Transl Clin Pharmacol.  2019 Dec;27(4):123-126. 10.12793/tcp.2019.27.4.123.

Treatment response and disease progression

• Holford N

• KMID: 2467965
• DOI: http://doi.org/10.12793/tcp.2019.27.4.123

Abstract

This tutorial defines the concepts of disease progression in the context of clinical pharmacology. Disease progression describes the natural history of disease, such as pain, or biomarker of drug response, such as blood pressure. The action of a drug, such as inhibiting an enzyme or activating a receptor, leads to a change in disease status over time. Two main types of drug response can be defined based on the pattern of the time course of disease status. The most common is a symptomatic effect equivalent to a shift up or down of the natural history curve. Less common but quite clinically important is a disease-modifying effect equivalent to a change in the rate of disease progression.

Keyword

Disease-modifying; Disease progression; Drug action; Symptomatic

MeSH Terms

Blood Pressure
Disease Progression*
Natural History
Pharmacology, Clinical

Figure

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  Figure 1 Clinical pharmacology is the sum of disease progress and drug action.

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  Figure 2 Disease progression across the human life span. This graph shows the change in bone mineral density (Knochenmesse) in men (Männer) and women (Frauen) from age (Alter) 0 to 90 years.

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  Figure 3 Linear natural history model of disease progression.

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  Figure 4 Linear natural history model of disease progression with a symptomatic offset drug effect.

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  Figure 5 Linear natural history model of disease progression with a disease-modifying drug effect.

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  Figure 6 Linear natural history (blue) with delayed offset drug response at 2 active doses (red) with early placebo and late nocebo response (green).

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