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van der Laan JW, van Malderen K, de Jager N, Duarte D, Egger GF, Lavergne F, Roque CG, Vieira I, Wiesner L, Carleer J. Evaluation of Juvenile Animal Studies for Pediatric CNS-Targeted Compounds: A Regulatory Perspective. Int J Toxicol 2019; 38:456-475. [PMID: 31662008 DOI: 10.1177/1091581819883569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Central nervous system (CNS)-targeted products are an important category of pediatric pharmaceuticals. In view of the significant postnatal maturation of the CNS, juvenile animal studies (JAS) are performed to support pediatric development of these new medicines. In this project, the design and results of juvenile toxicity studies from 15 drug compounds for the treatment of neurologic or psychiatric conditions were analyzed. Studies were conducted mostly in rats; sometimes in addition in dogs and monkeys. The study design of the pivotal JAS was variable, even for compounds with a similar therapeutic indication. Age of the juvenile animals was not consistently related to the starting age of the intended patient population. Of 15 compounds analyzed, 6 JAS detected more severe toxicities and 6 JAS evidenced novel CNS effects compared to their adult counterparts. The effects of CNS on acoustic startle and learning and memory were observed at high dosages. Reversibility was tested in most cases and revealed some small effects that were retained or only uncovered after termination of treatment. The interpretation of the relevance of these findings was often hampered by the lack of matching end points in the adult studies or inappropriate study designs. Detailed clinical observation and motor activity measures were the most powerful end points to detect juvenile CNS effects. The need for more detailed behavioral examinations in JAS, for example, on learning and memory, should, therefore, be decided upon on a case-by-case basis, based on specific concerns in order to avoid overloading the studies.
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Affiliation(s)
- Jan Willem van der Laan
- Section on Pharmacological, Toxicological, and Kinetic Assessment, Medical Evaluation Board (MEB), Utrecht, the Netherlands.,Division of Toxicology, Leiden Academic Center for Drug Research, Leiden, the Netherlands.,Members of the Non-Clinical Working Group of the PDCO (EMA) Amsterdam, the Netherlands
| | - Karen van Malderen
- Members of the Non-Clinical Working Group of the PDCO (EMA) Amsterdam, the Netherlands.,Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium.,Alternate members of the Pediatric Committee (PDCO-EMA), Belgium
| | - Nico de Jager
- Section on Pharmacological, Toxicological, and Kinetic Assessment, Medical Evaluation Board (MEB), Utrecht, the Netherlands.,Division of Toxicology, Leiden Academic Center for Drug Research, Leiden, the Netherlands
| | - Dinah Duarte
- Members of the Non-Clinical Working Group of the PDCO (EMA) Amsterdam, the Netherlands.,INFARMED-National Authority of Medicines and Health Products, Lisbon, Portugal
| | | | - Fabien Lavergne
- Members of the Non-Clinical Working Group of the PDCO (EMA) Amsterdam, the Netherlands.,Agence Nationale de Sécurité du Médicament et des produits de santé, Saint-Denis, France
| | | | - Isabel Vieira
- Members of the Non-Clinical Working Group of the PDCO (EMA) Amsterdam, the Netherlands.,INFARMED-National Authority of Medicines and Health Products, Lisbon, Portugal
| | - Lutz Wiesner
- Members of the Non-Clinical Working Group of the PDCO (EMA) Amsterdam, the Netherlands.,Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Jacqueline Carleer
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium.,Alternate members of the Pediatric Committee (PDCO-EMA), Belgium.,Retired de Jager is now with Hospital Pharmacy-Clinical Pharmacology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands. Roque is now with The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
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Fisher JE, Ravindran A, Elayan I. CDER Experience With Juvenile Animal Studies for CNS Drugs. Int J Toxicol 2019; 38:88-95. [DOI: 10.1177/1091581818824313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A survey was undertaken to evaluate juvenile animal studies conducted for drug applications reviewed by the Center for Drug Evaluation and Research between 2009 and 2014. Some conclusions about the nonclinical pediatric safety assessment based on studies performed in support of central nervous system–active compounds are presented here. A total of 44 completed studies from 32 New Drug Applications submitted to the Divisions of Psychiatry and Neurology Products were evaluated. Data on animal species and age range used, endpoints evaluated, and outcomes included in labeling were analyzed. Of the drugs evaluated, all but one had studies conducted in rats. In some cases, a second study in a nonrodent species (dog) was also conducted. Indices of growth and development and standard general toxicity parameters were included in all of the studies. Expanded neurohistopathology evaluations, bone mineral density measurements, and reproductive and neurobehavioral functional assessments were also generally carried out. A variety of neurological and neurobehavioral tests were employed. In the majority of rat studies, the potential for long-term cognitive impairment was evaluated using a complex water maze. Juvenile animal studies provided safety information considered relevant to drug use in children and that was included in labeling for 78% of the applications surveyed. The most commonly reported findings in labeling were for neurobehavioral effects, including changes in locomotor activity, auditory startle habituation, and learning and memory. Of the studies described in labeling with neurobehavioral effects, 54% found these effects to be persistent and to provide evidence of developmental neurotoxicity.
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Affiliation(s)
- J. Edward Fisher
- Division of Neurology Products, Center for Drug Evaluation and Research (CDER), Office of New Drugs (OND), US Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Arippa Ravindran
- Division of Psychiatry Products, Center for Drug Evaluation and Research (CDER), Office of New Drugs (OND), US Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Ikram Elayan
- Division of Psychiatry Products, Center for Drug Evaluation and Research (CDER), Office of New Drugs (OND), US Food and Drug Administration (FDA), Silver Spring, MD, USA
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Zucker I. Psychoactive drug exposure during breastfeeding: a critical need for preclinical behavioral testing. Psychopharmacology (Berl) 2018; 235:1335-1346. [PMID: 29549392 DOI: 10.1007/s00213-018-4873-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/26/2018] [Indexed: 12/11/2022]
Abstract
Breastfeeding women are excluded from clinical trials of psychoactive drugs because of ethical concerns. Animal testing, which often is predictive of adverse effects in humans, represents the only avenue available for assessing drug safety for human offspring exposed to drugs during lactation. I determined whether behavioral outcomes for children exposed during breastfeeding to antidepressants, anxiolytics, antipsychotics, anti-seizure medications, analgesics, sedatives, and marijuana can be predicted by rodent studies of offspring exposed to drugs during lactation. Animal data were available for only 10 of 80 CNS-active drugs canvassed. Behavioral deficits in adolescence or adulthood in rats and mice after various drug exposures during lactation included reductions in sexual behavior, increased anxiety, hyperactivity, and impaired learning and memory. Whether similar adverse effects will emerge in adulthood in children exposed to drugs during breastfeeding is unknown. Rodent research has the potential to forecast impairments in breastfed children long before information emerges from post-marketing reports and should be prioritized during preclinical drug evaluation by the FDA for new drugs and for drugs currently prescribed off-label for lactating women.
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Affiliation(s)
- Irving Zucker
- Departments of Psychology and Integrative Biology, University of California, Berkeley, CA, 94720, USA. .,Psychology Department, University of California, Berkeley, CA, 94720, USA.
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