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Clinical Pharmacokinetics
Published in: Clinical Pharmacokinetics 1/2006

01-01-2006 | Original Research Article

Compliance-Guided Therapy

A New Insight Into the Potential Role of Clinical Pharmacologists

Authors: Alexia Blesius, Sylvie Chabaud, Michel Cucherat, Patrick Mismetti, Jean-Pierre Boissel, Dr Patrice Nony

Published in: Clinical Pharmacokinetics | Issue 1/2006

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Abstract

Background and objective

In the field of drug noncompliance, we investigated an original approach that could give the prescribing physician, in collaboration with a clinical pharmacologist, an active role. The aim here is for the prescribing physician to take compliance into account so as to provide an optimised prescription (choice of molecule prescribed and its rhythm of administration) adapted to each patient. The example considered is that of oral anticoagulant treatment prescribed long-term.

Methods

In order to investigate the choice of the best molecule and treatment regimen for a given noncompliance pattern, we performed an in silico study with two oral anticoagulant agents, warfarin and acenocoumarol, each taken in one or two daily doses. Three linked models were used: the first model generated specific noncompliance patterns, the second model described the pharmacokinetics of oral anticoagulant agents and the third model summarised the pharmacokinetic-pharmacodynamic relations.

Results

Considering different patterns of noncompliance (including timing errors in drug intake and the phenomenon of drug holidays) and comparing warfarin with acenocoumarol, we identified different situations in which one agent (prescribed once or twice daily) could clearly minimise both the thromboembolic and haemorrhagic risks. However, for some specific noncompliance patterns, the choice of the optimal therapy should also be guided by the basal individual thromboembolic and haemorrhagic risks.

Conclusion

Individualisation of drug therapy involves both drug dose and drug choice. In addition to the classical approach (i.e. drug level measurements, enzyme assays and even genetic sequence data), our study suggests that compliance-guided therapy may represent a potential, evolving way for the individualisation of prescriptions.
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Metadata
Title
Compliance-Guided Therapy
A New Insight Into the Potential Role of Clinical Pharmacologists
Authors
Alexia Blesius
Sylvie Chabaud
Michel Cucherat
Patrick Mismetti
Jean-Pierre Boissel
Dr Patrice Nony
Publication date
01-01-2006
Publisher
Springer International Publishing
Published in
Clinical Pharmacokinetics / Issue 1/2006
Print ISSN: 0312-5963
Electronic ISSN: 1179-1926
DOI
https://doi.org/10.2165/00003088-200645010-00007

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