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Denis L, Kirstine Jørgensen A, Fleury T, Daguet E, Vaz-Luis I, Pistilli B, Rieutord A, Basit AW, Goyanes A, Annereau M. Developing an innovative 3D printing platform for production of personalised medicines in a hospital for the OPERA clinical trial. Int J Pharm 2024:124306. [PMID: 38871137 DOI: 10.1016/j.ijpharm.2024.124306] [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: 03/16/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
Breast cancer is the most frequently diagnosed cancer in women worldwide, and non-adherence to adjuvant hormonotherapy can negatively impact cancer recurrence and relapse. Non-adherence is associated with side effects of hormonotherapy. Pharmacological strategies to mitigate the side effects include coadministration of antidepressants, however patients remain non-adherent. The aim of this work was to develop medicines containing both hormonotherapy, tamoxifen (20 mg), along with anti-depressants, either venlafaxine (37.5 or 75 mg) or duloxetine (30 or 60 mg), to assess the acceptability and efficacy of this personalised approach for mitigating tamoxifen side effects in a clinical trial. A major criterion for the developed medicines was the production rate, specified at minimum 200 dosage units per hour to produce more than 40,000 units required for the clinical trial. A novel capsule filling approach enabled by the pharmaceutical 3D printer M3DIMAKER 2 was developed for this purpose. Firstly, semi-solid extrusion 3D printing enabled the filling of tamoxifen pharma-ink prepared according to French compounding regulation, followed by filling of commercial venlafaxine or duloxetine pellets enabled by the development of an innovative pellet dispensing printhead. The medicines were successfully developed and produced in the clinical pharmacy department of the cancer hospital Gustave Roussy, located in Paris, France. The developed medicines satisfied quality and production rate requirements and were stable for storage up to one year to cover the duration of the trial. This work demonstrates the feasibility of developing and producing combined tamoxifen medicines in a hospital setting through a pharmaceutical 3D printer to enable a clinical trial with a high medicines production rate requirement.
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Affiliation(s)
- Lucas Denis
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant 94800 Villejuif, France
| | - Anna Kirstine Jørgensen
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Thomas Fleury
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant 94800 Villejuif, France
| | - Emmanuel Daguet
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant 94800 Villejuif, France
| | - Inès Vaz-Luis
- Department for the Organization of Patient Pathways (DIOPP), Gustave Roussy, Department of Medical Oncology, Gustave Roussy, Villejuif, France; Unit INSERM 981 - Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM 1279, Gustave Roussy, Villejuif, France
| | - André Rieutord
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant 94800 Villejuif, France
| | - Abdul W Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; FABRX Ltd., Henwood House, Henwood, Ashford TN24 8DH, UK; Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Alvaro Goyanes
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK; FABRX Artificial Intelligence, Carretera de Escairón, 14, Currelos (O Saviñao), CP 27543, Spain; FABRX Ltd., Henwood House, Henwood, Ashford TN24 8DH, UK; Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Instituto de Materiales (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Maxime Annereau
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant 94800 Villejuif, France.
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Peng H, Han B, Tong T, Jin X, Peng Y, Guo M, Li B, Ding J, Kong Q, Wang Q. 3D printing processes in precise drug delivery for personalized medicine. Biofabrication 2024; 16:10.1088/1758-5090/ad3a14. [PMID: 38569493 PMCID: PMC11164598 DOI: 10.1088/1758-5090/ad3a14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/03/2024] [Indexed: 04/05/2024]
Abstract
With the advent of personalized medicine, the drug delivery system will be changed significantly. The development of personalized medicine needs the support of many technologies, among which three-dimensional printing (3DP) technology is a novel formulation-preparing process that creates 3D objects by depositing printing materials layer-by-layer based on the computer-aided design method. Compared with traditional pharmaceutical processes, 3DP produces complex drug combinations, personalized dosage, and flexible shape and structure of dosage forms (DFs) on demand. In the future, personalized 3DP drugs may supplement and even replace their traditional counterpart. We systematically introduce the applications of 3DP technologies in the pharmaceutical industry and summarize the virtues and shortcomings of each technique. The release behaviors and control mechanisms of the pharmaceutical DFs with desired structures are also analyzed. Finally, the benefits, challenges, and prospects of 3DP technology to the pharmaceutical industry are discussed.
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Affiliation(s)
- Haisheng Peng
- Department of Pharmacology, Medical College, University of Shaoxing, Shaoxing, People’s Republic of China
- These authors contributed equally
| | - Bo Han
- Department of Pharmacy, Daqing Branch, Harbin Medical University, Daqing, People’s Republic of China
- These authors contributed equally
| | - Tianjian Tong
- Department of Chemical and Biological Engineering, Iowa State University, Ames, IA 50011, United States of America
| | - Xin Jin
- Department of Pharmacology, Medical College, University of Shaoxing, Shaoxing, People’s Republic of China
| | - Yanbo Peng
- Department of Pharmaceutical Engineering, China Pharmaceutical University, 639 Longmian Rd, Nanjing 211198, People’s Republic of China
| | - Meitong Guo
- Department of Pharmacology, Medical College, University of Shaoxing, Shaoxing, People’s Republic of China
| | - Bian Li
- Department of Pharmacology, Medical College, University of Shaoxing, Shaoxing, People’s Republic of China
| | - Jiaxin Ding
- Department of Pharmacology, Medical College, University of Shaoxing, Shaoxing, People’s Republic of China
| | - Qingfei Kong
- Department of Neurobiology, Harbin Medical University, Heilongjiang Provincial Key Laboratory of Neurobiology, Harbin, Heilongjiang 150086, People’s Republic of China
| | - Qun Wang
- Department of Chemical and Biological Engineering, Iowa State University, Ames, IA 50011, United States of America
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Ianno V, Vurpillot S, Prillieux S, Espeau P. Pediatric Formulations Developed by Extrusion-Based 3D Printing: From Past Discoveries to Future Prospects. Pharmaceutics 2024; 16:441. [PMID: 38675103 PMCID: PMC11054634 DOI: 10.3390/pharmaceutics16040441] [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: 01/30/2024] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
Three-dimensional printing (3DP) technology in pharmaceutical areas is leading to a significant change in controlled drug delivery and pharmaceutical product development. Pharmaceutical industries and academics are becoming increasingly interested in this innovative technology due to its inherent inexpensiveness and rapid prototyping. The 3DP process could be established in the pharmaceutical industry to replace conventional large-scale manufacturing processes, particularly useful for personalizing pediatric drugs. For instance, shape, size, dosage, drug release and multi-drug combinations can be tailored according to the patient's needs. Pediatric drug development has a significant global impact due to the growing needs for accessible age-appropriate pediatric medicines and for acceptable drug products to ensure adherence to the prescribed treatment. Three-dimensional printing offers several significant advantages for clinical pharmaceutical drug development, such as the ability to personalize medicines, speed up drug manufacturing timelines and provide on-demand drugs in hospitals and pharmacies. The aim of this article is to highlight the benefits of extrusion-based 3D printing technology. The future potential of 3DP in pharmaceuticals has been widely shown in the last few years. This article summarizes the discoveries about pediatric pharmaceutical formulations which have been developed with extrusion-based technologies.
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Affiliation(s)
- Veronica Ianno
- CNRS, INSERM, Chemical and Biological Technologies for Health Group (UTCBS), Université Paris Cité, 75006 Paris, France;
- Delpharm Reims, 51100 Reims, France; (S.V.); (S.P.)
| | | | | | - Philippe Espeau
- CNRS, INSERM, Chemical and Biological Technologies for Health Group (UTCBS), Université Paris Cité, 75006 Paris, France;
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Al-Rayess H, Lahoti A, Simpson LL, Palzer E, Thornton P, Heksch R, Kamboj M, Stanley T, Regelmann MO, Gupta A, Raman V, Mehta S, Geffner ME, Sarafoglou K. Practice Variation among Pediatric Endocrinologists in the Dosing of Glucocorticoids in Young Children with Congenital Adrenal Hyperplasia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1871. [PMID: 38136073 PMCID: PMC10742174 DOI: 10.3390/children10121871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
A Pediatric Endocrine Society (PES) Drugs and Therapeutics Committee workgroup sought to determine the prescribing practices of pediatric endocrinologists when treating children <10 years of age with congenital adrenal hyperplasia (CAH). Our workgroup administered a 32-question online survey to PES members. There were 187 respondents (88.9% attending physicians), mostly from university-affiliated clinics (~80%). Ninety-eight percent of respondents prescribed the short-acting glucocorticoid hydrocortisone to treat young children, as per the Endocrine Society CAH Guidelines, although respondents also prescribed long-acting glucocorticoids such as prednisolone suspension (12%), prednisone tablets (9%), and prednisone suspension (6%). Ninety-seven percent of respondents indicated that they were likely/very likely to prescribe hydrocortisone in a thrice-daily regimen, as per CAH Guidelines, although 19% were also likely to follow a twice-daily regimen. To achieve smaller doses, using a pill-cutter was the most frequent method recommended by providers to manipulate tablets (87.2%), followed by dissolving tablets in water (25.7%) to create a daily batch (43.7%) and/or dissolving a tablet for each dose (64.6%). Thirty-one percent of providers use pharmacy-compounded hydrocortisone suspension to achieve doses of <2.5 mg. Our survey shows that practices among providers in the dosing of young children with CAH vary greatly and sometimes fall outside of the CAH Guidelines-specifically when attempting to deliver lower, age-appropriate hydrocortisone doses.
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Affiliation(s)
- Heba Al-Rayess
- Department of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA;
| | - Amit Lahoti
- Department of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USA; (A.L.); (M.K.)
| | - Leslie Long Simpson
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (L.L.S.); (E.P.)
| | - Elise Palzer
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (L.L.S.); (E.P.)
| | - Paul Thornton
- Division of Endocrinology and Diabetes, Cook Children’s Medical Center, Fort Worth, TX 76104, USA;
| | - Ryan Heksch
- Center for Diabetes and Endocrinology, Department of Pediatrics, Akron Children’s Hospital, Akron, OH 44308, USA;
| | - Manmohan Kamboj
- Department of Pediatrics, Division of Endocrinology, Nationwide Children’s Hospital at The Ohio State University, Columbus, OH 43205, USA; (A.L.); (M.K.)
| | - Takara Stanley
- Pediatric Endocrine Unit and Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA;
| | - Molly O. Regelmann
- Division of Pediatric Endocrinology and Diabetes, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Anshu Gupta
- Division of Pediatric Endocrinology, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Vandana Raman
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Shilpa Mehta
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, New York Medical College, Valhalla, NY 10595, USA
| | - Mitchell E. Geffner
- The Saban Research Institute, Children’s Hospital Los Angeles, The Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA;
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Division of Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA;
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
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Kaba K, Purnell B, Liu Y, Royall PG, Alhnan MA. Computer numerical control (CNC) carving as an on-demand point-of-care manufacturing of solid dosage form: A digital alternative method for 3D printing. Int J Pharm 2023; 645:123390. [PMID: 37683980 DOI: 10.1016/j.ijpharm.2023.123390] [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: 05/24/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Computer numerical control (CNC) carving is a widely used method of industrial subtractive manufacturing of wood, plastics, and metal products. However, there have been no previous reports of applying this approach to manufacture medicines. In this work, the novel method of tablet production using CNC carving is introduced for the first time. This report provides a proof-of-concept for applying subtractive manufacturing as an alternative to formative (powder compression) and additive (3D printing) manufacturing for the on-demand production of solid dosage forms. This exemplar manufacturing approach was employed to produce patient-specific hydrocortisone (HC) tablets for the treatment of children with congenital adrenal hyperplasia. A specially made drug-polymer cast based on polyethene glycol (PEG 6,000) and hydroxypropyl cellulose was produced using thermal casting. The cast was used as a workpiece and digitally carved using a small-scale 3-dimensional (3D) CNC carving. To establish the ability of this new approach to provide an accurate dose of HC, four different sizes of CNC carved tablet were manufactured to achieve HC doses of 2.5, 5, 7.5 and 10 mg with a relative standard deviation of the tablet weight in the range of 3.69-4.79%. In addition, batches of 2.5 and 5 mg HC tablets met the British Pharmacopeia standards for weight uniformity. Thermal analysis and X-ray powder diffraction indicated that the model drug was in amorphous form. In addition, HPLC analysis indicated a level of purity of 96.5 ± 1.1% of HC. In addition, the process yielded mechanically strong cylindrical tablets with tensile strength ranging from 0.49 to 1.6 MPa and friability values of <1%, whilst maintaining an aesthetic look. In vitro, HC release from the CNC-carved tablets was slower with larger tablet sizes and higher binder contents. This is the first report on applying CNC carving in the pharmaceutical context of producing solid dosage forms. The work showed the potential of this technology as an alternative method for the on-demand manufacturing of patient-specific dosage forms.
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Affiliation(s)
- Kazim Kaba
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
| | - Bryn Purnell
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
| | - Yujing Liu
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
| | - Paul G Royall
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom
| | - Mohamed A Alhnan
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College London, London SE1 9NH, United Kingdom.
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