Provision of information on regulatory authorities’ websites

Drug development: how academia, industry and authorities interact

Unfortunately, abundant examples could be given of pitfalls in the current drug development paradigm-including in the design, conduct and evaluation of phase III clinical trials. This article discusses issues of particular relevance to clinical trials in nephrology, including the inappropriate use of placebo, publication of reports that emphasize potential treatment benefits over adverse reactions, the sometimes dubious impartiality of independent guidelines, and inadequate recruitment of elderly patients. This Perspectives article aims to highlight and summarize the flaws in the current drug development process, while suggesting a way forward that equally satisfies the requirements of academia, patients and the pharmaceutical industry. We suggest improvements to the drug development process and related legislation that intend to balance public needs with commercial aims and ensure effective drug evaluation by regulatory authorities.

Toward a jurisprudence of drug regulation

Efforts to foster transparency in biopharmaceutical regulation are well underway: drug manufacturers are, for example, legally required to register clinical trials and share research results in the United States and Europe. Recently, the policy conversation has shifted toward the disclosure of clinical trial data, not just trial designs and basic results. Here, I argue that clinical trial registration and disclosure of clinical trial data are necessary but insufficient. There is also a need to ensure that regulatory decisions that flow from clinical trials - whether positive (i.e., product approvals) or negative (i.e., abandoned products, product refusals, and withdrawals) - are open to outside scrutiny. Further, a jurisprudence of drug regulation is needed. I develop two arguments motivated by (1) innovation concerns and (2) the value of good governance in support of openly publishing all final decisions for approved, abandoned, refused, and withdrawn products. After articulating why greater transparency in regulatory decision-making is needed, I distil four essential features of a jurisprudence of drug regulation that prescribe policy changes in terms not only of the transparency of regulatory outcomes and the underlying reasoning, but also regulatory organization.

The potential of the internet

The internet and the World Wide Web have changed the ways that we function. As technologies grow and adapt, there is a huge potential for the internet to affect drug research and development, as well as many other aspects of clinical pharmacology. We review some of the areas of interest to date and discuss some of the potential areas in which internet-based technology can be exploited. Information retrieval from the web by health-care professionals is common, and bringing evidence-based medicine to the bedside affects the care of patients. As a primary research tool the web can provide a vast array of information in generating new ideas or exploring previous research findings. This has facilitated systematic reviewing, for example. The content of the web has become a subject of research in its own right. The web is also widely used as a research facilitator, including enhancement of communication between collaborators, provision of online research tools (such as questionnaires, management of large scale multicentre trials, registration of clinical trials) and distribution of information. Problems include information overload, ignorance of early data that are not indexed in databases, difficulties in keeping web sites up to date and assessing the validity of information retrieved. Some web-based activities are viewed with suspicion, including analysis by pharmaceutical companies of drug information to facilitate direct-to-consumer advertising of novel pharmaceuticals. Use of these technologies will continue to expand in often unexpected ways. Clinical pharmacologists must embrace internet technology and include it as a key priority in their research agenda.

Selected national pharmacovigilance websites: an analysis of contents

BACKGROUND

Pharmacovigilance involves the detection, assessment, understanding, and prevention of adverse drug reactions (ADRs), nationally and internationally. Effective communication, which relies increasingly on the Internet, is a crucial aspect of pharmacovigilance activities.

AIM

The aim of this study was to perform an exploratory survey of national pharmacovigilance websites and compare their contents.

METHODS

Of 99 international pharmacovigilance organizations known to us (listed in the Side Effects of Drugs Annual 30), 45 included website addresses and 35 provided some or all of the information in English. We reviewed 10 of these 35 websites in order to identify their contents. The 10 sites that we selected contained the most extensive information on pharmacovigilance of those that we were able to access. Reviewing these sites, we identified 32 items of information that we used to assess the scope of each website systematically, using a scoring system based on the presence or absence of those items.

RESULTS

All the websites gave clear descriptions of national pharmacovigilance requirements and the reporting systems for ADRs, and all included devices. Beyond this, there was great variability in content from site to site. Few websites allowed access to raw pharmacovigilance data, such as individual case reports.

CONCLUSIONS

Online drug safety communication from the selected national websites we examined is highly variable from site to site, although a wider study is needed to confirm this. Agreement on the key components of pharmacovigilance websites would facilitate the development of a standardized format to improve online communication.

Regulatory agencies, pharmaceutical information and the Internet: a European perspective

The Internet facilitates access to health information and can therefore support the effectiveness of healthcare provision and empower patients in healthcare decisions. In the field of pharmaceutical therapy the electronic provision of information can improve compliance and strengthen the general understanding of pharmaceutical risks and benefits. Current political developments in Europe encourage a stronger role of the pharmaceutical industry in this regard. In light of potential conflicts inherent to the private provision of information and given their public health mandate, regulatory bodies in the pharmaceutical sector may represent an important alternative source of information. The explorative analysis in this paper reviews the websites of European pharmaceutical regulatory agencies regarding the usability and provision of information from a Layman's perspective. It is found that while the majority of agencies do provide product-related information, the usability of websites from the lay perspective is subject to variation. The reluctant position of agencies can be attributed to sectoral path dependencies, the regulatory approach and a lack of regulatory resources.

Regulating medicines in Croatia: five-year experience of Agency for Medicinal Products and Medical Devices

AIM

To present the activities of the Agency for Medicinal Products and Medical Devices in the first 5 years of its existence and to define its future challenges.

METHODS

Main activities within the scope of the Agency as a regulatory authority were retrospectively analyzed for the period from 2004-2008. Data were collected from the Agency's database and analyzed by descriptive statistics.

RESULTS

The number of issued medicine authorizations rose from 240 in 2004 to 580 in 2008. The greatest number of new chemical and biological entities was approved in 2005. The greatest number of regular quality controls (n=5833) and special quality controls was performed in 2008 (n=589), while the greatest number of off-shelf quality controls (n=132) was performed in 2007. The greatest number of medicine labeling irregularities was found in 2007 (n=19) and of quality irregularities in 2004 (n=9). The greatest number of adverse reactions was reported in 2008 (n=1393). The number of registered medical devices rose from 213 in 2004 to 565 in 2008.

CONCLUSION

Over its 5 years of existence, the Agency has successfully coped with the constant increase in workload. In the future, as Croatia enters the European Union, the Agency will have to face the challenge of joining the integrated European regulatory framework.

Reporting of studies on new medicines in major medical journals: a case study in breast cancer

A comparison of the results of pivotal trials on three new medicines for advanced breast cancer published in medical journals with those presented in the US Food and Drug Administration (FDA) reviews showed that analyses reported in journals were of lower quality and were given a favorable interpretation by minimizing toxicity and ignoring methodological shortcomings. Several proposals to strengthen the quality of reporting of clinical trials in medical journals and to support reliable assessment of the therapeutic value of new medicines are discussed.