IDoser: Improving individualized dosing policies with clinical practice and machine learning

Abstract

Optimizing drug dosages is essential for effective treatment. Clinical protocols may not suit all types of patients evenly, due to many drug trials not being designed to account for all comorbities or clinically relevant outcomes. Methodologies to optimize drug policies with observational data exist, but struggle due to limited data completeness in clinical settings. Computational methods can help overcome these challenges by leveraging field knowledge.This paper proposes an Individualized Doser (IDoser), a core dosing model that links drug dose to relevant covariates via a set of coefficients and includes a loss function to code needed assumptions and requirements. Coordinate descent is used to obtain a fitted model with minimal loss. The loss function also measures performance when validating the model with unseen data. We validated the proposed approach using the case of follicle-stimulating hormone (FSH) dosing for controlled ovarian stimulation (COS).When compared to clinical practice, IDoser achieved a net improvement of up to 31.97% in the validation cases.We present a simple but effective method to bridge the gap between current clinical dosing policies and gold policies based on the true underlying and often unknown dose–response functions.