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Chege W, Poddar A, Samson ME, Almeida C, Miller R, Raafat D, Fakhouri T, Fienkeng M, Omokaro SO, Crentsil V. Demographic Diversity of Clinical Trials for Therapeutic Drug Products: A Systematic Review of Recently Published Articles, 2017-2022. J Clin Pharmacol 2024; 64:514-528. [PMID: 38098162 DOI: 10.1002/jcph.2398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/12/2023] [Indexed: 01/21/2024]
Abstract
The US Food and Drug Administration (FDA) encourages the use of enrollment practices that will lead to clinical trials that reflect the population most likely to use the therapeutic product (drug or biologic), if approved. In doing so, the benefit-risk profile of the product may be assessed more completely and offer patients and their health care providers a better understanding of the drug profile and greater confidence in clinical trial results. The objective of this systematic review was to assess recent literature on the demographic diversity of clinical trial participants, describe the methods used in defining clinical trial diversity, and address knowledge gaps to enhance clinical trial diversity. Our literature search initially yielded 246 articles. After applying our eligibility criteria, we conducted a full-text review and analyzed the contents of the 28 remaining articles in our systematic review. Eleven (39%) of the 28 articles used a reference standard to compare the participation of populations in clinical trials to assess diversity. The majority of the 28 articles reported on adult participants; only 5 included pediatric populations. Most articles found that women and minority populations were underrepresented in clinical trials. Some articles proposed solutions to improve clinical trial diversity; however, several did not comment on clinical trial diversity. Despite a growing emphasis on demographic diversity in research, certain populations continue to be underrepresented in clinical trials. There is a need to standardize the definition of diversity in clinical trials. Future research into effective enrollment approaches and appropriate reference standards could improve demographic diversity.
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Affiliation(s)
- Wambui Chege
- Division of Medical Product Development, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Atasi Poddar
- Division of Medical Product Development, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Marsha E Samson
- Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Cecilia Almeida
- Division of Medical Product Development, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Rihana Miller
- Division of Medical Product Development, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Dina Raafat
- Division of Medical Product Development, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Tala Fakhouri
- Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Mathilda Fienkeng
- Division of Medical Product Development, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Stephanie O Omokaro
- Division of Medical Product Development, Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Victor Crentsil
- Office of Medical Policy Initiatives, Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Mitra A, Lee JB, Steinbach D, Hazra A, Krishna R. Rare oncology therapeutics: review of clinical pharmacology package of drug approvals (2019-2023) by US FDA, best practices and recommendations. J Pharmacokinet Pharmacodyn 2023; 50:475-493. [PMID: 37925369 DOI: 10.1007/s10928-023-09896-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
There are many challenges with rare diseases drug development and rare oncology indications are not different. To understand the regulatory landscape as it relates to application of clinical pharmacology principles in rare oncology product development, we reviewed publicly available information of 39 approvals by US FDA between January 2019 and March 2023. The objective was to understand the expected clinical pharmacology studies and knowledge base in such approvals. Model informed drug development (MIDD) applications were also reviewed, as such approaches are expected to play a critical role in filling clinical pharmacology gaps in rare oncology, where number of clinical trials and size of these trials will perhaps continue to be small. The findings highlighted how clinical pharmacology contributed to the evidence of effectiveness, dose optimization and elucidation of intrinsic and extrinsic factors affecting drug's behavior. Clinical pharmacology studies were often integrated with modeling in many of the NDAs/BLAs. Of the post marketing requirements (PMR) received, 18% were for dose optimization, 49% for DDI, 8% for QTc, 49% for specific population, and 5% for food effect. Two post marketing commitments (PMC) were issued for immunogenicity of the 11 biologics submissions. 15% (6 of 39) of the submissions used maximum tolerated dose (MTD) to advance their molecule into Phase 2 studies. Of them 3 approvals received PMR for dose optimization. 3 + 3 was the most prevalent Phase 1 design with use in 74% of the New Drug Applications (NDA)/Biologic License Applications (BLA) reviewed. Rest used innovative approaches such as BLRM, BOIN or mTPi, with BLRM being the most common. Seamless clinical pharmacology and MIDD approaches are paramount for rare oncology drug development.
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Affiliation(s)
- Amitava Mitra
- Clinical Pharmacology, Kura Oncology Inc, Boston, MA, USA.
| | - Jong Bong Lee
- PK Sciences, Novartis Institutes for BioMedical Research, East Hanover, NJ, USA
| | - Douglas Steinbach
- Clinical Pharmacology and Pharmacometrics, Janssen R&D, Spring House, Titusville, PA, USA
| | - Anasuya Hazra
- Clinical Pharmacology, Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | - Rajesh Krishna
- Drug Development Solutions, Certara USA, Inc, Princeton, NJ, USA
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Bai JP, Wang J, Zhang Y, Wang L, Jiang X. Quantitative Systems Pharmacology for Rare Disease Drug Development. J Pharm Sci 2023; 112:2313-2320. [PMID: 37422281 DOI: 10.1016/j.xphs.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
Though hundreds of drugs have been approved by the US Food and Drug Administration (FDA) for treating various rare diseases, most rare diseases still lack FDA-approved therapeutics. To identify the opportunities for developing therapies for these diseases, the challenges of demonstrating the efficacy and safety of a drug for treating a rare disease are highlighted herein. Quantitative systems pharmacology (QSP) has increasingly been used to inform drug development; our analysis of QSP submissions received by FDA showed that there were 121 submissions as of 2022, for informing rare disease drug development across development phases and therapeutic areas. Examples of published models for inborn errors of metabolism, non-malignant hematological disorders, and hematological malignancies were briefly reviewed to shed light on use of QSP in drug discovery and development for rare diseases. Advances in biomedical research and computational technologies can potentially enable QSP simulation of the natural history of a rare disease in the context of its clinical presentation and genetic heterogeneity. With this function, QSP may be used to conduct in-silico trials to overcome some of the challenges in rare disease drug development. QSP may play an increasingly important role in facilitating development of safe and effective drugs for treating rare diseases with unmet medical needs.
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Affiliation(s)
- Jane Pf Bai
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Jie Wang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Yifei Zhang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Lingshan Wang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
| | - Xiling Jiang
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20903, USA
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Qosa H, Hassan HE, Younis IR. Overview of Clinical Pharmacology Packages of New Drug Applications Approved for the Treatment of Rare Diseases. J Clin Pharmacol 2022; 62 Suppl 2:S72-S78. [DOI: 10.1002/jcph.2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/04/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Hisham Qosa
- Bristol Myers Squibb Princeton New Jersey USA
| | - Hazem E. Hassan
- Regeneron Pharmaceuticals, Inc. Tarrytown New York USA
- Department of Pharmaceutical Sciences School of Pharmacy University of Maryland Baltimore Baltimore Maryland USA
| | - Islam R. Younis
- Department of Clinical Pharmacology Gilead Sciences Inc. Foster City California USA
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Bridging the Gap With Clinical Pharmacology in Innovative Rare Disease Treatment Modalities: Targeting DNA to RNA to Protein. J Clin Pharmacol 2022; 62 Suppl 2:S95-S109. [DOI: 10.1002/jcph.2172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/12/2022] [Indexed: 12/04/2022]
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Li R, Ma L, Li F, Li L, Bi Y, Yuan Y, Li Y, Xu Y, Zhang X, Liu J, Bhattaram VA, Wang J, Schuck R, Pacanowski M, Zhu H. Model‐Informed Approach Supporting Drug Development and Regulatory Evaluation for Rare Diseases. J Clin Pharmacol 2022; 62 Suppl 2:S27-S37. [DOI: 10.1002/jcph.2143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/15/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Ruo‐Jing Li
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Lian Ma
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Fang Li
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Liang Li
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Youwei Bi
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Ye Yuan
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Yangbing Li
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Yuan Xu
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Xinyuan Zhang
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Jiang Liu
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Venkatesh Atul Bhattaram
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Jie Wang
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Robert Schuck
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Michael Pacanowski
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
| | - Hao Zhu
- Office of Clinical Pharmacology Center for Drug Evaluation and Research Food and Drug Administration Silver Spring Maryland USA
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Hsieh J, Sahre M, Yang X, Madabushi R, Ramamoorthy A. Clinical pharmacology information in regulatory submissions and labeling: A comparative analysis of orphan and non-orphan drugs approved by the FDA. Clin Transl Sci 2022; 15:2583-2596. [PMID: 36165094 PMCID: PMC9652444 DOI: 10.1111/cts.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 01/25/2023] Open
Abstract
Clinical pharmacology is an integral discipline supporting the development, regulatory evaluation, and clinical use of drugs for the treatment of both common and rare diseases. Here, we evaluated the recommendations and information available from select clinical pharmacology studies in the therapeutic product labeling of new molecular entities (NMEs) approved from 2017 to 2019 for both common and rare diseases. A total of 151 NMEs, including 72 orphan and 79 non-orphan drugs, were analyzed for recommendations and information available related to food-drug interaction, drug-drug interaction, renal impairment, hepatic impairment, QT assessment, and human radiolabeled mass balance studies using data collected from the original labeling and other regulatory documents. The analysis showed no statistically significant difference in the recommendations between orphan and non-orphan drugs except for renal impairment related recommendations in section 8 of the labeling. Although not significant, fewer hepatic impairment labeling recommendations were available for orphan drugs when compared with non-orphan drugs. At the time of initial approval, 79 postmarketing requirements (PMRs) and postmarketing commitments (PMCs) for 33 orphan drugs and 39 PMRs and PMCs for 19 non-orphan drugs were established; with most difference observed for drug-drug interaction, hepatic impairment, and QT assessment. Overall, although there was a trend for more labeling recommendations and fewer postmarketing studies and clinical trials for non-orphan drugs, there appeared to be no substantial differences in how these select clinical pharmacology studies are leveraged during the development and approval of orphan and non-orphan drugs.
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Affiliation(s)
- Julie Hsieh
- Office of Clinical Pharmacology, Center for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - Martina Sahre
- Office of Clinical Pharmacology, Center for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - Xinning Yang
- Office of Clinical Pharmacology, Center for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - Rajanikanth Madabushi
- Office of Clinical Pharmacology, Center for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
| | - Anuradha Ramamoorthy
- Office of Clinical Pharmacology, Center for Drug Evaluation and ResearchUS Food and Drug AdministrationSilver SpringMarylandUSA
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Minichmayr IK, Ravenstijn P, van der Graaf PH, Vamvakas S. Therapeutic Innovations in Neuroscience: What's New on the Horizon? Clin Pharmacol Ther 2022; 111:715-717. [PMID: 35313013 DOI: 10.1002/cpt.2547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Piet H van der Graaf
- Certara, Canterbury, UK.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Spiros Vamvakas
- Human Division, European Medicines Agency, Amsterdam, The Netherlands
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