Tech Companies Partner to Individualize Antibiotic Dosing

InsightRx, a company specializing in precision medicine, and Premier Inc, a health care improvement company, have partnered to individualize medication dosing for drugs used to treat infectious diseases.

InsightRx has been developing precision dosing guidance since its founding in 2015. With this partnership, their infectious disease bundle will now be included in Premier’s TheraDoc technology, extending access to the technology to more than 1100 hospitals.¹

Antibiotics used to treat infectious diseases require careful monitoring and dosing regimens, which are affected by patient-specific pharmacokinetics and pharmacodynamics. Without precise and careful administration, these drugs can lead to serious adverse effects, such as acute kidney injury (AKI).¹

Vancomycin is a particularly troublesome antimicrobial, which requires very careful monitoring, according to a press release. New vancomycin dosing guidelines from the American Society of Health-System Pharmacists, Infectious Disease Society of America, Pediatric Infectious Disease Society, and Society of Infectious Disease Pharmacists have emphasized the potential risks when dosing is incorrect.²

According to the guidelines, acute kidney injury occurs in 5% to 43% of patients, with an attributable risk to vancomycin of 59%. Even mild AKI has been shown to significantly decrease long-term survival rates, increase morbidity, prolong hospitalizations, and increase health care costs.²

Sirj Goswami, PhD, co-founder and CEO of InsightRx, said that although infectious disease dosing is only 1 area of focus for the company, it’s especially important because the unmet need in that area is so clear and pressing.

“These are drugs that have a lot of pharmacokinetic variability and require individualization,” Goswami said.

Although drug development and dosing recommendations are developed based on an “average” patient, Goswami added that this is not always realistic in real-world settings.

“A lot of safety concerns are actually related to prescribers not prescribing the correct dose,” Goswami said. “The issue is, in the real world clinical setting, each patient may absorb, distribute, metabolize, and fundamentally respond to drugs at different extents and different rates.”

In order to tackle this concern, the partnership between InsightRx and Premier Inc. will combine the precision dosing platform InsightRx Nova with Premier’s TheraDoc clinical surveillance technology, allowing clinicians to individualize antibiotic therapy. Physicians will be able to identify at-risk patients and create a unique, effective, and safe antimicrobial dose with greater accuracy using quantitative pharmacology models and Bayesian forecasting.¹

The Bayesian method is based on Bayes’ Theorem, a theorem of conditional probabilities that describe how evidence from prior experiences and the likelihood of separate events are related. The Bayesian approach starts by using population data to provide estimates of an individual patient’s pharmacokinetic parameters, known as Bayesian prior. Then, after obtaining a single level, a revision of pharmacokinetic parameter estimates is provided. These estimates, referred to as the Bayesian conditional posterior, can be used to estimate a patient-specific AUC. The Bayesian approach to vancomycin dose optimization requires the use of 1 of several commercially available software programs.

The partnership aims to benefit patients by improving safety, as well as clinicians by streamlining their antibiotic prescribing.

“Clinicians need access to tools that give them the ability to more effectively dose high risk antimicrobials,” said Michelle Allen, vice president and general manager of clinical solutions at Premier, in a statement. ¹

REFERENCES

• InsightRx and Premier Inc. Partner to Enable Hospitals, Health Systems, and Providers to Individualize Treatment for Infectious Disease Patientgs [news release]. Nov. 13, 2019, via E-mail. Accessed Nov. 13, 2019.
• Therapeutic monitoring of vancomycin: A revised consensus guideline and review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. ASHP website. https://www.ashp.org/-/media/assets/policy-guidelines/docs/draft-guidelines/draft-guidelines-ASHP-IDSA-PIDS-SIDP-therapeutic-vancomycin.ashx?la=en&hash=8126CEE49F401CDEE5DB49712225F0A4518DB94B&fbclid=IwAR0tgq_SfaBvgdRLOeb-y1umK2P2ROLwnJ-RMzSoY5iFSTVn-FeAhfSonoA. Accessed Nov. 12, 2019.