Drug Safety in Labeling for Pediatric Drug Development and Dose Selection in Submissions to the US Food and Drug Administration

Extent of safety database in pediatric drug development: types of assessment, analytical precision, and pathway for extrapolation through on-target effects

Pediatric patients should have access to medicines that have been appropriately evaluated for safety and efficacy through revised labelling. Given this goal, the adequacy of the pediatric clinical development plan and resulting safety database are critical factors to inform a favorable benefit-risk assessment for the intended use of the medicinal product. While extrapolation from adults can be used to support efficacy of drugs in children, there may be a reluctance to use the same approach in safety assessments, wiping out potential gains in trial efficiency through a reduction of sample size. To address this issue, we explore safety review in pediatric trials, including specific types of safety assessments and precision on the estimation of event rates for specific adverse events (AEs) that can be achieved. In addition, we discuss the assessments which can provide a benchmark for the use of extrapolation of safety that focuses on on-target effects. Finally, we explore a unified approach for understanding precision using Bayesian approaches as the most appropriate methodology to describe or ascertain risk in probabilistic terms for the estimate of the event rate of specific AEs.

Impact of Clinical Pharmacist-Led Interventions on Drug-Related Problems Among Pediatric Cardiology Patients: First Palestinian Experience

Background

Discovery and resolution of drug-related problems (DRPs) are taken as the cornerstone in the entire pharmaceutical care process to improve patient outcomes. Very limited reports on the analysis of DRPs in pediatric cardiology have been released worldwide.

Objective

The aim of this study was to disclose the impact of clinical pharmacist’s interventions on DRPs among pediatric cardiology patients in Palestine.

Methods

Between January and September 2021, a prospective interventional study involving clinical pharmacist’s care was implemented in the cardiology ward of Al-Rantisy Specialized Pediatric Hospital in Gaza, Palestine. Pharmaceutical Care Network Europe model 9.1 was used to identify DRPs, causes of the problem, clinical pharmacist’s interventions, cardiologist’s acceptance, and outcomes.

Results

A total of 309 DRPs were identified in 87 patients, representing a mean of 3.55 problems per patient. The most common DRPs were “Treatment effectiveness” (50.8%) and “Treatment safety” (30.4%), while the main causes of these DRPs were “Errors in dose timing instructions” (9.4%) and “Inappropriate combination of drugs” (13.7%), respectively. Analysis revealed that 96.7% of the interventions suggested by the clinical pharmacist were accepted by cardiologists and that 92.1% of problems were fully resolved with improved patient outcomes.

Conclusion

Interventions offered by the clinical pharmacist successfully addressed DRPs and positively impacted treatment outcomes in pediatric cardiology patients. With the high acceptance of pediatric cardiologists to the clinical pharmacist’s experience in Palestine, there is a growing need to integrate clinical pharmacists into cardiology teamwork care to optimize drug therapy and patient safety.