Bioequivalence History

Untangling Absorption Mechanisms and Variability in Bioequivalence Studies Using Population Analysis

PURPOSE

Both inter-individual (IIV) and inter-occasion (IOV) variabilities are observed in bioequivalence studies. High IOV may be a cause of problems on the demonstration of bioequivalence, despite strict measures are taken to control it. The objective of this study is to investigate further means of controlling IIV by optimizing study design of crossover studies.

METHODS

Data from 18 bioequivalence studies were used to develop population pharmacokinetics (popPK) models to characterize the absorption and disposition processes of 14 drugs, to estimate IOV for each drug substance and to evaluate possible correlations with biopharmaceutical properties of drug substances, classified in accordance to the Biopharmaceutics Drug Disposition Classification System (BDDCS).

RESULTS

Plasma-pharmacokinetics profiles for the 14 drugs analyzed were successfully described using popPK. The pharmacokinetic parameters that showed greater variability were first-order rate constant of absorption, duration of the zero-order absorption process, relative bioavailability and time of latency. ISCV% estimated for C_max seems to correlate with the log-Dose-Number for Class 1, 2 and 3, despite no direct correlation was observed between popPK model residual variability (RUV) and ISCV%. Nevertheless, higher RUV estimates were observed for Class 2 drugs in comparison to Class 1 and 3.

CONCLUSION

Pharmacokinetic parameters related to drug absorption showed greater variability. Ingestion of the IMP along with 240 mL of water showed to standardize gastric emptying. Given the dependency between C_max variability and dose-solubility ratio, for classes 2 and 4, ad libitum water intake may increase C_max and AUC ISCV%. A water ingestion standardization until the expected T_max of the drug is suggested.

P > .05: The incorrect interpretation of "not significant" results is a significant problem

Statistically nonsignificant (p > .05) results from a null hypothesis significance test (NHST) are often mistakenly interpreted as evidence that the null hypothesis is true-that there is "no effect" or "no difference." However, many of these results occur because the study had low statistical power to detect an effect. Power below 50% is common, in which case a result of no statistical significance is more likely to be incorrect than correct. The inference of "no effect" is not valid even if power is high. NHST assumes that the null hypothesis is true; p is the probability of the data under the assumption that there is no effect. A statistical test cannot confirm what it assumes. These incorrect statistical inferences could be eliminated if decisions based on p values were replaced by a biological evaluation of effect sizes and their confidence intervals. For a single study, the observed effect size is the best estimate of the population effect size, regardless of the p value. Unlike p values, confidence intervals provide information about the precision of the observed effect. In the biomedical and pharmacology literature, methods have been developed to evaluate whether effects are "equivalent," rather than zero, as tested with NHST. These methods could be used by biological anthropologists to evaluate the presence or absence of meaningful biological effects. Most of what appears to be known about no difference or no effect between sexes, between populations, between treatments, and other circumstances in the biological anthropology literature is based on invalid statistical inference.

Assessing the ratio of means as a causal estimand in clinical endpoint bioequivalence studies in the presence of intercurrent events

In clinical endpoint bioequivalence studies, the observed per-protocol (PP) population (compliers and completers in general) is usually used in the primary analysis for equivalence assessment. However, intercurrent events, ie, missingness and noncompliance, are not properly handled. The resulting estimand is not causal. Previously, we proposed the first causal framework to assess equivalence in the presence of missing data and noncompliance. We proposed a causal survivor average causal effect (SACE) estimand for the difference of means (DOM). In equivalence assessment, DOM is not as widely used as the ratio of means (ROM). However, no existing formula links the observed PP estimand to the SACE estimand for ROM as exists for DOM. Herein, we propose a similar causal framework for ROM using the principal stratification approach, one of the strategies recommended by the International Conference on Harmonisation (ICH) E9 R1 addendum. We quantify the bias of the observed ROM PP estimand for the SACE estimand, which provides a basis to identify three conditions under which the two estimands are equal. We propose a sensitivity analysis method to evaluate the robustness of the current PP estimator to estimate the SACE estimand. We extend Fieller's confidence interval for the SACE estimand using ROM, which can be applied to many settings. Simulation demonstrates that the PP estimator is biased in either directions and may inflate type 1 error and/or change power when the three identified conditions are violated. Our work can be applied to comparative clinical biosimilar studies.

In vitro evaluation of the interchangeability of different brands of diclofenac sodium tablets available in the Colombian market

Introduction: Diclofenac sodium is classified as a non-steroidal anti-inflammatory drug. As diclofenac is an over-the-counter drug, its use among patients cannot be monitored by health teams in follow-up sessions. Given the multiple sources of diclofenac sodium, their interchangeability must be investigated, particularly in the form of in vitro studies, which are the most practical research type and entail minimal ethical commitment. Objectives: To determine the interchangeability of the different commercial brands of diclofenac sodium relative to the innovative product, this work carries out an in vitro study of eight commercial products of diclofenac sodium (50 mg) following the guidelines of the Biopharmaceutical Classification System. Materials and methods: Physical and chemical tests were developed following the guidelines of the 39th edition of the United States Pharmacopoeia. An analytical methodology was validated for the quantification of diclofenac according to the current pharmacopoeia and the Q2 guideline ofthe International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH). Dissolution profiles and their analyseswere governed by the regulations established by the World Health Organization and the national regulations. Results: All the products passed the physical tests. In the dissolution assays, the acid stage was overcome by all brands, but in the alkaline stage, one brand failed. The analysis of the similarities revealed that only one product was equivalent to the innovator and that three were supra-available, although these brands could also be considered equivalent to the innovator. Conclusions: Of the eight brands evaluated, three failed the test forthe active principle and the percentage of dissolution. Only one brand was found to be interchangeable with the innovator, and three were identified to besupra-availableand, thus, they do not present a risk for patients.