%0 Journal Article
%T Where Model-Informed Precision Dosing Changes Patient Care—and Where It Remains a Technical Exercise: A Global Evidence-Mapping Review of Implementation, Equity, and Outcomes, 2017–2025
%A Julia Berg
%A Rakesh Nair
%J Annals of Pharmacy Practice and Pharmacotherapy
%@ 3062-4436
%D 2024
%V 4
%N 2
%R 10.51847/h64fK9gmU5
%P 176-188
%X Model-informed precision dosing (MIPD) integrates pharmacometric models with patient-specific information to individualize treatment. Increasing availability of Bayesian dosing software has made bedside use technically feasible, but model validation, clinical implementation, pharmacokinetic target attainment, and improvement in patient outcomes represent different evidentiary levels. This evidence-mapping review examined where MIPD progressed into real clinical decisions during 2017–2025 and where evidence remained primarily technical. Literature searches used PubMed-indexed records, journal and publisher sources, targeted citation chaining, and iterative searches covering MIPD, Bayesian dosing, therapeutic drug monitoring, software, clinical decision support, implementation, access, and outcomes. The evidence-development search identified 66 candidate records. After removal of 20 duplicates, 46 records were screened; 11 were excluded at title/abstract screening. Thirty-five full-text reports were assessed and 11 were excluded, leaving 24 evidence units in the map. Evidence was coded by drug, population, geography, clinical decision use, implementation maturity, access requirements, and outcome level. Technical validation was kept separate from enacted patient care. Clinical implementation was concentrated in antimicrobial therapy, transplantation, hydroxyurea, and selected biologic applications, predominantly in specialist services in the United States and Western Europe, with additional pediatric antimicrobial implementation in Mexico. EHR integration, therapeutic-drug-monitoring infrastructure, model qualification, accessible software, trained personnel, and defined workflow ownership influenced implementation. Improvements in exposure or target attainment were more frequent than improvements in safety, efficacy, healthcare utilization, or survival. Randomized critical-care antibiotic evaluations supplied important null evidence, whereas selected transplant and hydroxyurea applications demonstrated stronger patient-facing consequences. MIPD changes patient care when patient-specific model output reaches an actionable treatment decision and is enacted within a functioning clinical service. Evidence from 2017–2025 demonstrates such implementation for selected therapies but does not justify treating technical model performance or pharmacokinetic target attainment as universal evidence of clinical benefit. Implementation capacity, transportability, infrastructure, and patient-outcome evaluation remain central constraints on broader adoption.
%U https://galaxypub.co/article/where-model-informed-precision-dosing-changes-patient-careand-where-it-remains-a-technical-exercise-w82g6pdlh6aauck