Dear SoJeong,

First you might want to answer the question whether that phenotype is indeed 
important in your dataset. With the initial popPK model you could plot posthoc 
clearance against bodyweight and/or inspect the posthocs of clearance for 
evidence of multiple peaks in your distribution. You also may see the impact of 
phenotype in stratified concentration versus time plots. Depending on the 
dataset, with its sampling scheme, number of subjects (perhaps a low number) 
and distribution across age, it could be masked. 

If the impact is clear however, it might be benificial to try to include the 
subjects wih missing genotype. With a clear effect, you might be able to 
develop a mixture model. The mixture  approach would describe the different 
populations in your dataset corresponding to the different phenotypes. The 
genotype would than inform the mixture as a covariate - the missing information 
would fall back to the pure mixture approach. As a warning, this approach is 
quite difficult. I would advise you to read up on the nonmem guides ($MIX) on 
this and look in the literature for examples - the Karlsson group has published 
about it, most recently this one (it contains code): 
http://link.springer.com/article/10.1208/s12248-009-9093-4. A search in the 
literature gives you additional background such as 
http://www.page-meeting.org/pdf_assets/9595-PAGE2007_3.pdf and 
http://link.springer.com/article/10.1007/s10928-006-9038-9. 

If the impact is not clear, a more empirical approach might be called for, in 
this case a subset analysis, i.e. where you exclude the missing subjects, of 
the covariate relationship might be all that you could achieve. If there is no 
impact at all, you do not need the genotype of course.

Hope this helps!

Best regards,

Jeroen

http://pd-value.com
[email protected]
@PD_value
+31 6 23118438
-- More value out of your data!



On Nov 19, 2014, 7:57 AM, at 7:57 AM, "이소정" <[email protected]> wrote:
>Dear all,
>
> 
>
>I’ve analyzed a tacrolimus PopPK in pediatric patients.
>
>As you know, CYP3A5 genotype can change the tacrolimus PK
>significantly, 3A5 genotyping was performed in the study, 
>
>however, in 20% of the subjects, the genotype data was missed. 
>
> 
>
>Then, how can I reflect the CYP3A5 genotype effect to the tacrolimus
>population model appropriately?
>
>Is there any solution?
>
> 
>
>Best regards,
>
>SoJeong Yi
>
> 

Reply via email to