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Münch J, Schwarzwälder AL, Kloft C, Bosse HM, Wargenau M, Reidemeister S, Klingmann I, Klingmann V. Validating a composite endpoint for acceptability evaluation of oral drug formulations in the pediatric population: a randomized, open-label, single dose, cross-over study. Front Pharmacol 2024; 15:1436554. [PMID: 39224774 PMCID: PMC11366573 DOI: 10.3389/fphar.2024.1436554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Objective This study aimed to validate the newly developed composite acceptability endpoint to investigate acceptability of oral pediatric drug formulations that integrates swallowability and palatability assessments. Methods In this open-label study acceptability of oral formulations was tested in three age groups (1-<6 months, 6-<12 years, and 12-<18 years) with a 2-way cross-over design in children aged 1-<6 months (syrup and mini-tablets), and with an incomplete block design of four sequences with three out of four formulations (syrup, mini-tablets, oblong tablet, and round tablet) each in children aged 6-<18 years. The primary endpoint was acceptability derived from the composite acceptability endpoint. Secondary endpoints were palatability and acceptability derived from swallowability. Results A total of 320 children were stratified into three age groups (80 children aged 1-<6 months, 120 children aged 6-<12 years, and 120 children aged 12-<18 years). All participants completed the study. Age-specific differences were observed in acceptability derived from the composite acceptability endpoint. Mini-tablets had the highest acceptability in participants aged 1-<6 months and 6-<12 years while the oblong tablet was leading in adolescent participants (12-<18 years). Conclusion This study demonstrated that the composite acceptability endpoint method integrating both swallowability and palatability assessments is a sensitive method to assess acceptability of drug formulations in children of different age. Clinical Trial Registration https://drks.de/search/de, identifier DRKS00027948.
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Affiliation(s)
- Juliane Münch
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Anna Lena Schwarzwälder
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Carolin Kloft
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Hans Martin Bosse
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
| | - Manfred Wargenau
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Duesseldorf, Germany
| | - Sibylle Reidemeister
- Novartis Pharma AG, Global Drug Development/Technical Research and Development, Novartis Campus, Basel, Switzerland
| | | | - Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany
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Hauber B, Hand MV, Hancock BC, Zarrella J, Harding L, Ogden-Barker M, Antipas AS, Watt SJ. Patient Acceptability and Preferences for Solid Oral Dosage Form Drug Product Attributes: A Scoping Review. Patient Prefer Adherence 2024; 18:1281-1297. [PMID: 38919378 PMCID: PMC11197953 DOI: 10.2147/ppa.s443213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Background There is no consistent framework for patient-centric drug product design, despite the common understanding that drug product acceptability and preferences influence adherence and, therefore, drug product effectiveness. The aim of this review was to assess current understanding of patient acceptability and preferences for solid oral dosage form (SODF) drug product attributes, and the potential impact of these attributes on patient behaviors and outcomes. Patients and Methods A scoping review was conducted. Embase, Ovid MEDLINE®, and PubMed® were searched for full-text articles published between January 2013 and May 2023. Following screening and assessment against predefined inclusion criteria, data were analyzed thematically. Results Nineteen studies were included. Four overarching domains of drug product attributes were identified and summarized in a framework: appearance, swallowability, palatability, and handling. Each domain was informed by specific drug product attributes: texture, form, size, shape, color, marking, taste, mouthfeel, and smell. The most frequently studied domains were swallowability and appearance, while the most studied attributes were size, shape, and texture. Smell, marking, and mouthfeel were the least studied attributes. Texture intersected all domains, while form, shape, and size intersected appearance, swallowability, and handling. Swallowability and size appeared to be the key domain and attribute, respectively, to consider when designing drug products. Few studies explored the impact of drug product attributes on behaviors and outcomes. Conclusion While existing studies of drug product attributes have focused on appearance and swallowability, this review highlighted the importance of two less well-understood domains-palatability and handling-in understanding patients' acceptability and preferences for SODF drug products. The framework provides a tool to facilitate patient-centric design of drug products, organizing and categorizing physical drug product attributes into four overarching domains (appearance, swallowability, palatability, and handling), encouraging researchers to comprehensively assess the impact of drug product attributes on patient acceptability, preferences, and outcomes.
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Affiliation(s)
| | - Mark V Hand
- Pfizer Ireland Pharmaceuticals, Ballintaggart, Cork, Ringaskiddy, Ireland
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Meruva S, Singaraju AB, Vinjamuri BP, Ternik R, Stagner WC. Current State of Minitablet Product Design: A Review. J Pharm Sci 2024; 113:1123-1154. [PMID: 38369020 DOI: 10.1016/j.xphs.2024.02.016] [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: 10/18/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
Interest in minitablets (MTs) has grown exponentially over the last 20 years and especially the last decade, as evidenced by the number of publications cited in Scopus and PubMed. MTs offer significant opportunities for personalized medicine, dose titration and flexible dosing, taste masking, and customizing drug delivery systems. Advances in specialized MT tooling, manufacturing, and characterization instrumentation have overcome many of the earlier development issues. Breakthrough MT swallowability, acceptability, and palatability research have challenged the long-standing idea that only liquids are acceptable dosage forms for infants and young children. MTs have been shown to be a highly acceptable dosage form for infants, small children, and geriatric patients who have difficulty swallowing. This review discusses the current state of MT applications, acceptability in pediatric and geriatric populations, medication adherence, manufacturing processes such as tableting and coating, running powder and tablet characterization, packaging and MT dispensing, and regulatory considerations.
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Affiliation(s)
| | | | - Bhavani Prasad Vinjamuri
- Department of Pharmaceutics and Drug Delivery, The University of Mississippi, University, MS 38677, USA
| | - Robert Ternik
- Rolara Medaka Consulting LLC, Fishers, IN 46037, USA
| | - William C Stagner
- Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC 27506, USA.
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Wargenau M, Baase F, Eckardt K, Spitzhorn LS, Reidemeister S, Klingmann I, Klingmann V. Questionnaire Study to Investigate the Preferences of Children, Parents, and Healthcare Professionals for Different Formulations of Oral Medicinal Products. Pharmaceutics 2024; 16:515. [PMID: 38675176 PMCID: PMC11054268 DOI: 10.3390/pharmaceutics16040515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Since the acceptability of a medicine can significantly impact therapeutic outcomes, this study aimed to determine and compare the preferences of children, parents, and healthcare professionals for the most commonly used pediatric oral medicine formulations (syrup, mini-tablets, oblong tablets, round tablets) addressing all pediatric age groups, 0-<18 years (y). This survey study employed sex-, age-, and participant group-adapted questionnaires for eight cohorts of participants, i.e., children 6-<12 y, adolescents 12-<18 y, parents of children in four age groups (0-<2 y, 2-<6 y, 6-<12 y, and 12-<18 y), nurses, and pediatricians. Descriptive statistics were used for data analysis. In the age groups 0-<2 y and 2-<6 y, mini-tablets were preferred over syrup by all participants. In the age group 6-12 y, solid dosage forms were also preferred over syrup by all participants. In the age group 12-<18 y, healthcare professionals preferred solid dosage forms over syrup. Parents preferred higher amounts of mini-tablets and syrup compared to round and oblong tablets, while adolescents' preferences did not differentiate between these formulations. Based on the study results and in contrast to current practice, it is suggested to consider solid dosage forms for future age-appropriate medicinal products already for younger age groups.
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Affiliation(s)
- Manfred Wargenau
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Schirmerstrasse 71, 40211 Duesseldorf, Germany; (M.W.); (K.E.); (L.-S.S.)
| | - Felicitas Baase
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Kristin Eckardt
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Schirmerstrasse 71, 40211 Duesseldorf, Germany; (M.W.); (K.E.); (L.-S.S.)
| | - Lucas-Sebastian Spitzhorn
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Schirmerstrasse 71, 40211 Duesseldorf, Germany; (M.W.); (K.E.); (L.-S.S.)
| | - Sibylle Reidemeister
- Novartis Pharma AG, Global Drug Development/Technical Research & Development, Novartis Campus, 4056 Basel, Switzerland;
| | - Ingrid Klingmann
- Pharmaplex bv, Avenue Saint-Hubert 51, 1970 Wezembeek-Oppem, Belgium;
| | - Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
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Jiwa NA, Ketang’enyi E, Nganyanyuka K, Mbwanji R, Mwenisongole D, Masuka E, Brown M, Charles M, Mwasomola DL, Nyangalima T, Olomi W, Komba L, Gwimile J, Kasambala B, Mwita L. Factors associated with the acceptability of Lopinavir/Ritonavir formulations among children living with HIV/AIDS attending care and treatment clinics in Mbeya and Mwanza, Tanzania. PLoS One 2024; 19:e0292424. [PMID: 38165867 PMCID: PMC10760675 DOI: 10.1371/journal.pone.0292424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/20/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Children living with chronic illnesses are offered formulations based on manufacturer and distributor research. The aim of this study is to better understand the perspectives of children and their caregivers in accepting Lopinavir/ritonavir (LPV/r) formulations. METHODS 362 participants were recruited from two pediatric HIV/AIDS clinics in Mbeya and Mwanza, Tanzania, from December 2021 to May 2022. A translated questionnaire was piloted and validated at both clinics, followed by the implementation of a cross-sectional study. RESULTS 169 participants (47.1%) reported general difficulties in swallowing, regardless of formulation, while 34.3% and 38.5% reported vomiting tablets and syrups, respectively. Statistical significance is shown to support that children can swallow medications if they can eat stiffened porridge (Ugali). This correlated with the lower incidence of younger children being able to swallow compared to older children (above six years of age). Children older than six years preferred taking tablets (independent of daily dosage) better than other formulations. Significantly, older children who attend school were associated with high odds of swallowing medicine (AOR = 3.06, 95%CI; 1.32-7.05); however, age was not found to be statistically related to ease of administration for Lopinavir/Ritonavir in this study. CONCLUSIONS Lopinavir/Ritonavir tablets remain the most accepted formulation among children and adolescents with HIV/AIDS. This study highlights the impact of various factors affecting the acceptability of pediatric formulation, suggesting that children younger than six years, unable to eat Ugali and not attending schools may be most vulnerable regarding their ability to accept Lopinavir/Ritonavir formulations. Further studies are needed to assess the acceptability of other medications in chronically ill children.
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Affiliation(s)
| | | | | | - Ruth Mbwanji
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | | | - Eutropia Masuka
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Mary Brown
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Mary Charles
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | | | | | - Willyhelmina Olomi
- National Institute of Medical Research (NIMR)- Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Lilian Komba
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Judith Gwimile
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Bertha Kasambala
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Lumumba Mwita
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
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Reidemeister S, Nafria Escalera B, Marín D, Balayla J, Klingmann I, Klingmann V. Young patients' involvement in a composite endpoint method development on acceptability for paediatric oral dosage forms. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:108. [PMID: 38031172 PMCID: PMC10688476 DOI: 10.1186/s40900-023-00520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In line with the European Paediatric Regulation, the European Medicines Agency (EMA) asks for investigation of a medicine's acceptability in paediatric medicines development. A standardised acceptability testing method combining the outcome of "swallowability" and "palatability" assessments to a "composite endpoint on acceptability" was recently developed. Before this method's suitability for selection of the most acceptable drug formulation of a new medicine for children can be broadly recommended, the acceptance and relevance of such established acceptability needs the critical review and input from young patients with understanding of the medicines development methodology. The benefit of involving patients in drug product development, clinical research and innovation is well established. METHODS During a focus group meeting with the KIDS Barcelona (young people advisory group, age 16-23 years) the suitability of the "composite endpoint on acceptability" methodology was assessed. Via electronic questionnaires the importance of involving patients in the medicines development and in the acceptability method development was investigated. Questions on how best to determine palatability and swallowability were asked. The relevance of all EMA-listed acceptability elements was assessed via coloured and numbered stickers and questionnaires. RESULTS The results showed that the involvement of young people in the medicines and acceptability method development was rated high. The group worked out that a 5-point smiley Likert Scale is preferred for assessing acceptability by 6-11 year old patients, while a Visual Analogue Scale is preferred for collecting adolescents' opinion. The ranking of the EMA-listed acceptability elements showed that palatability and swallowability are the most relevant parameters, while colour of the medicine was rated as least relevant. These results, established face-to-face, were confirmed in a repeat of the ranking through an electronic questionnaire, completed by the participants individually and remotely, 5 weeks later. CONCLUSION This work reinforced the need and value to involve young people in the medicines lifecycle, and specifically in this acceptability method development. As next step other focus group meetings with more young people from different European countries are planned.
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Affiliation(s)
- Sibylle Reidemeister
- Global Drug Development, Novartis Pharma AG, WSJ-188 10 001, 4056, Basel, Switzerland
| | - Begonya Nafria Escalera
- KIDS Barcelona, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-56, 08950, Esplugues de Llobregat, Spain
- Patient Engagement in Research Coordinator, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-56, 08950, Esplugues de Llobregat, Spain
- Innovation Department, Hospital Sant Joan de Déu de Barcelona, Passeig de Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Spain
| | - Daniel Marín
- KIDS Barcelona, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-56, 08950, Esplugues de Llobregat, Spain
| | - Jan Balayla
- KIDS Barcelona, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-56, 08950, Esplugues de Llobregat, Spain
| | - Ingrid Klingmann
- Pharmaplex Bv, Avenue Saint-Hubert 51, 1970, Wezembeek-Oppem, Belgium
| | - Viviane Klingmann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Stegemann S, Klingmann V, Reidemeister S, Breitkreutz J. Patient-centric drug product development acceptability across patient populations- Science and evidence. Eur J Pharm Biopharm 2023:S0939-6411(23)00105-4. [PMID: 37164232 DOI: 10.1016/j.ejpb.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
The 6th APV (Arbeitsgemeinschaft für Pharmazeutische Verfahrenstechnologie e.V., The International Association for Pharmaceutical Technology) Winter Conference took place in Salzburg (Austria) from January 19-20, 2023. This conference was dedicated to advance patient-centric drug development across all dosage forms, indications and patient populations and was organized by the APV PaCeMe IN Task Force. The topic was chosen due to emerging evidence and increasing regulatory requirements to consider patient needs and capabilities in drug product development. It is well acknowledged that acceptability of a drug product and its dosage form is a fundamental aspect of patient centric drug product design which can directly impact adherence and intended use, hence effectiveness and safety. Despite the requirement to proof acceptability within the drug development program, respective methods to determine and compare the degree of acceptability of different dosage forms and drug product designs are still limited.
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Affiliation(s)
- Sven Stegemann
- Leibniz JointLab First in Translation, Forckenbeckstrasse 50, 52074 Aachen, Germany.
| | - Viviane Klingmann
- University Hospital Düsseldorf, , Department of General Paediatrics, Neonatology and Paediatric Cardiology , Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Sibylle Reidemeister
- Novartis, Global Drug Development/Technical Research & Development, Novartis Campus, 4056 Basel, Switzerland
| | - Jörg Breitkreutz
- University of Düsseldorf, Institute of Pharmaceutical Technology and Biopharmacy, Universitätsstrasse 1, 40225 Düsseldorf, Germany
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Accelerating Pediatric Drug Development: A 2022 Special Issue of Therapeutic Innovation & Regulatory Science. Ther Innov Regul Sci 2022; 56:869-872. [DOI: 10.1007/s43441-022-00398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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