ) and the volume of the larger peripheral compartment. ConclusionThe model provided a good description of the available data, confirmed by accurate estimates of parameter values and low residual variability (17%).

Using population analysis, sparsely sampled Phase 3 clinical data can be utilized to determine the pharmacokinetic characteristics of the target population. Data arising from such studies are likely to be constrained to certain sampling windows, i.e., the visiting hours at the study clinic. When the sampling window is narrow compared to the half-life of the drug, the advantage of taking more than one sample is not obvious. Study designs with one or two samples per visit have been compared with respect to (i) precision and bias of the population parameter estimates, (ii) the ability to identify the underlying pharmacokinetic model, and (iii) the estimation of individual parameter values. The first point was assessed using simulated data while the latter two were studied using a real data set. Results show: (i) Parameter estimates are more biased and imprecise when only one sample is taken compared to when two samples are obtained, this is true irrespective of the time span between the two samples. (ii) Ability to identify a more complex model is increased if two samples are taken. Specifically, the variability between occasions can be quantified. (iii) Two-sample designs are generally better with respect to prediction of individual parameter values. Even minor changes to commonly employed study designs, in this case the addition of one sample at each study occasion, can improve quality and quantity of the information obtained.

Certolizumab pegol (CZP), an anti-tumor necrosis factor a agent, is an effective therapy for Crohn's disease (CD). A population pharmacokinetic (PK) analysis of subcutaneously administered CZP was performed using data from 2157 CD patients from 9 separate studies. The aim was to determine which covariates influence the disposition of CZP. The final CZP population PK model consisted of a baseline, first-order absorption, and 1-compartment disposition. CZP antibodies were treated as a structural model covariate and caused apparent clearance (CL/F) to increase from 0.685 to 2.74 L/day. Body surface area (BSA) influenced both CL/F and apparent volume of distribution (V/F) in a linear fashion; both parameters increased by more than 53% and 49%, respectively, across the range of BSA measurements in the data. Albumin influenced CZP CL/F in a nonlinear fashion; CL/F decreased from 1.05 to 0.613 L/day with increasing albumin concentrations in antibody-negative patients. C-reactive protein (CRP) had a borderline influence and CL/F increased by more than 20% across the range of CRP measurements in the data set. Race had a minor influence on V/F. The determined covariates' impact on CZP disposition may be of clinical utility in CZP therapy of CD patients when the PK/pharmacodynamic relationship becomes available.