Pharmacology, drug efficacy, and the individual

The efficacy of drugs has to be demonstrated following the principal approach of statistical evaluation in controlled clinical trials. This scientifically and internationally accepted numerical approach has developed over the years to its importance, in contrast to the more pharmacologically attempt to extrapolate human efficacy of drugs from data obtained in animal experiments or, to the so-called physiological medicine, which did not allow to delineate the suitability of drugs from a given collective to the individual patient. The requirements for the clinical trial are not always met, especially not with so-called surrogate markers. In addition, concerns exist now as ever that the numerically based approach leads to average drugs and information for the "responsible adult" only, to the debit of the individual patient. The concern does not mind the clinical trial as such, which principally can be tailored to the individual as applied with pharmacogenetics. On the other hand, an unbearable situation of increased efforts towards individualization, drug tailoring, and neglect of treatment for patients with neglected diseases, respectively, is immense. The contribution of the pharmacologists is, to present those detailed information which allow proper judgement for the clinical application of drugs for all patients.

Drug compliance in therapeutic trials: a review

Because poor compliance introduces a major risk of bias in the interpretation of the results of a therapeutic trial, it is an important element to consider. At the planning stage, factors known to be associated with poor compliance should be recognized. The different methods of evaluating compliance, either clinical or biological, should be reviewed and the best strategy selected. During the therapeutic trial, the objective is to maintain an appropriate level of compliance. Patients, investigators, and sponsors have different options and responsibilities. The analysis should incorporate compliance as a specific variable in order to help test the robustness of the data. Compliance constitutes by itself a specific outcome measure. Compliance should be an integral part of study reports and publications, but it is frequently not discussed.

A classification of drug action based on therapeutic effects

A systematic classification system has been developed for the categorization of therapeutic effects of individual drugs based on their relationships to the underlying disease processes being treated or prevented, rather than on the pharmacologic or biochemical effects of the individual drugs. This system involves a total of six categories of different therapeutic specificities, involving four categories based on disease process-oriented mechanisms of drug action (Categories I through IV), and two additional ones (Categories 0 and V) to complete the classification system. Category 0 includes drugs or drug uses that prevent the development of a disease when none exists; Category I, those that affect etiologic factors of a disease; Category II, those that affect specific disease processes; Category III, those that affect specific disease manifestations; Category IV, those that affect non-specific disease manifestations or symptoms; and Category V includes drug uses or drugs used to diagnose or facilitate treatment of a disease. Examples are provided for each category as well as for applications of the classification system.