Using Pharmacometrics to Predict First-in-Human Dosing in Early Trials

Introduction

Predicting a safe and pharmacologically relevant starting dose is one of the most critical decisions in early-phase clinical development. Pharmacometrics—the science of applying mathematical modeling and simulation to pharmacokinetic (PK) and pharmacodynamic (PD) data—plays a vital role in guiding dose selection, estimating exposure, and anticipating human variability before entering Phase 1. This tutorial explores how pharmacometric approaches such as allometric scaling, physiologically based pharmacokinetic (PBPK) modeling, and population PK (PopPK) support early trial design, reduce risk, and enhance regulatory confidence.

What Is Pharmacometrics?

Pharmacometrics is a discipline that uses quantitative models to describe the relationship between drug dose, exposure (PK), and effect (PD). In Phase 1, it helps:

• Predict human PK from animal or in vitro data
• Estimate safe starting dose for FIH trials
• Design sampling schedules and dose escalations
• Support regulatory submissions with predictive simulations

Key Pharmacometrics Tools Used in Phase 1 Planning

1. Allometric Scaling

• Uses body weight and interspecies correction factors
• Commonly used to scale clearance (CL) and volume of distribution (Vd)
• Equations:
  CL_human = CL_animal × (W_human/W_animal)^0.75

2. Physiologically Based Pharmacokinetic (PBPK) Modeling

• Mechanistic simulation based on drug-specific and system-specific parameters
• Incorporates tissue partitioning, metabolism, transporters, and formulation properties
• Used to simulate scenarios for different routes, doses, and populations

3. Minimal PBPK Models

• Hybrid between compartmental and full PBPK models
• Faster to develop; ideal for early estimation of systemic exposure

4. Population PK (PopPK)

• Analyzes Phase 1 trial data across individuals to estimate variability
• Identifies covariates (e.g., weight, sex, renal function) that affect PK

How Pharmacometrics Helps Select First-in-Human Dose

1. Estimating Human PK from Preclinical Data

• Use rodent and non-human primate data to model absorption, clearance, and half-life
• Simulate single-dose and multiple-dose profiles

2. Identifying Minimum Anticipated Biological Effect Level (MABEL)

• Derived from in vitro potency (e.g., EC50) and target occupancy models
• Ensures pharmacological relevance without excess exposure

3. Supporting NOAEL to HED Conversion

• Use NOAEL (No Observed Adverse Effect Level) from animal studies
• Convert to Human Equivalent Dose (HED) using body surface area (BSA)
• Apply safety factor (typically 10-fold) to derive starting dose

4. Predicting Exposure-Response Relationships

• Link predicted exposure to expected pharmacologic or toxicologic outcomes

Regulatory Guidelines and Expectations

FDA

• Accepts PBPK models for FIH dose prediction, pediatric bridging, and DDI simulation
• Encourages MABEL-based dosing for high-risk modalities (e.g., mAbs, cell/gene therapy)

EMA

• Strongly supports PBPK and PopPK as part of the clinical pharmacology package
• Requires justification of initial dose selection in IMPD

CDSCO

• Permits animal-to-human scaling and modeling in preclinical-to-clinical transition plans
• Emphasizes need for transparent modeling assumptions in IND application

Applications of Pharmacometrics Beyond Dose Prediction

1. Sample Size and Sampling Schedule Optimization

• Simulations identify optimal blood sampling timepoints for Cmax and AUC estimation

2. Simulation of Inter-Subject Variability

• Predict likelihood of outliers or exposure deviations

3. Food-Effect Prediction

• PBPK models assess whether high-fat meals impact absorption or Tmax

4. Special Population Projections

• Estimate PK in pediatrics, renal impairment, hepatic impairment before clinical data is available

Examples from Industry

Example 1: Monoclonal Antibody

• Predicted MABEL using target occupancy model in vitro and in vivo
• First dose was 0.1 mg/kg—1/100 of estimated therapeutic dose

Example 2: Oral Small Molecule

• Used PBPK model to simulate fasted vs fed exposure
• Identified risk of Cmax > safety threshold with food—triggered formulation change

Example 3: Oncology FIH Trial

• Applied Bayesian adaptive design using pharmacometric exposure-response model
• Enabled early identification of RP2D with fewer subjects

Best Practices for Pharmacometrics in Phase 1

• Start model development during preclinical phase
• Use validated software (e.g., Simcyp, GastroPlus, NONMEM, Monolix)
• Document assumptions, equations, and source data clearly
• Engage statisticians, pharmacologists, and regulatory experts in model review
• Use modeling results in protocol design, investigator brochure, and IND filing