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Rezaei H, Khoubnasabjafari M, Jouyban-Gharamaleki V, Hamishehkar H, Afshar Mogaddam MR, Rahimpour E, Mehvar R, Jouyban A. A new method for investigating bioequivalence of inhaled formulations: A pilot study on salbutamol. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2023; 26:11466. [PMID: 37206631 PMCID: PMC10188931 DOI: 10.3389/jpps.2023.11466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023]
Abstract
Purpose: An efficient, cost-effective and non-invasive test is required to overcome the challenges faced in the process of bioequivalence (BE) studies of various orally inhaled drug formulations. Two different types of pressurized meter dose inhalers (MDI-1 and MDI-2) were used in this study to test the practical applicability of a previously proposed hypothesis on the BE of inhaled salbutamol formulations. Methods: Salbutamol concentration profiles of the exhaled breath condensate (EBC) samples collected from volunteers receiving two inhaled formulations were compared employing BE criteria. In addition, the aerodynamic particle size distribution of the inhalers was determined by employing next generation impactor. Salbutamol concentrations in the samples were determined using liquid and gas chromatographic methods. Results: The MDI-1 inhaler induced slightly higher EBC concentrations of salbutamol when compared with MDI-2. The geometric MDI-2/MDI-1 mean ratios (confidence intervals) were 0.937 (0.721-1.22) for maximum concentration and 0.841 (0.592-1.20) for area under the EBC-time profile, indicating a lack of BE between the two formulations. In agreement with the in vivo data, the in vitro data indicated that the fine particle dose (FPD) of MDI-1 was slightly higher than that for the MDI-2 formulation. However, the FPD differences between the two formulations were not statistically significant. Conclusion: EBC data of the present work may be considered as a reliable source for assessment of the BE studies of orally inhaled drug formulations. However, more detailed investigations employing larger sample sizes and more formulations are required to provide more evidence for the proposed method of BE assay.
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Affiliation(s)
- Homa Rezaei
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Khoubnasabjafari
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Jouyban-Gharamaleki
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Kimia Idea Pardaz Azarbayjan (KIPA) Science Based Company, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Elaheh Rahimpour
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Mehvar
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA, United States
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Abolghasem Jouyban,
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Hh B, M M, G B, A D, G H, W J, A K, J L, H P, B S, A S, N T, Tsang YC, J W, J W. The Global Bioequivalence Harmonisation Initiative (GBHI): Report of EUFEPS/AAPS fourth conference. Eur J Pharm Sci 2021; 167:105987. [PMID: 34481066 DOI: 10.1016/j.ejps.2021.105987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
This report provides a summary of the 4th International Conference on Global Bioequivalence Harmonisation Initiative (GBHI) that was co-organised by the European Federation of Pharmaceutical Sciences (EUFEPS) and the American Association of Pharmaceutical Scientists (AAPS). The goal of the GBHI conference is to offer the most informative and up to date science and regulatory thinking of bioequivalence (BE) in global drug development to support the intended process of a scientific global harmonisation. The workshop provided an open forum for pharmaceutical scientists from academia, industry and regulatory agencies to discuss three BE topics of interest, (a) BE assessment for long-acting injectables and implants, (b) necessity of fed BE studies for immediate-release products and (c) procedures to demonstrate equivalence of orally inhaled products. Moreover, in keynote lectures, a potential road map to an international BE reference product was discussed, and visions and perspectives for future global BE harmonisation activities have been presented. The meeting delivered a cutting-edge insight into the topics in an interactive and at the same time focused way.
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Affiliation(s)
- Blume Hh
- SocraTec C&S GmbH, Oberursel, Germany.
| | - Mehta M
- U.S. Food and Drug Administration, Silver Spring, MD, United States
| | | | - Dorantes A
- U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Hempel G
- University of Muenster, Muenster, Germany
| | - Jiang W
- U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Kovar A
- Sanofi-Aventis Deutschland GmbH, Frankfurt/Main, Germany
| | - Lee J
- U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Potthast H
- BfArM, Bonn, Germany (until October 2020)
| | - Schug B
- SocraTec R&D GmbH, Oberursel/Erfurt, Germany
| | - Seidlitz A
- University of Greifswald, Greifswald, Germany
| | - Tampal N
- U.S. Food and Drug Administration, Silver Spring, MD, United States
| | | | - Walstab J
- SocraTec R&D GmbH, Oberursel/Erfurt, Germany
| | - Welink J
- Medicines Evaluation Board, Utrecht, The Netherlands
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Xu SM, Xu YY, Yan J, Zhang YF, Li D, Li D, Li XM, Guo J, Xu PS. Method for evaluating the human bioequivalence of acarbose based on pharmacodynamic parameters. J Int Med Res 2020; 48:300060520960317. [PMID: 33044102 PMCID: PMC7556174 DOI: 10.1177/0300060520960317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To explore a method for evaluating the bioequivalence of acarbose based on pharmacodynamic parameters using a single-dose, randomized-sequence, three-way crossover study of acarbose test (T) and reference (R) formulations. Methods Baseline-adjusted, pre-dose value deduction, and direct comparison methods were used to evaluate the geometric T/R ratios and 90% confidence intervals (CIs) of the ln-transformed pharmacodynamic parameters to identify the most suitable evaluation system. Twelve participants were randomly divided into three groups to receive treatment in the following sequences: TRR, RTR, and RRT, each including a 7-day washout period between treatment periods. The serum glucose concentration (baseline) was determined. Pharmacodynamic parameters, including the maximum reduction in serum glucose concentrations (ΔCSG,max) and difference of the AUC of glucose between before and after acarbose exposure (ΔAUEC), were tested. Results Using the direct comparison method, the geometric mean ratios of CSG,max, AUEC(0-2h), and AUEC(0-4h) were 94.13%, 97.82% and 99.76%, respectively. The 90% CIs of the geometric T/R ratios for CSG,max, AUEC(0-2h), and AUEC(0-4h) all fell between 80% and 125%. Conversely, ΔCSG,max and ΔAUEC(0-4h) were less reliable measures of acarbose bioequivalence. Conclusions Pre-dose value deduction and direct comparison methods can be initially considered suitable for assessing acarbose bioequivalence.
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Affiliation(s)
- Su-Mei Xu
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Yu-Ying Xu
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Juan Yan
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Yi-Fei Zhang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Dai Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Dan Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Xiao-Min Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Jie Guo
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
| | - Ping-Sheng Xu
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
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Allan R, Haughie S, Ahrens R, Singh S, Ward J. A Dose-Response Study Examining the Use of Methacholine Challenge to Demonstrate Local Therapeutic Equivalence of the Salmeterol Component of Generic Inhaled Fluticasone Propionate/Salmeterol Combination Products. J Aerosol Med Pulm Drug Deliv 2019; 32:352-363. [PMID: 31259673 DOI: 10.1089/jamp.2018.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Asthma is widely treated using inhaled corticosteroid/long-acting beta agonist (LABA) combinations, for example, fluticasone propionate/salmeterol (FPS) dry powder inhaler, marketed as Advair® Diskus®. Some regulators require generics to demonstrate local (lung) therapeutic equivalence (LTE) for each component of the FPS reference, ideally with a dose-response within the approved FPS dose range. We sought to develop a methacholine challenge (MeCh) LTE methodology for assessing the LABA (salmeterol) component of FPS. Methods: Forty-six patients with asthma received single doses of albuterol (active control; 90 or 180 μg), FPS (100/50 or 200/100 μg), and placebo on 5 separate study days. Spirometry and MeCh were performed 1, 6, and 10 hours after study drug inhalation. Primary endpoint was provocative concentration of methacholine producing a 20% fall in forced expiratory volume in 1 second (PC20). Study entry required screening PC20 ≤8 mg/mL, with a greater than fourfold increase (and PC20 ≤128 mg/mL) after 180 μg albuterol. Results: Both albuterol (90 and 180 μg) and FPS (100/50 and 200/100 μg) significantly increased PC20 compared with placebo (sustained 6 and 10 hours postdose with FPS but not albuterol). The dose-response slopes (95% confidence interval) estimated 1 hour after treatment were 0.374 (-0.068 to 0.815) and 0.310 (-0.135 to 0.754) between low and high doses of albuterol and FPS, respectively, both nonsignificant. Slopes were shallower than those available in the literature for albuterol and formoterol, but similar to those for salmeterol. Conclusions: These data confirm that the bronchoprotective effect of FPS lasts longer than that of albuterol. The shallow dose-response slope we observed for albuterol is contrary to previous reports, probably due to the measurement of PC20 beginning at 1 hour postdose. The results suggest that use of MeCh to assess LTE for salmeterol formulations may be more difficult to accomplish than it is for albuterol and formoterol products.
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Affiliation(s)
| | | | - Richard Ahrens
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Sachinkumar Singh
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Jon Ward
- Mylan Pharma UK Limited, Sandwich, United Kingdom
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Zeng Y, Singh S, Wang K, Ahrens RC. Effect of Study Design on Sample Size in Studies Intended to Evaluate Bioequivalence of Inhaled Short-Acting β-Agonist Formulations. J Clin Pharmacol 2017; 58:457-465. [PMID: 29281130 PMCID: PMC5901014 DOI: 10.1002/jcph.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/23/2017] [Indexed: 11/15/2022]
Abstract
Pharmacodynamic studies that use methacholine challenge to assess bioequivalence of generic and innovator albuterol formulations are generally designed per published Food and Drug Administration guidance, with 3 reference doses and 1 test dose (3‐by‐1 design). These studies are challenging and expensive to conduct, typically requiring large sample sizes. We proposed 14 modified study designs as alternatives to the Food and Drug Administration–recommended 3‐by‐1 design, hypothesizing that adding reference and/or test doses would reduce sample size and cost. We used Monte Carlo simulation to estimate sample size. Simulation inputs were selected based on published studies and our own experience with this type of trial. We also estimated effects of these modified study designs on study cost. Most of these altered designs reduced sample size and cost relative to the 3‐by‐1 design, some decreasing cost by more than 40%. The most effective single study dose to add was 180 μg of test formulation, which resulted in an estimated 30% relative cost reduction. Adding a single test dose of 90 μg was less effective, producing only a 13% cost reduction. Adding a lone reference dose of either 180, 270, or 360 μg yielded little benefit (less than 10% cost reduction), whereas adding 720 μg resulted in a 19% cost reduction. Of the 14 study design modifications we evaluated, the most effective was addition of both a 90‐μg test dose and a 720‐μg reference dose (42% cost reduction). Combining a 180‐μg test dose and a 720‐μg reference dose produced an estimated 36% cost reduction.
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Affiliation(s)
- Yaohui Zeng
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Sachinkumar Singh
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kai Wang
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Richard C Ahrens
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Rahimkhani S, Ghanbarzadeh S, Nokhodchi A, Hamishehkar H. An In Vitro Aerosolization Efficiency Comparison of Generic and Branded Salbutamol Metered Dose Inhalers. PHARMACEUTICAL SCIENCES 2017. [DOI: 10.15171/ps.2017.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Levine M, Gaebel K, Spino M. A Study of Patient Responses to a Perceived Change in Salbutamol Metered Dose Inhalers. ACTA ACUST UNITED AC 2016. [DOI: 10.1057/palgrave.jgm.4940070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Experience in the clinic reveals that some patients have attributed negative changes in their respiratory health status to generic substitution of inhaled medications, even though — from a pharmacological perspective — therapeutic equivalence would be expected. The objective of this study was to evaluate patient-reported changes in efficacy or toxicity following a perceived switch of an inhaled drug product. Forty-eight patients with air flow limitation had their usual brand of salbutamol metered-dose inhaler (MDI) replaced for one week with a new MDI. Patients were not informed that the replacement MDI was exactly the same brand as their usual MDI, and the product identity was disguised by a label. Forced expiratory volume in one second, respiratory symptoms and MDI use were compared between the week when the patients knew they were using their usual brand of MDI and the week they were using the perceived new MDI. Patient MDI preference was assessed at the end of the study. Even though there was no change in the brand of salbutamol MDI, 46 per cent of patients thought that the new MDI was better at managing their symptoms, 27 per cent thought that the new MDI was worse and 27 per cent perceived no difference (p<0.05 for rejecting the null hypothesis that all responses would be for no difference). Seventy per cent of patients stated that they had a preference for one MDI over the other, even though there had been no change in inhaler. Factors other than product differences are likely to be responsible for patient claims of changes in respiratory health status subsequent to generics substitution with inhaled medications when equivalent products are used. If such changes are reported following the introduction of a new generic product, the changes may be incorrectly attributed to the new product, confounding the ability to assess the quality of the new product in post-marketing evaluation.
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Hendeles L, Daley-Yates PT, Hermann R, De Backer J, Dissanayake S, Horhota ST. Pharmacodynamic Studies to Demonstrate Bioequivalence of Oral Inhalation Products. AAPS JOURNAL 2015; 17:758-68. [PMID: 25716149 DOI: 10.1208/s12248-015-9735-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/03/2015] [Indexed: 11/30/2022]
Abstract
In the session on "Pharmacodynamic studies to demonstrate efficacy and safety", presentations were made on methods of evaluating airway deposition of inhaled corticosteroids and bronchodilators, and systemic exposure indirectly using pharmacodynamic study designs. For inhaled corticosteroids, limitations of measuring exhaled nitric oxide and airway responsiveness to adenosine for anti-inflammatory effects were identified, whilst measurement of 18-h area under the cortisol concentration-time curve was recommended for determining equivalent systemic exposure. For bronchodilators, methacholine challenge was recommended as the most sensitive method of determining the relative amount of β-agonist or anti-muscarinic agent delivered to the airways. Whilst some agencies, such as the Food and Drug Administration (FDA), do not require measuring systemic effects when pharmacokinetic measurements are feasible, the European Medicines Agency requires measurement of heart rate and serum potassium, and some require serial electrocardiograms when bioequivalence is not established by pharmacokinetic (PK) studies. The Panel Discussion focused on whether PK would be the most sensitive marker of bioequivalence. Furthermore, there was much discussion about the FDA draft guidance for generic fluticasone propionate/salmeterol. The opinion was expressed that the study design is not capable of detecting a non-equivalent product and would require an unfeasibly large sample size.
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Affiliation(s)
- Leslie Hendeles
- Pharmacotherapy and Translational Research and Pediatrics (Pulmonary), University of Florida, PO Box 100486, Gainesville, Florida, 32610-0486, USA,
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Lee S, Chung JY, Hong KS, Yang SH, Byun SY, Lim HS, Shin SG, Jang IJ, Yu KS. Pharmacodynamic comparison of two formulations of Acarbose 100-mg tablets. J Clin Pharm Ther 2012; 37:553-7. [DOI: 10.1111/j.1365-2710.2012.01339.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Evans C, Cipolla D, Chesworth T, Agurell E, Ahrens R, Conner D, Dissanayake S, Dolovich M, Doub W, Fuglsang A, García Arieta A, Golden M, Hermann R, Hochhaus G, Holmes S, Lafferty P, Lyapustina S, Nair P, O'Connor D, Parkins D, Peterson I, Reisner C, Sandell D, Singh GJP, Weda M, Watson P. Equivalence considerations for orally inhaled products for local action-ISAM/IPAC-RS European Workshop report. J Aerosol Med Pulm Drug Deliv 2012; 25:117-39. [PMID: 22413806 DOI: 10.1089/jamp.2011.0968] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this article is to document the discussions at the 2010 European Workshop on Equivalence Determinations for Orally Inhaled Drugs for Local Action, cohosted by the International Society for Aerosols in Medicine (ISAM) and the International Pharmaceutical Consortium on Regulation and Science (IPAC-RS). The article summarizes current regulatory approaches in Europe, the United States, and Canada, and presents points of consensus as well as ongoing debate in the four major areas: in vitro testing, pharmacokinetic and pharmacodynamic studies, and device similarity. Specific issues in need of further research and discussion are also identified.
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Affiliation(s)
- Carole Evans
- Catalent Pharma Solutions, Research Triangle Park, NC 27709, USA.
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Daley-Yates PT, Parkins DA. Establishing bioequivalence for inhaled drugs; weighing the evidence. Expert Opin Drug Deliv 2011; 8:1297-308. [DOI: 10.1517/17425247.2011.592827] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Prabhakaran S, Shuster J, Ahrens R, Hendeles L. Methacholine challenge as a clinical bioassay of pulmonary delivery of a long-acting β₂-adrenergic agonist. Pharmacotherapy 2011; 31:449-57. [PMID: 21923426 PMCID: PMC3845881 DOI: 10.1592/phco.31.5.449] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine whether the methacholine challenge method used for albuterol can be applied to assess long-acting β2-adrenergic agonist (LABA) bioequivalence, which would require a sufficiently steep dose-response curve. DESIGN Prospective, unblinded, randomized, 2-way crossover study. SETTING University medical center clinical research laboratory. PATIENTS Ten adults, aged 21-58 years, with mild asthma (forced expiratory volume in 1 sec [FEV(1)] ≥ 70% predicted) and a baseline provocational concentration of methacholine required to decrease FEV(1) by 20% (PC(20)) of 4 mg/ml or less completed the study. INTERVENTION Patients were randomized to receive a single dose of either 12 or 24 μg of formoterol delivered by a dry powder inhaler; 3-7 days later, at the same time of day, they received the other dose. MEASUREMENTS AND MAIN RESULTS The FEV(1) was measured before and 1 hour after dosing, followed by performance of a methacholine challenge. Statistical analysis was performed by the 2-sample regression method for crossover studies. The dose-response curve for bronchodilatation was flat; the mean ± SD increase in FEV(1) after formoterol 12 and 24 μg was 14 ± 5% and 14 ± 8%, respectively (p>0.05). In contrast, the geometric mean PC20 (95% confidence interval) was 7 mg/ml (2-22 mg/ml) after the 12-μg dose and 16 mg/ml (5-45 mg/ml) after the 24-μg dose (p<0.001). CONCLUSION Bioassay by methacholine challenge will be useful for bioequivalence studies of LABAs. A sample of at least 28 patients will be required for formoterol when methacholine challenge is performed in an optimal manner. The sample size may differ for other LABAs.
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Affiliation(s)
- Sreekala Prabhakaran
- Pediatric Pulmonary Division, University of Florida, Gainesville, Florida 32610-0486, USA
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Abstract
Albuterol (salbutamol outside the USA) is used to acutely relieve symptoms related to airway obstruction and prevent exercise-induced bronchospasm. Albuterol is most commonly administered by metered-dose inhaler (MDI). MDIs had used chlorofluorocarbon (CFC) propellants, but CFCs accumulate in the stratosphere and contribute to ozone catabolism. Loss of the 'ozone layer', which filters UVB rays, has public health concerns. Albuterol has been reformulated in MDIs using hydrofluoroalkane (HFA) propellants, which do not affect the ozone layer. Albuterol HFA MDIs deliver the same amount of drug per puff with similar particle size distributions as albuterol CFC MDIs, resulting in comparable bronchodilator efficacy of the two products. The highly favorable safety profile of albuterol has not been altered with reformulation. The propellant HFA-134a appears to be devoid of safety concerns.
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Affiliation(s)
- Gene L Colice
- The George Washington University School of Medicine, and Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, 110 Irving Street, NW Washington, DC 20010, USA.
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14
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Adams WP, Ahrens RC, Chen ML, Christopher D, Chowdhury BA, Conner DP, Dalby R, Fitzgerald K, Hendeles L, Hickey AJ, Hochhaus G, Laube BL, Lucas P, Lee SL, Lyapustina S, Li B, O'Connor D, Parikh N, Parkins DA, Peri P, Pitcairn GR, Riebe M, Roy P, Shah T, Singh GJP, Sharp SS, Suman JD, Weda M, Woodcock J, Yu L. Demonstrating Bioequivalence of Locally Acting Orally Inhaled Drug Products (OIPs): Workshop Summary Report. J Aerosol Med Pulm Drug Deliv 2010; 23:1-29. [DOI: 10.1089/jamp.2009.0803] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wallace P. Adams
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Science, Office of Generic Drugs, Rockville, Maryland
| | - Richard C. Ahrens
- University of Iowa Hospitals and Clinics, Department of Pediatrics, Iowa City, Iowa
| | - Mei-Ling Chen
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | | | - Badrul A. Chowdhury
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | - Dale P. Conner
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Science, Office of Generic Drugs, Rockville, Maryland
| | | | | | | | | | - Günther Hochhaus
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Beth L. Laube
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul Lucas
- Pfizer Global Research and Development, Sandwich, Kent, CT13 9NJ, United Kingdom
| | - Sau L. Lee
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Science, Office of Generic Drugs, Rockville, Maryland
| | | | - Bing Li
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Science, Office of Generic Drugs, Rockville, Maryland
| | - Dennis O'Connor
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | | | | | - Prasad Peri
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | - Gary R. Pitcairn
- Pfizer Limited, Ramsgate Road, Sandwich, Kent, CT13 9NJ, United Kingdom
| | | | - Partha Roy
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | | | | | - Sandra Suarez Sharp
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | | | - Marjolein Weda
- National Institute for Public Health and the Environment (RIVM) Centre for Quality of Chemical-Pharmaceutical Products, Bilthoven, The Netherlands
| | - Janet Woodcock
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | - Lawrence Yu
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmaceutical Science, Office of Generic Drugs, Rockville, Maryland
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15
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Lavorini F, Geri P, Camiciottoli G, Pistolesi M, Fontana GA. Agreement between two methods for assessing bioequivalence of inhaled salbutamol. Pulm Pharmacol Ther 2007; 21:380-4. [PMID: 17997115 DOI: 10.1016/j.pupt.2007.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 09/14/2007] [Accepted: 10/06/2007] [Indexed: 11/19/2022]
Abstract
For inhaled medications, bioequivalence testing is becoming increasingly important owing to the availability of many inhalation devices. We evaluated agreement between the Finney bioassay and the Emax model in the assessment of bioequivalence of salbutamol administered via a metered-dose inhaler with a spacer (pMDI+ Volumatic) or via a dry-powder inhaler (Diskus) in asthmatic patients with methacholine-induced bronchoconstriction. Eighteen patients inhaled methacholine until FEV 1 decreased by approximately 35% of control. Following inhalation of placebo, 200 and 400 mcg salbutamol through the pMDI+ Volumatic or the Diskus, changes in FEV 1 were repeatedly measured over a 60-min observation period. Bioequivalence of salbutamol administered via the two inhalation devices was assessed by calculating the relative potency of each device by using the Finney 2-by-2 parallel regression analysis and the non-linear, Emax model. Agreement between these methods in calculating relative potency was evaluated by using the Bland-Altman method. After salbutamol FEV 1 values were similar irrespective of the device employed, and greater (P<0.01) than those after placebo. However, assessment of relative potencies obtained with both the Finney (1.97, 90% CI 1.62-2.32) and the Emax (2.25, 90% CI 1.90-2.60) methods revealed that twice the salbutamol dose was needed to reverse methacholine-induced bronchoconstriction when the drug was inhaled via the Diskus than via the pMDI+ Volumatic. The mean difference in relative potency (-0.28, 90% CI -0.001 to -0.56) calculated with both methods did not significantly differ from zero, and none of the individual differences exceeded the limits of agreement. The Finney and the Emax methods provide comparable results in the evaluation of bioequivalence of different salbutamol formulations. The pMDI+ Volumatic is twice as efficient as the Diskus in lung delivery of salbutamol in asthma patients.
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Affiliation(s)
- Federico Lavorini
- Dipartimento di Area Critica Medico Chirurgica, Unità Funzionale di Medicina Respiratoria, Università degli Studi di Firenze, Viale G B Morgagni 85-50134, Firenze, Italy.
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Hendeles L, Colice GL, Meyer RJ. Withdrawal of albuterol inhalers containing chlorofluorocarbon propellants. N Engl J Med 2007; 356:1344-51. [PMID: 17392304 DOI: 10.1056/nejmra050380] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Leslie Hendeles
- College of Pharmacy and the Pediatric Pulmonary Division, University of Florida, Gainesville, FL 32610-0486, USA.
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Lavorini F, Geri P, Mariani L, Marmai C, Maluccio NM, Pistolesi M, Fontana GA. Speed of onset of bronchodilator response to salbutamol inhaled via different devices in asthmatics: a bioassay based on functional antagonism. Br J Clin Pharmacol 2006; 62:403-11. [PMID: 16995861 PMCID: PMC1885153 DOI: 10.1111/j.1365-2125.2006.02641.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 01/24/2006] [Indexed: 11/28/2022] Open
Abstract
AIMS To evaluate the speed of onset of bronchodilation following salbutamol administered via a metered-dose inhaler with a spacer (pMDI + Volumatic) and a dry-powder inhaler (Diskus), as well as the relative potencies of these devices in asthmatic patients with methacholine-induced bronchoconstriction. METHODS Eighteen patients inhaled methacholine (MCh) until FEV(1) decreased by 35% of control. Following administration of placebo, 200 microg salbutamol or 400 microg salbutamol through the pMDI + Volumatic or the Diskus, we calculated the time elapsed from drug administration and the appearance of a 90% increase in post-MCh forced vital capacity (FVC), FEV(1) and volume-adjusted mid-expiratory flow (recovery times). The salbutamol doses to be delivered by the two inhalation devices to achieve similar recovery times and the relative potencies of the devices were calculated by using the 2-by-2 Finney parallel regression method. RESULTS For all functional variables, recovery times were significantly (P < 0.01) shorter in pMDI + Volumatic than Diskus trials. The salbutamol doses to be delivered by the Diskus to achieve recovery times for FVC, FEV(1) and volume-adjusted mid-expiratory flow similar to those obtained with 200 microg salbutamol administered via the pMDI + Volumatic were 558 (95% CI 537, 579) microg, 395 (95% CI 388, 404) microg and 404 (95% CI 393, 415) microg, respectively, and corresponded to relative potencies of 2.79 (95% CI 2.68, 2.90), 1.98 (95% CI 1.94, 2.02), and 2.02 (95% CI 1.96, 2.07). CONCLUSIONS Administration of salbutamol via the pMDI + Volumatic provides faster reversal of induced bronchoconstriction than via the Diskus. The salbutamol dose targeting the lungs with the pMDI + Volumatic is approximately twice that with the Diskus.
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Affiliation(s)
- Federico Lavorini
- Dipartimento di Area Critica Medico Chirurgica, Unità Funzionale di Medicina Respiratoria, Università degli Studi di Firenze, Italia.
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Smyth HDC. The influence of formulation variables on the performance of alternative propellant-driven metered dose inhalers. Adv Drug Deliv Rev 2003; 55:807-28. [PMID: 12842602 DOI: 10.1016/s0169-409x(03)00079-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There are a multitude of formulation factors to consider when developing a pMDI. Evaluation of each of these variables has been performed over the years, but there has been an abundance of different approaches in the determination of the effects on device performance. Thus, although much is known about pMDI on the empirical level, a systematic approach has clearly been missing. With the ratification of the Montreal Protocol and the introduction of alternative propellant systems, the opportunity to establish relationships between different levels of testing, such as in vitro measurements and in vivo outcomes, and in vivo assessments and clinical outcomes, has arrived. This review outlines research efforts that have focused on the formulation of propellant-driven metered dose inhalers using alternative propellants. These formulation factors, including device characteristics, are reviewed with respect to the performance of MDIs.
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Affiliation(s)
- Hugh D C Smyth
- 1311 Kerr Hall, CB 7360, Division of Drug Delivery and Disposition, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Creticos PS, Adams WP, Petty BG, Lewis LD, Singh GJP, Khattignavong AP, Molzon JA, Martinez MN, Lietman PS, Williams RL. A methacholine challenge dose-response study for development of a pharmacodynamic bioequivalence methodology for albuterol metered- dose inhalers. J Allergy Clin Immunol 2002; 110:713-20. [PMID: 12417879 DOI: 10.1067/mai.2002.129036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the expiration of the patent on albuterol metered-dose inhalers (MDIs) in 1989, methods to assess in vivo bioequivalence of generic formulations required investigation. OBJECTIVE In an effort to develop a sensitive method to document bioequivalence, bronchoprovocation with methacholine chloride was used to assess the dose-response relationship of albuterol as delivered by MDI. Sensitivity was assessed in terms of magnitudes of ED(50), the estimated albuterol dose required to achieve 50 % of the fitted maximal value of the pharmacodynamic effect above baseline, and change in response as a function of dose, with emphasis on 1 and 2 actuations. METHODS On separate study days, 15 nonsmokers with mild asthma received randomized nominal albuterol doses of 0 to 576 microg by using specially manufactured MDI canisters. FEV(1) was measured 15 minutes after MDI dosing. Serially increasing doses of methacholine were administered, and FEV(1) was measured after each methacholine dose until a 20 % decrease in FEV(1) (PD(20)) was achieved. RESULTS Mean PD(20) values after use of each of the albuterol-containing MDIs were significantly greater than either mean screening or mean placebo PD(20) values (P <.05). Mean responses and most individual subject responses to 1 and 2 actuations (90 and 180 microg) of albuterol MDI were within the sensitive region of the dose- response curve. The mean estimated ED(50) value on the basis of nonlinear mixed effect modeling was 119.2 microg (range, 33.3-337.1 microg), with an intersubject percentage coefficient of variation of 69.0 %. CONCLUSIONS The methacholine bronchoprovocation model is safe and useful in the study of albuterol MDI dose-response in asthmatic subjects. Bronchoprovocation studies may be used for determination of bioequivalence of multisource albuterol MDI products.
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Affiliation(s)
- Peter S Creticos
- Department of Medicine, Division of Clinical Immunology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ahrens R, Weinberger M. Levalbuterol and racemic albuterol: are there therapeutic differences? J Allergy Clin Immunol 2001; 108:681-4. [PMID: 11692088 DOI: 10.1067/mai.2001.119407] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ahrens RC, Teresi ME, Han SH, Donnell D, Vanden Burgt JA, Lux CR. Asthma stability after oral prednisone: a clinical model for comparing inhaled steroid potency. Am J Respir Crit Care Med 2001; 164:1138-45. [PMID: 11673199 DOI: 10.1164/ajrccm.164.7.2008112] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinical studies comparing the potency of inhaled corticosteroids require steep dose-response slopes (b) and minimal response variability (s), as statistical power is inversely related to the s/b ratio. To evaluate a new study model, we performed a randomized, crossover study of 12 adult asthmatics who required 800 to 2,000 microg of inhaled corticosteroids daily, and calculated s/b for 21 raw clinical outcomes and 36 mathematically derived variables based on these raw outcomes. Each of two 21-d treatment periods was preceded by 4 to 7 d of oral prednisone to maximize asthma control and minimize carry-over of previous inhaled treatment. Treatments were 100 and 800 micron/d of an HFA-134a beclomethasone dipropionate formulation. Assessments included daily home spirometry, histamine challenge, inhaled albuterol use, and asthma symptom scores. Efficacy variables with the greatest power (lowest s/b values) were A.M.FEF25-75, A.M.FEV1, and A.M.PEF, (s/b = 0.46, 0.48, and 0.59). Carry-over between treatment periods was not significant. Crossover study sample size calculations using these ratios yielded samples of 23, 25, and 37 patients, respectively. Otherwise identical parallel studies would require sample sizes of 657, 1,438, and 2,261 patients. These results support the use of a crossover asthma stability model after a short course of oral prednisone as a clinical study model for comparing topical potency of inhaled corticosteroids.
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Affiliation(s)
- R C Ahrens
- Pediatric Allergy/Pulmonary, The University of Iowa, College of Medicine, Iowa City, Iowa 52242-1083, USA.
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