Hi Marie,

I would like to state, in my view, that the terminology "direct" is not based 
on a clear understanding of PKPD. The terminology of direct and indirect should 
be avoided. These terms might be translated into immediate and delayed effects 
but it's better to use more precise terms to describe what you want to use your 
PKPD model to describe.

In real biology there is no such thing as an immediate effect. All drug effects 
must have some delay between changes in plasma unbound concentration and the 
development of the effect associated with that concentration. These delays may 
include distribution from plasma to the effect site, binding of the drug once 
it has reached its effect site to its receptor and transduction into a stimulus 
leading to the effect, turnover of physiological mediators that are change such 
things as the input or elimination of physiological mediators that lead to the 
observed effect.

I'd be happy to provide NONMEM code for an immediate effect with an Emax model. 
But you should think carefully before using it to describe real observed 
effects which must be delayed in relation to the   concentrations used in PK 
models.

Best wishes,
Nick

--
Nick Holford, Professor Emeritus Clinical Pharmacology, MBChB, FRACP
mobile: NZ+64(21) 46 23 53 ; FR+33(6) 62 32 46 72
email: n.holf...@auckland.ac.nz<mailto:n.holf...@auckland.ac.nz>
web: http://holford.fmhs.auckland.ac.nz/

From: owner-nmus...@globomaxnm.com <owner-nmus...@globomaxnm.com> On Behalf Of 
Marie Rajerison
Sent: Wednesday, 9 October 2024 2:20 pm
To: nmusers@globomaxnm.com
Subject: [NMusers] Emax model

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Dear NM users,

Hope my message finds you well,
Can anyone share NM control streams for a direct Emax PK/PD model?

Thank you in advance for your help

Marie

Marie RAJERISON
PharmD PhD
Pharmacometrician
e-mail: 
marie.rajeri...@corteriapharma.com<mailto:marie.rajeri...@corteriapharma.com>
128 rue de la Boetie
75008 Paris
France
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