Journal of Pharmacokinetics and Pharmacodynamics

, Volume 38, Issue 2, pp 237–260

Informative dropout modeling of longitudinal ordered categorical data and model validation: application to exposure–response modeling of physician’s global assessment score for ustekinumab in patients with psoriasis

  • Chuanpu Hu
  • Philippe O. Szapary
  • Newman Yeilding
  • Honghui Zhou
Article

DOI: 10.1007/s10928-011-9191-7

Cite this article as:
Hu, C., Szapary, P.O., Yeilding, N. et al. J Pharmacokinet Pharmacodyn (2011) 38: 237. doi:10.1007/s10928-011-9191-7

Abstract

The physician’s global assessment (PGA) score is a 6-point measure of psoriasis severity that is widely used in clinical trials to assess response to psoriasis treatment. The objective of this study was to perform exposure–response modeling using the PGA score as a pharmacodynamic endpoint following treatment with ustekinumab in patients with moderate-to-severe psoriasis who participated in two Phase 3 studies (PHOENIX 1 and PHOENIX 2). Patients were randomly assigned to receive ustekinumab 45 or 90 mg or placebo, followed by active treatment or placebo crossover to ustekinumab, dose intensification or randomized withdrawal and long-term extension periods. A novel joint longitudinal-dropout model was developed from serum ustekinumab concentrations, PGA scores, and patient dropout information. The exposure–response component employed a semi-mechanistic drug model, integrated with disease progression and placebo effect under the mixed-effect logistic regression framework. This allowed potential tolerance to be investigated with a mechanistic approach. The dropout component of the joint model allowed the examination of its potential influence on the exposure–response relationship. The flexible Weibull dropout hazard function was used. Visual predictive check of the joint longitudinal-dropout model required special handling, and a conditional approach was proposed. The conditional approach was extended to external model validation. Finally, appropriate interpretation of model validation is discussed. This longitudinal-dropout model can serve as a basis to support future alternative dosing regimens for ustekinumab in patients with moderate-to-severe plaque psoriasis.

Keywords

Monoclonal antibodyInformative censoringNonlinear mixed effect modelingVisual predictive checkNONMEM

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Chuanpu Hu
    • 1
  • Philippe O. Szapary
    • 2
  • Newman Yeilding
    • 2
  • Honghui Zhou
    • 1
  1. 1.Pharmacokinetics and Pharmacometrics, Biologics Clinical PharmacologyCentocor Research and Development, Inc.MalvernUSA
  2. 2.Clinical ImmunologyCentocor Research and Development, Inc.MalvernUSA