To characterise the pharmacokinetics of dofetilide in patients and to identify clinically relevant parameter–covariate relationships.
To investigate three different modelling strategies in covariate model building using dofetilide as an example: (1) using
statistical criteria only or in combination with clinical irrelevance criteria for covariate selection, (2) applying covariate
effects on total clearance or separately on non-renal and renal clearances and (3) using separate data sets for covariate
selection and parameter estimation. Pooled concentration-time data (1,445 patients, 10,133 observations) from phase III clinical
trials was used. A population pharmacokinetic model was developed using NONMEM. Stepwise covariate model building was applied
to identify important covariates using the strategies described above. Inclusion and exclusion of covariates using clinical
irrelevance was based on reduction in interindividual variability and changes in parameters at the extremes of the covariate
distribution. Parametric separation of the elimination pathways was accomplished using creatinine clearance as an indicator
of renal function. The pooled data was split in three parts which were used for covariate selection, parameter estimation
and evaluation of predictive performance. Parameter estimations were done using the first-order (FO) and the first-order conditional
estimation (FOCE) methods. A one-compartment model with first order absorption adequately described the data. Using clinical
irrelevance criteria resulted in models containing less parameter–covariate relationships with a minor loss in predictive
power. A larger number of covariates were found significant when the elimination was divided into a renal part and a non-renal
part, but no gain in predictive power could be seen with this data set. The FO and FOCE estimation methods gave almost identical
final covariate model structures with similar predictive performance. Clinical irrelevance criteria may be valuable for practical
reasons since stricter inclusion/exclusion criteria shortens the run times of the covariate model building procedure and because
only the covariates important for the predictive performance are included in the model.
Keywords Covariates - Dofetilide - Modelling - NONMEM
K. Tunblad and L. Lindbom contributed equally to the work.