Clients' experience of change: An exploration of the influence of reformulation tools in cognitive analytic therapy

Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small-N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self-Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation-10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT-specific tools.

Reformulation as an Integrated Approach of Four Disciplines: A Qualitative Study with Food Companies

In 2014, the Dutch government agreed with the food sector to lower salt, sugar, saturated fat and energy in foods. To reformulate, an integrated approach of four disciplines (Nutrition & Health, Food Technology, Legislation, and Consumer Perspectives) is important for food companies (Framework for Reformulation). The objective of this study was to determine whether this framework accurately reflects reformulation processes in food companies. Seventeen Dutch food companies in the bakery, meat and convenience sector were interviewed with a semi-structured topic list. Interviews were transcribed, coded and analysed. Interviews illustrated that there were opportunities to lower salt, sugar and saturated fat (Nutrition & Health). However, there were barriers to replacing the functionality of these ingredients (Food Technology). Most companies would like the government to push reformulation more (Legislation). Traditional meat products and luxury sweet bakery products were considered less suitable for reformulation (Consumer Perspectives). In addition, the reduction of E-numbers was considered important. The important role of the retailer is stressed by the respondents. In conclusion, all four disciplines are important in the reformulation processes in food companies. Reformulation does not only mean the reduction of salt, saturated fat and sugar for companies, but also the reduction of E-numbers.

Evaluation of Australian soup manufacturer compliance with national sodium reduction targets

AIM

Packaged foods dominate Australia's food supply and are important contributors to nutrition-related disease. To help address this problem, the Food and Health Dialogue (FHD) was launched in 2009, setting voluntary sodium reduction targets for various categories of packaged foods. The aim of this study was to examine the food industry's progress and compliance with the FHD sodium reduction targets for soup products.

METHODS

Nutritional information was collected from product labels of all soup products available from four major Australian supermarkets annually between 2011 and 2014. Products were assigned to categories in line with those in the FHD. The proportion of soup products meeting sodium reduction targets was examined by (i) soup category; (ii) FHD participant status; and (iii) manufacturer.

RESULTS

A 6% reduction in sodium levels in soups overall was found from 2011 to 2014 (P = 0.002). Significant reductions were observed for FHD participants (P < 0.05 for all) but not for non-participants. In 2014, 67% dry soups and 76% of wet soups met national sodium reduction targets.

CONCLUSIONS

Despite the majority of soup products meeting the sodium reduction targets specified by the FHD, re-evaluation of the targets may be required to further reduce sodium levels in soups. Manufacturers participating in the FHD are likely to be driving sodium reductions in the Australian soup market, further highlighting the need for continued government leadership in this area to ensure all manufacturers are actively involved in the process.

Effects of a Voluntary Front-of-Pack Nutrition Labelling System on Packaged Food Reformulation: The Health Star Rating System in New Zealand

Interpretive, front-of-pack (FOP) nutrition labels may encourage reformulation of packaged foods. We aimed to evaluate the effects of the Health Star Rating (HSR), a new voluntary interpretive FOP labelling system, on food reformulation in New Zealand. Annual surveys of packaged food and beverage labelling and composition were undertaken in supermarkets before and after adoption of HSR i.e., 2014 to 2016. Outcomes assessed were HSR uptake by food group star ratings of products displaying a HSR label; nutritional composition of products displaying HSR compared with non-HSR products; and the composition of products displaying HSR labels in 2016 compared with their composition prior to introduction of HSR. In 2016, two years after adoption of the voluntary system, 5.3% of packaged food and beverage products surveyed (n = 807/15,357) displayed HSR labels. The highest rates of uptake were for cereals, convenience foods, packaged fruit and vegetables, sauces and spreads, and ‘Other’ products (predominantly breakfast beverages). Products displaying HSR labels had higher energy density but had significantly lower mean saturated fat, total sugar and sodium, and higher fibre, contents than non-HSR products (all p-values < 0.001). Small but statistically significant changes were observed in mean energy density (−29 KJ/100 g, p = 0.002), sodium (−49 mg/100 g, p = 0.03) and fibre (+0.5 g/100 g, p = 0.001) contents of HSR-labelled products compared with their composition prior to adoption of HSR. Reformulation of HSR-labelled products was greater than that of non-HSR-labelled products over the same period, e.g., energy reduction in HSR products was greater than in non-HSR products (−1.5% versus −0.4%), and sodium content of HSR products decreased by 4.6% while that of non-HSR products increased by 3.1%. We conclude that roll-out of the voluntary HSR labelling system is driving healthier reformulation of some products. Greater uptake across the full food supply should improve population diets.

Applying a Consumer Behavior Lens to Salt Reduction Initiatives

Reformulation of food products to reduce salt content has been a central strategy for achieving population level salt reduction. In this paper, we reflect on current reformulation strategies and consider how consumer behavior determines the ultimate success of these strategies. We consider the merits of adopting a ‘health by stealth’, silent approach to reformulation compared to implementing a communications strategy which draws on labeling initiatives in tandem with reformulation efforts. We end this paper by calling for a multi-actor approach which utilizes co-design, participatory tools to facilitate the involvement of all stakeholders, including, and especially, consumers, in making decisions around how best to achieve population-level salt reduction.

Testing the Capacity of a Multi-Nutrient Profiling System to Guide Food and Beverage Reformulation: Results from Five National Food Composition Databases

Nutrient profiling ranks foods based on their nutrient composition, with applications in multiple aspects of food policy. We tested the capacity of a category-specific model developed for product reformulation to improve the average nutrient content of foods, using five national food composition datasets (UK, US, China, Brazil, France). Products (n = 7183) were split into 35 categories based on the Nestlé Nutritional Profiling Systems (NNPS) and were then classified as NNPS 'Pass' if all nutrient targets were met (energy (E), total fat (TF), saturated fat (SFA), sodium (Na), added sugars (AS), protein, calcium). In a modelling scenario, all NNPS Fail products were 'reformulated' to meet NNPS standards. Overall, a third (36%) of all products achieved the NNPS standard/pass (inter-country and inter-category range: 32%-40%; 5%-72%, respectively), with most products requiring reformulation in two or more nutrients. The most common nutrients to require reformulation were SFA (22%-44%) and TF (23%-42%). Modelled compliance with NNPS standards could reduce the average content of SFA, Na and AS (10%, 8% and 6%, respectively) at the food supply level. Despite the good potential to stimulate reformulation across the five countries, the study highlights the need for better data quality and granularity of food composition databases.

What can the food and drink industry do to help achieve the 5% free sugars goal?

AIMS

To contribute evidence and make recommendations to assist in achieving free sugars reduction, with due consideration to the broader picture of weight management and dietary quality.

METHODS

An expert workshop in July 2016 addressed options outlined in the Public Health England report 'Sugar reduction: The evidence for action' that related directly to the food industry. Panel members contributed expertise in food technology, public heath nutrition, marketing, communications, psychology and behaviour. Recommendations were directed towards reformulation, reduced portion sizes, labelling and consumer education. These were evaluated based on their feasibility, likely consumer acceptability, efficacy and cost.

RESULTS

The panel agreed that the 5% target for energy from free sugars is unlikely to be achievable by the UK population in the near future, but a gradual reduction from average current level of intake is feasible. Progress requires collaborations between government, food industry, non-government organisations, health professionals, educators and consumers. Reformulation should start with the main contributors of free sugars in the diet, prioritising those products high in free sugars and relatively low in micronutrients. There is most potential for replacing free sugars in beverages using high-potency sweeteners and possibly via gradual reduction in sweetness levels. However, reformulation alone, with its inherent practical difficulties, will not achieve the desired reduction in free sugars. Food manufacturers and the out-of-home sector can help consumers by providing smaller portions. Labelling of free sugars would extend choice and encourage reformulation; however, government needs to assist industry by addressing current analytical and regulatory problems. There are also opportunities for multi-agency collaboration to develop tools/communications based on the Eatwell Guide, to help consumers understand the principles of a varied, healthy, balanced diet.

CONCLUSION

Multiple strategies will be required to achieve a reduction in free sugars intake to attain the 5% energy target. The panel produced consensus statements with recommendations as to how this might be achieved.

Effect of 25% Sodium Reduction on Sales of a Top-Selling Bread in Remote Indigenous Australian Community Stores: A Controlled Intervention Trial

Reducing sodium in the food supply is key to achieving population salt targets, but maintaining sales is important to ensuring commercial viability and maximising clinical impact. We investigated whether 25% sodium reduction in a top-selling bread affected sales in 26 remote Indigenous community stores. After a 23-week baseline period, 11 control stores received the regular-salt bread (400 mg Na/100 g) and 15 intervention stores received the reduced-salt version (300 mg Na/100 g) for 12-weeks. Sales data were collected to examine difference between groups in change from baseline to follow-up (effect size) in sales (primary outcome) or sodium density, analysed using a mixed model. There was no significant effect on market share (-0.31%; 95% CI -0.68, 0.07; p = 0.11) or weekly dollars ($58; -149, 266; p = 0.58). Sodium density of all purchases was not significantly reduced (-8 mg Na/MJ; -18, 2; p = 0.14), but 25% reduction across all bread could significantly reduce sodium (-12; -23, -1; p = 0.03). We found 25% salt reduction in a top-selling bread did not affect sales in remote Indigenous community stores. If achieved across all breads, estimated salt intake in remote Indigenous Australian communities would be reduced by approximately 15% of the magnitude needed to achieve population salt targets, which could lead to significant health gains at the population-level.

Cross-sectional survey of the amount of free sugars and calories in carbonated sugar-sweetened beverages on sale in the UK

OBJECTIVES

To investigate the free sugars and calorie content of carbonated sugar-sweetened beverages (CSSB) available in the main UK supermarkets.

STUDY DESIGN

We carried out a cross-sectional survey in 2014 of 169 CSSB.

METHODS

The free sugars (sugars g/100 mL) and calorie (kcal/100 mL) were collected from product packaging and nutrient information panels of CSSB available in 9 main UK supermarkets.

RESULTS

The average free sugars content in CSSB was 30.1±10.7 g/330 mL, and 91% of CSSB would receive a 'red' (high) label for sugars per serving. There was a large variation in sugars content between different flavours of CSSB and within the same type of flavour ranging from 3.3 to 52.8 g/330 mL. On average, ginger beer (38.5±9.9 g/330 mL) contained the highest amounts of sugars and ginger ale (22.9±7.7 g/330 mL) contained the lowest. Cola flavour is the most popular flavour in the UK with an average free sugars content of 35.0±1.1 g/330 mL. On average, the supermarket own brand contained lower levels of sugars than branded products (27.9±10.6 vs 31.6±10.6 g/330 mL, p=0.02). The average calorie content in CSSB was 126.1±43.5 kcal/330 mL. Cola flavour had a calorie content of 143.5±5.2 kcal/330 mL. Among the 169 products surveyed, 55% exceeded the maximum daily recommendation for free sugars intake (30 g) per 330 mL.

CONCLUSIONS

Free sugars content of CSSB in the UK is high and is a major contributor to free sugars intake. There is a wide variation in the sugars content of CSSB and even within the same flavour of CSSB. These findings demonstrate that the amount of free sugars added to CSSB can be reduced without technical issues, and there is an urgent need to set incremental free sugars reduction targets. A reduction in sugars content and overall CSSB consumption will be very beneficial in reducing obesity, type 2 diabetes and dental caries.

Effects of Active Listening, Reformulation, and Imitation on Mediator Success: Preliminary Results

An experiment with 212 students (100 men, 112 women; M age = 18.3 years, SD = 0.9) was carried out to compare the effect of four techniques used by mediators on the number of agreements contracted by negotiators. Under experimental conditions, mediators were asked either to rephrase (reformulate) negotiators' words or to imitate them or to show active listening behavior, or finally, to use a free technique. More agreements were reached in the active listening condition than in both free and rephrase conditions. Furthermore, mediators in the active listening condition were perceived, by the negotiators, as more efficient than mediators using other techniques, although there was no significant difference observed between the active listening and imitation conditions.

Dietary Impact of Adding Potassium Chloride to Foods as a Sodium Reduction Technique

Potassium chloride is a leading reformulation technology for reducing sodium in food products. As, globally, sodium intake exceeds guidelines, this technology is beneficial; however, its potential impact on potassium intake is unknown. Therefore, a modeling study was conducted using Dutch National Food Survey data to examine the dietary impact of reformulation (n = 2106). Product-specific sodium criteria, to enable a maximum daily sodium chloride intake of 5 grams/day, were applied to all foods consumed in the survey. The impact of replacing 20%, 50% and 100% of sodium chloride from each product with potassium chloride was modeled. At baseline median, potassium intake was 3334 mg/day. An increase in the median intake of potassium of 453 mg/day was seen when a 20% replacement was applied, 674 mg/day with a 50% replacement scenario and 733 mg/day with a 100% replacement scenario. Reformulation had the largest impact on: bread, processed fruit and vegetables, snacks and processed meat. Replacement of sodium chloride by potassium chloride, particularly in key contributing product groups, would result in better compliance to potassium intake guidelines (3510 mg/day). Moreover, it could be considered safe for the general adult population, as intake remains compliant with EFSA guidelines. Based on current modeling potassium chloride presents as a valuable, safe replacer for sodium chloride in food products.

Detection of 12.5% and 25% Salt Reduction in Bread in a Remote Indigenous Australian Community

Food reformulation is an important strategy to reduce the excess salt intake observed in remote Indigenous Australia. We aimed to examine whether 12.5% and 25% salt reduction in bread is detectable, and, if so, whether acceptability is changed, in a sample of adults living in a remote Indigenous community in the Northern Territory of Australia. Convenience samples were recruited for testing of reduced-salt (300 and 350 mg Na/100 g) versus Standard (~400 mg Na/100 g) white and wholemeal breads (n = 62 for white; n = 72 for wholemeal). Triangle testing was used to examine whether participants could detect a difference between the breads. Liking of each bread was also measured; standard consumer acceptability questionnaires were modified to maximise cultural appropriateness and understanding. Participants were unable to detect a difference between Standard and reduced-salt breads (all p values > 0.05 when analysed using binomial probability). Further, as expected, liking of the breads was not changed with salt reduction (all p values > 0.05 when analysed using ANOVA). Reducing salt in products commonly purchased in remote Indigenous communities has potential as an equitable, cost-effective and sustainable strategy to reduce population salt intake and reduce risk of chronic disease, without the barriers associated with strategies that require individual behaviour change.

Development of a nutritionally balanced pizza as a functional meal designed to meet published dietary guidelines

OBJECTIVE

To develop a worked example of product reformulation of a very popular 'junk food' to meet nutritional guidelines for public health in a ready meal.

DESIGN

Indicative survey of popular Margherita pizzas, followed by product reformulation, applying dietary guidelines to generate a single-item pizza meal containing 30 % daily amounts of energy and all nutrients. An iterative process was used; first to optimize nutrient balance by adjusting the proportions of bread base, tomato-based sauce and mozzarella topping, then adding ingredients to provide specific nutrients and consumer tasting.

SETTING

Urban areas of contrasting socio-economic status.

SUBJECTS

Untrained unselected adults (n 49) and children (n 63), assessing pizza at tasting stations.

RESULTS

Most commercial pizzas provide insufficient information to assess all nutrients and traditional Margherita pizza ingredients provide insufficient Fe, Zn, iodine, and vitamins C and B12. Energy content of the portions currently sold as standard range from 837 to 2351 kJ (200 to 562 kcal), and most exceed 30 % Guideline Daily Amounts for saturated fat and Na when a 2510 kJ (600 kcal) notional meal is considered. The 'nutritionally balanced pizza' provides the required energy for a single-item meal (2510 kJ/600 kcal), with all nutrients within recommended ranges: Na (473 mg, ∼45 % below recommended level), saturated fat (<11 % energy) and dietary fibre (13·7 g). Most adults (77 %) and children (81 %) rated it 'as good as' or 'better than' their usual choice.

CONCLUSIONS

Nutritional guidelines to reduce chronic diseases can be applied to reformulate 'junk food' ready meals, to improve public health through a health-by-stealth approach without requiring change in eating habits.

Drug repurposing in pharmaceutical industry and its impact on market access: market access implications

BACKGROUND

Drug repurposing is a group of development strategies employed in order to overcome some of the hurdles innate to drug research and development. Drug repurposing includes drug repositioning, reformulation and combination.

OBJECTIVE

This study aimed to identify the determinants of successful market access outcome for drug repurposing in the United States of America (USA) and in Europe.

METHODS

The case studies of repurposing strategies were identified through a systematic review of the literature. Price information and reimbursement conditions for all the case studies were collected mainly through access of public datasources. A list of attributes that could be associated with market access outcome (price level and reimbursement conditions) was developed, discussed, and validated by an external expert group. Detailed information for all attributes was researched and collected for each case study. Bivariate regression models were conducted to identify factors associated with price change for all repurposing cases. A similar analysis was performed for reformulation and repositioning cases, in the USA and in Europe, separately. A significance level of 5% was used for all analyses.

RESULTS

A total of 144 repurposing case studies were included in the statistical analysis for evaluation of mean price change. Combination cases (the combination of two or more individual drug components) were excluded from the statistical analysis due to the low number of cases retrieved. The main attributes associated with a significant price increase for overall repurposing cases were 'change in administration setting to hospital' (374%, p<0.0001), 'addressing unmet needs' (69%, p<0.05), 'reformulations belonging to Group 3'-that is, change in administration route (117%, p<0.001), and being a repurposed product with the 'same brand name' as the original product (65%, p<0.05).

CONCLUSION

We found that the ability of the repurposed product to address unmet needs, a reformulation where the target product had a different administration route than the source product, and having a similar brand name for repurposed and original products, were variables that impacted a positive price change for repurposed drugs overall. Our research results also suggested that orphan designation could have a positive impact for repositioning in the USA, in particular. Although a change of administration from ambulatory to hospital setting seemed to be significantly correlated with a price increase for the target product, only one case was retrieved for this parameter; as such, it was not possible to infer a firm correlation between this parameter and a change in price.

Drug reformulations and repositioning in the pharmaceutical industry and their impact on market access: regulatory implications

BACKGROUND

Repurposing has become a mainstream strategy in drug development, but it faces multiple challenges, amongst them the increasing and ever changing regulatory framework. This is the second study of a series of three-part publication project with the ultimate goal of understanding the market access rationale and conditions attributed to drug repurposing in the United States and in Europe. The aim of the current study to evaluate the regulatory path associated with each type of repurposing strategy according to the previously proposed nomenclature in the first article of this series.

METHODS

From the cases identified, a selection process retrieved a total of 141 case studies in all countries, harmonized for data availability and common approval in the United States and in Europe. Regulatory information for each original and repurposed drug product was extracted, and several related regulatory attributes were also extracted such as, designation change and filing before or after patent expiry, among others. Descriptive analyses were conducted to determine trends and to investigate potential associations between the different regulatory paths and attributes of interest, for reformulation and repositioning cases separately.

RESULTS

Within the studied European countries, most of the applications for reformulated products were filed through national applications. In contrast, for repositioned products, the centralized procedure was the most frequent regulatory pathway. Most of the repurposing cases were approved before patent expiry, and those cases have followed more complex regulatory pathways in the United States and in Europe. For new molecular entities filed in the United States, a similar number of cases were developed by serendipity and by a hypothesis-driven approach. However, for the new indication's regulatory pathway in the United States, most of the cases were developed through a hypothesis-driven approach.

CONCLUSION

The regulations in the United States and in Europe for drug repositionings and reformulations allowed confirming that repositioning strategies were usually filed under a more complex regulatory process than reformulations. Also, it seems that parameters such as patent expiry and type of repositioning approach or reformulation affect the regulatory pathways chosen for each case.

A linearly convergent first-order algorithm for total variation minimisation in image processing

We introduce a new formulation for total variation minimisation in image denoising. We also present a linearly convergent first-order method for solving this reformulated problem and show that it possesses a nearly dimension-independent iteration complexity bound.

Abuse potential, pharmacokinetics, pharmacodynamics, and safety of intranasally administered crushed oxycodone HCl abuse-deterrent controlled-release tablets in recreational opioid users

The objective of this study was to evaluate abuse potential, pharmacokinetics, pharmacodynamics, and safety of intranasally administered, crushed reformulated OxyContin® (oxycodone HCl controlled-release) tablets (ORF), relative to crushed original OxyContin® (OC), oxycodone powder (Oxy API), and OC placebo. This randomized, double-blind, positive- and placebo-controlled crossover study enrolled healthy, adult, nonphysically dependent recreational opioid users with recent history of intranasal drug abuse (N = 27). Active treatments contained oxycodone (30 mg). Pharmacokinetics, pharmacodynamics (e.g., Overall Drug Liking [ODL], Take Drug Again [TDA], and High Visual Analog Scales [VAS]; Subjective Drug Value [SDV]; pupillometry; intranasal irritation), and safety (e.g., adverse events, vital signs, laboratory tests) were assessed to 24 hours postdose. Crushed ORF administration yielded reduced oxycodone Cmax and increased Tmax versus crushed OC and Oxy API. Peak effects for pharmacodynamic measures were delayed with ORF (1-2 hours) versus OC and Oxy API (0.5-1 hour). ODL, TDA, High VAS, and SDV Emax values were significantly lower (P ≤ .05) and some intranasal irritation ratings were greater for ORF versus OC and Oxy API. No significant or unexpected safety findings were observed. Compared with OC and Oxy API, intranasally administered ORF was associated with lower and delayed peak plasma concentrations, decreased drug-liking, and decreased intranasal tolerability. This suggests that ORF has a decreased potential for intranasal oxycodone abuse. There were no significant or unexpected safety findings. As is true for all abuse potential studies, epidemiological or other appropriate post-marketing studies are required to assess the impact of the reduction in intranasal oxycodone abuse potential observed in the present study on real-world patterns of ORF misuse, abuse, and diversion.

A survey of the reformulation of Australian child-oriented food products

BACKGROUND

Childhood obesity is one of the most pressing public health challenges of the 21st century. Reformulating commonly eaten food products is a key emerging strategy to improve the food supply and help address rising rates of obesity and chronic disease. This study aimed to monitor reformulation of Australian child-oriented food products (products marketed specifically to children) from 2009-2011.

METHODS

In 2009, all child-oriented food products in a large supermarket in metropolitan Adelaide were identified. These baseline products were followed up in 2011 to identify products still available for sale. Nutrient content data were collected from Nutrient Information Panels in 2009 and 2011. Absolute and percentage change in nutrient content were calculated for energy, total fat, saturated fat, sugars, sodium and fibre. Data were descriptively analysed to examine reformulation in individual products, in key nutrients, within product categories and across all products. Two methods were used to assess the extent of reformulation; the first involved assessing percentage change in single nutrients over time, while the second involved a set of nutrient criteria to assess changes in overall healthiness of products over time.

RESULTS

Of 120 products, 40 remained unchanged in nutrient composition from 2009-2011 and 80 underwent change. The proportions of positively and negatively reformulated products were similar for most nutrients surveyed, with the exception of sodium. Eighteen products (15%) were simultaneously positively and negatively reformulated for different nutrients. Using percentage change in nutrient content to assess extent of reformulation, nearly half (n = 53) of all products were at least moderately reformulated and just over one third (n = 42) were substantially reformulated. The nutrient criteria method revealed 5 products (6%) that were positively reformulated and none that had undergone negative reformulation.

CONCLUSION

Positive and negative reformulation was observed to a similar extent within the sample indicating little overall improvement in healthiness of the child-oriented food supply from 2009-2011. In the absence of agreed reformulation standards, the extent of reformulation was assessed against criteria developed specifically for this project. While arbitrary in nature, these criteria were based on reasonable assessment of the meaningfulness of reformulation and change in nutrient composition. As well as highlighting nutrient composition changes in a number of food products directed to children, this study emphasises the need to develop comprehensive, targeted and standardised reformulation benchmarks to assess the extent of reformulation occurring in the food supply.

Drug reformulations and repositioning in pharmaceutical industry and its impact on market access: reassessment of nomenclature

BACKGROUND

Medicinal products that have been developed and approved for one disease may be the object of additional clinical development in other disease areas or of additional pharmaceutical development for new and different formulations. The newly developed products can be named as repositioned or reformulated products, respectively. Market access of repositioned or reformulated products in Europe and the United States is an interesting object of study as it may provide clarity about which parameters are assessed and considered to bring added value, other than the molecule itself. As such, we aim to evaluate if the added value of repositioned or reformulated medicinal products can be systematically described, quantified, and predicted. As a first step toward investigating the impact of market access on drug research and development trends for repositioned and reformulated products, it is necessary to have consistency in the designations for the case studies evaluated in this project. In an attempt to achieve that consistency, the current study aims to propose harmonized definitions for the repositioning and reformulation strategies and to propose a taxonomy for the medicinal products derived thereof.

METHODS

A systematic literature review was conducted to collect information on existing cases of repositioning or reformulation. A search strategy was developed by defining the search objectives, targeted data sources, search keywords, and inclusion/exclusion criteria for the retrieved documents.

RESULTS

A total of 505 publications were retrieved through a search of the main data sources. The screenings and the ad hoc search led to a total of 56 publications to be used for the case study data extraction. In total, 87 repositioning and/or reformulation cases were found described in the literature, 23 of which presented different definitions and/or classifications by different authors.

CONCLUSION

Given the disparity and inconsistency of terminologies and classifications in the literature, a harmonized nomenclature for drug repositioning, reformulation, and combination cases will allow for a robust analysis of the added value and market access conditions attributed for each strategy and case type as assessed by regulators and payors in Europe and the United States. After evaluation of the existing terminologies and given the absence of clear and consistent definitions for drug reformulation and repositioning in the literature, we propose a global terminology and taxonomy in order to cover all of the previously unclear definitions and classifications for repositioned and reformulated products.

Reduced abuse, therapeutic errors, and diversion following reformulation of extended-release oxycodone in 2010

This study evaluated changes in abuse exposures, therapeutic error exposures, and diversion into illegal markets associated with brand extended-release oxycodone (ERO) following introduction of reformulated ERO. Original ERO and reformulated ERO street prices also were compared. Data from the Poison Center and Drug Diversion programs of the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System were used. Quarterly rates 2 years prior to introduction of reformulated ERO (October 2008 through September 2010) were compared to quarterly rates after introduction (October 2010 through March 2012) using negative binomial regression. Street prices were compared using a mixed effects linear regression model. Following reformulated ERO introduction, poison center ERO abuse exposures declined 38% (95% confidence interval [CI]: 31-45) per population and 32% (95% CI: 24-39) per unique recipients of dispensed drug. Therapeutic error exposures declined 24% (95% CI: 15-31) per population and 15% (95% CI: 6-24) per unique recipients of dispensed drug. Diversion reports declined 53% (95% CI: 41-63) per population and 50% (95% CI: 39-59) per unique recipients of dispensed drug. Declines exceeded those observed for other prescription opioids in aggregate. After its introduction, the street price of reformulated ERO was significantly lower than original ERO.

PERSPECTIVE

This article indicates that the abuse, therapeutic errors, and diversion of ERO declined following the introduction of a tamper-resistant reformulation of the product. Reformulating abused prescription opioids to include tamper-resistant properties may be an effective approach to reduce abuse of such products.