Hi nonmem users,

I have a question related to shrinkage in PK when doing a sequential PK-PD 
analysis.



Consider a situation with substantial  shrinkage in the estimated individual PK 
(e.g. CL).

When simulating PD based on dose from the model, it seems to me that 
variability in PD will be over-predicted if the estimated variability in CL 
(omega) is used.

Would it then be appropriate to apply shrinkage to the variability in CL prior 
to simulating the PD?

Does this have any practical consequences, and is meaningful to consider?



I have mostly seen examples of consequences of shrinkage in the context of  
covariate analyses. Are there any examples relating to PK-PD analyses. E.g 
simultaneous, versus sequential?



Consider for example the situations below:

I.e. analysis performed by:

1.       Derive individual PK parameters.

2.       Relate posthoc plasma conc to PD



If doing the analysis based on dose, any variability in PK will show up as 
variability in the dose-PD relationship.

When doing the analysis based on plasma concentration (E.g. AUC), the 
PK-variability is accounted for by the PK-model and will not influence the 
variability in exposure response.



However in the presence of shrinkage in the PK parameters, the situation should 
be somewhere in-between these two scenarios and some of the variability in PK 
will still show up as variability in PD.

Hence when simulating based on the estimated variability in CL  the variability 
in pd should theoretically be exaggerated.





Regards,

Matts Kågedal

Senior Pharmacometrician

AstraZeneca




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