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Huang X, Hu B, Ye L, Li T, He L, Tan W, Yang G, Liu JP, Guo C. Pharmacogenomics and adverse effects of anti-infective drugs in children. Clin Exp Pharmacol Physiol 2024; 51:3-9. [PMID: 37840030 DOI: 10.1111/1440-1681.13830] [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: 02/21/2023] [Revised: 08/23/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
Children, as a special group, have their own peculiarities in terms of individualized medication use compared to adults. Adverse drug reactions have been an important issue that needs to be addressed in the hope of safe medication use in children, and the occurrence of adverse drug reactions is partly due to genetic factors. Anti-infective drugs are widely used in children, and they have always been an important cause of the occurrence of adverse reactions in children. Pharmacogenomic technologies are becoming increasingly sophisticated, and there are now many guidelines describing the pharmacogenomics of anti-infective drugs. However, data from paediatric-based studies are scarce. This review provides a systematic review of the pharmacogenomics of anti-infective drugs recommended for gene-guided use in CPIC guidelines by exploring the relationship between pharmacogenetic frequencies and the incidence of adverse reactions, which will help inform future studies of individualized medication use in children.
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Affiliation(s)
- Xin Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Biwen Hu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ling Ye
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Tong Li
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Li He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Tan
- Department of Neonatology, Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jun-Ping Liu
- Institute of Aging Research, Hangzhou Normal University School of Medicine, Zhejiang, China
- Department of Immunology, Monash University Faculty of Medicine, Prahran, Victoria, Australia
| | - Chengxian Guo
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
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Effects of the number of drugs used on the prevalence of adverse drug reactions in children. Sci Rep 2020; 10:21341. [PMID: 33288793 PMCID: PMC7721890 DOI: 10.1038/s41598-020-78358-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
In pediatric individuals, polypharmacy would increase the prevalence of adverse drug reactions (ADRs). However, there is no report on the ADR increase adjusted for the influence of concomitant disease types. We conducted a retrospective study in pediatric patients to determine whether polypharmacy is a risk factor for ADR development, after the adjustment. Patients aged 1–14 years on medication who visited Gifu Municipal Hospital (Gifu, Japan) were included. We evaluated patient characteristics, ADR causality, ADR classification and severity, and ADR-causing drugs. We examined the association between ADR prevalence and number of drugs used. We performed multiple logistic regression analyses to investigate risk factors for ADR development. Of 1330 patients, 3.5% sought medical attention for ADRs. ADR causality was most often assessed as “possible,” with gastrointestinal ADRs being the most common. Grade 1 ADRs were the most and antibiotics were the most common suspected ADR-inducing drug. The multiple logistic regression analysis showed that ≥ 2 or ≥ 4 drug use, neoplasms, mental and behavioral disorders, and circulatory system diseases significantly increased ADR prevalence. Polypharmacy increased the prevalence of ADR resulting in hospital visits in children, after adjusting for the influence of disease types. Therefore, proactive polypharmacy control measures are necessary for children.
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Song YK, Han N, Burckart GJ, Oh JM. International Coherence of Pediatric Drug Labeling for Drug Safety: Comparison of Approved Labels in Korea and the United States. Clin Pharmacol Ther 2019; 107:530-540. [PMID: 31544241 PMCID: PMC7028218 DOI: 10.1002/cpt.1640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/06/2019] [Indexed: 01/24/2023]
Abstract
The objective of this study was to analyze information on pediatric use in Korean drug product labels and compare it with that in US Food and Drug Administration (FDA) labeling information. Prescription information on pediatric use contained in the commonly used drugs’ product labels approved by Korean government was compared with that approved by the FDA. Among the top 50 commonly prescribed drugs, 20 drugs were deemed to have insufficient prescribing information in Korean drug labels. Pediatric prescribing information regarding indication, approved age, formulations, and safety was insufficient in Korean drug labels compared with those in the FDA. Most important, the adverse events frequently reported in Korean children were not sufficiently presented in drug labels. In conclusion, this study highlights the urgent need for the Korean regulatory agency to encourage and accelerate research and development to increase the extent of pediatric prescribing information to be added to drug labels to promote appropriate drug prescribing for children.
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Affiliation(s)
- Yun-Kyoung Song
- College of Pharmacy, Daegu Catholic University, Gyeongsan-si, Gyeongbuk, Korea
| | - Nayoung Han
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Gwanak-gu, Seoul, Korea
| | - Gilbert J Burckart
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jung Mi Oh
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Gwanak-gu, Seoul, Korea
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Liu XI, Schuette P, Burckart GJ, Green DJ, La J, Burnham JM, Rakhmanina N, Robb A, Huang SM, van den Anker JN. A Comparison of Pediatric and Adult Safety Studies for Antipsychotic and Antidepressant Drugs Submitted to the United States Food and Drug Administration. J Pediatr 2019; 208:236-242.e3. [PMID: 30679050 PMCID: PMC7171692 DOI: 10.1016/j.jpeds.2018.12.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/08/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine the differences in the adverse drug reaction (ADR) profile of antipsychotic and antidepressant agents between pediatric and adult patients in studies submitted to the Food and Drug Administration (FDA) during the drug development process. STUDY DESIGN Clinical trials in adult and pediatric patients were conducted by sponsors as part of the drug development programs for antipsychotic and antidepressant agents, and ADR information was collected as part of those trials and submitted to the FDA. Data collection was conducted by reviewing publicly available FDA-authored reviews and FDA-approved product labels for 10 drugs with an antipsychotic or an antidepressant indication from 2007 to 2017. RESULTS There were 308 drug and ADR combinations for the 10 drugs and drug combinations with 113 (36.7%) having a significantly different incidence in pediatric patients compared with adults. Sixty-eight (60.2%) of these ADRs had a significantly higher incidence in pediatric patients than in adults. Sedation was higher in 6 of the 10 drugs and drug combinations with risk differences ranging from 9.6 to 36.6%. CONCLUSIONS This analysis indicates that there were significant differences between the pediatric and adult safety profiles of antipsychotic and antidepressant drugs. Sedation was the major ADR associated with the use of atypical antipsychotic drugs in pediatric patients. Clinicians caring for children should consider the ADR profile when prescribing antipsychotics and antidepressants in pediatric patients.
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Affiliation(s)
| | - Paul Schuette
- Office of Biostatistics, United States Food and Drug Administration, Silver Spring, MD
| | - Gilbert J. Burckart
- Office of Clinical Pharmacology, United States Food and Drug Administration, Silver Spring, MD
| | - Dionna J. Green
- Office of Pediatric Therapeutics, United States Food and Drug Administration, Silver Spring, MD
| | - Julie La
- Loma Linda School of Pharmacy, Loma Linda, CA
| | - Janelle M. Burnham
- Office of Clinical Pharmacology, United States Food and Drug Administration, Silver Spring, MD
| | | | | | - Shiew Mei Huang
- Office of Clinical Pharmacology, United States Food and Drug Administration, Silver Spring, MD
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Pansa P, Hsia Y, Bielicki J, Lutsar I, Walker AS, Sharland M, Folgori L. Evaluating Safety Reporting in Paediatric Antibiotic Trials, 2000-2016: A Systematic Review and Meta-Analysis. Drugs 2019; 78:231-244. [PMID: 29218501 DOI: 10.1007/s40265-017-0850-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are very few options to treat multidrug-resistant bacterial infections in children. A major barrier is the duration and complexity of regulatory trials of new antibiotics. Extrapolation of safety data from adult trials could facilitate drug development for children. OBJECTIVE We performed a systematic review on the safety of antibiotic clinical trials (CTs) in children (0-18 years) to evaluate the overall quality of safety trials conducted in children and to determine if age-specific adverse events (AEs) could be identified for specific antibiotic classes. DATA SOURCES We searched the MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov electronic databases for trials conducted between 2000 and 2016. STUDY SELECTION All trials in which safety was declared a primary or secondary endpoint were included. Exclusion criteria were (1) topical or inhalational route of administration; (2) non-infectious conditions; (3) administration for prophylaxis rather than treatment; (4) selected population (i.e. cystic fibrosis, malignancies, HIV and tuberculosis); and (5) design other than randomized controlled trials. Trials reporting data on both adults and children were included only if paediatric results were reported separately. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted the data. To assess the quality of published trials, the Extension for harms for Consolidated Standards of Reporting Trials (CONSORT) Statement 2004 was used. MAIN OUTCOME AND MEASURE In order to quantitatively assess the rate of developing AEs by drug class, the numbers of overall and body-system-specific AEs were collected for each study arm, and then calculated per single drug class as median and interquartile range (IQR) of the proportions across CTs. The AEs most frequently reported were compared in the meta-analysis by selecting the CTs on the most represented drug classes. RESULTS Eighty-three CTs were included, accounting for 27,693 children. Overall, 69.7% of CONSORT items were fully reported. The median proportion of children with any AE was 22.5%, but did not exceed 8% in any single body system. Serious drug-related AEs and drug-related discontinuations were very rare (median 0.3 and 0.9%, respectively). Limitations included the inability to stratify by age group, particularly neonates. CONCLUSIONS AND RELEVANCE Overall, AEs in paediatric antibiotic CTs were predictable and class-specific, and no unexpected (age-specific) side effects were identified. Smaller, open-label, dose-finding, high-quality, single-arm pharmacokinetic trials seem potentially sufficient for certain common antibiotic classes, extrapolating well-established safety profiles determined from large adult efficacy trials. This approach could reduce duration and enhance subsequent registration of urgently needed new antibiotics. This will need to be combined with enhanced methods of pharmacovigilance for monitoring of emerging AEs in routine clinical practice.
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Affiliation(s)
- Paola Pansa
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Cranmer Terrace, London, SW17 0RE, UK.,Department of Pediatrics, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Yingfen Hsia
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Cranmer Terrace, London, SW17 0RE, UK
| | - Julia Bielicki
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Cranmer Terrace, London, SW17 0RE, UK.,Paediatric Pharmacology, University Children's Hospital Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Irja Lutsar
- Institute of Medical Microbiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - A Sarah Walker
- Nuffield Department of Clinical Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, OX1 3PA, UK
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Cranmer Terrace, London, SW17 0RE, UK
| | - Laura Folgori
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Cranmer Terrace, London, SW17 0RE, UK.
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Shebley M, Menon RM, Gibbs JP, Dave N, Kim SY, Marroum PJ. Accelerating Drug Development in Pediatric Oncology With the Clinical Pharmacology Storehouse. J Clin Pharmacol 2018; 59:625-637. [PMID: 30562405 PMCID: PMC6590144 DOI: 10.1002/jcph.1359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
Pediatric drug development is a challenging process due to the rarity of the population, the need to meet regulatory requirements across the globe, the associated uncertainty in extrapolating data from adults, the paucity of validated biomarkers, and the lack of systematic testing of drugs in pediatric patients. In oncology, pediatric drug development has additional challenges that have historically delayed availability of safe and effective medicines for children. In particular, the traditional approach to pediatric oncology drug development involves conducting phase 1 studies in children once the drug has been characterized and in some cases approved for use in adults. The objective of this article is to describe clinical pharmacology factors that influence pediatric oncology trial design and execution and to highlight efficient approaches for designing and expediting oncology drug development in children. The topics highlighted in this article include (1) study design considerations, (2) updated dosing approaches, (3) ways to overcome the significant biopharmaceutical challenges unique to the oncology pediatric population, and (4) use of data analysis strategies for extrapolating data from adults, with case studies. Finally, suggestions for ways to use clinical pharmacology approaches to accelerate pediatric oncology drug development are provided.
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Affiliation(s)
- Mohamad Shebley
- Clinical Pharmacology and PharmacometricsAbbVie Inc.North ChicagoILUSA
| | - Rajeev M. Menon
- Clinical Pharmacology and PharmacometricsAbbVie Inc.North ChicagoILUSA
| | - John P. Gibbs
- Clinical Pharmacology and PharmacometricsAbbVie Inc.North ChicagoILUSA
| | - Nimita Dave
- Clinical Pharmacology and PharmacometricsAbbVie Inc.North ChicagoILUSA
| | - Su Y. Kim
- Oncology DevelopmentAbbVie Inc.North ChicagoILUSA
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Barrett JS, Bishai R, Bucci-Rechtweg C, Cheung A, Corriol-Rohou S, Haertter S, James A, Kovacs SJ, Liu J, Potempa D, Strougo A, Vanevski K. Challenges and Opportunities in the Development of Medical Therapies for Pediatric Populations and the Role of Extrapolation. Clin Pharmacol Ther 2018; 103:419-433. [DOI: 10.1002/cpt.1000] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/14/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Jeffrey S. Barrett
- Translational Medicine, Translational Informatics, Sanofi; Bridgewater New Jersey USA
| | - Raafat Bishai
- Clinical Development, Metabolic Disease Department; AstraZeneca; Gaithersburg Maryland USA
| | - Christina Bucci-Rechtweg
- Global Health Policy, Regulatory Affairs, Novartis Pharmaceuticals Corporation; East Hanover New Jersey USA
| | - Amy Cheung
- Quantitative Clinical Pharmacology, Early Clinical Development, Innovative Medicines and Early Development Biotech Unit; AstraZeneca Cambridge UK
| | | | - Sebastian Haertter
- Translational Med & Clinical Pharmacology, Boehringer-Ingelheim Pharma; Ridgefield Connecticut USA
| | - Angela James
- Clinical Pharmacology and Exploratory Department; Astellas Pharma; Northbrook Illinois USA
| | - Steven J. Kovacs
- Translational Medicine, Novartis Institutes for BioMedical Research; East Hanover New Jersey USA
| | - Jing Liu
- Clinical Pharmacology, Pfizer; Groton Connecticut USA
| | - Dennis Potempa
- Translational Medicine, Pharmacokinetics, Dynamics and Metabolism, M&S; Sanofi Frankfurt Germany
| | - Ashley Strougo
- Translational Medicine, Pharmacokinetics, Dynamics and Metabolism, M&S; Sanofi Frankfurt Germany
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Green DJ, Zineh I, Burckart GJ. Pediatric Drug Development: Outlook for Science-Based Innovation. Clin Pharmacol Ther 2018; 103:376-378. [DOI: 10.1002/cpt.1001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Dionna J. Green
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration; Silver Spring Maryland USA
| | - Issam Zineh
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration; Silver Spring Maryland USA
| | - Gilbert J. Burckart
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration; Silver Spring Maryland USA
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Leong R, Zhao H, Reaman G, Liu Q, Wang Y, Stewart CF, Burckart G. Bridging Adult Experience to Pediatrics in Oncology Drug Development. J Clin Pharmacol 2017; 57 Suppl 10:S129-S135. [PMID: 28921643 DOI: 10.1002/jcph.910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/06/2017] [Indexed: 01/14/2023]
Abstract
Pediatric drug development in the United States has grown under the current regulations made permanent by the Food and Drug Administration Safety and Innovation Act of 2012. Over 1200 pediatric studies have now been submitted to the US FDA, but there is still a high rate of failure to obtain pediatric labeling for the indication pursued. Pediatric oncology represents special problems in that the disease is most often dissimilar to any cancer found in the adult population. Therefore, the development of drug dosing in pediatric oncology patients represents a special challenge. Potential approaches to pediatric dosing in oncology patients include extrapolation of efficacy from adult studies in those few cases where the disease is similar, inclusion of adolescent patients in adult trials when possible, and bridging the adult dose to the pediatric dose. An analysis of the recommended phase 2 dose for 40 molecularly targeted agents in pediatric patients provides some insight into current practices. Increased knowledge of tumor biology and efforts to identify and validate molecular targets and genetic abnormalities that drive childhood cancers can lead to increased opportunities for precision medicine in the treatment of pediatric cancers.
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Affiliation(s)
- Ruby Leong
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Hong Zhao
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Gregory Reaman
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Qi Liu
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Yaning Wang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gilbert Burckart
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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