1
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Lechat P, Kir F, Marquet P, Woillard JB. Within-subject pharmacokinetic variability has a strong influence on individual exposure ratios in bioequivalence studies, hence on drug formulation interchangeability. Eur J Clin Pharmacol 2023; 79:1565-1578. [PMID: 37737912 DOI: 10.1007/s00228-023-03565-6] [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: 05/12/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Bioequivalence between a reference and a generic drug is based on the hypothesis that a ± 20% change in blood exposure (or ± 10% for drugs with narrow therapeutic index, NTI) following the generic/reference switch will not have any therapeutic consequences. However, the individual exposure ratio between generic and reference can be higher than 1.20 (or 1.10). This study aims to analyse the different parameters influencing the individual exposure ratio, hence the conditions for reference/generic interchangeability. METHODS Bioequivalence studies with a double cross-over design for a virtual drug were simulated using 100 random sets of 12, 24, 48 or 100 pairs of areas under the curve (AUC), varying the generic/reference AUC geometric mean ratios between 0.80 and 1.25 and the within-subject exposure variance of the reference and the generic formulations. RESULTS The proportion of subjects with an exposure generic/reference ratio outside the ± 10% or ± 20% acceptance intervals increases when (1) the reference within-subject variance increases; (2) the ratio of the generic within-subject variance on the reference within-subject variance increases; and (3) the generic/reference mean AUC ratio diverges from 1.0. When only considering replicated administrations of the reference, the individual exposure ratio increases with the within-subject variance, yielding values outside the usually accepted individual exposure ratio range of 0.5 to 2 for drugs with narrow therapeutic index as soon as the within-subject variance standard deviation is ≥ 0.25 (equivalent to within-patient CV% > 25%). CONCLUSIONS Interchangeability between reference and generic formulations, especially for drugs with narrow therapeutic index can only be assumed if, the within-subject variance of generic is less or equal to the within-subject variance of reference or, if this is not the case, if the distribution of the generic/generic individual exposure ratios is included within the therapeutic margins of the reference drug.
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Affiliation(s)
- Philippe Lechat
- Paris-cité University, Paris, France.
- Pharmacology and Toxicology Department, Georges Pompidou European Hospital, Drug Evaluation unit, Agence Générale des équipements et des produits de santé (AGEPS), 7 rue du fer à moulin, 75005 Paris, Assistance Publique des Hôpitaux de Paris, France.
| | - Fatma Kir
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Lokman Hekim University, Ankara, Turkey
| | - Pierre Marquet
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
| | - Jean-Baptiste Woillard
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
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2
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Balon M, Tessier S, Damase-Michel C, Cottin J, Lambert A, Thompson MA, Benevent J, Lacroix I. Adverse drug reactions in pregnant women: Do they differ from those in non-pregnant women of childbearing age? Therapie 2023; 78:165-173. [PMID: 36517304 DOI: 10.1016/j.therap.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/14/2022] [Indexed: 11/30/2022]
Abstract
Pharmacoepidemiological research in pregnant women has focused on adverse drug reactions for the course of pregnancy or for the unborn child, but little is known on the risks for the mother. We reported the results of a study that compared adverse drug reactions in pregnant women with non-pregnant women of childbearing age, and investigated whether which types of adverse reactions were more often reported in pregnant women and which drugs were more often involved. This study was carried out in the French pharmacovigilance database (BNPV). We compared adverse drug reactions reported between 1 January 2010 and 31 December 2019 in pregnant women with those reported in of non-pregnant women of childbearing age. We cross-matched each pregnant woman with three non-pregnant women of childbearing age according to geographic area, age and year the adverse reaction was reported. Data analysis revealed that serious adverse reactions were more frequently reported in pregnant women, including anaphylactic reactions. Other adverse reactions including tachycardia, hypotension and hepatic injury were also more frequent in pregnant women than in non-pregnant women of the same age. This could be explained by physiological changes in pregnancy that lead to greater sensitivity to certain adverse reactions. Some drugs, such as phloroglucinol, metoclopramide, iron, atosiban and nifedipine, were more frequently involved in adverse reactions in pregnant women. These drugs are specifically used during pregnancy, which may explain why they are over-represented in adverse reactions. This is the first comparative descriptive study on drug adverse reactions in pregnant women. Specific epidemiological and pharmacokinetic studies are necessary to confirm these results and better understand the differences observed to improve the monitoring of pregnant women exposed to certain drugs.
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Affiliation(s)
- Maylis Balon
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Samuel Tessier
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Christine Damase-Michel
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Judith Cottin
- Centre régional de pharmacovigilance, hospices civils de Lyon, 69424 Lyon, France
| | - Aude Lambert
- Centre régional de pharmacovigilance, hôpital civil, 67091 Strasbourg, France
| | - Marie-Andrée Thompson
- Centre régional de pharmacovigilance, service de pharmacologie médicale et toxicologie, CHU de Montpellier, 34295 Montpellier, France
| | - Justine Benevent
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Isabelle Lacroix
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France.
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3
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Response to Comment on "Interchangeability Between Generic and Reference Products: Limits of Average Bioequivalence Methodology". Eur J Drug Metab Pharmacokinet 2023; 48:217-219. [PMID: 36670338 DOI: 10.1007/s13318-022-00813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/22/2023]
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4
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Nicolas P, Bertagna X. Comment on "Interchangeability between Generic and Reference Products: Limits of Average Bioequivalence Methodology". Eur J Drug Metab Pharmacokinet 2023; 48:213-215. [PMID: 36670339 DOI: 10.1007/s13318-022-00814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Patrick Nicolas
- School of Medicine, Paris 13 University, Bobigny, France. .,CHU Avicenne - Service de Biochimie - Pharmacologie, Bobigny, France. .,Assistance Publique des Hôpitaux de Paris, Paris, France.
| | - Xavier Bertagna
- Emeritus Professor of Endocrinology, Paris Descartes School of Medicine, Paris 5 University, Paris, France
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5
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Lechat P. Potentiel Impact thérapeutique de la substitution en cours de traitement d’un princeps par un générique : limites de la bioéquivalence moyenne pour les médicaments à marge thérapeutique étroite. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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6
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Lechat P. Interchangeability between Generic and Reference Products: Limits of Average Bioequivalence Methodology. Eur J Drug Metab Pharmacokinet 2022; 47:777-787. [PMID: 35986193 DOI: 10.1007/s13318-022-00785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 01/22/2023]
Abstract
Marketing authorisation of generic drugs is based on a demonstration of the "average" bioequivalence (ABE), with acceptance limits of 0.8-1.25 for the 90% confidence interval (CI) of the ratio (generic versus reference) of geometric means of exposure (whole blood, serum or plasma drug concentration). However, when interchangeability of reference by one generic is considered during treatment of a given patient, such methodology cannot guarantee the lack of therapeutic impact especially for drugs with narrow therapeutic index. This review article describes the basis and limits of ABE methodology, and the adaptations that have been proposed by regulatory agencies. For highly variable drugs, given their large therapeutic margin, regulatory agencies even allow widening of the bioequivalence acceptance limits. For drugs with a narrow therapeutic index, the average bioequivalence methodology has been amended differently by regulatory agencies. The European Medicine Agency only requires the narrowing of the ABE acceptance limits to the 0.9-1.10 range. The US Food and Drug Administration (FDA) has proposed to narrow the ABE acceptance limits according to the reference within-subject variance. The FDA requires a fully replicate cross-over study (with four periods) which allows one to compare the within-subject variance between generic and reference drug, and to detect any subject-by-formulation interaction. Indeed, any within-subject variance difference or subject by formulation interaction is an obstacle to interchangeability at the individual level. These amendments for the ABE do not fundamentally change the fact that individual ratios of exposure (generic/reference) will vary to a larger extent than the ratio of their means. For these reasons, since true individual bioequivalence studies cannot be performed for practical reasons and statistical issues, one can suggest that, in addition to the usual average bioequivalence criteria, the limits of the 95% confidence interval of the individual generic/reference exposure ratios could be used to allow interchangeability during treatment (at least for narrow therapeutic index drugs). Limit values of such CI for interchangeability acceptance should be scaled to the therapeutic margin of the reference drug. Regulatory agencies could conduct calculations based on real datasets of bioequivalence studies to determine if such criteria could be acceptable to allow interchangeability.
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Affiliation(s)
- Philippe Lechat
- Emeritus Professor, Paris-City University, Paris, France. .,Georges Pompidou European Hospital, Pharmacology department and Medicine Evaluation Unit, Agence Générale des Equipements et des Produits de Santé (AGEPS), Assistance Publique des Hôpitaux de Paris, Paris, France.
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7
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Romani S, Fresse A, Parassol‐Girard N, Gerard A, Levraut M, Yamani S, Van Obberghen EK, Pariente A, Rocher F, Viard D, Drici M. Spontaneous reporting of adverse drug reactions as an outlet for patient dismay? The case of Levothyrox® change of excipients. Fundam Clin Pharmacol 2022; 36:553-562. [DOI: 10.1111/fcp.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/09/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Serena Romani
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Audrey Fresse
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Nadège Parassol‐Girard
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Alexandre Gerard
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Mathieu Levraut
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Samir Yamani
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Elise K. Van Obberghen
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Antoine Pariente
- INSERM U1219, Bordeaux Population Health, Team Pharmacoepidemiology, University of Bordeaux Bordeaux France
- Service de Pharmacologie Médicale, Pôle de Santé Publique, CHU de Bordeaux Bordeaux France
| | - Fanny Rocher
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Delphine Viard
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
| | - Milou‐Daniel Drici
- Department of Clinical Pharmacology University Côte d'Azur Medical Center, Hôpital Pasteur Nice France
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8
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Glerum PJ, Neef C, Burger DM, Yu Y, Maliepaard M. Pharmacokinetics and Generic Drug Switching: A Regulator's View. Clin Pharmacokinet 2021; 59:1065-1069. [PMID: 32557345 PMCID: PMC7467961 DOI: 10.1007/s40262-020-00909-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There appears to be a mismatch between the assumed therapeutic equivalence of generic drugs, their interchangeability, and reported clinical discomfort following generic drug use and drug switches. In this article, we describe why we are of the opinion that the current regulatory approach to the evaluation of generic drugs based on average bioequivalence is sufficient to expect therapeutic equivalence in the clinical setting. This has often been debated, specifically as adverse drug reactions related to generic drug switches are regularly reported. We agree that clinical discomfort during a bioequivalent drug switch may indeed be caused by different exposures to the active substance. However, this difference in exposure is not a result of the characteristics or quality of generic drugs; it is caused by the pharmacokinetic within-subject variability of the active substance, i.e., the variability on the bioavailability of the active substance, when comparing two occasions of administration of the same drug product, to the same patient. Therefore, reported clinical discomfort following generic drug use and drug switches does not warrant a change in the regulatory approach to the evaluation of the bioequivalence of generic drugs. Switching from a brand-name drug to currently approved generic drugs, or between different generic drugs, will in principle result in comparable exposure, within boundaries determined by the within-subject variability of the pharmacokinetics of the active substance involved.
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Affiliation(s)
- Pieter J Glerum
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yang Yu
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marc Maliepaard
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands. .,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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9
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Kaur N, Suryanarayanan R. Levothyroxine sodium pentahydrate tablets - formulation considerations. J Pharm Sci 2021; 110:3743-3756. [PMID: 34384799 DOI: 10.1016/j.xphs.2021.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022]
Abstract
Even though levothyroxine sodium pentahydrate tablets have been in the market since 1955, there continue to be recalls due to sub potency. We have comprehensively reviewed the factors affecting its stability in solid oral dosage forms. A compilation of marketed formulation compositions enabled the identification of the potential 'problem excipients'. Two excipient properties, hygroscopicity and microenvironmental acidity, appeared to be responsible for inducing drug instability. In drug products, depending on the formulation composition and storage conditions, the pentahydrate can dehydrate to highly reactive levothyroxine sodium monohydrate, or undergo salt disproportionation to the free acid form of the drug. The USP assay method (HPLC based) is insensitive to these different physical forms of the drug. The influence of physical form of levothyroxine on its chemical stability is incompletely understood. The USP has five product-specific dissolution tests reflecting the complexity in its evaluation.
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Affiliation(s)
- Navpreet Kaur
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota-Twin Cities, 9-177 WDH, 308 Harvard Street Southeast, Minneapolis, Minnesota 55455, United States
| | - Raj Suryanarayanan
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota-Twin Cities, 9-177 WDH, 308 Harvard Street Southeast, Minneapolis, Minnesota 55455, United States.
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10
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Why Were More Than 200 Subjects Required to Demonstrate the Bioequivalence of a New Formulation of Levothyroxine with an Old One? Clin Pharmacokinet 2021; 59:1-5. [PMID: 31432471 PMCID: PMC6994420 DOI: 10.1007/s40262-019-00812-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
At the request of French Regulatory Authorities, a new formulation of Levothyrox® was licensed in France in 2017, with the objective of avoiding the stability deficiencies of an existing licensed formulation. Before launching the new formulation, an average bioequivalence (ABE) trial was conducted, having enrolled 204 subjects and selected for interpretation a narrow a priori bioequivalence range of 0.90-1.11. Bioequivalence was concluded. In a previous publication, we questioned the ability of an ABE trial to guarantee the switchability within patients of the new and old levothyroxine formulations. It was suggested that the two formulations should be compared using the conceptual framework of individual bioequivalence. The present paper is a response to those claiming that, despite the fact that ABE analysis does not formally address the switchability of the two formulations, future patients will nevertheless be fully protected. The basis for this claim is that the ABE study was established in a large trial and analyzed using a stringent a priori acceptance interval of equivalence. These claims are questionable, because the use of a very large number of subjects nullifies the implicit precautionary intention of the European guideline when, for a Narrow Therapeutic Index drug, it recommends shortening the a priori acceptance interval from 0.80-1.25 to 0.90-1.11.
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11
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Metsu D, Aquilina C, Delobel P, Gandia P, Savagner F, Raymond S, Caron P, Martin-Blondel G. Maraviroc exposure is influenced by exogenous thyrotoxicosis. AIDS 2021; 35:701-703. [PMID: 33620876 DOI: 10.1097/qad.0000000000002754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David Metsu
- Laboratory of Pharmacokinetics and Toxicology, Purpan Hospital, University Hospital of Toulouse
- INTHERES UMR1436 INRA-ENVT
| | | | - Pierre Delobel
- Department of Infectious Diseases, University Hospital of Toulouse
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
| | - Peggy Gandia
- Laboratory of Pharmacokinetics and Toxicology, Purpan Hospital, University Hospital of Toulouse
- INTHERES UMR1436 INRA-ENVT
| | - Frédérique Savagner
- Biochemistry and Genetic Laboratory, Federative Institute of Biology, CHU Toulouse
- Team 6, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), CHU Rangueil
| | - Stéphanie Raymond
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
- Department of Virology, CHU Purpan
| | - Philippe Caron
- Team 6, Inserm UMR 1048, Institute of Metabolic and Cardiovascular Diseases (I2MC), CHU Rangueil
- Department of Endocrinology and Metabolic Diseases, Pôle Cardiovascular and Metabolic, Larrey University Hospital, Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious Diseases, University Hospital of Toulouse
- Inserm U1043 - CNRS UMR 5282, Toulouse-Purpan Pathophysiology Center
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12
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Kaur N, Young VG, Su Y, Suryanarayanan R. Partial Dehydration of Levothyroxine Sodium Pentahydrate in a Drug Product Environment: Structural Insights into Stability. Mol Pharm 2020; 17:3915-3929. [DOI: 10.1021/acs.molpharmaceut.0c00661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Navpreet Kaur
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota—Twin Cities, 9-177 WDH, 308 Harvard Street Southeast, Minneapolis, Minnesota 55455, United States
| | - Victor G. Young
- Department of Chemistry, X-Ray Crystallographic Laboratory, LeClaire-Dow Chemical Instrumentation Facility, University of Minnesota—Twin Cities, 207 Pleasant Street SE, Minneapolis, Minnesota 55455, United States
| | - Yongchao Su
- Pharmaceutical Sciences, Merck & Co., Inc., Rahway, New Jersey 07065, United States
| | - Raj Suryanarayanan
- Department of Pharmaceutics, College of Pharmacy, University of Minnesota—Twin Cities, 9-177 WDH, 308 Harvard Street Southeast, Minneapolis, Minnesota 55455, United States
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13
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Emerson CH. Understanding the Regulation of the Levothyroxine Market Has Implications for Managing Hypothyroidism. ACTA ACUST UNITED AC 2020. [DOI: 10.1089/ct.2020;32.296-299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Charles H. Emerson
- Division of Endocrinology, Department of Medicine, University of Massachusetts School of Medicine Worcester, Massachusetts, U.S.A
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14
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Old active ingredients in new medicinal products: is the regulatory path coherent with patients' expectations? Drug Discov Today 2020; 25:1337-1347. [PMID: 32485225 DOI: 10.1016/j.drudis.2020.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/28/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
The rising costs of new medicinal products are a challenge to the economic sustainability of national healthcare systems in ensuring patients' access to therapies. European Union (EU) and US legislators have provided regulatory pathways aimed at simplifying Marketing Authorization (MA) applications for new medicinal products in cases when safety and efficacy profiles can be derived from the data of already-marketed products. In this review, we discuss the different regulatory pathways towards the MA of new medicinal products containing old drug substances and intended to improve the therapeutic value of a treatment, to obtain a new therapeutic indication (drug repositioning), or to ensure the same therapeutic value of a reference product at lower costs.
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15
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Toft DJ. A Change in Levothyroxine Manufacturer Frequently Results in Abnormal Serum Thyroid Function Tests. ACTA ACUST UNITED AC 2020. [DOI: 10.1089/ct.2020;32.211-213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel J. Toft
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, U.S.A
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16
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Comment on “Levothyrox® New and Old Formulations: Are They Switchable for Millions of Patients?”. Clin Pharmacokinet 2020; 59:655-657. [DOI: 10.1007/s40262-020-00887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Glerum PJ, Maliepaard M, de Valk V, Scholl JHG, van Hunsel FPAM, van Puijenbroek EP, Burger DM, Neef K. Quantification of Adverse Drug Reactions Related to Drug Switches in The Netherlands. Clin Transl Sci 2020; 13:599-607. [PMID: 32052597 PMCID: PMC7214643 DOI: 10.1111/cts.12746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/02/2019] [Indexed: 01/17/2023] Open
Abstract
We performed a retrospective cohort study in the Dutch patient population to identify active substances with a relatively high number of adverse drug reactions (ADRs) potentially related to drug switching. For this, we analyzed drug switches and reported ADRs related to switching between June 1, 2009, and December 31, 2016, for a selection of 20 active substances. We also compared pharmacovigilance analyses based on the absolute, switch-corrected, and user-corrected numbers of ADRs. In total, 1,348 reported ADRs and over 23.8 million drug switches were obtained from the National Health Care Institute in The Netherlands and from Lareb, which is The Netherlands Pharmacovigilance Centre. There was no correlation between the number of ADRs and the number of switches, but, on average, we found 5.7 reported ADRs per 100,000 switches. The number was relatively high for rivastigmine, levothyroxine, methylphenidate, and salbutamol, with 74.9, 50.9, 47.6, and 26.1 ADRs per 100,000 switches, respectively. When comparing analyses using the absolute number and the switch-corrected number of ADRs, we demonstrate that different active substances would be identified as having a relatively high number of ADRs, and different time periods of increased numbers of ADRs would be observed. We also demonstrate similar results when using the user-corrected number of ADRs instead of the switch-corrected number of ADRs, allowing for a more feasible approach in pharmacovigilance practice. This study demonstrates that pharmacovigilance analyses of switch-related ADRs leads to different results when the number of reported ADRs is corrected for the actual number of drug switches.
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Affiliation(s)
- Pieter J Glerum
- Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc Maliepaard
- Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Joep H G Scholl
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | | | - Eugène P van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands.,Pharmaco-Therapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kees Neef
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Ledeți I, Romanescu M, Cîrcioban D, Ledeți A, Vlase G, Vlase T, Suciu O, Murariu M, Olariu S, Matusz P, Buda V, Piciu D. Stability and Compatibility Studies of Levothyroxine Sodium in Solid Binary Systems-Instrumental Screening. Pharmaceutics 2020; 12:pharmaceutics12010058. [PMID: 31936742 PMCID: PMC7022666 DOI: 10.3390/pharmaceutics12010058] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 02/07/2023] Open
Abstract
The influence of excipients on the stability of sodium levothyroxine pentahydrate (LTSS) under ambient conditions and thermal stress was evaluated. Since LTSS is a synthetic hormone with a narrow therapeutic index, the interactions of LTSS with excipients can lead to a drastic diminution of therapeutic activity. Ten commonly used pharmaceutical excipients with different roles in solid formulations were chosen as components for binary mixtures containing LTSS, namely, starch, anhydrous lactose, D-mannitol, D-sorbitol, gelatin, calcium lactate pentahydrate, magnesium stearate, methyl 2-hydroxyethyl cellulose (Tylose), colloidal SiO2 (Aerosil) and talc. As investigational tools, universal attenuated total reflectance- Fourier transform infrared spectroscopy UATR-FTIR spectroscopy and thermal analysis were chosen and used as follows: UATR-FTIR spectra were drawn up for samples kept under ambient conditions, while thermoanalytical tools (TG/DTG/HF data) were chosen to evaluate the inducing of interactions during thermal stress. The corroboration of instrumental results led to the conclusion that LTSS is incompatible with lactose, mannitol and sorbitol, and these excipients should not be considered in the development of new generic solid formulations.
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Affiliation(s)
- Ionuț Ledeți
- Department of Pharmacy I, Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania; (I.L.); (M.R.); (D.C.)
| | - Mirabela Romanescu
- Department of Pharmacy I, Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania; (I.L.); (M.R.); (D.C.)
| | - Denisa Cîrcioban
- Department of Pharmacy I, Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania; (I.L.); (M.R.); (D.C.)
| | - Adriana Ledeți
- Department of Pharmacy I, Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania; (I.L.); (M.R.); (D.C.)
- Correspondence: (A.L.); (O.S.); (M.M.)
| | - Gabriela Vlase
- Research Centre for Thermal Analysis in Environmental Problems, West University of Timișoara, 300115 Timișoara, Romania
| | - Titus Vlase
- Research Centre for Thermal Analysis in Environmental Problems, West University of Timișoara, 300115 Timișoara, Romania
| | - Oana Suciu
- Department of Medicine XIV, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania
- Correspondence: (A.L.); (O.S.); (M.M.)
| | - Marius Murariu
- Department of Medicine X, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania;
- Correspondence: (A.L.); (O.S.); (M.M.)
| | - Sorin Olariu
- Department of Medicine X, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania;
| | - Petru Matusz
- Department of Medicine I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania;
| | - Valentina Buda
- Department of Pharmacy II, Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy, 300011 Timișoara, Romania;
| | - Doina Piciu
- Department of Nuclear Medicine, Prof. Dr. Ion Chiricuță Institute of Oncology, 400015 Cluj-Napoca, Romania;
- Department of Oncology, Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Krebs-Brown A, Munafo A, Gaikwad S, Urgatz B, Castello-Bridoux C. Comment on: "Why Were More Than 200 Subjects Required to Demonstrate the Bioequivalence of a New Formulation of Levothyroxine with an Old One?". Clin Pharmacokinet 2019; 59:265-267. [PMID: 31802400 PMCID: PMC7007443 DOI: 10.1007/s40262-019-00847-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Alain Munafo
- Merck Institute for Pharmacometrics (An Affiliate of Merck KGaA, Darmstadt, Germany), Lausanne, Switzerland
| | | | | | - Claire Castello-Bridoux
- Direction des Affaires Médicales, Merck Santé s.a.s, 37 rue Saint-Romain, 69008, Lyon, France.
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Authors' Reply to Yu et al.: "Levothyrox ® New and Old Formulations: Are They Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 59:283-285. [PMID: 31802402 PMCID: PMC7007434 DOI: 10.1007/s40262-019-00852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Concordet D, Gandia P, Montastruc JL, Bousquet-Mélou A, Lees P, Ferran AA, Toutain PL. Authors' Reply to Nicolas: "Why Were More than 200 Subjects Required to Demonstrate the Bioequivalence of a New Formulation of Levothyroxine with an Old One?". Clin Pharmacokinet 2019; 59:277-279. [PMID: 31802398 PMCID: PMC7007421 DOI: 10.1007/s40262-019-00851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Didier Concordet
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Peggy Gandia
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Alain Bousquet-Mélou
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Peter Lees
- The Royal Veterinary College, University of London, London, UK
| | - Aude A Ferran
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France. .,The Royal Veterinary College, University of London, London, UK.
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Comment on "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 59:281-282. [PMID: 31802403 DOI: 10.1007/s40262-019-00850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Comment on: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 58:1351-1352. [PMID: 31452152 DOI: 10.1007/s40262-019-00814-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Concordet D, Gandia P, Montastruc JL, Bousquet-Mélou A, Lees P, Ferran AA, Toutain PL. Authors' Reply to Lechat et al.: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 58:1353-1354. [PMID: 31452151 PMCID: PMC6768902 DOI: 10.1007/s40262-019-00815-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Peggy Gandia
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | | | - Peter Lees
- The Royal Veterinary College, University of London, London, UK
| | - Aude A Ferran
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France
| | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France. .,The Royal Veterinary College, University of London, London, UK.
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Concordet D, Gandia P, Montastruc JL, Bousquet-Mélou A, Lees P, Ferran AA, Toutain PL. Authors’ Reply to Nicolas: “Levothyrox® New and Old Formulations: Are they Switchable for Millions of Patients?”. Clin Pharmacokinet 2019; 58:961-963. [PMID: 31161456 PMCID: PMC6584219 DOI: 10.1007/s40262-019-00781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Peggy Gandia
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, INSERM, UMR 1027, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | | | - Peter Lees
- The Royal Veterinary College, University of London, London, UK
| | - Aude A Ferran
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France
| | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France.
- The Royal Veterinary College, University of London, London, UK.
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Concordet D, Gandia P, Montastruc JL, Bousquet-Mélou A, Lees P, Ferran AA, Toutain PL. Author’s Reply to Trechot: “Comment on Levothyrox® New and Old Formulations: Are they Switchable for Millions of Patients?”. Clin Pharmacokinet 2019; 58:979-980. [DOI: 10.1007/s40262-019-00787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Authors' Reply to Castello-Bridoux et al.: "Comment on Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 58:973-975. [PMID: 31187470 PMCID: PMC6584249 DOI: 10.1007/s40262-019-00786-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Munafo A, Krebs-Brown A, Gaikwad S, Urgatz B, Castello-Bridoux C. Comment on "Levothyrox ® New and Old Formulations: Are They Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 58:969-971. [PMID: 31187469 PMCID: PMC6584227 DOI: 10.1007/s40262-019-00785-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alain Munafo
- Merck Institute for Pharmacometrics-an affiliate of Merck KGaA, Darmstadt, Germany, Lausanne, Switzerland
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Concordet D, Gandia P, Montastruc JL, Bousquet-Mélou A, Lees P, Ferran AA, Toutain PL. Authors' Reply to Coste et al.: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 58:967-968. [PMID: 31161455 PMCID: PMC6584222 DOI: 10.1007/s40262-019-00780-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Peggy Gandia
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, INSERM, UMR 1027, CIC INSERM 1436, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | | | - Peter Lees
- The Royal Veterinary College, University of London, London, UK
| | - Aude A Ferran
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France
| | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRA, ENVT, Toulouse, France. .,The Royal Veterinary College, University of London, London, UK.
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Comment on: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 58:959-960. [PMID: 31161454 DOI: 10.1007/s40262-019-00778-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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31
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Comment on: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 58:965-966. [PMID: 31161457 DOI: 10.1007/s40262-019-00779-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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