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Samuels S, Bai JPF, Green DJ, Abulwerdi G, Burckart GJ. Application of Quantitative Systems Pharmacology to Pediatric Drug Safety Assessment. Clin Pharmacol Ther 2023; 114:748-750. [PMID: 37452513 DOI: 10.1002/cpt.2990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Sherbet Samuels
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jane P F Bai
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Dionna J Green
- Office of Pediatric Therapeutics, Office of the Commissioner, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gelareh Abulwerdi
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gilbert J Burckart
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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Jo JC, Jeon Y, Kim D, Yang DH, Lee WS, Choi YS, Yi JH, Yoon DH, Kong JH, Choe JY, Kim S, Ahn K, Park T, Ju H, Kwon S, Cho SG. A non-interventional, post-marketing surveillance study evaluating the safety and effectiveness of biosimilar rituximab (CT-P10) during routine clinical practice in the Republic of Korea. Expert Opin Biol Ther 2023; 23:737-747. [PMID: 36757373 DOI: 10.1080/14712598.2023.2177101] [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: 09/13/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND CT-P10 was the first licensed rituximab biosimilar. This Korean post-marketing surveillance study evaluated CT-P10 safety and effectiveness in approved indications. RESEARCH DESIGN AND METHODS This prospective, open-label, observational, phase 4 study collected routine clinical practice data across 27 centers in the Republic of Korea. Patients received their first CT-P10 treatment, per prescribing information, for non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA) during the surveillance period (16 November 2016-15 November 2020). Safety (including adverse events [AEs] and adverse drug reactions [ADRs]) and disease-specific clinical response (by best overall response [NHL/CLL], Disease Activity Score in 28-joints [RA], or Birmingham Vasculitis Activity Score for Wegener's Granulomatosis [GPA/MPA]) were assessed for ≤1 year (NHL/CLL) or ≤24 weeks (RA/GPA/MPA). RESULTS The safety population comprised 677 patients (604 NHL, 16 CLL, 42 RA, 7 GPA, 8 MPA). AEs/ADRs were reported for 68.4%/27.7% (NHL/CLL), 31.0%/14.3% (RA), and 86.7%/13.3% (GPA/MPA) of patients. Serious AEs and unexpected ADRs did not raise new safety signals. Pneumonia was the most frequent serious ADR overall. Positive effectiveness outcomes were observed. CONCLUSIONS Findings were consistent with the known CT-P10/reference rituximab safety profile, with high effectiveness observed in NHL/CLL and RA.
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Affiliation(s)
- Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Youngwoo Jeon
- Department of Hematology, Lymphoma and Cell Therapy-Research Center, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - DaJung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University, Seo-gu, Busan, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Republic of Korea
| | - Won Sik Lee
- Department of Internal Medicine, Hemato-oncology, Inje University Busan Paik Hospital, Busangjin-gu, Busan, Republic of Korea
| | - Yoon Seok Choi
- Department of Hematology-Oncology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea
| | - Jun Ho Yi
- Department of Internal Medicine, Division of Hematology and Oncology, Chung-ang University Hospital, Dongjak-gu, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Jee Hyun Kong
- Department of Hematology-Oncology, Division of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Gangwon-do, Republic of Korea
| | - Jung-Yoon Choe
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Nam-gu, Daegu, Republic of Korea
| | - SungHyun Kim
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - KeumYoung Ahn
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - TaeHong Park
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - Hana Ju
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - Soonbum Kwon
- Celltrion, Inc., Yeonsu-gu, Incheon, Republic of Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
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Mlotshwa CR, Burger JR, Vorster M, Rakumakoe DM, Cockeran M. Completeness of pharmaceutical industry insulin adverse event reports from Africa and the Middle East. Expert Opin Drug Saf 2022; 22:221-229. [PMID: 35946933 DOI: 10.1080/14740338.2022.2110863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Growing numbers of patients with diabetes mellitus in Africa and the Middle East on antidiabetic therapies necessitate an understanding of adverse event reporting in these regions. We assessed pharmaceutical industry insulin individual case safety report (ICSR) completeness and completeness-associated variables. RESEARCH DESIGN AND METHODS The observational cross-sectional study, set in an insulin-manufacturing company's safety database, assessed vigiGrade® completeness scores of African and Middle Eastern post-marketing ICSRs during January to December 2018, and the effects of case variables on completeness. Low vigiGrade® scores indicated poorly documented ICSRs. RESULTS We analyzed 4854 ICSRs; 59.8% from the Middle East. The mean vigiGrade® score was 0.58. Middle Eastern ICSRs had higher mean scores than African ICSRs (0.65 vs. 0.46, p<0.001). Scores peaked at 0.32, 0.70, and 1.00, for Middle Eastern ICSRs compared to 0.35 and 0.50 for African ICSRs. Middle Eastern serious (0.77 vs. 0.47; p<0.001) and solicited (0.70 vs. 0.48; p<0.001) ICSRs had higher mean scores than African ICSRs. Mean scores were highest for Middle Eastern physicians (0.89) and other healthcare professionals (0.82) whereas, in Africa, scores were highest for consumer- (0.47) and pharmacist-reported ICSRs (0.47) (p<0.001). CONCLUSIONS Middle Eastern pharmaceutical industry insulin ICSRs were documented with greater detail than African ICSRs. Event seriousness, report source, and reporter type significantly impacted ICSR completeness.
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Affiliation(s)
- Charity Rn Mlotshwa
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, South Africa
| | - Martine Vorster
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, South Africa
| | - Dorcas M Rakumakoe
- Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, South Africa
| | - Marike Cockeran
- School of Mathematical and Statistical Sciences, Faculty of Natural and Agricultural Sciences, North-West University, South Africa
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Cornelius VR, Phillips R. Improving the analysis of adverse event data in randomised controlled trials. J Clin Epidemiol 2021; 144:185-192. [PMID: 34954021 DOI: 10.1016/j.jclinepi.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
Analysing treatment harm is vital but problematic with the relatively small sample sizes afforded in randomised controlled trials (RCTs). Good analysis practice for efficacy outcomes are well established but there has been minimal progress for the analysis of adverse events (AEs). In this commentary we examine four key issues for AE analysis. Namely, why harm data in RCTs is undervalued, why AE analysis is difficult, what aspects of current analysis practice are unsatisfactory, and the challenges for selection and interpretation of AEs results in publications. We discuss how the value of harm data from RCTs could be better realised by reframing the research question to one for detecting signals of adverse reactions. We align established good statistical practice to current unsatisfactory practice. We encourage use of Bayesian analyses to enable cumulative assessment of harm across trial research phases and discourage selecting AEs to report based on arbitrary rules. We propose comprehendible summaries to be based on core outcome sets, serious and pre-specified events, and events leading to discontinuation. Analysis of AEs in contemporary clinical trials needs attention to progress. In the following we have outlined immediate, mid and longer-term strategies for trialists to adopt to support a change in practice.
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Affiliation(s)
- Victoria R Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH.
| | - Rachel Phillips
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH
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Revisiting the X. J Addict Med 2021; 16:440-446. [DOI: 10.1097/adm.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hendrickson BA, Wang W, Ball G, Bennett D, Bhattacharyya A, Fries M, Kuebler J, Kurek R, McShea C, Tremmel L. Aggregate Safety Assessment Planning for the Drug Development Life-Cycle. Ther Innov Regul Sci 2021; 55:717-732. [PMID: 33755928 DOI: 10.1007/s43441-021-00271-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The Program Safety Analysis Plan (PSAP) was proposed previously as a tool to proactively plan for integrated analyses of product safety data. Building on the PSAP and taking into consideration the evolving regulatory landscape, the Drug Information Association-American Statistical Association (DIA-ASA) Interdisciplinary Safety Evaluation scientific working group herein proposes the Aggregate Safety Assessment Plan (ASAP) process. The ASAP evolves over a product's life-cycle and promotes interdisciplinary, systematic safety planning as well as ongoing data review and characterization of the emerging product safety profile. Objectives include alignment on the safety topics of interest, identification of safety knowledge gaps, planning for aggregate safety evaluation of the clinical trial data and preparing for safety communications. The ASAP seeks to tailor the analyses for a drug development program while standardizing the analyses across studies within the program. The document is intended to be modular and flexible in nature, depending on the program complexity, phase of development and existing sponsor processes. Implementation of the ASAP process will facilitate early safety signal detection, improve characterization of product risks, harmonize safety messaging, and inform program decision-making.
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Affiliation(s)
| | - William Wang
- Clinical Safety Statistics, Biostatistics and Research Decision Sciences, Merck Research Laboratories, North Wales, PA, USA
| | - Greg Ball
- Clinical Safety Statistics, Biostatistics and Research Decision Sciences, Merck Research Laboratories, Rahway, NJ, USA
| | - Dimitri Bennett
- Takeda Pharmaceutical Company Ltd., Cambridge, MA, USA.,Perelman School of Medicine, Adjunct, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Michael Fries
- Quantitative Clinical Sciences and Reporting, CSL Behring, King of Prussia, PA, USA
| | - Juergen Kuebler
- QSciCon, Quantitative Scientific Consulting, Marburg, Germany
| | - Raffael Kurek
- Early Oncology Clinical Group, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Cynthia McShea
- Statistical Sciences and Innovation, UCB BioSciences, Inc., Raleigh, NC, USA
| | - Lothar Tremmel
- Quantitative Clinical Sciences and Reporting, CSL Behring, King of Prussia, PA, USA
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Ball G, Hendrickson BA, Freedman AL, Gordon R, Crowe B, Veenhuizen MF, Buchanan J. Interdisciplinary Safety Evaluation for Learning and Decision-Making. Ther Innov Regul Sci 2021; 55:705-716. [PMID: 33730364 DOI: 10.1007/s43441-021-00268-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The FDA IND safety reporting Final Rule (21CFR 312.32) applies to all human drugs and biological products being studied under an Investigational New Drug (IND). A sponsor must file an IND safety report for any serious unexpected suspected adverse reaction (SUSAR) of a medicinal product being investigated. Some events may be obviously drug-related (e.g., agranulocytosis, anaphylactic reaction, drug-induced hepatic injury, Stevens-Johnson Syndrome). For serious adverse events that are not interpretable as individual occurrences, additional processes and procedures need to be employed for identifying and assessing risks in the accumulating safety data. The approaches shared in this manuscript apply principally to safety reporting of events that are anticipated to occur in the patient population-regardless of study participation. For these events, the study sponsor should periodically review the data in the aggregate and make a judgment as to whether there is a reasonable possibility of an event having been caused by the study drug rather than the underlying condition of the patient or a concomitant therapy. Factors cited for consideration are the size and consistency of the difference in event frequency between the test and control groups, supportive preclinical findings, evidence of a dose response relationship, plausible mechanism of action, known class effect and occurrence of other related adverse events. Examples are provided that demonstrate the flexibility sponsors have in meeting the spirit of the Final Rule; some combination and variation of methods from the examples could be employed. The important thing, as expressed by Jacqueline Corrigan-Curay (Director of the Office of Medical Policy, Center for Drug Evaluation and Research, FDA), is to have a thoughtful process; a system in place to look for clinically important imbalances, applying the best clinical and quantitative judgment, while maintaining trial integrity (Ball et al. in Interdisciplinary aggregate assessments for IND safety reporting: a dialogue among colleagues from industry, Academia and the FDA. ASA biopharmaceutical section regulatory-industry statistics workshop, 2018).
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Affiliation(s)
- Greg Ball
- Clinical Safety Statistics, Merck & Co, Inc, RY 34‑A318, 126 E Lincoln Ave, Rahway, NJ, 07065-4607, USA.
| | | | - Amy L Freedman
- Global Medical Organization, Janssen Pharmaceuticals, Titusville, NJ, USA
| | - Robert Gordon
- Statistics and Decision Sciences, Janssen Pharmaceuticals, Spring House, PA, USA
| | - Brenda Crowe
- Statistics, Eli Lilly and Company, Indianapolis, IN, USA
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