Precision dosing in hospitals is stepping up


Artificial intelligence (AI) and emerging technologies are bringing exciting changes to hospitals and healthcare systems. With the technological advancements of recent years, healthcare organizations are increasingly adopting digital healthcare solutions to improve patient care. Clinical Decision Support Platforms (CDS), for example, are used by providers to optimize treatment to ensure that medications are working as intended. Precision-dosing CDS platforms integrate AI to empower hospitals to reduce medication errors, improve quality of care, and increase cost savings in 2021 and beyond.

Precision dosage specific to hospital settings

Precision dosing is defined as the process of individualizing drug doses taking into account patient-specific factors such as demographics, clinical characteristics, and genetic data. Precision-dosing CDS platforms are essential tools for reducing adverse drug events (ADEs), which are among the costliest medical complications and add more than $ 30 billion per year to the U.S. healthcare system. ADEs also cause 1.3 million annual emergency room trips, according to the CDC. Ultimately, ADRs cause many negative downstream effects for patients, including longer hospital stays, increased emergency department visits, and higher rates of admissions and readmissions.

Many patients are at risk for ADEs because drugs are usually developed with the average patient in mind. The drugs are often studied in a few thousand patients during a clinical development program. As a result, many types of patients are not sufficiently studied in clinical trials, including geriatric patients, pediatric patients, and those with target organ dysfunction. This has downstream implications since once the drug is approved, it is typically administered more widely to patient populations that are not well characterized in clinical trials. These groups of patients are at greater risk for poor clinical outcomes. In fact, the FDA has reported that drugs across a range of therapeutic areas are only effective in 25-62% of patients. Precision dosing has the ability to solve both of these problems through individualized dosing.

Precision dosing is particularly beneficial for drugs with a narrow therapeutic window (that is, drugs whose toxic dose is very close to the minimum dose necessary for the drug to be effective). The approach may also be beneficial for drugs whose drug response is highly variable between patients. Key therapeutic areas for precision dosing include infectious diseases, oncology, blood and marrow transplant, solid organ transplant, and inflammatory bowel disease. For example, precision dosing worked well when individualizing the dosage of vancomycin, an antibiotic prescribed for bacterial infections that can cause acute kidney damage if the dose is too high, resulting in longer hospital stays and higher costs.

Today, hospital physicians and pharmacists are incorporating precision dosing into their clinical practices to ensure patients receive the correct dose of complicated drugs, from intravenous antibiotics to chemotherapy. Hospital clinicians can access precision dosing guidance through an EHR-integrated application that is integrated into their clinical workflow, or through stand-alone web applications.

Modern precision dosing support platforms use pharmacological models and machine learning, running on patient-specific data (including demographic, clinical, laboratory, and genetic information) to help clinicians understand the individual pharmacological profile of a patient to guide dosage decisions. The goal is to ensure that each patient receives the right dose at the right time. Precision dosing can be applied to many drugs and improve patient outcomes by ensuring the patient receives the maximum effective dose while reducing the likelihood of an adverse drug event.

What lies ahead for 2021 and beyond?
We are seeing that healthcare continues to shift from a fixed-dosage mindset to one that adopts individualized dosage, as AI and machine learning advance and dosing technology advances. precision becomes more available at the point of care. We also expect an increase in precision dosing and monitoring of specialty drugs as well as conditioning regimens for gene therapy and cell therapy.

Individualized point-of-care treatment with precision dosing and medication monitoring is also gaining momentum thanks to the recently revised consensus guidelines for vancomycin dosing. The new guidelines call for a shift in vancomycin monitoring based on serum residuals only to area under the curve (AUC) guided assay using Bayesian assay software, which adapts different treatment regimens and changes in the physiology of each patient. during therapy classes.

In addition to precision point-of-care dosing, we will see greater utility during the drug development process. Biopharmaceutical companies are increasingly incorporating precision dosing into clinical trials and are motivated to combine precision dosing with new drugs used to treat rare and common diseases to maximize the effectiveness of new therapies. This means that once the drug is approved, clinicians can benefit from the immediate availability of a CDS tool that helps determine an individualized dosage regimen for the newly approved drug.

At the same time, large hospitals and healthcare systems may also benefit from the ability to tailor pharmacological models to their specific patient populations. Currently, precision assay platforms use pharmacokinetic models derived from general population data to guide dosage decisions. A healthcare system with a patient population that does not closely resemble the general population on which a model is based may find that the dosage regimens suggested by these models are less precise, potentially increasing the time it takes for patients to reach drug exposure. target.

In the near future, provider organizations will be able to use retrospective data from their patient populations to develop a tailor-made predictive model unique to their patient demographics, allowing more accurate dosing in their populations. Using more accurate, population-specific precision dosage models will help organizations improve quality of care and reduce costs as they move more towards value-based care and contracts risk-based.

As AI expands into more areas of healthcare delivery, precision medicine will be redefined and its benefits extended to more patients. Precision medicine will no longer mean just the selection of targeted drugs for patients with a specific genomic profile, an approach that in oncology would only benefit about 5% of cancer patients. Precision medicine will expand to include individualized dosing of a wide range of drugs already widely used in many therapeutic areas. Precision medicine, including precision dosing, not only has positive implications for the patient, but also holds promise for improving the operational business models of hospitals and healthcare systems, reducing costs for payers, and improving research. clinical and drug development.

Photo: Stas_V, Getty Images

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