1
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Bobr A, Roberts T, Koepsell S, Williams SM, Schwartz J. Handling the different requirements for commercial and investigational MNC collections by apheresis. Cytotherapy 2024:S1465-3249(24)00599-1. [PMID: 38703156 DOI: 10.1016/j.jcyt.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND With the success of chimeric antigen receptor T-cell (CAR-T) and similar cellular-based therapies, the demand for collection of autologous mononuclear cells by apheresis (MNC(A)) from blood by apheresis has increased. From an apheresis technical standpoint, the collection of MNC(A) is relatively straightforward, especially when compared with collection of hematopoietic progenitor cells (HPC(A)). Most of the collection for MNC(A) are performed for the commercial entities, who use the product for manufacturing cellular therapeutics. We have noticed discrepancies in the handling and apheresis processes required by different companies in obtaining essentially the same product (all companies in the study manufacture CAR-T-based products). We have analyzed the MNC collection requirements from all FDA-approved CAR-T cellular products and some investigational products collected at University of Nebraska Medical Center. We identified discrepancies in the process and suggested mitigation strategies. METHODS Step-by-step analysis of the collection requirements. Review of the current guidelines and recommendations on this issue. RESULTS Multiple discrepancies in the collection process have been identified, even in the products collected for the same company. Practical approach of satisfying all the requirements based on University of Nebraska Medical Center experience has been suggested. CONCLUSION The current recommendations from multiple sources were reviewed in discussion.
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Affiliation(s)
- Aleh Bobr
- Department of Pathology, Microbiology and Immunology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, Nebraska, USA.
| | - Timothy Roberts
- Department of Pathology, Microbiology and Immunology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, Nebraska, USA
| | - Scott Koepsell
- Department of Pathology, Microbiology and Immunology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, Nebraska, USA
| | - Shelly M Williams
- Department of Pathology, Microbiology and Immunology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, Nebraska, USA
| | - Joseph Schwartz
- Department of Pathology/Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, Florida, USA
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2
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Arts JHE, Faulhammer F, Schneider S, Salverda JGW. Investigations on learning and memory function in extended one-generation reproductive toxicity studies - when considered needed and based on what? Crit Rev Toxicol 2023; 53:372-384. [PMID: 37540214 DOI: 10.1080/10408444.2023.2236134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023]
Abstract
To justify investigations on learning and memory (L&M) function in extended one-generation reproductive toxicity studies (EOGRTS; Organization for Economic Co-operation and Development (OECD) test guideline (TG) 443) for registration under Registration, Evaluation, Authorization, and Restriction of Chemical (REACH), the European Chemicals Agency has referred to three publications based on which the Agency concluded that "perturbation of thyroid hormone signaling in offspring affects spatial cognitive abilities (learning and memory)" and "Therefore, it is necessary to conduct spatial learning and memory tests for F1 animals". In this paper, the inclusion of the requested L&M tests in an EOGRTS is challenged. In addition, next to the question on the validity of rodent models in general for testing thyroid hormone-dependent perturbations in brain development, the reliability of the publications specifically relied upon by the agency is questioned as these contain numerous fundamental errors in study methodology, design, and data reporting, provide contradicting results, lack crucial information to validate the results and exclude confounding factors, and finally show no causal relationship. Therefore, in our opinion, these publications cannot be used to substantiate, support, or conclude that decreases in blood thyroid (T4) hormone level on their own would result in impaired L&M in rats and are thus not adequate to use as fundament to ask for L&M testing as part of an EOGRTS.
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Affiliation(s)
- Josje H E Arts
- Nouryon Functional Chemicals B.V., Deventer, The Netherlands
| | - Frank Faulhammer
- GB Product Stewardship - Regulations, Toxicology and Ecology, BASF SE, Ludwigshafen, Germany
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3
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Alvarez AL, Maisonet IO, Ruiz O, Lumsden RS, Ferreira APE, Avila Flores EM. Establishing a core dossier for multiple regulatory submissions: a case study in the Latin America region. Front Med (Lausanne) 2023; 10:1102452. [PMID: 37261120 PMCID: PMC10229127 DOI: 10.3389/fmed.2023.1102452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
The Latin America region comprises several countries that do not follow harmonized regulatory requirements for drug product (DP) marketing authorization applications (MAA), resulting in customized registration dossiers for each country. Here, we established a core dossier for multiple MAA in the Latin America region by examining the similarities between regulatory requirements and reconciling their potential discrepancies through discussions among all national regulatory representatives. The core dossier was used in the submission of a new small molecule, NME1, to nine markets. Assessment of the process included the time to submission; the timing, number, and complexity of questions received; and timing of final national regulatory agencies (NRA) evaluation decisions. The core dossier resulted in an accelerated submission timeline for most markets and earlier receipt of NRA queries from some markets, compared with projections. One round of queries of a low or medium complexity was received from all agencies. The receipt of final NRA evaluation decisions was also accelerated in most markets, compared with the best-case approval timeframes. The core dossier approach was also evaluated against the standard submission of a similar small molecule, NME2. In contrast to the core dossier submission of NME1, a second round of questions, and high-complexity questions were received from two markets for NME2. In conclusion, a core dossier has the potential to simplify the regulatory process for both reviewers and applicants in regions that do not share harmonized regulatory requirements, with a consequential acceleration of DP approvals.
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Affiliation(s)
| | - Irma O. Maisonet
- Global Regulatory Affairs International, Pfizer Ltd, San Juan, PR, United States
| | - Omar Ruiz
- Global Regulatory Affairs International, Pfizer Ltd, New York, NY, United States
| | - Rebecca S. Lumsden
- Global Regulatory Policy and Intelligence, Global Regulatory Affairs, Pfizer Ltd, Tadworth, Surrey, United Kingdom
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4
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Pal R, Athamneh AI, Deshpande R, Ramirez JAR, Adu KT, Muthuirulan P, Pawar S, Biazzo M, Apidianakis Y, Sundekilde UK, de la Fuente-Nunez C, Martens MG, Tegos GP, Seleem MN. Probiotics: insights and new opportunities for Clostridioides difficile intervention. Crit Rev Microbiol 2023; 49:414-434. [PMID: 35574602 PMCID: PMC9743071 DOI: 10.1080/1040841x.2022.2072705] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/17/2022] [Accepted: 04/28/2022] [Indexed: 02/08/2023]
Abstract
Clostridioides difficile infection (CDI) is a life-threatening disease caused by the Gram-positive, opportunistic intestinal pathogen C. difficile. Despite the availability of antimicrobial drugs to treat CDI, such as vancomycin, metronidazole, and fidaxomicin, recurrence of infection remains a significant clinical challenge. The use of live commensal microorganisms, or probiotics, is one of the most investigated non-antibiotic therapeutic options to balance gastrointestinal (GI) microbiota and subsequently tackle dysbiosis. In this review, we will discuss major commensal probiotic strains that have the potential to prevent and/or treat CDI and its recurrence, reassess the efficacy of probiotics supplementation as a CDI intervention, delve into lessons learned from probiotic modulation of the immune system, explore avenues like genome-scale metabolic network reconstructions, genome sequencing, and multi-omics to identify novel strains and understand their functionality, and discuss the current regulatory framework, challenges, and future directions.
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Affiliation(s)
- Rusha Pal
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
| | - Ahmad I.M. Athamneh
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | | | - Jose A. R Ramirez
- ProbioWorld Consulting Group, James Cook University, 4811, Queensland, Australia
| | - Kayode T. Adu
- ProbioWorld Consulting Group, James Cook University, 4811, Queensland, Australia
- Cann Group, Walter and Eliza Hall Institute, La Trobe University, Victoria 3083, Australia
| | | | - Shrikant Pawar
- The Anlyan Center Yale Center for Genomic Analysis, Yale School of Medicine, New Haven CT USA
| | - Manuele Biazzo
- The Bioarte Ltd Laboratories at Life Science Park, San Gwann, Malta
| | | | | | - Cesar de la Fuente-Nunez
- Machine Biology Group, Departments of Psychiatry and Microbiology, Institute for Biomedical Informatics, Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Departments of Bioengineering and Chemical and Biomolecular Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Penn Institute for Computational Science, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Mark G. Martens
- Reading Hospital, Tower Health, West Reading, PA 19611, USA
- Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - George P. Tegos
- Drexel University College of Medicine, Philadelphia, PA, 19129, USA
| | - Mohamed N. Seleem
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA
- Center for Emerging, Zoonotic and Arthropod-borne Pathogens, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
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5
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Su G, Deng D. Regulatory requirements and optimization of multiple criteria decision analysis to quantify the benefit-risk assessment of medical devices. Expert Rev Med Devices 2023; 20:273-281. [PMID: 36896851 DOI: 10.1080/17434440.2023.2190021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Worldwide medical device regulatory authorities increasingly rely on the benefit-risk ratio for decision-making. However, current benefit-risk assessment (BRA) methods are mostly descriptive, not quantitative. AREAS COVERED We aimed to summarize the regulatory requirements of BRA, discuss the feasibility of adopting multiple criteria decision analysis (MCDA), and explore factors for optimizing the MCDA for quantitative BRA of devices. EXPERT OPINION Regulatory organizations emphasize BRA in their guidance, and some recommend user-friendly worksheets to conduct qualitative/descriptive BRA. The MCDA is considered one of the most useful and relevant quantitative BRA methods by pharmaceutical regulatory agencies and the industry; the International Society for Pharmacoeconomics and Outcomes Research summarized the principles and good practice guidance of MCDA. We recommend optimizing the MCDA by considering the following unique characteristics of the device BRA: using data from state of the art as a control and clinical data from post-market surveillance and literature; considering the device's diverse characteristics when selecting controls; assigning weight according to type, magnitude/severity, and duration of benefits and risks; and including physician and patient opinions in the MCDA. This article is the first to explore using MCDA for device BRA and might lead to a novel quantitative BRA method for devices.
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Affiliation(s)
- Gui Su
- Department of Clinical Research and Medical Science, Medtronic China, Beijing, China
| | - Dongyuan Deng
- Department of Clinical Research and Medical Science, Medtronic China, Beijing, China
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6
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Rose L, McCaney J, Dave G, Brownley KA, Sheridan D, Shah P, Zapotoczny G, Espinoza J. Software to manage regulatory workflows for medical device development at academic medical centers: A critical gap. J Clin Transl Sci 2023; 7:e45. [PMID: 36845297 DOI: 10.1017/cts.2023.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/03/2023] [Indexed: 02/17/2023] Open
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7
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Williams K. Guidelines in Practice: Patient Information Management. AORN J 2023; 117:52-60. [PMID: 36573752 DOI: 10.1002/aorn.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 12/28/2022]
Abstract
Patient information management can involve paper and electronic documentation. Because the patient's health care record (HCR) is a legal document, it must provide an accurate representation of care. The record contains protected health information and must be secure. In addition, the documentation must adhere to local, state, and federal regulations and facility policies; it also may incorporate recommendations from national professional guidelines. The AORN "Guideline for patient information management" was recently updated and provides evidence-based best practices for comprehensive perioperative documentation that aligns with the nursing workflow. This article includes an overview of patient information management and discusses recommendations for health information technology, the patient HCR, perioperative record design, documentation and nursing workflow, informed consent documentation, order documentation, modifying patient HCRs, education, policies and procedures, and quality. Perioperative nurses should review the guideline in its entirety and apply the recommendations for patient information management as applicable to their individual roles.
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8
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Han Z, Zhao Y, L Y, Dong J, Deng G. [Ideas and Briefing about Regulatory Requirements for Laboratory Developed Tests in the US]. Zhongguo Yi Liao Qi Xie Za Zhi 2022; 46:534-537. [PMID: 36254482 DOI: 10.3969/j.issn.1671-7104.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
As a special kind of in vitro diagnostic devices(IVDs), laboratory developed tests(LDTs) are of great significance to the development of clinical laboratories. This study aims to explore the regulatory requirements ideas of LDTs. By introducing the development of LDTs and the changing of regulatory requirements in the United States, combing the current regulatory framework and discussing relevant ideas in the regulatory requirements of LDTs.
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Affiliation(s)
- Zhaozhao Han
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
| | - Yang Zhao
- National Medical Products Administration, Beijing, 100037
| | - Yunfeng L
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
| | - Jinchun Dong
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
| | - Gang Deng
- Center for Medical Device Evaluation, NMPA, Beijing, 100081
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9
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Adriaansen J, Stanton J, Schaut W, Bowden R. Compliance and cost control for cryopreservation of cellular starting materials: An industry perspective. Cytotherapy 2022:S1465-3249(22)00051-2. [PMID: 35304076 DOI: 10.1016/j.jcyt.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/15/2022] [Accepted: 02/07/2022] [Indexed: 11/20/2022]
Abstract
Over the last decade, cancer immunotherapy has progressed from an academically interesting field to one of the most promising forms of new treatments in which not the cancer but the immune system is treated. In particular, genetic modification for purposeful redirection of autologous T cells is providing hope to many treatment-resistant patients. This personalized form of medicine is radically different from more traditional oncologic drugs. With these evolving medical advancements and more cellular therapies becoming available, some regulatory agencies have created new regulatory requirements to manage the production of these types of products. The regulations are specifically suited for the manufacture of gene and cell therapy products, as they use a risk-based approach towards product development and manufacturing, when there is limited characterization available. The correct interpretation of how and when requirements apply is crucial, since theoretical approaches to implementing GMP can easily lead to disproportionate and unwarranted restrictions that may not address the specific risks that regulators were intending to control. This is especially relevant for cell collection and biopreservation preceding the manufacturing process for products manufactured from autologous T cells. Both the fresh and cryopreserved apheresis materials can be filed as minimally manipulated starting materials to the authorities. The preservation of such cellular material can then routinely be managed using the available regulations for tissues and cells, allowing for a more fit-for-purpose approach to the control measures implemented.
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10
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Bassani GA, Vincoli V, Biagiotti M, Valsecchi E, Zucca MV, Clavelli C, Alessandrino A, Freddi G. A Route to Translate a Silk-Based Medical Device from Lab to Clinic: The Silk Biomaterials Srl Experience. Insects 2022; 13:insects13020212. [PMID: 35206785 PMCID: PMC8875467 DOI: 10.3390/insects13020212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 01/13/2023]
Abstract
The medical device is a nerve conduit entirely made of Bombyx mori silk fibroin. It is a tubular scaffold used for repairing peripheral nerve gaps, whose function is to protect the severed nerves and to favor their natural healing process. As any implantable medical device, the conduit must perform its function without causing adverse effects to the patient, meaning that it must be compliant with a range of regulations aimed at evaluating the risks related to the constituent materials and the manufacturing process, the toxicological impact of the processing aids, the biological safety, the functional performance, and the ability to sustain tissue regeneration processes. An exhaustive on-bench testing plan has been performed for the determination of the morphological, geometrical, physical, structural, and mechanical properties. For the toxicological analysis, the device was extracted with solvent and the number of leachable substances was determined by suitable chromatographic techniques. The biological safety was assessed by means of a set of tests, including cytotoxicity, delayed hypersensitivity, intracutaneous reactivity, pyrogen test, LAL (Limulus Amebocyte Lysate) test, acute systemic toxicity, and genotoxicity. Overall, the accumulated results demonstrated the suitability of the device for the intended use and supported the starting of a first-in-human clinical trial.
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11
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Patil PJ, Usman M, Zhang C, Mehmood A, Zhou M, Teng C, Li X. An updated review on food-derived bioactive peptides: Focus on the regulatory requirements, safety, and bioavailability. Compr Rev Food Sci Food Saf 2022; 21:1732-1776. [PMID: 35142435 DOI: 10.1111/1541-4337.12911] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023]
Abstract
Food-derived bioactive peptides (BAPs) are recently utilized as functional food raw materials owing to their potential health benefits. Although there is a huge amount of scientific research about BAPs' identification, purification, characterization, and physiological functions, and subsequently, many BAPs have been marketed, there is a paucity of review on the regulatory requirements, bioavailability, and safety of BAPs. Thus, this review focuses on the toxic peptides that could arise from their primary proteins throughout protein extraction, protein pretreatment, and BAPs' formulation. Also, the influences of BAPs' length and administration dosage on safety are summarized. Lastly, the challenges and possibilities in BAPs' bioavailability and regulatory requirements in different countries were also presented. Results revealed that the human studies of BAPs are essential for approvals as healthy food and to prevent the consumers from misinformation and false promises. The BAPs that escape the gastrointestinal tract epithelium and move to the stomach are considered good peptides and get circulated into the blood using different pathways. In addition, the hydrophobicity, net charge, molecular size, length, amino acids composition/sequences, and structural characteristics of BAPs are critical for bioavailability, and appropriate food-grade carriers can enhance it. The abovementioned features are also vital to optimize the solubility, water holding capacity, emulsifying ability, and foaming property of BAPs in food products. In the case of safety, the possible allergenic and toxic peptides often exhibit physiological functions and could be produced during the hydrolysis of food proteins. It was also noted that the production of iso-peptides bonds and undesirable Maillard reaction might occur during protein extraction, sample pretreatments, and peptide synthesis.
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Affiliation(s)
- Prasanna J Patil
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Muhammad Usman
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Chengnan Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Arshad Mehmood
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Mingchun Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Chao Teng
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China.,Beijing Engineering and Technology Research Center of Food Additives, School of Food and Chemical Technology, Beijing Technology and Business University, Beijing, China
| | - Xiuting Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China.,School of Food and Health, Beijing Technology and Business University, Beijing, China.,Beijing Engineering and Technology Research Center of Food Additives, School of Food and Chemical Technology, Beijing Technology and Business University, Beijing, China
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12
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Wagner R, Meißner J, Grabski E, Sun Y, Vieths S, Hildt E. Regulatory concepts to guide and promote the accelerated but safe clinical development and licensure of COVID-19 vaccines in Europe. Allergy 2022; 77:72-82. [PMID: 33887070 PMCID: PMC8251031 DOI: 10.1111/all.14868] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 01/17/2023]
Abstract
The ongoing COVID-19 pandemic caused by the SARS-CoV-2 coronavirus has affected the health of tens of millions of people worldwide. In particular, in elderly and frail individuals the infection can lead to severe disease and even fatal outcomes. Although the pandemic is primarily a human health crisis its consequences are much broader with a tremendous impact on global economics and social systems. Vaccines are considered the most powerful measure to fight the pandemic and protect people from COVID-19. Based on the concerted activities of scientists, manufacturers and regulators, the urgent need for effective countermeasures has provoked the development and licensure of novel COVID-19 vaccines in an unprecedentedly fast and flexible manner within <1 year. To ensure the safety and efficacy of these novel vaccines during the clinical development and the routine use in post-licensure vaccination campaigns existing regulatory requirements and procedures had to be wisely and carefully adapted to allow for an expedited evaluation without compromising the thoroughness of the regulatory and scientific assessment. In this review, we describe the regulatory procedures, concepts and requirements applied to guide and promote the highly accelerated development and licensure of safe and efficacious COVID-19 vaccines in Europe.
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Affiliation(s)
- Ralf Wagner
- Section for Viral Vaccines Department of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Juliane Meißner
- Section for Viral Vaccines Department of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Elena Grabski
- Section for Viral Vaccines Department of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Yuansheng Sun
- Section for Viral Vaccines Department of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Stefan Vieths
- Vice President Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
| | - Eberhard Hildt
- Department of Virology Paul‐Ehrlich‐InstitutFederal Institute for Vaccines and Biomedicines Langen Germany
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13
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Iansante V, Brooks A, Coney L. Considerations in the Design of Non-Clinical Development Programmes to Support Non-Viral Genetically Modified Mesenchymal Stromal Cell Therapies. Pharmaceutics 2021; 13:pharmaceutics13060823. [PMID: 34199356 PMCID: PMC8228211 DOI: 10.3390/pharmaceutics13060823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
Due to their immune suppressive pharmacology, regenerative capacity, and immune privileged status, mesenchymal stromal cells (MSCs) are an attractive cell type to treat a variety of diseases. Genetically engineered MSCs are currently in non-clinical and clinical development for a wide range of applications including the delivery of pro-drugs and therapeutic proteins or modified to enhance their regenerative potential. Unmodified MSCs have been shown to have good safety profiles in clinical development. The introduction of exogenous transgenes introduces possible additional risks that need to be assessed in non-clinical studies prior to initiating clinical studies. The use of ex vivo non-viral genetic modification approaches potentially reduces the risks associated with viral vector transfection approaches, including the potential for cell transformation. This review provides an overview of the regulatory-compliant non-clinical proof-of-concept and safety studies required to take MSC-based gene therapy products from the bench to the clinic.
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Affiliation(s)
| | | | - Lee Coney
- Correspondence: ; Tel.: +44-(0)-203-728-9500
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14
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Shah S, Singh A. Drug labeling: The study of compliance of regulatory requirements for prescription drugs in India. Perspect Clin Res 2021; 11:164-167. [PMID: 33489834 PMCID: PMC7819375 DOI: 10.4103/picr.picr_195_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/23/2019] [Accepted: 04/03/2019] [Indexed: 11/08/2022] Open
Abstract
Objectives: The objective was to check the compliance of regulatory requirements of drug labeling in India according to guidelines given under the Drug and Cosmetic Rules (D & CRs) 1945, Section 96, 97; drug samples were collected from government drug supply and private practitioners (PPs). Materials and Methods: A total of 100 drugs were selected randomly from schedule H. They were divided into two groups, each containing 50 drugs: (1) drug samples from drug store of a government hospital, manufactured for Gujarat government and (2) drug samples from PPs which are given to them by pharmaceutical companies. Each drug label was checked according to the criteria given under the D & CRs 1945, Section 96, 97. Data entry was done in Microsoft Excel 2013 and analysis was done. Results: Major deficiencies were seen in criteria of pharmacopeia (absent in 8% samples from government supply [GS] and 64% in samples from PPs), schedule (absent in 18% GS samples and 32% in PP samples), warning of schedule (absent in 6% GS samples and 4% in PP samples), Rx (absent in 22% GS samples and 28% in PP samples), red line (absent in 14% GS samples), and drug warning (absent in 84% GS samples and 72% in PP samples). Conclusion: As the study results show lacunae in the contents of the labeling of prescribed drugs in samples from both the groups, there should be strict enforcement of D & CR 1945 and monitoring of drug labels for better and safer use of medicines.
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Affiliation(s)
- Suchi Shah
- Department of Pharmacology, B.J. Medical College, Ahmedabad, Gujarat, India
| | - Anil Singh
- Department of Pharmacology, PDU Government Medical College, Rajkot, Gujarat, India
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Simões A, Miranda M, Cardoso C, Veiga F, Vitorino C. Rheology by Design: A Regulatory Tutorial for Analytical Method Validation. Pharmaceutics 2020; 12:pharmaceutics12090820. [PMID: 32872221 PMCID: PMC7558587 DOI: 10.3390/pharmaceutics12090820] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023] Open
Abstract
The increasing demand for product and process understanding as an active pursuit in the quality guideline Q8 and, more recently, on the draft guideline on quality and equivalence of topical products, has unveiled the tremendous potential of rheology methods as a tool for microstructure characterization of topical semisolid dosage forms. Accordingly, procedure standardization is a dire need. This work aimed at developing and validating a methodology tutorial for rheology analysis. A 1% hydrocortisone cream was used as model cream formulation. Through a risk assessment analysis, the impact of selected critical method variables (geometry, temperature and application mode) was estimated in a broad range of rheological critical analytical attributes-zero-shear viscosity, upper-shear thinning viscosity, lower-shear thinning viscosity, infinite-shear viscosity, rotational yield point, thixotropic relative area, linear viscoelastic region, oscillatory yield point, storage modulus, loss modulus, and loss tangent. The proposed validation of the approach included the rheometer qualification, followed by the validation of numerous operational critical parameters regarding a rheology profile acquisition. The thixotropic relative area, oscillatory yield point, flow point and viscosity related endpoints proved to be highly sensitive and discriminatory parameters. This rationale provided a standard framework for the development of a reliable and robust rheology profile acquisition.
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Affiliation(s)
- Ana Simões
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; (A.S.); (M.M.); (F.V.)
- Associated Laboratory for Green Chemistry of the Network of Chemistry and Technology (LAQV. REQUIMTE) Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Margarida Miranda
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; (A.S.); (M.M.); (F.V.)
- Coimbra Chemistry Center, Department of Chemistry, University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal
| | - Catarina Cardoso
- Laboratórios Basi, Mortágua, Parque Industrial Manuel Lourenço Ferreira, lote 15, 3450-232 Mortágua, Portugal;
| | - Francisco Veiga
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; (A.S.); (M.M.); (F.V.)
- Associated Laboratory for Green Chemistry of the Network of Chemistry and Technology (LAQV. REQUIMTE) Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Carla Vitorino
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; (A.S.); (M.M.); (F.V.)
- Coimbra Chemistry Center, Department of Chemistry, University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal
- Centre for Neurosciences and Cell Biology (CNC), University of Coimbra, Rua Larga, Faculty of Medicine, Pólo I, 1st floor, 3004-504 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-488-400
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Campbell EH, Elston DM, Straughan CL, Antonovich DD. Regulations, liability, safety, and economics related to compounding. J Am Acad Dermatol 2019; 83:184-188. [PMID: 31821858 DOI: 10.1016/j.jaad.2019.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
Extemporaneous compounding is a means to tailor a medication to an individual patient's needs and may be required when no commercial product exists to meet that need. Compounded products range from buffered lidocaine to topical creams and ointments. Recent heightened regulations have made compounding more challenging for dermatologists and prompted this review of regulations, liability, and safety related to compounding. With this information, providers may minimize liability and maximize safety while caring for their patients.
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Affiliation(s)
| | - Dirk M Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Diana D Antonovich
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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Abstract
Until January 2019, Medicare beneficiaries requiring maintenance dialysis therapy were eligible for telehealth services only if the originating site was located in a rural area and the patient was situated in an authorized facility. Free-standing dialysis facilities and the patient's home were clearly restricted sites. Beginning in 2019, new opportunities are available for home dialysis patients in the United States to engage in telehealth; these include existing waivers within End-Stage Renal Disease (ESRD) Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care demonstration project and, more broadly, for most prevalent home dialysis patients based on legislation within the 2018 Bipartisan Budget Act. Under this act, Medicare will pay for a monthly comprehensive telehealth encounter with the patient that originates from his or her home or a dialysis unit without geographic restrictions. The home dialysis patient has the sole power to choose the telehealth option, which may occur twice over a 3-month cycle and cannot occur during the first 3 months of home dialysis therapy. With studies suggesting that effective use of remote monitoring and telehealth encounters may improve patient satisfaction and outcomes while reducing the cost of care, increased use of telehealth has the potential to improve patient-centered care for home dialysis patients. In this perspective, we review the legislative changes, regulatory requirements, and technical and operational challenges for conducting telehealth encounters for home dialysis patients.
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Affiliation(s)
- Susie Q Lew
- Department of Medicine, George Washington University, Washington, DC.
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC
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18
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Choksi NY, Truax J, Layton A, Matheson J, Mattie D, Varney T, Tao J, Yozzo K, McDougal AJ, Merrill J, Lowther D, Barroso J, Linke B, Casey W, Allen D. United States regulatory requirements for skin and eye irritation testing. Cutan Ocul Toxicol 2018; 38:141-155. [PMID: 30418044 DOI: 10.1080/15569527.2018.1540494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Eye and skin irritation test data are required or considered by chemical regulation authorities in the United States to develop product hazard labelling and/or to assess risks for exposure to skin- and eye-irritating chemicals. The combination of animal welfare concerns and interest in implementing methods with greater human relevance has led to the development of non-animal skin- and eye-irritation test methods. To identify opportunities for regulatory uses of non-animal replacements for skin and eye irritation tests, the needs and uses for these types of test data at U.S. regulatory and research agencies must first be clarified. METHODS We surveyed regulatory and non-regulatory testing needs of U.S. Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) agencies for skin and eye irritation testing data. Information reviewed includes the type of skin and eye irritation data required by each agency and the associated decision context: hazard classification, potency classification, or risk assessment; the preferred tests; and whether alternative or non-animal tests are acceptable. Information on the specific information needed from non-animal test methods also was collected. RESULTS A common theme across U.S. agencies is the willingness to consider non-animal or alternative test methods. Sponsors are encouraged to consult with the relevant agency in designing their testing program to discuss the use and acceptance of alternative methods for local skin and eye irritation testing. CONCLUSIONS To advance the implementation of alternative testing methods, a dialog on the confidence of these methods to protect public health and the environment must be undertaken at all levels.
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Affiliation(s)
- Neepa Y Choksi
- a Integrated Laboratory Systems, Inc , Morrisville , NC , USA
| | - James Truax
- a Integrated Laboratory Systems, Inc , Morrisville , NC , USA
| | - Adrienne Layton
- b Division of Pharmacology and Physiology Assessment , U.S. Consumer Product Safety Commission , Rockville , MD , USA
| | - Joanna Matheson
- c U.S. Consumer Product Safety Commission , Rockville , MD , USA
| | - David Mattie
- d Bioeffects Division, Human Effectiveness Directorate, Air Force Research Laboratory , Wright-Patterson AFB, OH , USA
| | - Timothy Varney
- e Research Institute of Chemical Defense , U.S. Army, Aberdeen Proving Ground, MD , USA
| | - Jenny Tao
- f Office of Pesticide Programs , U.S. Environmental Protection Agency , Washington , DC , USA
| | - Krystle Yozzo
- f Office of Pesticide Programs , U.S. Environmental Protection Agency , Washington , DC , USA
| | - Andrew J McDougal
- g Center for Drug Evaluation and Research , U.S. Food and Drug Administration , Silver Spring , MD , USA
| | - Jill Merrill
- h Dermatologic and Dental Drug Products , U.S. Food and Drug Administration , Silver Spring , MD , USA
| | - Donnie Lowther
- i Office of Cosmetics and Colors , U.S. Food and Drug Administration, University Station , MD , USA
| | - Joao Barroso
- j EU Reference Laboratory for Alternatives to Animal Testing , Institute for Health and Consumer Protection , Ispra , Italy
| | - Brenda Linke
- k Health Effects Division 1, Health Evaluation Directorate , Health Canada's Pest Management Regulatory Agency , Ottawa , Canada
| | - Warren Casey
- l National Toxicology Program , National Institutes of Environmental Health Sciences , Morrisville , NC , USA
| | - David Allen
- a Integrated Laboratory Systems, Inc , Morrisville , NC , USA
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Calvo B, Martinez-Gorostiaga J, Echevarria E. The surge in biosimilars: considerations for effective pharmacovigilance and EU regulation. Ther Adv Drug Saf 2018; 9:601-608. [PMID: 30283628 DOI: 10.1177/2042098618790442] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/03/2018] [Indexed: 01/03/2023] Open
Abstract
The development of biosimilars is growing rapidly, especially in Europe. They are a cost-effective alternative to original biological medicines and can help improve patient access to these therapies. The European Medicines Agency (EMA) has been the first to issue scientific guidelines related to regulatory requirements for the approval of biosimilars. These guidelines have been being updated in line with advances in analytical techniques and growing experience in the clinical use of these drugs. Given the complex nature of biological medicines, they pose a greater potential risk of immunogenicity than nonbiological medicines, and hence warrant special consideration. The risk management plan for biopharmaceuticals (innovator and biosimilar drugs) should be based on strengthening ongoing pharmacovigilance activities, especially in the post-approval period. This paper addresses regulatory issues related to the approval of biosimilars in Europe associated with safety considerations linked to the development and use of these medicines. We also discuss the issues of immunogenicity, interchangeability and traceability of biological medicines.
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Affiliation(s)
- Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz 01008, Spain
| | - Javier Martinez-Gorostiaga
- Integrated Healthcare Organisation (OSI Araba), Basque Health Service (Osakidetza), Vitoria-Gasteiz, Spain
| | - Enrique Echevarria
- Physiology Department. University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
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21
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Kirchhoff CF, Wang XM, Conlon HD, Anderson S, Ryan AM, Bose A. Biosimilars: Key regulatory considerations and similarity assessment tools. Biotechnol Bioeng 2017; 114:2696-2705. [PMID: 28842986 PMCID: PMC5698755 DOI: 10.1002/bit.26438] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022]
Abstract
A biosimilar drug is defined in the US Food and Drug Administration (FDA) guidance document as a biopharmaceutical that is highly similar to an already licensed biologic product (referred to as the reference product) notwithstanding minor differences in clinically inactive components and for which there are no clinically meaningful differences in purity, potency, and safety between the two products. The development of biosimilars is a challenging, multistep process. Typically, the assessment of similarity involves comprehensive structural and functional characterization throughout the development of the biosimilar in an iterative manner and, if required by the local regulatory authority, an in vivo nonclinical evaluation, all conducted with direct comparison to the reference product. In addition, comparative clinical pharmacology studies are conducted with the reference product. The approval of biosimilars is highly regulated although varied across the globe in terms of nomenclature and the precise criteria for demonstrating similarity. Despite varied regulatory requirements, differences between the proposed biosimilar and the reference product must be supported by strong scientific evidence that these differences are not clinically meaningful. This review discusses the challenges faced by pharmaceutical companies in the development of biosimilars.
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Affiliation(s)
- Carol F. Kirchhoff
- Pfizer IncGlobal Technology ServicesBiotechnology and Aseptic Sciences GroupChesterfieldMissouri
| | | | - Hugh D. Conlon
- Pfizer IncAnalytical Research and DevelopmentAndoverMassachusetts
| | | | - Anne M. Ryan
- Pfizer IncDrug Safety Research and DevelopmentGrotonConnecticut
| | - Arindam Bose
- Pfizer IncBioTherapeutics Pharmaceutical SciencesGrotonConnecticut
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22
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Ji Z, Ball NS, LeBaron MJ. Global regulatory requirements for mutagenicity assessment in the registration of industrial chemicals. Environ Mol Mutagen 2017; 58:345-353. [PMID: 28543740 DOI: 10.1002/em.22096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/23/2017] [Indexed: 06/07/2023]
Abstract
Mutagenicity is an important toxicological endpoint that requires thorough evaluation during the industrial chemical registration process. Regulatory requirements for mutagenicity assessment in registration of industrial chemicals vary in geographic regions (and in some cases by intended application). Here we compile the mutagenicity testing requirements for registration of industrial chemicals from representative geographic regions (in alphabetical order), that is Australia, Brazil, Canada, China, European Union (EU), India, Japan, South Korea, Taiwan, and United States (US). We further discuss the challenges that industry is facing to meet global regulations, for example, different testing requirements among geographic regions, different strategies in follow-up tests to in vitro positive findings, no-observed-adverse-effect-levels in genetic toxicity testing, and human relevance of mutagenicity. Environ. Mol. Mutagen. 58:345-353, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Zhiying Ji
- Toxicology & Environmental Research & Consulting, The Dow Chemical Company, Midland, Michigan
| | - Nicholas S Ball
- Toxicology & Environmental Research & Consulting, The Dow Chemical Company, Midland, Michigan
| | - Matthew J LeBaron
- Toxicology & Environmental Research & Consulting, The Dow Chemical Company, Midland, Michigan
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23
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Mbanya JC, Sandow J, Landgraf W, Owens DR. Recombinant Human Insulin in Global Diabetes Management - Focus on Clinical Efficacy. Eur Endocrinol 2017; 13:21-25. [PMID: 29632602 PMCID: PMC5813441 DOI: 10.17925/ee.2017.13.01.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/13/2017] [Indexed: 11/25/2022]
Abstract
Biosynthetic human insulin and insulin analogues are the mainstay of insulin therapy for both type 1 and type 2 diabetes although access to human insulin at affordable prices remains a global issue. The world is experiencing an exponential rise in the prevalence of diabetes presenting an urgent need to establish effective diabetes therapy in countries burdened by inadequate health care budgets, malnutrition and infectious diseases. Recombinant human insulin has replaced animal insulins and animal-based semisynthetic human insulin thereby available in sufficient quantities and at affordable prices able to provide global access to insulin therapy. In many patients, analog insulins can offer additional clinical benefit, although at a considerably higher price thus severely restricting availability in low income countries. The approval process for recombinant human insulins (i.e. biosimilars) and analogue insulins is highly variable in the developing countries in contrast to Europe and in North America, where it is well established within a strict regulatory framework. This review aims to discuss the future access to human insulin therapy in a global context with an ever increasing burden of diabetes and significant economic implications.
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Affiliation(s)
- Jean Claude Mbanya
- University of Yaoundé I, Cameroon and Endocrinology and Metabolic Diseases Unit at the Hospital Central in Yaoundé, Cameroon
| | - Juergen Sandow
- Centre of Pharmacology, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany
| | - Wolfgang Landgraf
- Medical Affairs Diabetes Division, Sanofi-Aventis Frankfurt, Germany
| | - David R Owens
- Diabetes Research Group, College of Medicine, University of Swansea, Wales, UK
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24
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Giannakou C, Park MV, de Jong WH, van Loveren H, Vandebriel RJ, Geertsma RE. A comparison of immunotoxic effects of nanomedicinal products with regulatory immunotoxicity testing requirements. Int J Nanomedicine 2016; 11:2935-52. [PMID: 27382281 PMCID: PMC4922791 DOI: 10.2147/ijn.s102385] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nanomaterials (NMs) are attractive for biomedical and pharmaceutical applications because of their unique physicochemical and biological properties. A major application area of NMs is drug delivery. Many nanomedicinal products (NMPs) currently on the market or in clinical trials are most often based on liposomal products or polymer conjugates. NMPs can be designed to target specific tissues, eg, tumors. In virtually all cases, NMPs will eventually reach the immune system. It has been shown that most NMs end up in organs of the mononuclear phagocytic system, notably liver and spleen. Adverse immune effects, including allergy, hypersensitivity, and immunosuppression, have been reported after NMP administration. Interactions of NMPs with the immune system may therefore constitute important side effects. Currently, no regulatory documents are specifically dedicated to evaluate the immunotoxicity of NMs or NMPs. Their immunotoxicity assessment is performed based on existing guidelines for conventional substances or medicinal products. Due to the unique properties of NMPs when compared with conventional medicinal products, it is uncertain whether the currently prescribed set of tests provides sufficient information for an adequate evaluation of potential immunotoxicity of NMPs. The aim of this study was therefore, to compare the current regulatory immunotoxicity testing requirements with the accumulating knowledge on immunotoxic effects of NMPs in order to identify potential gaps in the safety assessment. This comparison showed that immunotoxic effects, such as complement activation-related pseudoallergy, myelosuppression, inflammasome activation, and hypersensitivity, are not readily detected by using current testing guidelines. Immunotoxicity of NMPs would be more accurately evaluated by an expanded testing strategy that is equipped to stratify applicable testing for the various types of NMPs.
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Affiliation(s)
- Christina Giannakou
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven; Department of Toxicogenomics, Maastricht University, Maastricht, the Netherlands
| | - Margriet Vdz Park
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven
| | - Wim H de Jong
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven
| | - Henk van Loveren
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven; Department of Toxicogenomics, Maastricht University, Maastricht, the Netherlands
| | - Rob J Vandebriel
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven
| | - Robert E Geertsma
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven
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25
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García-Arieta A, Ferrero-Cafiero JM, Puntes M, Gich I, Morales-Alcelay S, Tarré M, Font X, Antonijoan RM. Impact of Chiral Bioanalytical Methods on the Bioequivalence of Ibuprofen Products Containing Ibuprofen Lysinate and Ibuprofen Base. Chirality 2016; 28:429-33. [PMID: 27094918 DOI: 10.1002/chir.22598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 11/11/2022]
Abstract
The purpose was to assess the impact of the use of a chiral bioanalytical method on the conclusions of a bioequivalence study that compared two ibuprofen suspensions with different rates of absorption. A comparison of the conclusion of bioequivalence between a chiral method and an achiral approach was made. Plasma concentrations of R-ibuprofen and S-ibuprofen were determined using a chiral bioanalytical method; bioequivalence was tested for R-ibuprofen and for S-ibuprofen separately and for the sum of both enantiomers as an approach for an achiral bioanalytical method. The 90% confidence interval (90% CI) that would have been obtained with an achiral bioanalytical method (90% CI: Cmax: 117.69-134.46; AUC0 (t) : 104.75-114.45) would have precluded the conclusion of bioequivalence. This conclusion cannot be generalized to the active enantiomer (90% CI: Cmax : 103.36-118.38; AUC0 (t) : 96.52-103.12), for which bioequivalence can be concluded, and/or the distomer (90% CI: Cmax : 132.97-151.33; AUC0 (t) : 115.91-135.77) for which a larger difference was observed. Chiral bioanalytical methods should be required when 1) the enantiomers exhibit different pharmacodynamics and 2) the exposure (AUC or Cmax ) ratio of enantiomers is modified by a difference in the rate of absorption. Furthermore, the bioequivalence conclusion should be based on all enantiomers, since the distomer(s) might not be completely inert, in contrast to what is required in the current regulatory guidelines. In those cases where it is unknown if the ratio between enantiomers is modified by changing the rate of absorption, chiral bioanalytical methods should be employed unless enantiomers exhibit the same pharmacodynamics. Chirality 28:429-433, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alfredo García-Arieta
- Division of Pharmacology and Clinical Evaluation, Department of Human Use Medicines, Spanish Agency for Medicines and Health Care Products, Madrid, Spain
| | - Juan Manuel Ferrero-Cafiero
- Centre d'Investigació de Medicaments, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau. (CIM-Sant Pau), Barcelona, Spain.,Farmacologia Clínica, Hospital de la Santa Creu i Sant Pau, Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montse Puntes
- Centre d'Investigació de Medicaments, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau. (CIM-Sant Pau), Barcelona, Spain.,Farmacologia Clínica, Hospital de la Santa Creu i Sant Pau, Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ignasi Gich
- Centre d'Investigació de Medicaments, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau. (CIM-Sant Pau), Barcelona, Spain.,Farmacologia Clínica, Hospital de la Santa Creu i Sant Pau, Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Morales-Alcelay
- Division of Pharmacology and Clinical Evaluation, Department of Human Use Medicines, Spanish Agency for Medicines and Health Care Products, Madrid, Spain
| | - Maite Tarré
- Laboratorio de Aplicaciones Farmacodinámicas, S.A. (FARDI), Barcelona, Spain
| | - Xavier Font
- Laboratorio de Aplicaciones Farmacodinámicas, S.A. (FARDI), Barcelona, Spain
| | - Rosa Maria Antonijoan
- Centre d'Investigació de Medicaments, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau. (CIM-Sant Pau), Barcelona, Spain.,Farmacologia Clínica, Hospital de la Santa Creu i Sant Pau, Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Barcelona, Spain
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26
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Abstract
This article describes the European Union stepwise approach used for the development and assessment of second-entry orally inhaled products. This approach is similar to the approach used for systemically acting products. In some cases, in vitro data can be used to show equivalence without performing in vivo studies (e.g., solutions for nebulization in the case of inhalation products, and oral solutions or Biopharmaceutics Classification System-based biowaivers in the case of systemically acting drugs). If equivalence cannot be shown in the first step, the Applicant can show equivalence in a second step by means of conventional pharmacokinetic bioequivalence studies to assess directly systemic exposure and lung deposition indirectly. The dose absorbed from the lungs should be distinguished from the dose absorbed from the gastrointestinal tract. Then the fraction of dose absorbed (area under the curve) represents the dose that reached the site of action, and the peak exposure gives information on the pattern of deposition within the lungs. This information is more discriminative than any pharmacodynamic or clinical endpoint, because these have flat dose-response curves. If equivalence is not shown with pharmacokinetic data, the Applicant can decide to show equivalence by means of pharmacodynamic or clinical trials, but assay sensitivity must be demonstrated within the study and relative potency should be estimated. This article focuses on the in vitro requirements applicable in the European Union for a waiver of in vivo studies and for waiving studies with all drug product strengths or pharmacokinetic studies in patients. The reasons why in the European Union in vitro data alone can be used to show equivalence are discussed, and some examples are given.
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Affiliation(s)
- Alfredo García-Arieta
- Head of Service on Pharmacokinetics and Generics, Division of Pharmacology and Clinical Evaluation , Department of Human Use Medicines, Spanish Agency for Medicines and Health Care Products, Madrid, Spain
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27
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Abstract
Biosimilar insulins are likely to enter clinical practice in Europe in the near future. It is important that clinicians are familiar with and understand the concept of biosimilarity and how a biosimilar drug may differ from its reference product. The present article provides an overview of biosimilars, the European regulatory requirements for biosimilars and safety issues. It also summarizes the current biosimilars approved in Europe and the key clinical issues associated with the use of biosimilar insulins.
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Affiliation(s)
- J H DeVries
- Endocrinology, Academic Medical CentreAmsterdam, The Netherlands
- Correspondence to: J. Hans DeVries, Endocrinology, Academic Medical Center, Meibergdreef 9,
1105 AZ Amsterdam, The Netherlands. E-mail:
| | - S C L Gough
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research CentreOxford, UK
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28
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Abstract
Clinical trials in the development of new medical device products are in many ways analogous to clinical trials in the development of new drug or biologic products. However, the differences are important and not always intuitive to a statistician with only experience supporting development of drug and biologic products. In this paper we discuss some of the interesting differences with focus on the statistical innovation that is coming out of the medical device area. We discuss examples of the differences in clinical trial design and effects of these differences on clinical development programs.
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Peyvandi F, Farrugia A, Iorio A, Key NS, Srivastava A. Joint WFH-ISTH session: issues in clinical trial design. Haemophilia 2014; 20 Suppl 4:137-44. [PMID: 24762289 DOI: 10.1111/hae.12415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Abstract
Haemophilia therapy is experiencing an unprecedented expansion in the number and novelty of clotting factor concentrates. Every product must be licensed by regulatory authorities, primarily on the basis of its safety and efficacy profiles. The low prevalence of haemophilia, and other inherited bleeding disorders, presents a significant challenge to patient recruitment for preauthorization clinical trials, especially given the low frequency of inhibitory antibodies, the major adverse event related to clotting factor exposure. Other challenges include a lack of harmonization between the major regulatory authorities in certain key areas, the selection of laboratory monitoring methodologies and the difficulty in obtaining high-quality phase IV safety data following authorization. These aspects will be reviewed in this session, which will also highlight the roles played by the World Federation of Hemophilia and International Society on Thrombosis and Haemostasis in the promotion of these discussions.
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Affiliation(s)
- F Peyvandi
- Department of Pathophysiology and Transplantation, Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Luigi Villa Foundation, Milan, Italy
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Abstract
The preparation and release of the International Conference on Harmonisation guideline on safety evaluation of human metabolites and the technical progresses in bioanalysis have triggered an intense debate on the value of absorption, distribution, metabolism and excretion radiolabelled studies in animals. Some authors have radically challenged the traditional approach whereas others, while accepting the need of significant changes, argue that these studies remain an irreplaceable component of the preclinical registration dossier. This paper reviews some of the representative positions and describes the potential evolution.
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Janero DR. Medications development for substance-use disorders: contextual influences (dis)incentivizing pharmaceutical-industry positioning. Expert Opin Drug Discov 2014; 9:1265-79. [PMID: 25162124 DOI: 10.1517/17460441.2014.951631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The significant contribution of substance-use disorders (SUDs) to the global-disease burden and associated unmet medical needs has not engendered a commensurate level of pharma-industry research and development (R&D) for novel SUD therapeutics invention. Analysis of contextual factors shaping this position suggests potential routes toward incentivizing R&D commitment for that purpose. AREAS COVERED This article considers multiple primary factors that have consorted to disincentivize pharma industry's operating in the SUD space: ill-understood pathology; variegated treatments and patient profiles; involved clinical trials; and - with particular reference to SUDs-negative cultural/business stigmas and shallow commercial precedent. Industry incentivization for SUD drug innovation requires progress on several fronts, including: translational experimental data and systems; personalized, holistic SUD treatment approaches; interactions among pharma, nonindustry constituencies, and the medical profession with vested interests in countering negative stereotypes and expanding SUD treatment options; and public-private alliances focused on improving SUD pharmacotherapy. EXPERT OPINION Given the well-entrenched business stance whereby the prospect of future profits in major markets largely determines drug-company R&D investment trajectory, strategic initiatives offering substantial reductions in the risks and opportunity (i.e., time and money) costs associated with SUD drug discovery are likely to be the most potent drivers for encouraging mainstream industry positioning in this therapeutic area. Such initiatives could originate from front-loaded R&D operational and back-loaded patent, regulatory, marketing and health-care policy reforms. These may be too involved and protracted for the turbulent pharmaceutical industry to entertain amid its recent retrenchment from psychiatric/CNS diseases and intense pressures to increase productivity and shareholder value.
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Affiliation(s)
- David R Janero
- Northeastern University, Bouvé College of Health Sciences, Center for Drug Discovery, Department of Pharmaceutical Sciences, Health Sciences Entrepreneurs , 360 Huntington Avenue, 116 Mugar Life Sciences Hall, Boston, MA 02115-5000 , USA +1 617 373 2208 ; +1 617 373 7493 ;
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Abstract
Companion diagnostics (CDx) holds the promise of improving the predictability of the oncology drug development process and become an important tool for the oncologist in relation to the choice of treatment for the individual patient. A number of drug-diagnostic co-development programs have already been completed successfully, and in the clinic, the use of several targeted cancer drugs is now guided by a CDx. This central role of the CDx assays has attracted the attention of the regulators, and especially the US Food and Drug Administration has been at the forefront in relation to developing regulatory strategies for CDx and the drug-diagnostic co-development project. For an increasing number of cancer patients the treatment selection will depend on the result generated by a CDx assay, and consequently this type of assay has become critical for the care and safety of the patients. In order to secure that the CDx assays have a high degree of analytical and clinical validity, they must undergo an extensive non-clinical and clinical testing before release for routine patient management. This review will give a brief introduction to some of the scientific and medical challenges related to the CDx development with specific emphasis on the regulatory requirements in different regions of the world.
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Affiliation(s)
- Dana Olsen
- Regulatory Affairs, Dako Denmark A/S, an Agilent Technologies Company , Glostrup , Denmark
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Martinez MN, McGilveray I. AAPS/RAPS/CAPRA collaborative program: exploring the challenges of drug regulation in a global environment: clinical concerns. AAPS PharmSci 2003; 5:E27. [PMID: 15198515 PMCID: PMC2750989 DOI: 10.1208/ps050427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2003] [Accepted: 07/21/2003] [Indexed: 02/02/2023]
Abstract
Globalization of the pharmaceutical industry has led to a need to harmonize the regulatory requirements governing the marketing of medicinal products. To minimize the barriers impeding global drug product registration, the International Conference on the Harmonization of Technical Requirements of Pharmaceuticals for Human Use (ICH) was established in 1990. The ICH has developed a series of guidelines that reflect agreements reached by participating nations on aspects of the chemistry and clinical technical sections that will fulfill the regulatory requirements of these various jurisdications. Nevertheless, there continue to be points of divergent perspectives and barriers that can impede the use of foreign clinical data. Given the importance of these issues, the Regulatory Science (RS) section of the American Association of Pharmaceutical Scientists (AAPS), in conjunction with the Regulatory Affairs Professional Society (RAPS) and the Canadian Association of Professional Regulatory Affairs (CAPRA) cosponsored a public forum on this topic. This manuscript provides a summary of the speaker presentations and audience discussions regarding the design of clinical trials and the extrapolation of results from these trials to support international drug registration.
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Affiliation(s)
- Marilyn N Martinez
- Center for Veterinary Medicine, Food and Drug Administration, Rockville, MD 20855, USA.
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