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Optimization of Ganciclovir and Valganciclovir Starting Dose in Children by Machine Learning.

Authors :
Ponthier, Laure
Autmizguine, Julie
Franck, Benedicte
Åsberg, Anders
Ovetchkine, Philippe
Destere, Alexandre
Marquet, Pierre
Labriffe, Marc
Woillard, Jean-Baptiste
Source :
Clinical Pharmacokinetics. Apr2024, Vol. 63 Issue 4, p539-550. 12p.
Publication Year :
2024

Abstract

Background and Objectives: Ganciclovir (GCV) and valganciclovir (VGCV) show large interindividual pharmacokinetic variability, particularly in children. The objectives of this study were (1) to develop machine learning (ML) algorithms trained on simulated pharmacokinetics profiles obtained by Monte Carlo simulations to estimate the best ganciclovir or valganciclovir starting dose in children and (2) to compare its performances on real-world profiles to previously published equation derived from literature population pharmacokinetic (POPPK) models achieving about 20% of profiles within the target. Materials and Methods: The pharmacokinetic parameters of four literature POPPK models in addition to the World Health Organization (WHO) growth curve for children were used in the mrgsolve R package to simulate 10,800 pharmacokinetic profiles. ML algorithms were developed and benchmarked to predict the probability to reach the steady-state, area-under-the-curve target (AUC0–24 within 40–60 mg × h/L) based on demographic characteristics only. The best ML algorithm was then used to calculate the starting dose maximizing the target attainment. Performances were evaluated for ML and literature formula in a test set and in an external set of 32 and 31 actual patients (GCV and VGCV, respectively). Results: A combination of Xgboost, neural network, and random forest algorithms yielded the best performances and highest target attainment in the test set (36.8% for GCV and 35.3% for the VGCV). In actual patients, the best GCV ML starting dose yielded the highest target attainment rate (25.8%) and performed equally for VGCV with the Franck model formula (35.3% for both). Conclusion: The ML algorithms exhibit good performances in comparison with previously validated models and should be evaluated prospectively. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
03125963
Volume :
63
Issue :
4
Database :
Academic Search Index
Journal :
Clinical Pharmacokinetics
Publication Type :
Academic Journal
Accession number :
176910182
Full Text :
https://doi.org/10.1007/s40262-024-01362-7