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A new class of antibiotics is cause for cautious celebration - but the economics must be fixed. Nature 2024; 625:7. [PMID: 38172365 DOI: 10.1038/d41586-023-04086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
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2
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Devenport J, Schacht A. Leading beyond regulatory approval: Opportunities for statisticians to optimize evidence generation and impact clinical practice. Pharm Stat 2023; 22:1135-1140. [PMID: 37431704 DOI: 10.1002/pst.2325] [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: 08/19/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
The role and value of statistical contributions in drug development up to the point of health authority approval are well understood. But health authority approval is only a true 'win' if the evidence enables access and adoption into clinical practice. In today's complex and evolving healthcare environment, there is additional strategic evidence generation, communication, and decision support that can benefit from statistical contributions. In this article, we describe the history of medical affairs in the context of drug development, the factors driving post-approval evidence generation needs, and the opportunities for statisticians to optimize evidence generation for stakeholders beyond health authorities in order to ensure that new medicines reach appropriate patients.
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Affiliation(s)
- Jenny Devenport
- Data Sciences, Hoffmann-La Roche Ltd, Basel, Basel Stadt, Switzerland
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3
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Vogel M, Kesselheim AS, Feldman WB, Rome BN. Will Medicare Price Negotiation Delay Cancer-Drug Launches? N Engl J Med 2023; 389:1546-1548. [PMID: 37819215 DOI: 10.1056/nejmp2310269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Matthew Vogel
- From the Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School, Cambridge (M.V.), and the Program on Regulation, Therapeutics, and Law, Brigham and Women's Hospital and Harvard Medical School, Boston (A.S.K., W.B.F., B.N.R.) - all in Massachusetts
| | - Aaron S Kesselheim
- From the Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School, Cambridge (M.V.), and the Program on Regulation, Therapeutics, and Law, Brigham and Women's Hospital and Harvard Medical School, Boston (A.S.K., W.B.F., B.N.R.) - all in Massachusetts
| | - William B Feldman
- From the Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School, Cambridge (M.V.), and the Program on Regulation, Therapeutics, and Law, Brigham and Women's Hospital and Harvard Medical School, Boston (A.S.K., W.B.F., B.N.R.) - all in Massachusetts
| | - Benjamin N Rome
- From the Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School, Cambridge (M.V.), and the Program on Regulation, Therapeutics, and Law, Brigham and Women's Hospital and Harvard Medical School, Boston (A.S.K., W.B.F., B.N.R.) - all in Massachusetts
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4
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Naci H, Forrest R, Davis C. Putting patients first in medicines regulation? BMJ 2021; 375:n2883. [PMID: 34848394 DOI: 10.1136/bmj.n2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Robin Forrest
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Courtney Davis
- Department of Global Health and Social Medicine, King's College London, UK
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5
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Rei Bolislis W, Bejeuhr G, Benzaghou F, Corriol‐Rohou S, Herrero‐Martinez E, Hildebrand H, Hill‐Venning C, Hoogland H, Johnson C, Joos A, Vart R, Le Visage G, Kühler TC. Optimizing Pediatric Medicine Developments in the European Union Through Pragmatic Approaches. Clin Pharmacol Ther 2021; 110:871-879. [PMID: 33411346 PMCID: PMC8518420 DOI: 10.1002/cpt.2152] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
The European Union's Pediatric Regulation has strengthened the development of medicines for children in Europe through its system of obligations and rewards. However, opportunities remain to further optimize pediatric medicine developments, notably in relation to the implementation of the regulatory framework. This paper therefore describes bottlenecks identified by industry that occur during the medicinal development process, including those relating to the scientific advice process, pediatric investigation plan (PIP) development, compliance checks, and study submissions, and offers some considerations and insights to address these. Considerations, which are workable within the current legislative framework, focus on an integrated scientific discussion, optimization of PIP procedures and compliance checks, and an alignment of study-reporting requirements.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Craig Johnson
- GlaxoSmithKline Research & Development Ltd.MiddlesexUK
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Beall RF, Hollis A, Kesselheim AS, Spackman E. Reimagining Pharmaceutical Market Exclusivities: Should the Duration of Guaranteed Monopoly Periods Be Value Based? Value Health 2021; 24:1328-1334. [PMID: 34452713 DOI: 10.1016/j.jval.2021.04.1277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/03/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe the main features of a pharmaceutical market in which the duration of guaranteed monopoly periods would correspond to a new pharmaceutical product's value. METHODS After reviewing patent and regulatory exclusivity-based mechanisms for protecting prescription drug markets from competition to incentivize drug innovation in developed countries, we model market protection mechanisms within the current framework to give the longest-lasting market protections to drug developers that bring the most affordable products to market with highest public health and clinical value. RESULTS An approach tying pharmaceutical market exclusivity to value would have 3 main features. First, it would be based on regulatory exclusivity (ie, the drug regulator refrains from authorizing generic entry for a certain amount of time), rather than patents. Second, the duration of exclusivity period would be pegged to the magnitude of a product's anticipated health impact and its proposed price by using modified methods from the field of health technology assessment. Third, the duration of the value-based exclusivity period would be reassessed routinely 3 years after the product's launch to account for its real-world effectiveness. CONCLUSIONS Linking a drug's proposed price to the duration of its regulatory-based exclusivities would both incentivize the development of high impact, low-cost products and motivate drug developers to introduce these products at lower prices.
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Affiliation(s)
- Reed F Beall
- Department of Community Health Sciences, Cummings School of Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Program on Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Aidan Hollis
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eldon Spackman
- Department of Community Health Sciences, Cummings School of Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Tang W, Huang Y, Zhou D, Huang Y, Chen Y, Ren S, Li Y, Wu S, Zhao X, Song X, Wang H, Jin Y, Yu H, Zhang L, Li Y, Boulton D, Shen K. Evolving drug regulatory landscape in China: A clinical pharmacology perspective. Clin Transl Sci 2021; 14:1222-1230. [PMID: 33503308 PMCID: PMC8301550 DOI: 10.1111/cts.12987] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022] Open
Abstract
In order to encourage innovative medicine to address Chinese unmet medical needs, China has changed its drug regulatory landscape to speed up access to new medicines. In order to understand the fast-changing landscape and to enable planning of more global drug development programs and study designs in China, we reviewed 15 published clinical pharmacology-related guidances by the National Medical Products Administration (NMPA), and compared them with reference guidances from the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), or the International Conference on Harmonization (ICH), to understand the similarities and differences, especially any China-specific requirements, such as ethnic sensitivity analysis. Overall, by reviewing these clinical pharmacology-related NMPA guidances, it is clear that NMPA guidances are very similar to FDA, EMA, and ICH guidances. There are no relevant differences in the major principles, but some differences in structure, contents, and focus were noted. The NMPA is adapting flexibility statements into newly published guidances. Ethnic sensitivity analysis needs to be implemented early in drug development plans. The NMPA encourages sponsors to conduct early clinical trials in China or include China early in multiregional clinical trials, and to obtain safety, efficacy, and pharmacokinetic data for ethnic sensitivity analysis. Depending on the stage of development, ethnic sensitivity analysis can be conducted using in vitro or literature data, other Asian clinical data, or Chinese clinical data.
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Affiliation(s)
- Weifeng Tang
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaGaithersburgMarylandUSA
| | | | - Diansong Zhou
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaWalthamMassachusettsUSA
| | | | - Yingxue Chen
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaWalthamMassachusettsUSA
| | - Song Ren
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaGaithersburgMarylandUSA
| | - Yan Li
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaWalthamMassachusettsUSA
| | | | | | - Xuyang Song
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaGaithersburgMarylandUSA
| | | | | | - Hongtao Yu
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaGaithersburgMarylandUSA
| | - Li Zhang
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaWalthamMassachusettsUSA
| | | | - David Boulton
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety SciencesR&D, AstraZenecaGaithersburgMarylandUSA
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Ren Z, Bremer AA, Pawlyk AC. Drug development research in pregnant and lactating women. Am J Obstet Gynecol 2021; 225:33-42. [PMID: 33887238 DOI: 10.1016/j.ajog.2021.04.227] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 02/11/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
Pregnant and lactating women are considered "therapeutic orphans" because they generally have been excluded from clinical drug research and the drug development process owing to legal, ethical, and safety concerns. Most medications prescribed for pregnant and lactating women are used "off-label" because most of the clinical approved medications do not have appropriate drug labeling information for pregnant and lactating women. Medications that lack human safety data on use during pregnancy and lactation may pose potential risks for adverse effects in pregnant and lactating women as well as risks of teratogenic effects to their unborn and newborn babies. Federal policy requiring the inclusion of women in clinical research and trials led to considerable changes in research design and practice. Despite more women being included in clinical research and trials, the inclusion of pregnant and lactating women in drug research and clinical trials remains limited. A recent revision to the "Common Rule" that removed pregnant women from the classification as a "vulnerable" population may change the culture of drug research and drug development in pregnant and lactating women. This review article provides an overview of medications studied by the Obstetric-Fetal Pharmacology Research Units Network and Centers and describes the challenges in current obstetrical pharmacology research and alternative strategies for future research in precision therapeutics in pregnant and lactating women. Implementation of the recommendations of the Task Force on Research Specific to Pregnant Women and Lactating Women can provide legislative requirements and opportunities for research focused on pregnant and lactating women.
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Affiliation(s)
- Zhaoxia Ren
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
| | - Andrew A Bremer
- Pediatric Growth and Nutrition Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Pregnancy and Perinatology Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Aaron C Pawlyk
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
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Barry E, Walsh JA, Weinrich SL, Beaupre D, Blasi E, Arenson DR, Jacobs IA. Navigating the Regulatory Landscape to Develop Pediatric Oncology Drugs: Expert Opinion Recommendations. Paediatr Drugs 2021; 23:381-394. [PMID: 34173206 PMCID: PMC8275539 DOI: 10.1007/s40272-021-00455-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
Regulatory changes have been enacted in the United States (US) and European Union (EU) to encourage the development of new treatments for pediatric cancer. Here, we review some of the factors that have hampered the development of pediatric cancer treatments and provide a comparison of the US and EU regulations implemented to address this clinical need. We then provide some recommendations for each stage of the oncology drug development pathway to help researchers maximize their chance of successful drug development while complying with regulations. A key recommendation is the engagement of key stakeholders such as regulatory authorities, pediatric oncologists, academic researchers, patient advocacy groups, and a Pediatric Expert Group early in the drug development process. During drug target selection, sponsors are encouraged to consult the Food and Drug Administration (FDA), European Medicines Agency (EMA), and the FDA target list, in addition to relevant US and European consortia that have been established to characterize and prioritize oncology drug targets. Sponsors also need to carefully consider the resourcing requirements for preclinical testing, which include ensuring appropriate access to the most relevant databases, clinical samples, and preclinical models (cell lines and animal models). During clinical development, sponsors can account for the pharmacodynamic (PD)/pharmacokinetic (PK) considerations specific to a pediatric population by developing pediatric formulations, selecting suitable PD endpoints, and employing sparse PK sampling or modeling/simulation of drug exposures where appropriate. Additional clinical considerations include the specific design of the clinical trial, the potential inclusion of children in adult trials, and the value of cooperative group trials.
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Abstract
Vadadustat (VAFSEO®) is a prolyl hydroxylase inhibitor being developed by Akebia Therapeutics, Inc. (Akebia) for the treatment of anaemia associated with chronic kidney disease (CKD). Akebia is collaborating with Mitsubishi Tanabe Pharma Corporation on the development and commercialization of vadadustat in Japan and with Otsuka Pharmaceutical Co. Ltd on the development and commercialization of vadadustat in the USA, the EU and certain other territories. The drug is approved in Japan for use in adult patients with anaemia associated with CKD and regulatory submissions are planned in the USA and the EU. This article summarizes the milestones in the development of vadadustat leading to this first approval.
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Affiliation(s)
- Anthony Markham
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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11
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Abstract
A fixed dose oral combination (FDC) of decitabine and cedazuridine (Inqovi®), is being developed by Astex Pharmaceuticals (a subsidiary of Otsuka Pharmaceuticals) for the treatment of various cancers like myelodysplastic syndromes (MDS), chronic myelomonocytic leukaemia (CMML), acute myeloid leukaemia (AML), glioma and solid tumours. Decitabine, a DNA methyltransferase inhibitor approved for the treatment of MDS and CMML, is degraded by cytidine deaminase in the gastrointestinal tract and liver, thereby limiting oral bioavailability. Cedazuridine is a proprietary, patented cytidine deaminase inhibitor that, when added to decitabine, increases oral bioavailability of the drug. In July 2020, decitabine/cedazuridine received its first approval in the USA and Canada for the treatment of MDS and CMML. In the USA, it is indicated for use in adults with MDS and CMML, including previously treated and untreated, de novo and secondary MDS with the following French–American–British subtypes (refractory anaemia, refractory anaemia with ringed sideroblasts, refractory anaemia with excess blasts and CMML) and intermediate-1, intermediate-2 and high-risk International Prognostic Scoring System groups. Clinical studies for AML, glioma and solid tumours are underway in several countries worldwide. This article summarizes the milestones in the development of decitabine/cedazuridine leading to this first approval for the treatment of MDS and CMML.
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Affiliation(s)
- Sohita Dhillon
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Laetsch TW, DuBois SG, Bender JG, Macy ME, Moreno L. Opportunities and Challenges in Drug Development for Pediatric Cancers. Cancer Discov 2021; 11:545-559. [PMID: 33277309 PMCID: PMC7933059 DOI: 10.1158/2159-8290.cd-20-0779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/02/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
The use of targeted small-molecule therapeutics and immunotherapeutics has been limited to date in pediatric oncology. Recently, the number of pediatric approvals has risen, and regulatory initiatives in the United States and Europe have aimed to increase the study of novel anticancer therapies in children. Challenges of drug development in children include the rarity of individual cancer diagnoses and the high prevalence of difficult-to-drug targets, including transcription factors and epigenetic regulators. Ongoing pediatric adaptation of biomarker-driven trial designs and further exploration of agents targeting non-kinase drivers constitute high-priority objectives for future pediatric oncology drug development. SIGNIFICANCE: Increasing attention to drug development for children with cancer by regulators and pharmaceutical companies holds the promise of accelerating the availability of new therapies for children with cancer, potentially improving survival and decreasing the acute and chronic toxicities of therapy. However, unique approaches are necessary to study novel therapies in children that take into account low patient numbers, the pediatric cancer genomic landscape and tumor microenvironment, and the need for pediatric formulations. It is also critical to evaluate the potential for unique toxicities in growing hosts without affecting the pace of discovery for children with these life-threatening diseases.
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Affiliation(s)
- Theodore W Laetsch
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, and Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | | | - Margaret E Macy
- Children's Hospital Colorado and University of Colorado, Denver, Colorado
| | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Santos L, Oliveira C, Vasconcelos BM, Vilela D, Melo L, Ambrósio L, da Silva A, Murback L, Kurissio J, Cavalcante J, Cassaro CV, Barros L, Barraviera B, Ferreira RS. Good management practices of venomous snakes in captivity to produce biological venom-based medicines: achieving replicability and contributing to pharmaceutical industry. J Toxicol Environ Health B Crit Rev 2021; 24:30-50. [PMID: 33308037 DOI: 10.1080/10937404.2020.1855279] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
One of the factors responsible for lack of reproducible findings may be attributed to the raw material used. To date, there are no apparent studies examining reproducibility using venoms for the development of new toxin-based drugs with respect to regulatory agencies' policies. For this reason, protocols were implemented to produce animal toxins with quality, traceability, and strict compliance with Good Manufacturing Practices. This required validation of the production chain from the arrival of the animal to the vivarium, followed by handling, housing, as well as compliance with respect to extraction, freeze-drying, and, finally, storage protocols, aimed at generating compounds to serve as candidate molecules applicable in clinical trials. Currently, to produce quality snake venoms to support reproductive studies, the Center for the Study of Venoms and Venomous Animals (CEVAP) from São Paulo State University (UNESP), São Paulo, Brazil has 449 microchipped snakes through rigid and standardized operating procedures for safety, health, and welfare of animals. Snakes were frequently subjected to vet clinical examination, anthelmintic, and antiparasitic treatment. Venom milk used to destroy prey was collected from each animal in individual plastic microtubes to avoid contamination and for traceability. In addition, venoms were submitted to microbiological, and biochemical toxicological analyses. It is noteworthy that investigators are responsible for caring, maintaining, and manipulating snakes and ensuring their health in captivity. This review aimed to contribute to the pharmaceutical industry the experimental experience and entire snake venom production chain required to generate quality products for therapeutic human consumption.
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Affiliation(s)
- Lucilene Santos
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Clinical Research, Botucatu Medical School (FMB) and CEVAP, São Paulo State University (UNESP) , Botucatu, Brazil
| | - Cristiano Oliveira
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Barbara Marques Vasconcelos
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Daniela Vilela
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Leonardo Melo
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Clinical Research, Botucatu Medical School (FMB) and CEVAP, São Paulo State University (UNESP) , Botucatu, Brazil
| | - Lívia Ambrósio
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Amanda da Silva
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Leticia Murback
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Jacqueline Kurissio
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Joeliton Cavalcante
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Claudia Vilalva Cassaro
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Luciana Barros
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Clinical Research, Botucatu Medical School (FMB) and CEVAP, São Paulo State University (UNESP) , Botucatu, Brazil
| | - Rui Seabra Ferreira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP) , Botucatu, Brazil
- Graduate Program in Clinical Research, Botucatu Medical School (FMB) and CEVAP, São Paulo State University (UNESP) , Botucatu, Brazil
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Cordaillat-Simmons M, Rouanet A, Pot B. Live biotherapeutic products: the importance of a defined regulatory framework. Exp Mol Med 2020; 52:1397-1406. [PMID: 32908212 PMCID: PMC8080583 DOI: 10.1038/s12276-020-0437-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [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: 03/05/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022] Open
Abstract
Probiotics have been defined as "Live microorganisms that when administered in adequate amounts confer a health benefit on the host". This definition covers a wide range of applications, target populations and (combinations of) microorganisms. Improved knowledge on the importance of the microbiota in terms of health and disease has further diversified the potential scope of a probiotic intervention, whether intended to reach the market as a food, a food supplement or a drug, depending on the intended use. However, the increased interest in the clinical application of probiotics may require specific attention given their administration in a diseased population. In addition to safety, the impact of the type of product, in terms of quality, production method and, e.g., the acceptance of side effects, is now part of the current regulatory constraints for developers. In the European Union, foods are regulated by the European Food Safety Authority and drugs by the European Medicines Agency; in the United States, the Food and Drug Administration (FDA) deals with both categories. More recently, the FDA has defined a new "live biotherapeutic products" (LBP) category, clarifying pharmaceutical expectations. Since 2019, the quality requirements for this category of drug products have also been clarified by the European Pharmacopoeia (Ph. Eur.). Similar to all products intended to prevent or treat diseases, LBPs will have to be registered as medicinal products to reach the market in the US and in Europe. In this area, regulatory authorities and the pharmaceutical industry will routinely use guidelines of the "International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use" (ICH). Although ICH guidelines are not legally binding, they provide very important recommendations, recognized by almost all drug authorities in the world. In this review, we discuss some aspects of this regulatory framework, especially focusing on products with an intended use in a diseased or vulnerable target population.
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Affiliation(s)
- Magali Cordaillat-Simmons
- Pharmabiotic Research Institute (PRI), 1 Quai Vallière, Résidence l´île verte, 11100, Narbonne, France
| | - Alice Rouanet
- Pharmabiotic Research Institute (PRI), 1 Quai Vallière, Résidence l´île verte, 11100, Narbonne, France
| | - Bruno Pot
- Pharmabiotic Research Institute (PRI), 1 Quai Vallière, Résidence l´île verte, 11100, Narbonne, France.
- Research Group of Industrial Microbiology and Food Biotechnology (IMDO), Vrije Universiteit Brussel, Pleinlaan 2, G7, 1050, Elsene, Belgium.
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Abstract
This second International Alliance for Biological Standardization COVID-19 webinar brought together a broad range of international stakeholders, including academia, regulators, funders and industry, with a considerable participation from low- and middle-income countries, to discuss the use of controlled human infection models to accelerate development and market authorization assessment of a vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Affiliation(s)
- Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium.
| | - Pieter Neels
- International Alliance for Biological Standardization - IABS, Geneva, Switzerland.
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16
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Abstract
Against the backdrop of the COVID pandemic, the scientific and medical communities are working with all deliberate speed with state-of-the-art technologies to develop diagnostic and therapeutic products that can identify, treat, and prevent infection with SARS-CoV-2. These activities may only be legally conducted with the necessary statutes and regulations in place to facilitate the timely development, manufacturing, evaluation, and distribution of products that meet quality standards. The present regulatory landscape for medicinal and medical products for human use has been shaped by nearly 12 decades of statutory history that followed in reaction to disasters and tragedies. Five distinct, closely woven threads of statutory history have led to the regulatory infrastructure we have in place: (1) standardized processes for routine development of medicinal and medical device products for human use; (2) processes for expedited development to shorten time frames and expand patient populations; (3) mechanisms of Expanded Access to make medicinal products available to patients prior to approval of the US Food and Drug Administration; (4) Emergency Use Authorization during public health emergencies; and (5) the development of pathways for bringing generic drugs and biosimilar biologics to market. These mechanisms are being brought to bear to facilitate the defeat of infection with SARS-CoV-2.
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Affiliation(s)
- Paul Beninger
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
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17
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Zahiruddin S, Basist P, Parveen A, Parveen R, Khan W, Ahmad S. Ashwagandha in brain disorders: A review of recent developments. J Ethnopharmacol 2020; 257:112876. [PMID: 32305638 DOI: 10.1016/j.jep.2020.112876] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 09/30/2019] [Revised: 01/20/2020] [Accepted: 04/11/2020] [Indexed: 05/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Withania somnifera (Family: Solanaceae), commonly known as Ashwagandha or Indian ginseng is distributed widely in India, Nepal, China and Yemen. The roots of plant consist of active phytoconstituents mainly withanolides, alkaloids and sitoindosides and are conventionally used for the treatment of multiple brain disorders. AIM OF THE REVIEW This review aims to critically assess and summarize the current state and implication of Ashwagandha in brain disorders. We have mainly focussed on the reported neuroactive phytoconstituents, available marketed products, pharmacological studies, mechanism of action and recent patents published related to neuroprotective effects of Ashwagandha in brain disorders. MATERIALS AND METHODS All the information and data was collected on Ashwagandha using keywords "Ashwagandha" along with "Phytoconstituents", "Ayurvedic, Unani and Homeopathy marketed formulation", "Brain disorders", "Mechanism" and "Patents". Following sources were searched for data collection: electronic scientific databases such as Science Direct, Google Scholar, Elsevier, PubMed, Wiley On-line Library, Taylor and Francis, Springer; books such as AYUSH Pharmacopoeia; authentic textbooks and formularies. RESULTS Identified neuroprotective phytoconstituents of Ashwagandha are sitoindosides VII-X, withaferin A, withanosides IV, withanols, withanolide A, withanolide B, anaferine, beta-sitosterol, withanolide D with key pharmacological effects in brain disorders mainly anxiety, Alzheimer's, Parkinson's, Schizophrenia, Huntington's disease, dyslexia, depression, autism, addiction, amyotrophic lateral sclerosis, attention deficit hyperactivity disorder and bipolar disorders. The literature survey does not highlight any toxic effects of Ashwagandha. Further, multiple available marketed products and patents recognized its beneficial role in various brain disorders; however, very few data is available on mechanistic pathway and clinical studies of Ashwagandha for various brain disorders is scarce and not promising. CONCLUSION The review concludes the results of recent studies on Ashwagandha suggesting its extensive potential as neuroprotective in various brain disorders as supported by preclinical studies, clinical trials and published patents. However vague understanding of the mechanistic pathways involved in imparting the neuroprotective effect of Ashwagandha warrants further study to promote it as a promising drug candidate.
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Affiliation(s)
- Sultan Zahiruddin
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Parakh Basist
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Abida Parveen
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Rabea Parveen
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Washim Khan
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Sayeed Ahmad
- Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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18
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Shore D. Divergence and Convergence of Royalty Determinations between Compulsory Licensing under the TRIPS Agreement and Ongoing Royalties as an Equitable Remedy. Am J Law Med 2020; 46:55-88. [PMID: 32460655 DOI: 10.1177/0098858820919553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patent rights are recognized as a property asset with an attendant right to exclude. However, recent policy developments highlight that the right to exclude is not inviolable. This paper explores two rapidly evolving exceptions to patent exclusivity, both of which take the form of compulsory licenses. First, under the international Agreement on Trade-Related Aspects of Intellectual Property Rights ("TRIPS"), national governments can compel patent owners to out-license technology in service of greater good. These egalitarian compulsory licenses improve access to technology but undermine patent value. Second, compulsory licenses are increasingly relied upon as an equitable remedy in U.S. patent litigation. Typically referred to as "ongoing royalties," these court-mandated compulsory licenses are a modern alternative to injunctions against adjudged infringers. TRIPS compulsory licenses and ongoing royalties arise under independent legal frameworks, but necessarily invoke parallel economic considerations. While the wisdom of each has been discussed at length by others, this paper explores principles of royalty determination employed in each context. Considering both frameworks, an analysis of where each succeeds and fails is provided, together with an exploration of optimized royalty frameworks.
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Affiliation(s)
- David Shore
- David Shore, PhD, JD, received his doctorate in biological and biomedical sciences from the Harvard Graduate School of Arts and Sciences in 2012 and his law degree from Boston University School of Law in 2019. Since transitioning from academic research to patent prosecution in 2012, Dr. Shore has practiced as a patent specialist, agent, and attorney with expertise in molecular biology. Dr. Shore's practice at Choate Hall & Stewart in Boston, MA, includes work on global patent prosecution strategies, preparation of patentability, freedom to operate, and competitive landscape analyses, and advocacy in adversarial proceedings on behalf of pharmaceutical companies and biotechnology startups
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19
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Affiliation(s)
- Rebecca L Haffajee
- From the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (R.L.H.); and RAND (R.L.H.) and the Department of Health Care Policy, Harvard Medical School (R.G.F.) - both in Boston
| | - Richard G Frank
- From the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (R.L.H.); and RAND (R.L.H.) and the Department of Health Care Policy, Harvard Medical School (R.G.F.) - both in Boston
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20
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Hodgson R, Kennedy BK, Masliah E, Scearce-Levie K, Tate B, Venkateswaran A, Braithwaite SP. Aging: therapeutics for a healthy future. Neurosci Biobehav Rev 2019; 108:453-458. [PMID: 31783058 DOI: 10.1016/j.neubiorev.2019.11.021] [Citation(s) in RCA: 10] [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: 02/13/2019] [Revised: 09/22/2019] [Accepted: 11/25/2019] [Indexed: 01/29/2023]
Abstract
Increased healthcare and pharmaceutical understanding has led to the eradication of many childhood, infectious and preventable diseases; however, we are now experiencing the impact of aging disorders as the lifespan increases. These disorders have already become a major burden on society and threaten to become a defining challenge of our generation. Indications such as Alzheimer's disease gain headlines and have focused the thinking of many towards dementia and cognitive decline in aging. Indications related to neurological function and related behaviors are thus an extremely important starting point in the consideration of therapeutics.However, the reality is that pathological aging covers a spectrum of significant neurological and peripheral indications. Development of therapeutics to treat aging and age-related disorders is therefore a huge need, but represents a largely unexplored path. Fundamental scientific questions need to be considered as we embark towards a goal of improving health in old age, including how we 1) define aging as a therapeutic target, 2) model aging preclinically and 3) effectively translate from preclinical models to man. Furthermore, the challenges associated with identifying novel therapeutics in a financial, regulatory and clinical sense need to be contemplated carefully to ensure we address the unmet need in our increasingly elderly population. The complexity of the challenge requires different perspectives, cross-functional partnerships and diverse concepts. We seek to raise issues to guide the field, considering the current state of thinking to aid in identifying roadblocks and important challenges early. The need for therapeutics that address aging and age-related disorders is acute, but the promise of effective treatments provides huge opportunities that, as a community, we all seek to enable effectively as soon as possible.
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Affiliation(s)
- Robert Hodgson
- Charles River Laboratories, Wilmington, MA, United States; CNS Biology, Takeda, San Diego, CA, United States
| | - Brian K Kennedy
- Departments of Biochemistry and Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Buck Institute for Research on Aging, Novato, CA, United States
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21
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Tsang VWL, West L, Woods C, Koh CJ, McCune S, Mullin T, Smith SR, Gaillard S, Claverol J, Nafria B, Preston J, Dicks P, Thompson C. Role of Patients and Parents in Pediatric Drug Development. Ther Innov Regul Sci 2019; 53:601-608. [PMID: 30663334 PMCID: PMC6744949 DOI: 10.1177/2168479018820875] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 09/19/2018] [Accepted: 11/26/2018] [Indexed: 12/15/2022]
Abstract
Patient engagement in health care has been an emerging priority in the global effort and move toward the consideration of patients as experts of their own conditions. However, the input of pediatric patients and their families have not been consistently requested nor regarded as valuable when deriving protocols for, as well as assessing the outcomes of, pediatric clinical trials. Extending this mutual collaboration further upstream is important, especially in the area of pediatric drug development where the lack of formalized trials for children and adolescents result in the increased use of off-label prescribing and risk of adverse effects. While recent changes to European and North American legislation contributed to the inclusion of children and youth in pediatric drug development, the lack of systematic guidelines and methodologies in literature serve as barriers for practical application. When combined with the work of external pediatric advocacy and patient advisory groups, the hope is that pediatric patient voices can be brought forward for the future. This article brings together international experts to review current best practices, progress from regulatory agencies, as well as global advocacy efforts to involve patients and families in the pursuit of drug development processes that value the voice of children and youth.
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Affiliation(s)
- Vivian W. L. Tsang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Leanne West
- Children’s Healthcare of Atlanta Pediatric Technology Center at the Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Chester J. Koh
- Division of Urology, Department of Surgery, Texas Children’s Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Susan McCune
- Office of Pediatric Therapeutics, US Food and Drug Administration, Silver Spring, MD, USA
| | - Theresa Mullin
- Associate Director for Strategic Initiatives, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD USA
| | - Sharon R. Smith
- Department of Pediatrics, University of Connecticut, CT Children’s Medical Center, Hartford, CT, USA
| | - Segolene Gaillard
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, 69677, Bron, France. Université de Lyon, Service de Pharmacologie Clinique, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, 69622, Villeurbanne, France. RIPPS (Réseau d’investigations pédiatriques des produits de santé)-KIDS France Groupement Hospitalier Est - Bâtiment “Les Tilleuls” 59 Boulevard Pinel 69677 Bron France
| | - Joana Claverol
- Institut de Recerca Sant Joan de Déu, Clinical Research Unit, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Begonya Nafria
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu Pg. Sant Joan de Déu, Barcelona, Spain
| | - Jennifer Preston
- National Institute for Health Research, Alder Hey Children’s Hospital, University of Liverpool, UK
| | - Pamela Dicks
- National Health Service National Research Services Children’s Research Network, NHS Grampian, Scotland
| | - Charles Thompson
- Pfizer Inc, New York, NY, USA
- International Children’s Advisory Network, Hartford, CT, USA
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22
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Affiliation(s)
- Florence T Bourgeois
- From the Pediatric Therapeutics and Regulatory Science Initiative and the Computational Health Informatics Program, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School (F.T.B.), and the Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (A.S.K.) - all in Boston
| | - Aaron S Kesselheim
- From the Pediatric Therapeutics and Regulatory Science Initiative and the Computational Health Informatics Program, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School (F.T.B.), and the Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (A.S.K.) - all in Boston
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23
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Affiliation(s)
- Ameet Sarpatwari
- From the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
| | - Aaron S Kesselheim
- From the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
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24
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Funck-Brentano C. [Early clinical drug development]. Rev Prat 2019; 69:607-611. [PMID: 31626415] [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: 06/10/2023]
Abstract
The first administrations of a molecule to humans, so-called phase I studies of drug development, follow experimental animal studies which allow to have a first assessment of the pharmacological effects and toxicity of the molecule under development. Typically, these studies are performed in "healthy" subjects or in relapsing patients with cancer. Participants' safety is a priority. Trained professionals administer single doses, followed by repeated doses, in authorized medical centres. They allow to study the pharmacokinetic and pharmacodynamic profile of tested molecules in humans and to explore some sources of variability of these parameters. These studies are highly regulated and their methodology is fairly standardized.
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Affiliation(s)
- Christian Funck-Brentano
- Sorbonne université, Inserm CIC Paris-Est, AP-HP, ICAN, service de pharmacologie médicale, groupe hospitalier La Pitié-Salpêtrière, Paris, France
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25
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Kennedy DC. Strange Bedfellows: Native American Tribes, Big Pharma, and the Legitimacy of Their Alliance. Duke Law J 2019; 68:1433-1468. [PMID: 30995705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lost in the cacophony surrounding the debate about high drug prices is the fundamental principle that pharmaceutical innovation will not occur without the prospect of outsized returns enabled through market exclusivity. Biopharmaceutical patents are currently under siege, subject to challenge both in inter partes review ("IPR") proceedings and in Hatch-Waxman actions. These twin assaults threaten to eliminate the incentives necessary for biotechnological innovation--particularly for discoveries made upstream in the innovation pipeline--thus imperiling the development of new drug therapies. But a fascinating solution has emerged: invoking tribal immunity to shield pharmaceutical patents from IPR before the Patent Trial and Appeal Board ("PTAB"). This serves two critically important objectives: promoting tribal self-sufficiency, and encouraging investment in life-saving and life-improving new drugs. Contractual partnerships between Native American tribes and pharmaceutical companies not only provide the tribes with a steady stream of royalty revenue, but also insulate biopharmaceutical patents from challenge in IPR proceedings through the invocation of long-established principles of tribal sovereign immunity. This Note is the first piece of scholarship to comprehensively analyze, and advocate for, the right to invoke tribal sovereign immunity in IPR proceedings.
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26
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Kaguelidou F, Durrieu G, Clavenna A. Pharmacoepidemiological research for the development and evaluation of drugs in pediatrics. Therapie 2019; 74:315-324. [PMID: 30773345 DOI: 10.1016/j.therap.2018.09.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/25/2018] [Accepted: 09/29/2018] [Indexed: 12/23/2022]
Abstract
New regulations have come into force in Europe and the US establishing the pediatric development as an integral part of the early development of medicinal products. Parallel to the advances in pediatric clinical research, it became obvious that all available sources and research tools to gather valuable information for the safe and efficacious prescription of medicines in children should be used. Real-life, pharmacoepidemiological studies provide information that contribute to the better knowledge of drug utilization, effects and safety in the pediatric population and thereby, a better prescribing in children. In this paper, we suggest some possible applications, provide examples of impact of pharmacoepidemiological and pharmacovigilance studies and expose future perspectives in pediatric pharmacoepidemiology.
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Affiliation(s)
- Florentia Kaguelidou
- CIC Inserm 1426, Department of pediatric pharmacology and pharmacogenetics, clinical investigations center, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; UMR-1123, ECEVE, Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; Department of pediatric pharmacology and pharmacogenetics, hôpital Robert-Debré, AP-HP, 75019 Paris, France.
| | - Geneviève Durrieu
- Inserm UMR 1027, CIC Inserm 1436, service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament, faculté de médecine, centre hospitalier universitaire, 31000 Toulouse, France
| | - Antonio Clavenna
- Laboratory for mother and child health, department of public health, IRCCS, Istituto di ricerche farmacologiche Mario Negri, 20156 Milan, Italy
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27
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Affiliation(s)
- Zakir Thomas
- Central Board of Direct Taxes, Department of Revenue, Ministry of Finance, New Delhi, India
- Open Source Drug Discovery, India
| | - Gautam Kumar Saha
- Apollo Hospitals Educational and Research Foundation, New Delhi, India
| | | | - Nirmal Kumar Ganguly
- Apollo Hospitals Educational and Research Foundation, New Delhi, India
- Indian Council of Medical Research, India
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28
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Todd K. The Promising Viral Threat to Bacterial Resistance: the Uncertain Patentability of Phage Therapeutics and the Necessity of Alternative Incentives. Duke Law J 2019; 68:767-805. [PMID: 30649837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Bacteriophages, or "phages," are a category of highly adept and adaptable viruses that can infect and kill bacteria. With concerns over the burgeoning antibiotic-resistance crisis looming in recent years, scientists and policymakers have expressed a growing interest in developing novel treatments for bacterial infections that utilize bacteriophages. Because of the great expense associated with bringing a new drug to market, patents are usually considered the gold standard for incentivizing research and development in the pharmaceutical field. Absent such strong protection for a developer’s front end investment, pharmaceutical development remains financially risky and unattractive. Unfortunately, recent Supreme Court jurisprudence analyzing patentable subject matter under 35 U.S.C. subsection 101 has cast doubt on whether phage therapeutics would be eligible for strong patent protection. In order for the promise of phage therapeutics to become a reality, alternative protections or incentives are likely necessary. Such a framework would likely include trade secrecy, regulatory exclusivities, research support, alternative payment models, or some combination thereof.
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29
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O'Connor SM, Lietzan E. The Surprising Reach of FDA Regulation of Cannabis, Even After Descheduling. Am Univ Law Rev 2019; 68:823-925. [PMID: 30919712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As more states legalize cannabis, the push to "deschedule" it from the Controlled Substances Act is gaining momentum. At the same time, the Food and Drug Administration (FDA) recently approved the first conventional drug containing a cannabinoid derived from cannabis—cannabidiol (CBD) for two rare seizure disorders. This would all seem to bode well for proponents of full federal legalization of medical cannabis. But some traditional providers are wary of drug companies pulling medical cannabis into the regular small molecule drug development system. The FDA's focus on precise analytical characterization and on individual active and inactive ingredients may be fundamentally inconsistent with the "entourage effects" theory of medical cannabis. Traditional providers may believe that descheduling cannabis would free them to promote and distribute their products free of federal intervention, both locally and nationally. Other producers appear to assume that descheduling would facilitate a robust market in cannabis-based edibles and dietary supplements. In fact, neither of these things is true. If cannabis were descheduled, the FDA's complex and comprehensive regulatory framework governing foods, drugs, and dietary supplements would preclude much of this anticipated commerce. For example, any medical claims about cannabis would require the seller to complete the rigorous new drug approval process, the cost of which will be prohibitive for most current traditional providers. Likely also unexpected to some, there is no pathway forward for conventional foods containing cannabis constituents, with the (probably exclusive) exception of certain hemp seed ingredients, if those foods cross state lines. And it will certainly come as a shock to many that federal law already prohibits the sale of dietary supplements containing CBD--including those already on the market as well as those made from "hemp," which has recently been descheduled under the 2018 Farm Bill. This Article describes in detail the surprising reach of the FDA and then outlines three modest, but legal, pathways forward for cannabis-based products in a world where cannabis has been descheduled.
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30
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Wilson JL, Racz R, Liu T, Adeniyi O, Sun J, Ramamoorthy A, Pacanowski M, Altman R. PathFX provides mechanistic insights into drug efficacy and safety for regulatory review and therapeutic development. PLoS Comput Biol 2018; 14:e1006614. [PMID: 30532240 PMCID: PMC6285459 DOI: 10.1371/journal.pcbi.1006614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022] Open
Abstract
Failure to demonstrate efficacy and safety issues are important reasons that drugs do not reach the market. An incomplete understanding of how drugs exert their effects hinders regulatory and pharmaceutical industry projections of a drug's benefits and risks. Signaling pathways mediate drug response and while many signaling molecules have been characterized for their contribution to disease or their role in drug side effects, our knowledge of these pathways is incomplete. To better understand all signaling molecules involved in drug response and the phenotype associations of these molecules, we created a novel method, PathFX, a non-commercial entity, to identify these pathways and drug-related phenotypes. We benchmarked PathFX by identifying drugs' marketed disease indications and reported a sensitivity of 41%, a 2.7-fold improvement over similar approaches. We then used PathFX to strengthen signals for drug-adverse event pairs occurring in the FDA Adverse Event Reporting System (FAERS) and also identified opportunities for drug repurposing for new diseases based on interaction paths that associated a marketed drug to that disease. By discovering molecular interaction pathways, PathFX improved our understanding of drug associations to safety and efficacy phenotypes. The algorithm may provide a new means to improve regulatory and therapeutic development decisions.
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Affiliation(s)
- Jennifer L. Wilson
- Department of Bioengineering, Stanford University, Palo Alto California, United States of America
| | - Rebecca Racz
- Division of Applied Regulatory Science, US Food and Drug Administration, Silver Spring Maryland, United States of America
| | - Tianyun Liu
- Department of Bioengineering, Stanford University, Palo Alto California, United States of America
| | - Oluseyi Adeniyi
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring Maryland, United States of America
| | - Jielin Sun
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring Maryland, United States of America
| | - Anuradha Ramamoorthy
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring Maryland, United States of America
| | - Michael Pacanowski
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring Maryland, United States of America
| | - Russ Altman
- Department of Bioengineering, Stanford University, Palo Alto California, United States of America
- Department of Genetics, Stanford University, Palo Alto California, United States of America
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31
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Williams DR, Spaulding TJ. The inherent risks associated with newly traded biopharmaceutical firms. Drug Discov Today 2018; 23:1680-1688. [PMID: 29936246 DOI: 10.1016/j.drudis.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/30/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022]
Abstract
Here, we provide a comprehensive study related to the risks of all biopharmaceutical firms going public in the USA between 1996 and 2015. We found 355 firms that met our requirements for being in the sector that focuses on creating drugs for humans. Collectively, these firms spent approximately US$86.9 billion on research and development (R&D) during this time. They also lost approximately US$69.3 billion in combined net income. We also examine the delisting of these firms from a public market, their number of collaborators at the initial public offering (IPO), and estimate the percentage ownership by other biopharmaceutical firms at the IPO.
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Affiliation(s)
- David R Williams
- Appalachian State University, Beaver College of Health Sciences, 261 Locust Street, Boone, NC 28608, USA.
| | - Trent J Spaulding
- Appalachian State University, Beaver College of Health Sciences, 261 Locust Street, Boone, NC 28608, USA
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32
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Abstract
Perpetual debate regarding the delicate balance between access and innovation and the protection of the public health and safety dominate discussions of the United States Food and Drug Administration ("FDA"). Established chiefly as a command and control federal administrative agency, iterative changes in legislation have shaped the FDA's activity in drug, biologic, and medical device regulation over the course of the last one hundred plus years. The most recent fundamental reframing of the agency's authority and directive presented itself in the 21st Century Cures Act, reflecting an important role for patient perspectives in the regulatory process. This Article explores recent developments in patient-focused product development efforts at the FDA and offers modest insights on the increasing role of patients, and patient advocacy groups, in agency decision-making. The Article terms this era "21st century citizen pharma."
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Affiliation(s)
- Jordan Paradise
- J.D., Georgia Reithal Professor of Law, Beazley Institute for Health Law & Policy, Loyola University Chicago School of Law
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33
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Chu GY, Chen YF, Chen HY, Chan MH, Gau CS, Weng SM. Stem cell therapy on skin: Mechanisms, recent advances and drug reviewing issues. J Food Drug Anal 2018; 26:14-20. [PMID: 29389549 PMCID: PMC9332639 DOI: 10.1016/j.jfda.2017.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/28/2017] [Accepted: 10/14/2017] [Indexed: 11/18/2022] Open
Abstract
Stem cell products and its clinical applications have been widely discussed in recent years, particularly when the Japanese “induced pluripotent stem cells” founder Dr. Yamanaka was awarded as Nobel Prize laureate in 2013. For decades, major progresses have been achieved in the stem cell biology field, and more and more evidence showed that skin stem cells are involved in the process of skin repair. Stem/progenitor cells of the epidermis are recognized to play the most essential role in the tissue regeneration of skin. In this review, we first illustrated basic stem cell characteristics and various stem cell subtypes resided in the skin. Second, we provided several literatures to elucidate how stem/progenitor cells collaborate in the process of skin repair with the evidence from animal model studies and in vitro experiments. Third, we also introduced several examples of skin cell products on the pharmaceutic market and the ongoing clinical trials aiming for unmet medical difficulties of skin. Last but not least, we summarized general reviewing concerns and some disputatious issues on dermatological cell products. With this concise review, we hope to provide further beneficial suggestions for the development of more effective and safer dermatological stem/progenitor cell products in the future.
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Affiliation(s)
- Gong-Yau Chu
- Center for Drug Evaluation, Taipei 11557,
Taiwan
- Department of Dermatology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 11101,
Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei 11221,
Taiwan
- Department of Dermatology, Kang-Ning General Hospital, Taipei 11490,
Taiwan
| | - Yu-Fu Chen
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei 11219,
Taiwan
| | | | | | | | - Shih-Ming Weng
- Center for Drug Evaluation, Taipei 11557,
Taiwan
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei 11219,
Taiwan
- Corresponding author. 3F No. 465, Sec. 6, Zhongxiao E. Rd., Taipei 11557, Taiwan. E-mail address: (S.-M. Weng)
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Farhat F, Torres A, Park W, de Lima Lopes G, Mudad R, Ikpeazu C, Abi Aad S. The Concept of Biosimilars: From Characterization to Evolution-A Narrative Review. Oncologist 2017; 23:346-352. [PMID: 29284760 DOI: 10.1634/theoncologist.2017-0126] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 03/10/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
Biologic agents are currently the fastest emerging segment of drug expenditure. Unlike chemically synthesized small-molecule drugs, biologics are more complex, medicinal products produced by a living organism. They have become part of the standard of care in the treatment of a large variety of diseases, such as growth disorders, autoimmune diseases, cancer, cardiovascular illnesses, hemophilia, and rare genetic conditions, to name a few. Biosimilars, which are copies of biologics that are highly similar, were introduced in the market with an aim to offer efficacy that is not clinically different from the originator or reference product, at lower prices. We aim to clarify the concept of biosimilar, from definitions, history, market entry, challenges faced, and future evolution. For that purpose, we performed a literature search on the sites of the medicines regulatory agencies and PubMed from 1990 to 2014 with the keywords "biosimilars," "market," and "regulatory." In 2006, the first biosimilar, somatropin [rDNA origin], was marketed and led the way for biosimilar drug manufacturing. As a result, manufacturers have entered a diversified competition, facing challenges in manufacturing these complex agents, such as immunogenicity and efficiency. Biosimilars are set to evolve differently in various markets, namely the U.S., Japan, the European Union, and the "pharmerging" economies. IMPLICATIONS FOR PRACTICE This article highlights the importance of biosimilars, as a cost-cutting strategy, in the delivery of state-of-the-art health care in developing countries, at a fraction of what a reference biological agent would cost.
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Affiliation(s)
- Fadi Farhat
- Department of Hematology-Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon
| | - Alfredo Torres
- Department of Hematology-Oncology, University of Miami-Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Wungki Park
- Department of Hematology-Oncology, University of Miami-Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Gilberto de Lima Lopes
- Department of Hematology-Oncology, University of Miami-Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Raja Mudad
- Department of Hematology-Oncology, University of Miami-Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Chukwuemeka Ikpeazu
- Department of Hematology-Oncology, University of Miami-Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Simon Abi Aad
- Department of Hematology-Oncology, University of Miami-Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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