Methotrexate is an antimetabolite and antifolate drug used in the treatment of cancer and autoimmune diseases. It acts by inhibiting the metabolism of folic acid. We chose methotrexate as our first drug dashboard because it is not well understood in children and because our division has prior experience with it. Gastrointestinal, renal and hematological toxicities are common with dosing methotrexate. Leucovorin is often administered as a rescue treatment for methotrexate overdose and a nomogram is used to help determine the proper dose. The physician champion for this effort is Jeffrey Skolnik, MD, an attending physician in the Hospital's Division of Oncology. The pharmacological modeling effort was provided by John Mondick, PhD, a senior biostatistician in the Division of Clinical Pharmacology.
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| Figure 1: An indexed view of drug information, created to give clinicians access to basic drug characteristics, such as contraindications, warnings and adverse reactions. | Figure 2: A quick overview of how the patient is responding to MTX, illustrated via time-based trend lines of serum concentrations of MTX, serum creatinine (SRCR) levels and total bilirubin (TBILI) levels. | Figure 3: An illustration of the power of predictive analytics on impending patient toxicity, which can alert the clinician to adjust the dose, to advance rescue treatments, or to increase the frequency of therapeutic drug monitoring. |
Tacrolimus is an immunosuppressive drug used after allogenic organ transplantation to reduce the activity of the patient's immune system, thereby reducing the risk of organ rejection. The need for guidance in dosing tacrolimus is critical - the large variability in tacrolimus pharmacokinetics in children makes it difficult to predict what drug concentration will be achieved with a given dose change. In addition, it has a narrow therapeutic window; it is essential to avoid the toxicities associated with higher levels and prevent organ rejection, which occurs at lower levels. The incidence of toxicity is 45 percent at plasma levels greater than 15 µg/L and there is a 30 percent incidence of acute rejection at levels less than 5 µg/L. We built the tacrolimus dashboard through our collaboration with the Hospital's Division of Nephrology. The physician champion for this effort is Olivera Marsenic, MD, a fellow in the Division of Nephrology who is completing a rotation in clinical pharmacology under the direction of Jeffrey Barrett, PhD, FCP, and Athena Zuppa, MD. The pharmacological modeling effort will be provided by Divya Menon, PhD, who is completing a post-doctorate rotation in pharmacometrics in Dr. Barrett's lab.
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| Figure 1: An indexed view of drug information, created to give clinicians access to basic drug characteristics, such as contraindications, warnings and adverse reactions. | Figure 2: A quick overview of how the patient is responding to TAC, illustrated via time-based trend lines of serum concentrations of TAC, serum creatinine (SRCR) levels and Alanine/Aspartate Transaminase (ALT/AST) levels. | |
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| Figure 3: An illustration of the power of predictive analytics on impending patient toxicity, which can alert the clinician to adjust the dose, to advance rescue treatments, or to increase the frequency of therapeutic drug monitoring. | Figure 4: An overview of patient history. | |
We are in the process of constructing an oncology therapy dashboard, and are currently in the proof of concept stage. Please stay tuned for more updates...
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