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Pharmacy and formulation support for paediatric clinical trials in England. Int J Pharm 2016; 511:1163-8. [PMID: 27039151 DOI: 10.1016/j.ijpharm.2016.03.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 03/18/2016] [Accepted: 03/29/2016] [Indexed: 11/20/2022]
Abstract
Availability and sourcing of investigational drugs for paediatric clinical trials is known to be a challenge for investigator-led clinical trials. The National Institute of Health Research Clinical Research Network: Children (CRN: Children) provides support for formulations and pharmacy related issues to researchers planning and setting up paediatric clinical trials within England. This paper reviews pharmacy and formulation support provided to a consecutive series of investigator-led clinical studies supported by CRN:Children. Case studies are included to describe some of the unique pharmaceutical challenges encountered. 44 trials were reviewed and a total of 103 products were required to support these clinical trials. UK authorised products were suitable for use for 62 of these 103 products. In the remaining 41 cases, 4 could be sourced as an authorised product within the European Union and the remaining 37 required bespoke manufacture. Bespoke manufacture of an investigational drug or placebo is costly. Typical costs for the initial development and testing of a bespoke investigational drug or placebo were in the range of £30,000-100,000 per product. The estimated cost for 19 out of 45 trials was available; in summary, the costs on a per patient per day of therapy basis ranged from under £1 to almost £600; short studies involving multiple agents are obviously the most expensive. This range is dependent upon the need for bespoke manufacture and also the number of participants within the trial. The arrangements for investigational drug supply can greatly affect the study design, regulatory requirements, trial logistics, as well as the total cost of research. As investigational product related activities are often costly, necessitating months of advance planning, it is imperative that specialist inputs are sought from the very start of the study design and planning process.
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Meier-Girard D, Tibi A, Abdoul H, Prot-Labarthe S, Brion F, Bourdon O, Alberti C. Academic pediatric clinical research: factors associated with study implementation duration. BMC Med Res Methodol 2016; 16:36. [PMID: 27025840 PMCID: PMC4812626 DOI: 10.1186/s12874-016-0138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 03/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ethical, methodological, and technical aspects of pediatric research, often results in complications and delays in implementation. Our objective was to identify factors associated with the implementation duration of hospital-based pediatric studies. METHODS All hospital-based pediatric studies sponsored by AP-HP between 2002 and 2008 were retrospectively identified. Association of the funding mechanism and methodological factors with the implementation duration was assessed using a multivariable mixed linear model. Pharmaceutical factors were explored as part of a subgroup analysis restricted to the studies involving drug therapy. Given that we took an exploratory approach, factors associated with implementation duration with p < 0.10 were kept in the final models. RESULTS A total of 139 studies were evaluated. The median implementation duration was 17.1 months (range: 0.9-55.3 months), and tended to increase over time (from 14.9 [25(th) percentile-75(th) percentile: 11.5-19.9] months in 2002 to 23.7 [15.2-31.0] months in 2008, p = 0.01). External (coefficient [95 % confidence interval]: -7.7 [-11.9;-3.5] months, p < 0.001) and internal funding (-5.3 95 % CI [-9.8;-0.8], p = 0.02) compared to governmental funding and number of centers (-0.1 95 % CI[-0.2;0.02] months for 1 center increase, p = 0.07) were associated with reduced duration, whereas interventional study (either involving drug therapy (6.0 95 % CI[0.7;11.3] months, p = 0.03 or not (3.5 95 % CI[-0.3;7.3] months, p = 0.06) was associated with increased duration compared to observational study. Regarding the 35 studies involving drug therapy, external funding decreased duration (-6.7 95 % CI[-13.2;-0.2] months, p = 0.05), whereas studies involving solely a pediatric population (7.8 95 % CI[1.1;14.5] months, p = 0.01) (compared to mixed adult-pediatric population), a placebo-controlled design (6.6 95 % CI[0.9;12.3] months, p = 0.01), and inappropriate drug formulation for at least one drug used in the study (6.9 95 % CI[-0.2;14.0] months, p = 0.06) were associated with increased duration. CONCLUSION Implementation of hospital-based pediatric studies primarily faced delays when they were interventional and, in particular, when they involved drug therapy. Regarding the latter, difficulties that resulted in delayed studies arose with respect to the supply of drugs and placebo in age-appropriate dosages and route of administration. Therefore, difficulties related to the use of pharmaceuticals need to be anticipated earlier in order to avoid implementation delays.
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Affiliation(s)
- Delphine Meier-Girard
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
- />University of Basel, University Children’s Hospital (UKBB), Basel, Switzerland
- />Department of Paediatric Pulmonology, University Children`s Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland
| | - Annick Tibi
- />Université Paris Descartes, Sorbonne Paris Cité, F-75270 Paris, France
- />Département d’Essais Cliniques, AP-HP, Agence Générale des Equipements et Produits de Santé, F-75013 Paris, France
| | - Hendy Abdoul
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
| | - Sonia Prot-Labarthe
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Pharmacie à Usage Intérieur, F-75019 Paris, France
| | - Françoise Brion
- />Université Paris Descartes, Sorbonne Paris Cité, F-75270 Paris, France
- />AP-HP, Hôpital Robert Debré, Pharmacie à Usage Intérieur, F-75019 Paris, France
| | - Olivier Bourdon
- />Université Paris Descartes, Sorbonne Paris Cité, F-75270 Paris, France
- />AP-HP, Hôpital Robert Debré, Pharmacie à Usage Intérieur, F-75019 Paris, France
| | - Corinne Alberti
- />Université Paris Diderot, Sorbonne Paris Cité, UMR-1123 ECEVE, F-75019 Paris, France
- />AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, F-75019 Paris, France
- />Inserm, U1123 and CICEC 1426, F-75019 Paris, France
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