System and method for managing a patient treatment program including a prescribed drug regimen

• US 20040193446A1
• Filed: 03/27/2003
• Published: 09/30/2004
• Est. Priority Date: 03/27/2003
• Status: Abandoned Application

• Current Assignee: Bernard Vrijens, Jean-Michel Metry, John Urquhart, Steven Lloyd Mayer
• Original Assignee: Bernard Vrijens, Jean-Michel Metry, John Urquhart, Steven Lloyd Mayer
• Inventors: Vrijens, Bernard, Mayer, Steven Lloyd, Urquhart, John, Metry, Jean-Michel
• Application Number:
  US10/400,271
• Publication Number:
  US 20040193446A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G01N 2333/16 HIV-1, HIV-2
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

The present invention relates to a system and method for managing a patient treatment program including a prescribed dosing regimen. The system and method develops and/or makes use of a pharmacokinetic model and a pharmacodynamic model and the monitored adherence of the patient to determine if and when testing should be performed. The system and method further determines if the prescribed dosing regimen should be adjusted, based upon a comparison of the results of the one or more tests and the results predicted by the one or more models.

Claims

1. A method of individualizing the treatment of a patient associated with a prescribed drug regimen comprising the steps of:

developing a pharmacokinetic model, which predicts the drug concentration over time in the patient in response to the drug dosage history of the patient;

developing a pharmacodynamic model, which includes a predicted level of effectiveness for various levels of dosing and various degrees of deviation from prescribed dosing regimen;

prescribing a drug regimen for the patient, designed to achieve a desired pharmacological effect, based upon the pharmacokinetic model and the pharmacodynamic model;

monitoring the adherence of the patient to a prescribed dosing regimen including the degree of deviation;

measuring the pharmacological effect in the patient of the prescribed dosing regimen;

comparing the measured effect with the level of effectiveness, predicted by the pharmacodynamic model, after taking into account the adherence of the patient to the prescribed dosing regimen; and

if the measured effect deviates from the predicted level of effectiveness,

performing additional tests to determine the actual drug concentration over time in the particular patient,

adjusting the pharmacokinetic model based upon the actual determined drug concentration over time, and

adjusting the prescribed drug regimen for the patient to account for adjustments in the pharmacokinetic model.

2. The method of claim 1, wherein the additional tests include therapeutic drug monitoring.

3. The method of claim 2, wherein the drug regimen includes an antiretroviral agent for treating a viral infection, and wherein if the results of the therapeutic drug monitoring test indicates that the drug concentration over time is within the expected range, then performing drug resistance testing to determine the presence or the emergence of a drug resistant virus.

4. The method of claim 3, wherein if a drug resistant virus is present or has emerged, adjusting the prescribed drug regimen to include another antiretroviral agent.

5. The method of claim 1, wherein the drug regimen includes an antiretroviral agent for treating a viral infection, and wherein the pharmacological effect includes at least one of a change in the viral load and an emergence of a resistant strain.

6. The method of claim 1, wherein the drug concentration over time in the patient includes the drug concentration over time in the plasma of the patient.

7. The method of claim 1, wherein the degree of deviation from the prescribed dosing regimen includes a measure of the number of missed doses.

8. The method of claim 1, wherein the degree of deviation from the prescribed dosing regimen includes a measure of the frequency of missed doses.

9. The method of claim 1, wherein when a dose is missed or delayed, the degree of deviation from the prescribed dosing regimen takes into account the length in time between the delayed dose or the dose taken after the preceding dose was missed, and the preceding dose, which was taken.

10. The method of claim 1, wherein monitoring the adherence of the patient to a prescribed dosing regimen includes monitoring the time and date the patient accesses an enclosure containing each of one or more medications prescribed as part of the prescribed dosing regimen.

11. The method of claim 1, wherein the pharmacokinetic model takes into account the rates of at least one of drug absorption, drug distribution, drug metabolism, and drug excretion.

44. The method of claim 1 wherein the drug regimen is for the treatment of thyroid disease.

12. A method of designing a clinical trial, which determines the effectiveness of a drug in producing a desired pharmacological effect over abroad range of patient adherence to a prescribed drug regimen comprising the steps of:

prescribing a drug regimen for one or more patients;

monitoring the adherence of the one or more patients to the prescribed drug regimen;

measuring the pharmacological effect in the one or more patients at various intervals; and

relating the measured pharmacological effect to the patient adherence and the degree of deviation from the prescribed dosing regimen, if any.

13. The method of claim 12 wherein the decision to measure the pharmacological effect in the one or more patients, in at least some instances, is prompted to occur, when the adherence to the drug regimen of the one or more patients is at a point in which the results of the testing is not substantially covered by already existing test data.

14. The method of claim 13, wherein the results of the testing not being covered by already existing test data includes instances where the additional data would reduce the degree of any interpolation required in making a prediction of the pharmacological effect from the already existing data.

15. A method of providing patient care comprising:

prescribing a drug regimen for a patient directed to achieving and maintaining a predetermined level of wellness, when a predetermined level of patient compliance is met or exceeded;

monitoring the adherence of the patient to the prescribed drug regimen;

if the patient compliance level approaches or falls below the predetermined level of patient compliance,

comparing the cost of subsequent corrective action in drug dosing, if necessary, to compensate for non-compliant patient behavior with the cost of intervening with the patient to encourage patient compliance,

if it is more cost effective to compensate for non-compliant patient behavior by adjusting the drug regimen, than by adjusting the drug regimen, and

if it is equally or more cost effective to intervene with the patient to encourage patient compliance, then intervening with the patient; and

if the patient compliance level meets or exceeds the predetermined level of patient compliance, and the predetermined level of wellness fails to be achieved and maintained, determining the need for change in the prescribed drug regimen.

16. The method of claim 15 wherein determining the need for change in the prescribed drug regimen includes

testing the patient to determine the drug concentration over time in the patient,

if the determined drug concentration over time in the patient deviates from the expected pattern, then adjusting at least one of the frequency and the dosing levels of the prescribed drug regimen to compensate for the determined deviation in the expected pattern of the drug concentration over time, and

if the determined time course of drug concentration in the patient is consistent with the expected pattern, altering the prescribed drug regimen to include alternative therapies.

17. The method of claim 15 wherein intervening with the patient includes explaining the consequences of sub-optimal compliance.

18. The method of claim 15, wherein monitoring the adherence of the patient to a prescribed dosing regimen includes monitoring the time and date the patient accesses an enclosure containing each of one or more medications prescribed as part of the prescribed dosing regimen.

19. The method of claim 18 wherein intervening with the patient includes contacting the patient about a missed event from prescribed drug regimen after a predetermined period of time, and the event has still not occurred.

20. A system for managing a patient treatment program comprising:

one or more enclosures each containing medication subscribed as part of a prescribed drug regimen for a respective one of the one or more patients, each enclosure being adapted for monitoring the access of the respective patient to the prescribed medication; and

a patient health management computer comprising

a communication unit for receiving the access information from each of the one or more enclosures,

a processor for executing a plurality of prestored instructions and data including

instructions and data for creating and maintaining a pharmacokinetic model, which predicts the drug concentration over time in the patients, based at least in part upon the access information received from the corresponding enclosures,

instructions and data for creating and maintaining a pharmacodynamic model, which receives the drug concentration over time predicted by the pharmacokinetic model, and predicts the level of effectiveness for various levels of dosing and various degrees of deviation from the prescribed dosing regimen, and

instructions and data for creating and maintaining a decision analytic model, which receives the dosing history, the predicted drug concentration over time in the respective patients, and the predicted levels of effectiveness, for recommending when at least one of one or more tests should be performed on a patient to determine the actual condition of at least one aspect of the patient, and for deciding when the prescribed dosing regimen should be changed, and

an interface unit for communicating to a user the recommendation when a test should be performed, and for receiving the results of the tests performed.

21. The system of claim 20, wherein the enclosure includes a reservoir encapsulating a space capable of holding one or more doses of a medication, said reservoir having an opening through which access to the one or more doses is possible, and a cap, which selectively covers said opening, and which is adapted to detect its position relative to the reservoir between covering said opening and not covering said opening.

22. The system of claim 21, wherein the cap includes a calender and clock for detecting when the patient accesses the enclosure.

23. The system of claim 21, wherein the cap includes a memory for storing the access data for each instance that the patient accesses the enclosure.

24. The system of claim 21, wherein the cap includes a transmitter and a receiver for wirelessly communicating the access data with the communication unit of the computer data server.

25. The system of claim 20, wherein the system is used for treating a patient with a viral infection, and the pharmacodynamic model includes a submodel for predicting the emergence of a drug resistant strain.

26. The system of claim 20, wherein the system is used for treating a patient with a viral infection, and the pharmacodynamic model includes a submodel for predicting the response of CD4 cell counts to the prescribed drug regimen.

27. The system of claim 20, wherein the prescribed drug regimen includes the use of an antiretroviral agent.

28. The system of claim 20, wherein the one or more tests include at least one of therapeutic drug monitoring for measuring the actual drug concentrations over time in the patient, a viral load test for measuring the actual amount of virus present in the patient, a drug resistance test for detecting the emergence of a drug resistant strain of the virus and measuring the relative amount of the drug resistant strain, and a CD4 count for measuring the absolute and relative amounts of CD4 cells in the plasma of the patient.

45. The system of claim 20 wherein the system is used for treating a patient with thyroid disease.

29. A method for managing an antiretroviral treatment program of a patient including one or more drugs comprising the steps of:

prescribing a drug regimen for treating a viral infection, the severity of which is represented by a viral load;

if the condition of the patient, including the viral load, does not improve after a predetermined period of time

monitoring the adherence of the patient to the prescribed drug regimen including a dosing history,

executing a pharmacokinetic model, which receives the dosing history and predicts the drug concentration over time in the patient,

executing a pharmacodynamic mode, which receives the drug concentration over time from the pharmacokinetic model and predicts the likelihood of emergence of a drug resistant virus, and

executing a decision analytic model, which receives the dosing history, the drug concentration over time, and the likelihood of emergence of a drug resistant virus and determines when at least one of additional tests should be performed and when the prescribed drug regimen should be altered.

30. The method of claim 29 wherein the dosing history includes both the time and day each of the drug doses is taken.

31. The method of claim 30 wherein monitoring the adherence of the patient includes determining the degree of deviation by comparing the actual time a particular drug dose is taken with the scheduled time the particular drug dose is taken.

32. The method of claim 29 wherein the pharmacodynamic model includes determining the instances, if any, and the corresponding duration in which the level of drug concentration in the patient, predicted by the pharmacokinetic model, falls below a predetermined level.

33. The method of claim 29 wherein the decision analytic model includes an economic submodel, which takes into account the economic costs of the additional tests and the predicted likelihood that the tests will produce useful information.

34. The method of claim 29 wherein the additional tests include therapeutic drug monitoring to measure the actual drug concentration over time for comparing with the drug concentration over time predicted by the pharmacokinetic model.

35. The method of claim 34 wherein if the actual drug concentration over time substantially deviates from the predicted drug concentration over time, then adjusting the pharmacokinetic model to account for the deviation.

36. The method of claim 35 wherein the predicted drug concentration over time includes a range of predicted drug concentration values, which varies over time.

37. The method of claim 29 wherein the additional tests include viral load testing to measure the actual amount of virus present for comparing with previously measured amounts of the virus present and for determining a change, if any, in the amount of virus present.

38. The method of claim 37 wherein if the viral load testing identifies a change in the amount of virus present, which corresponds to an increase in the amount of virus present, and the increase is inconsistent with the amount predicted given the monitored adherence of the patient to the prescribed drug regimen and the corresponding predicted drug concentration over time, then testing for the presence or emergence of drug resistant virus.

39. The method of claim 29 wherein the additional tests include drug resistance testing to test for the emergence of drug resistant virus, and the amount of drug resistant virus present, if any.

40. The method of claim 39 wherein if the drug resistance testing identifies the presence or emergence of drug resistant virus, then adjusting the prescribed drug regimen.

41. The method of claim 29 wherein the pharmacodynamic model includes a submodel for predicting the response of CD4 cell counts, based upon the received value of the drug concentration over time in the patient.

42. The method of claim 41 wherein the additional tests include a test which measures CD4 cell counts for determining the overall health of the immune system.

43. The method of claim 42 wherein if the test which measure CD4 cell counts falls below a predetermined threshold, then adjusting prescribed drug regimen to include drugs for preventing opportunistic infections.