Precision Dosing is the evolution of Therapeutic Drug Monitoring (TDM). It is about individualizing the dosage regimens of certain therapies based on the pharmacokinetics and mathematical modelling. Typically these therapies have the following characteristics: (a) They are of narrow therapeutic index, (b) they are of critical importance, and (c) they have a well characterized Exposure – Response relationship. Precision dosing is a complex process that includes the collaboration of medical doctors, clinical pharmacists, bioanalytical chemists and pharmacometricians and incudes coordination and standardization of the involved procedures. Precision Dosing is a necessary and complementary component of Precision Medicine often ignored. In our lab we have collaborated in the implementation of one the very first precision dosing projects in Greece, namely the optimization of Busulfan treatment in paediatric patients in Hagia Sofia Children Hospital in Athens. Busulfan is used for conditioning before Hematopoietic Stem Cell Transplantation for the treatment of Leukaemia. The project has produced a PhD thesis (E Neroutsos) and two papers:
Dose individualization of intravenous busulfan in pediatric patients undergoing bone marrow transplantation: impact and in vitro evaluation of infusion lag-time. Neroutsos E, Athanasiadou I, Paisiou A, Zisaki K, Goussetis E, Archontaki H, Tsirigotis P, Kitra M, Grafakos S, Spyridonidis A, Dokoumetzidis A, Valsami G.J Pharm Pharmacol. 2021 Sep 7;73(10):1340-1350. doi: 10.1093/jpp/rgab087.
Development of a Population Pharmacokinetic Model of Busulfan in Children and Evaluation of Different Sampling Schedules for Precision Dosing. Neroutsos E, Nalda-Molina R, Paisiou A, Zisaki K, Goussetis E, Spyridonidis A, Kitra V, Grafakos S, Valsami G, Dokoumetzidis A.Pharmaceutics. 2022 Mar 15;14(3):647. doi: 10.3390/pharmaceutics14030647.