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Lalonde RL, Peck CC. Probability of Success: A Crucial Concept to Inform Decision Making in Pharmaceutical Research and Development. Clin Pharmacol Ther 2021; 111:1001-1003. [PMID: 34951934 DOI: 10.1002/cpt.2513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Richard L Lalonde
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Carl C Peck
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA.,NDA Partners, a ProPharma Company, Rochelle, Virginia, USA
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2
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Wilson JL, Cheung KWK, Lin L, Green EAE, Porrás AI, Zou L, Mukanga D, Akpa PA, Darko DM, Yuan R, Ding S, Johnson WCN, Lee HA, Cooke E, Peck CC, Kern SE, Hartman D, Hayashi Y, Marks PW, Altman RB, Lumpkin MM, Giacomini KM, Blaschke TF. Scientific considerations for global drug development. Sci Transl Med 2021; 12:12/554/eaax2550. [PMID: 32727913 DOI: 10.1126/scitranslmed.aax2550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/05/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
Requiring regional or in-country confirmatory clinical trials before approval of drugs already approved elsewhere delays access to medicines in low- and middle-income countries and raises drug costs. Here, we discuss the scientific and technological advances that may reduce the need for in-country or in-region clinical trials for drugs approved in other countries and limitations of these advances that could necessitate in-region clinical studies.
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Affiliation(s)
- Jennifer L Wilson
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kit Wun Kathy Cheung
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lawrence Lin
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A E Green
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Analia I Porrás
- Medicines and Health Technologies Unit, Department of Health Systems and Services, Pan American Health Organization, Regional Office of the World Health Organization, Washington, DC, USA
| | - Ling Zou
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - David Mukanga
- Global Health, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Paul A Akpa
- Department of Pharmaceutics, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | - Rae Yuan
- Sinovant Sciences Co., Shanghai, China
| | - Sheng Ding
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.,Gladstone Institute of Cardiovascular Disease, San Francisco, CA, USA
| | | | - Howard A Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea.,Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic of Korea
| | - Emer Cooke
- World Health Organization, Geneva, Switzerland
| | - Carl C Peck
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.,NDA Partners LLC, San Luis Obispo, CA, USA
| | - Steven E Kern
- Global Health, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Dan Hartman
- Global Health, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | | | - Peter W Marks
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Russ B Altman
- Departments of Bioengineering and Genetics, Stanford University, Stanford, CA, USA
| | - Murray M Lumpkin
- Global Health, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Terrence F Blaschke
- Departments of Medicine and Molecular Pharmacology, Stanford University School of Medicine, Stanford, CA, USA
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3
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Temple RJ, O'Neill RT, Peck CC. Farewell to our Wonderful Friend and Colleague, J. Richard (Dick) Crout (1929-2020). Clin Pharmacol Ther 2020; 109:1384-1387. [PMID: 33111972 DOI: 10.1002/cpt.2063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Robert J Temple
- Deputy Director for Clinical Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert T O'Neill
- Former Director of the Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Bethany, Delaward, USA
| | - Carl C Peck
- Department of Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, California, USA.,NDA Partners, LLC, Rochelle, Virginia, USA
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4
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Peck CC, Breckenridge RA. Sir Alasdair Breckenridge 1937–2019. A Celebratory Tribute. Clin Pharmacol Ther 2020; 108:22-25. [DOI: 10.1002/cpt.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Carl C. Peck
- Department of Bioengineering and Therapeutic Sciences University of California at San Francisco San Francisco California USA
- NDA Partners, LLC Rochelle Virginia USA
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5
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Breckenridge AM, Breckenridge RA, Peck CC. Report on the current status of the use of real-world data (RWD) and real-world evidence (RWE) in drug development and regulation. Br J Clin Pharmacol 2019; 85:1874-1877. [PMID: 31290181 DOI: 10.1111/bcp.14026] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 05/08/2019] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 12/28/2022] Open
Abstract
Radically expanding use of real-world data (RWD) and real-world evidence (RWE) holds the potential to substantially impact drug development, pharmaceutical regulation, and payment within health care systems. Central to this is the reconfiguration of data gathering and transformation of data to information, which can be used as evidence for decision making. We discuss applications of this paradigm in the light of recent developments in both the United States and Europe on RWD and RWE.
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Affiliation(s)
- Alasdair M Breckenridge
- Clinical Pharmacology, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Ross A Breckenridge
- ARJUNA Therapeutics, C/ XESTA №78-A2, PARQUE EMPRESARIAL NOVO MILLADOIRO - 15895 MILLADOIRO, A CORUÑA, Spain
| | - Carl C Peck
- Department of Bioengineering and Therapeutic Sciences, University of California at San Francisco, San Francisco, CA, USA.,NDA Partners, LLC, Rochelle, VA, USA
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6
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Peck CC, Campbell G. Bayesian Approach to Establish Bioequivalence: Why and How? Clin Pharmacol Ther 2019; 105:301-303. [DOI: 10.1002/cpt.1288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Carl C. Peck
- Department of Bioengineering and Therapeutic SciencesUniversity of California San Francisco California USA
- NDA Partners LLC San Luis Obispo California USA
| | - Gregory Campbell
- GCStat Consulting, LLC Silver Spring Maryland USA
- NDA Partners LLC Silver Spring Maryland USA
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7
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Alshelh Z, Di Pietro F, Mills EP, Vickers ER, Peck CC, Murray GM, Henderson LA. Altered regional brain T2 relaxation times in individuals with chronic orofacial neuropathic pain. Neuroimage Clin 2018; 19:167-173. [PMID: 30035014 PMCID: PMC6051476 DOI: 10.1016/j.nicl.2018.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/15/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 01/12/2023]
Abstract
The neural mechanisms underlying the development and maintenance of chronic pain following nerve injury remain unclear. There is growing evidence that chronic neuropathic pain is associated with altered thalamic firing patterns, thalamocortical dysrhythmia and altered infra-slow oscillations in ascending pain pathways. Preclinical and post-mortem human studies have revealed that neuropathic pain is associated with prolonged astrocyte activation in the dorsal horn and we have suggested that this may result in altered gliotransmission, which results in altered resting neural rhythm in the ascending pain pathway. Evidence of astrocyte activation above the level of the dorsal horn in living humans is lacking and direct measurement of astrocyte activation in living humans is not possible, however, there is evidence that regional alterations in T2 relaxation times are indicative of astrogliosis. The aim of this study was to use T2 relaxometry to explore regional brain anatomy of the ascending pain pathway in individuals with chronic orofacial neuropathic pain. We found that in individuals with trigeminal neuropathic pain, decreases in T2 relaxation times occurred in the region of the spinal trigeminal nucleus and primary somatosensory cortex, as well as in higher order processing regions such as the dorsolateral prefrontal, cingulate and hippocampal/parahippocampal cortices. We speculate that these regional changes in T2 relaxation times reflect prolonged astrocyte activation, which results in altered brain rhythm and ultimately the constant perception of pain. Blocking prolonged astrocyte activation may be effective in preventing and even reversing the development of chronic pain following neural injury. Reduced T2 relaxation time in the ascending pain pathway in chronic orofacial pain. These reductions may be associated with astrogliosis. Increase astrocyte activity associated with chronic orofacial pain.
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Affiliation(s)
- Z Alshelh
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - F Di Pietro
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - E P Mills
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - E R Vickers
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia
| | - C C Peck
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - G M Murray
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - L A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, 2006, Australia.
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8
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Aksenov S, Peck CC, Eriksson UG, Stanski DR. Individualized treatment strategies for hyperuricemia informed by a semi-mechanistic exposure-response model of uric acid dynamics. Physiol Rep 2018; 6:e13614. [PMID: 29488355 PMCID: PMC5828935 DOI: 10.14814/phy2.13614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/06/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/08/2023] Open
Abstract
To provide insight into pharmacological treatment of hyperuricemia we developed a semi-mechanistic, dynamical model of uric acid (UA) disposition in human. Our model represents the hyperuricemic state in terms of production of UA (rate, PUA), its renal filtration (glomerular filtration rate, GFR) and proximal tubular reabsorption (fractional excretion coefficient, FE). Model parameters were estimated using data from 9 Phase I studies of xanthine oxidase inhibitors (XOI) allopurinol and febuxostat and a novel uricosuric, the selective UA reabsorption inhibitor lesinurad, approved for use in combination with a XOI. The model was qualified for prediction of the effect of patients' GFR and FE on concentration of UA in serum (sUA) and UA excretion in urine and their response to drug treatment, using data from 2 Phase I and 4 Phase III studies of lesinurad. Percent reduction in sUA from baseline by a XOI is predicted to be independent of GFR, FE or PUA. Uricosurics are more effective in underexcreters of UA or patients with normal GFR. Co-administration of a XOI and an uricosuric agent should be considered for patients with high sUA first in the treatment algorithm of gout before uptitration of XOI. The XOI dose in combination with a uricosuric can be reduced compared to XOI alone for the same target sUA to the degree dependent on patient's GFR and FE. This exposure-response model of UA can be used to rationally select the best drug treatment option to lower elevated sUA in gout patients under differing pathophysiological situations.
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Affiliation(s)
- Sergey Aksenov
- Quantitative Clinical PharmacologyEarly Clinical DevelopmentIMED Biotech UnitAstraZenecaWalthamMA
| | - Carl C. Peck
- University of California at San Francisco and NDA Partners LLCSan Luis ObispoCA
| | - Ulf G. Eriksson
- Quantitative Clinical PharmacologyEarly Clinical DevelopmentIMED Biotech UnitAstraZenecaGothenburgSweden
| | - Donald R. Stanski
- Quantitative Clinical PharmacologyEarly Clinical DevelopmentIMED Biotech UnitAstraZenecaGaithersburgMD
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9
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Schwartz JB, Woosley RL, Peck CC. Farewell to Our Good Friend, Outstanding Mentor, and Colleague Darrell R. Abernethy (1949-2017). Clin Pharmacol Ther 2018; 103:552-555. [PMID: 29435985 DOI: 10.1002/cpt.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 11/11/2022]
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10
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Alshelh Z, Marciszewski KK, Akhter R, Di Pietro F, Mills EP, Vickers ER, Peck CC, Murray GM, Henderson LA. Disruption of default mode network dynamics in acute and chronic pain states. Neuroimage Clin 2017; 17:222-231. [PMID: 29159039 PMCID: PMC5683191 DOI: 10.1016/j.nicl.2017.10.019] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/08/2017] [Accepted: 10/18/2017] [Indexed: 12/21/2022]
Abstract
It has been proposed that pain competes with other attention-demanding stimuli for cognitive resources, and many chronic pain patients display significant attention and mental flexibility deficits. These alterations may result from disruptions in the functioning of the default mode network (DMN) which plays a critical role in attention, memory, prospection and self-processing, and recent investigations have found alterations in DMN function in multiple chronic pain conditions. Whilst it has been proposed that these DMN alterations are a characteristic of pain that is chronic in nature, we recently reported altered oscillatory activity in the DMN during an acute, 5 minute noxious stimulus in healthy control subjects. We therefore hypothesize that altered DMN activity patterns will not be restricted to those in chronic pain but instead will also occur in healthy individuals during tonic noxious stimuli. We used functional magnetic resonance imaging to measure resting state infra-slow oscillatory activity and functional connectivity in patients with chronic orofacial pain at rest and in healthy controls during a 20-minute tonic pain stimulus. We found decreases in oscillatory activity in key regions of the DMN in patients with chronic pain, as well as in healthy controls during tonic pain in addition to changes in functional connectivity between the posterior cingulate cortex and areas of the DMN in both groups. The results show that similar alterations in DMN function occur in healthy individuals during acute noxious stimuli as well as in individuals with chronic pain. These DMN changes may reflect the presence of pain per se and may underlie alterations in attentional processes that occur in the presence of pain. Default mode network dynamics were measured in chronic and acute pain. Altered infra-slow activity and connectivity occurred in chronic and acute pain. Default mode network changes characterize pain per se.
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Affiliation(s)
- Z Alshelh
- Department of Anatomy and Histology, University of Sydney, 2006, Australia
| | - K K Marciszewski
- Department of Anatomy and Histology, University of Sydney, 2006, Australia
| | - R Akhter
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - F Di Pietro
- Department of Anatomy and Histology, University of Sydney, 2006, Australia
| | - E P Mills
- Department of Anatomy and Histology, University of Sydney, 2006, Australia
| | - E R Vickers
- Department of Anatomy and Histology, University of Sydney, 2006, Australia
| | - C C Peck
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - G M Murray
- Faculty of Dentistry, University of Sydney, 2006, Australia
| | - L A Henderson
- Department of Anatomy and Histology, University of Sydney, 2006, Australia.
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11
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Suh HY, Peck CC, Yu KS, Lee H. Determination of the starting dose in the first-in-human clinical trials with monoclonal antibodies: a systematic review of papers published between 1990 and 2013. Drug Des Devel Ther 2016; 10:4005-4016. [PMID: 27994442 PMCID: PMC5153257 DOI: 10.2147/dddt.s121520] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Indexed: 12/16/2022]
Abstract
A systematic review was performed to evaluate how the maximum recommended starting dose (MRSD) was determined in first-in-human (FIH) studies with monoclonal antibodies (mAbs). Factors associated with the choice of each MRSD determination method were also identified. PubMed was searched for FIH studies with mAbs published in English between January 1, 1990 and December 31, 2013, and the following information was extracted: MRSD determination method, publication year, therapeutic area, antibody type, safety factor, safety assessment results after the first dose, and number of dose escalation steps. Seventy-nine FIH studies with mAbs were identified, 49 of which clearly reported the MRSD determination method. The no observed adverse effects level (NOAEL)-based approach was the most frequently used method, whereas the model-based approach was the least commonly used method (34.7% vs 16.3%). The minimal anticipated biological effect level (MABEL)- or minimum effective dose (MED)-based approach was used more frequently in 2011–2013 than in 1990–2007 (31.6% vs 6.3%, P=0.036), reflecting a slow, but steady acceptance of the European Medicines Agency’s guidance on mitigating risks for FIH clinical trials (2007). The median safety factor was much lower for the MABEL- or MED-based approach than for the other MRSD determination methods (10 vs 32.2–53). The number of dose escalation steps was not significantly different among the different MRSD determination methods. The MABEL-based approach appears to be safer and as efficient as the other MRSD determination methods for achieving the objectives of FIH studies with mAbs faster.
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Affiliation(s)
- Hoon Young Suh
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Carl C Peck
- Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Howard Lee
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Seoul National University Hospital, Seoul, Korea; Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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12
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Peck CC, Woosley RL. Farewell to our Good Friend and Outstanding Colleague David Flockhart (1952-2015). Clin Pharmacol Ther 2016; 99:139-42. [DOI: 10.1002/cpt.327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 11/08/2022]
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13
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Layton D, Peck CC, Whittle T, Klineberg IJ. A clinical trial of active and passive treatment for TMD: a pilot study. Aust Dent J 2014. [DOI: 10.1111/j.1834-7819.2007.tb06131.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Wirianski A, Deall S, Whittle T, Wong M, Murray GM, Peck CC. Isotonic resistance jaw exercise alters jaw muscle coordination during jaw movements. J Oral Rehabil 2014; 41:353-66. [PMID: 24612288 DOI: 10.1111/joor.12153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 01/20/2014] [Indexed: 11/28/2022]
Abstract
The aim was to investigate the effects of isotonic resistance exercise on the electro-myographic (EMG) activity of the jaw muscles during standardised jaw movements. In 12 asymptomatic adults surface EMG activity was recorded from the anterior temporalis and masseter muscles bilaterally and the right anterior digastric muscle during right lateral jaw movements that tracked a target. Participants were randomly assigned to a Control group or an Exercise group. Jaw movement and EMG activity were collected (i) at baseline, before the exercise task (pre-exercise); (ii) immediately after the exercise task (isotonic resistance at 60% MVC against right lateral jaw movements); (iii) after 4 weeks of a home-based exercise programme; and, (iv) at 8-weeks follow-up. There were no significant within-subject or between-group differences in the velocity and amplitude of the right lateral jaw movements either within or between data collection sessions (P > 0.05). However, over the 8 weeks of the study, three of the tested EMG variables (EMG Duration, Time to Peak EMG from EMG Onset, and Time to Peak EMG activity relative to Movement Onset) showed significant (P < 0.05) differences in the five tested muscles. Many of the significant changes occurred in the Control group, while the Exercise group tended to maintain the majority of the tested variables at pre-exercise baseline values. The data suggest a level of variability between recording sessions in the recruitment patterns of some of the muscles of mastication for the production of the same right lateral jaw movement and that isotonic resistance exercise may reduce this variability.
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Affiliation(s)
- A Wirianski
- Jaw Function and Orofacial Pain Research Unit, Westmead Hospital Centre for Oral Health, Faculty of Dentistry, University of Sydney, Professorial Unit, Level 2, Westmead, NSW, Australia
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15
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Yim DS, Zhou H, Buckwalter M, Nestorov I, Peck CC, Lee H. Population Pharmacokinetic Analysis and Simulation of the Time-Concentration Profile of Etanercept in Pediatric Patients With Juvenile Rheumatoid Arthritis. J Clin Pharmacol 2013; 45:246-56. [PMID: 15703360 DOI: 10.1177/0091270004271945] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was performed to estimate the population pharmacokinetic (PK) parameters of etanercept in pediatric juvenile rheumatoid arthritis (JRA) patients and to compare the steady-state time-concentration profiles between etanercept 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly subcutaneous (SC) regimens by clinical trial simulation. To this end, mixed-effect analysis (NONMEM, Version 5.1) was performed using the etanercept PK database consisting of 69 JRA patients (4-17 years). Based on the population PK parameters obtained herein, a Monte Carlo clinical trial simulation experiment was conducted to compare the PK profiles in 200 virtual JRA patients who randomly received either etanercept 0.4 mg/kg SC twice weekly or 0.8 mg/kg once weekly for 12 weeks. The following population PK model could adequately describe etanercept PK profiles for twice-weekly SC dosing of 0.4 mg/kg: CL/F (L/h)=0.0576 (female) or 0.0772 (male) x (body surface area in m2/1.071)1.41, V/F(L)=7.88 x (body weight in kg/30.8). The means +/- standard deviations of simulated trough concentrations for 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly dosing regimens were 1.58 +/- 1.07 mg/L and 1.92 +/- 1.09 mg/L, respectively. Peaks during 0.8-mg/kg once-weekly dosing (2.92 +/- 1.41 mg/L) were only 11% higher than during 0.4 mg/kg twice-weekly dosing (2.62 +/- 1.23 mg/L). In conclusion, the clinical trial simulation confirmed that 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly SC regimens of etanercept are expected to yield overlapping steady-state time-concentration profiles, leading to equivalent clinical outcomes. This has been the basis of the recent Food and Drug Administration approval of the 0.8-mg/kg once-weekly regimen in pediatric patients with JRA.
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Affiliation(s)
- Dong-Seok Yim
- Center for Drug Development Science, Department of Pharmacology, Box 571441, Georgetown University School of Medicine, Washington, DC 20057-1441, USA
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Rowland M, Noe CR, Smith DA, Tucker GT, Crommelin DJA, Peck CC, Rocci ML, Besançon L, Shah VP. Impact of the pharmaceutical sciences on health care: a reflection over the past 50 years. J Pharm Sci 2012; 101:4075-99. [PMID: 22911654 DOI: 10.1002/jps.23295] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/10/2012] [Accepted: 07/31/2012] [Indexed: 11/07/2022]
Abstract
During the last century, particularly the latter half, spectacular progress has been made in improving the health and longevity of people. The reasons are many, but the development of medicines has played a critical role. This report documents and reflects on the impressive contribution that those working in the pharmaceutical sciences have made to healthcare over the past 50 years. It is divided into six sections (drug discovery; absorption, distribution, metabolism, and excretion; pharmacokinetics and pharmacodynamics; drug formulation; drug regulation; and drug utilization), each describing key contributions that have been made in the progression of medicines, from conception to use. A common thread throughout is the application of translational science to the improvement of drug discovery, development, and therapeutic application. Each section has been coordinated by a leading scientist who was asked, after consulting widely with many colleagues across the globe, to identify "The five most influential ideas/concepts/developments introduced by 'pharmaceutical scientists' (in their field) over the past 50 years?" Although one cannot predict where the important breakthroughs will come in the future to meet the unmet medical needs, the evidence presented in this report should leave no doubt that those engaged in the pharmaceutical sciences will continue to make their contributions heavily felt.
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Affiliation(s)
- Malcolm Rowland
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK.
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Abstract
BACKGROUND The "gate control" theory suggests pain can be reduced by simultaneous activation of nerve fibres that conduct non-noxious stimuli. This study investigated the effects of vibration stimuli on pain experienced during local anaesthetic injections. METHODS In a preliminary study, subjects were asked to rate anticipated and actual pain from regional anaesthetic injections in the oral cavity. A second study compared, within subjects, pain from injections with and without a simultaneous vibration stimulus. Both infiltration and block anaesthetic injection techniques were assessed. In each subject, two similar injections were given and with one, a vibration stimulus was randomly allocated. Injection pain was assessed by visual analogue scale and McGill pain descriptors. RESULTS Both infiltration and block injections were painful (mean anticipated intensity: 31.25, actual: 17.82 mm on 100 mm scale). Pain intensity with and without vibration was 12.9 mm (range 0-67) and 22.2 mm (range 0-83) respectively (p = 0.00005, paired T-test), and this effect was seen with both infiltration (p = 0.032) and block anaesthetic (p = 0.0001) injection subgroups. Furthermore, compared to no vibration-stimulus injections, injections with vibration resulted in less pain descriptors chosen (p = 0.004), and the descriptors had a lower pain rating (p = 0.001). CONCLUSIONS The results suggest that vibration can be used to decrease pain during dental local anaesthetic administration.
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Affiliation(s)
- E Nanitsos
- Faculty of Dentistry, The University of Sydney, New South Wales
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Ratain MJ, Humphrey RW, Gordon GB, Fyfe G, Adamson PC, Fleming TR, Stadler WM, Berry DA, Peck CC. Recommended changes to oncology clinical trial design: revolution or evolution? Eur J Cancer 2007; 44:8-11. [PMID: 17981025 DOI: 10.1016/j.ejca.2007.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 09/19/2007] [Indexed: 12/22/2022]
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Affiliation(s)
- C C Peck
- Center for Drug Development Science, University of California San Francisco, CA, USA.
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Tannenbaum SJ, Holford NHG, Lee H, Peck CC, Mould DR. Simulation of Correlated Continuous and Categorical Variables using a Single Multivariate Distribution. J Pharmacokinet Pharmacodyn 2006; 33:773-94. [PMID: 17053984 DOI: 10.1007/s10928-006-9033-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 03/25/2006] [Accepted: 08/22/2006] [Indexed: 11/28/2022]
Abstract
Clinical trial simulations make use of input/output models with covariate effects; the virtual patient population generated for the simulation should therefore display physiologically reasonable covariate distributions. Covariate distribution modeling is one method used to create sets of covariate values (vectors) that characterize individual virtual patients, which should be representative of real subjects participating in clinical trials. Covariates can be continuous (e.g., body weight, age) or categorical (e.g., sex, race). A modeling method commonly used for incorporating both continuous and categorical covariates, the Discrete method, requires the patient population to be divided into subgroups for each unique combination of categorical covariates, with separate multivariate functions for the continuous covariates in each subset. However, when there are multiple categorical covariates this approach can result in subgroups with very few representative patients, and thus, insufficient data to build a model that characterizes these patient groups. To resolve this limitation, an application of a statistical methodology (Continuous method) was conceived to enable sampling of complete covariate vectors, including both continuous and categorical covariates, from a single multivariate function. The Discrete and Continuous methods were compared using both simulated and real data with respect to their ability to generate virtual patient distributions that match a target population. The simulated data sets consisted of one categorical and two correlated continuous covariates. The proportion of patients in each subgroup, correlation between the continuous covariates, and ratio of the means of the continuous covariates in the subgroups were varied. During evaluation, both methods accurately generated the summary statistics and proper proportions of the target population. In general, the Continuous method performed as well as the Discrete method, except when the subgroups, defined by categorical value, had markedly different continuous covariate means, for which, in the authors' experience, there are few clinically relevant examples. The Continuous method allows analysis of the full population instead of multiple subgroups, reducing the number of analyses that must be performed, and thereby increasing efficiency. More importantly, analyzing a larger pool of data increases the precision of the covariance estimates of the covariates, thus improving the accuracy of the description of the covariate distribution in the simulated population.
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Affiliation(s)
- Stacey J Tannenbaum
- Novartis Pharmaceuticals Corp., One Health Plaza 435/1125, East Hanover, NJ 07936, USA.
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Huang BY, Whittle T, Peck CC, Murray GM. Ipsilateral interferences and working-side condylar movements. Arch Oral Biol 2006; 51:206-14. [PMID: 16154529 DOI: 10.1016/j.archoralbio.2005.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 02/16/2005] [Revised: 07/12/2005] [Accepted: 07/20/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED There is limited knowledge of the effects of the occlusion on temporomandibular joint function. AIM The aim was to investigate the influence of a working-side occlusal alteration (OA, i.e. interference) on trajectories of working-side condylar points during standardized lateral jaw movements (laterotrusion) tracked by a jaw-tracking system. METHODS Ten trials of right laterotrusion were repeated under: control 1 (before OA), OA (immediately after placement of a working-side interference) and control 2 (immediately after removal of OA) conditions. RESULTS During right jaw movement, the paths of the working-side condylar points under OA were significantly more inferior and anterior to those under control at the same amount of mid-incisor-point displacement from the intercuspal position. The OA significantly reduced the rotation of the mandible about the antero-posterior and supero-inferior axes and significantly increased the opening angle. Controls 1 and 2 were not significantly different. CONCLUSIONS A working-side interference has an immediate, significant effect on working-side condylar movement.
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Affiliation(s)
- B-Y Huang
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Level 3, Professorial Unit, Westmead Centre for Oral Health, Westmead, NSW 2145, Australia
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Abstract
Drug development can be a science of extrapolation if the use of a drug exposure-response relationship is embraced and implemented through mechanistically oriented pharmacokinetic (PK)-pharmacodynamic (PD) modeling analysis and clinical trial simulation. The traditional requirement of at least 2 adequate and well-controlled phase III studies by the US Food and Drug Administration for drug approval can be waived in certain situations, substantially reducing the resources and time. In this article, the authors introduce a real drug development case where the chance for this exemption was maximized by actively using PK-PD modeling followed by clinical trial simulation, resulting in faster and more economical introduction of a new dosage regimen to patients.
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Affiliation(s)
- Howard Lee
- Center for Clinical Pharmacology, University of Pittsburgh, Pittsburgh, PA 15219, USA.
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Affiliation(s)
- Holger Kraiczi
- Department of Clinical Pharmacology, Gothenburg University, Sweden
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Affiliation(s)
- Carl C Peck
- Center for Drug Development Science, Office of the Associate Dean for Clinical Research, Georgetown University School of Medicine, Washington, USA
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Lee H, Kimko HC, Rogge M, Wang D, Nestorov I, Peck CC. Population pharmacokinetic and pharmacodynamic modeling of etanercept using logistic regression analysis. Clin Pharmacol Ther 2003; 73:348-65. [PMID: 12709725 DOI: 10.1016/s0009-9236(02)17635-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Our objective was to develop a population pharmacokinetic and pharmacodynamic model of etanercept in patients with rheumatoid arthritis, with the American College of Rheumatology response criterion of 20% improvement (ACR20) used as a binary clinical outcome variable. METHODS Concentration-time profiles from 25 subjects, administered 25 mg subcutaneous etanercept twice weekly for 24 weeks, were pooled with data from 77 subjects, enrolled in a 24-week, randomized, double-blind study comparing 25 mg and 50 mg subcutaneous etanercept twice weekly. The cumulative area under the concentration-time curve (AUC) was used as the exposure variable, and ACR20 was the binomial clinical outcome. ACR20 data from another 80 placebo-treated patients enrolled in a randomized, double-blind phase III study were used to describe the placebo time course of ACR20. A logistic regression analysis with NONMEM was applied to describe the exposure-response relationship, and the 95% confidence intervals (95% CIs) were constructed by bootstrapping 1000 times. RESULTS The population mean apparent clearance was 0.117 L/h (95% CI, 0.108-0.130 L/h) for white female patients and 0.138 L/h (95% CI, 0.118-0.163 L/h) for white male patients. Interindividual variability and interoccasion variability were 41.1% and 27.6%, respectively. The mean absorption half-life was 20.9 hours, and the elimination half-life was 95.4 hours. An improved response profile in male patients was shown, but the multiplicative factor between slope on cumulative AUC between male and female patients was not statistically significant (1.69; 95% CI, 0.37-9.99). The model-predicted percentage of patients achieving ACR20 at 6 months after dosing of 25 mg subcutaneously twice weekly was 54.9%, comparable to the observed 52.9%. CONCLUSION The population pharmacokinetic analysis confirmed that etanercept is slowly absorbed and eliminated after subcutaneous administration. The logistic model linking cumulative AUC with ACR20 adequately characterized the time course of clinical improvement in patients with rheumatoid arthritis receiving etanercept.
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Affiliation(s)
- Howard Lee
- Center for Drug Development Science, Georgetown University, Washington DC 20057-1441, USA.
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Peck CC, Wechsler J. Report of a Workshop on Confirmatory Evidence to Support a Single Clinical Trial As a Basis for New Drug Approval. ACTA ACUST UNITED AC 2002. [DOI: 10.1177/009286150203600307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Forces opening the relaxed human jaw are resisted by intrinsic restraints, including passive tensions in the jaw-closing muscles. These muscle tensions have been modelled as viscoelastic elements, and static measurements suggest their elastic portions contribute approximately a total of 5 N resistance at wide gape. As the viscous damping properties of muscles which affect the jaw's dynamic behaviour are unknown, we measured the jaw opening force required to reach maximum gape during fast and slow opening in six relaxed subjects. These data were then incorporated in a dynamic mathematical jaw model to determine the damping properties of the masticatory system. During the 3 and 8 s opening trials, forces increased with gape (6.7 +/- 3.3 and 3.9 +/- 2.3 N, respectively, at 50% gape) and reached their maxima at wide gape (19.9 +/- 4.5 and 13.2 +/- 4.4 N, respectively). The muscle damping constant needed by the model to emulate these results was 150 Nsm(-1), approximately 25% lower than the calculated critical damping constant. This study suggests low forces are required to open the jaw in relaxed humans, and that jaw viscosity, not elasticity, provides the major resistance to motion.
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Affiliation(s)
- C C Peck
- The University of British Columbia, Wesbrook Mall, Vancouver BC, Canada.
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Walton JN, Huizinga SC, Peck CC. Implant angulation: a measurement technique, implant overdenture maintenance, and the influence of surgical experience. INT J PROSTHODONT 2001; 14:523-30. [PMID: 12066698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE The purposes of this study were to develop a technique to measure the angulation between two implants and between each implant and reference planes, to analyze the relationship between the maintenance (adjustments and repairs) of ball-attachment mandibular implant overdentures and implant angulation, and to see if there is any correlation between surgeon experience and implant orientation. MATERIALS AND METHODS Final casts of 41 patients who had received two-implant ball-attachment mandibular overdentures were used to measure implant angulations using digital photographs and plane geometry. The measured angles were compared with the number of adjustments and repairs of the prostheses and analyzed by surgeon experience for any trends. RESULTS No significant relationships were found between number of adjustments and repairs and the interimplant angles. However, there was a significantly higher number of repairs when the lingual inclination of an implant was > or = 6.0 degrees (P = .033) or if the facial inclination was < 6.5 degrees (P = .036). Less experienced surgeons had a significantly greater tendency to place implants that diverged from each other in the frontal plane (P = .045) and with a facial or lingual inclination in the sagittal plane (P = .035). CONCLUSION While interimplant angulation did not appear to affect prosthesis maintenance, individual implants with a lingual inclination > or = 6 degrees and a facial inclination < 6.5 degrees were associated with significantly more prosthesis repairs. There was a tendency for implants placed by less experienced surgeons to demonstrate greater inclination.
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Affiliation(s)
- J N Walton
- Department of Oral Health Sciences, University of British Colombia, 2199 Wesbrook Mall, Vancouver, British Colombia, Canada, V6T 1Z3.
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31
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Galluppi GR, Rogge MC, Roskos LK, Lesko LJ, Green MD, Feigal DW, Peck CC. Integration of pharmacokinetic and pharmacodynamic studies in the discovery, development, and review of protein therapeutic agents: a conference report. Clin Pharmacol Ther 2001; 69:387-99. [PMID: 11406736 DOI: 10.1067/mcp.2001.115455] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lesko LJ, Rowland M, Peck CC, Blaschke TF. Optimizing the science of drug development: opportunities for better candidate selection and accelerated evaluation in humans. Pharm Res 2000; 17:1335-44. [PMID: 11205725 DOI: 10.1023/a:1007574217260] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- L J Lesko
- Office of Clinical Pharmacology and Biopharmaceutics, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, Maryland 20851, USA
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Kimko HC, Reele SS, Holford NH, Peck CC. Prediction of the outcome of a phase 3 clinical trial of an antischizophrenic agent (quetiapine fumarate) by simulation with a population pharmacokinetic and pharmacodynamic model. Clin Pharmacol Ther 2000; 68:568-77. [PMID: 11103759 DOI: 10.1067/mcp.2000.110975] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A completed phase 3 trial result was simulated 100 times on the basis of a simulation model of quetiapine fumarate (Seroquel), an antischizophrenic agent. The simulation was executed by analysts who were completely blinded from results of the actual trial until after the simulations were submitted to the holder of the trial results. Data from two clinical investigations of quetiapine in patients with schizophrenia were analyzed by use of nonlinear mixed effects modeling to derive a population pharmacokinetic- and pharmacodynamic-based simulation model. The time course of quetiapine concentrations was described by use of a one-compartment open linear pharmacokinetic model with first-order absorption and elimination. The combination of an inhibitory maximum effect pharmacodynamic model for the active treatment effect and a linear function of time for the placebo effect characterized the observed time course of change in the Brief Psychiatric Rating Scale. Simulation results were compared with those in the actual trial to evaluate how well the simulations predicted the outcome. The actual trial results for all doses except the placebo group fell within the predicted Brief Psychiatric Rating Scale scores +/- 1 SE. Unlike the phase 2 trial, from which the pharmacokinetic/pharmacodynamic model was developed, the placebo group in the actual phase 3 trial showed deterioration of Brief Psychiatric Rating Scale scores with time. We conclude that variable placebo responses observed in short-term studies of schizophrenia provide an inadequate basis for the modeling and simulation of placebo subjects in clinical trials. Knowledge of the range of placebo response observed in other studies may have provided an improved basis for the placebo effect model. The model for active drug produced adequate predictions of the actual trial outcomes.
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Affiliation(s)
- H C Kimko
- Center for Drug Development Science, Georgetown University Medical Center, Washington, DC 20007, USA.
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Abstract
Human mandibular function is determined in part by masticatory muscle tensions and morphological restraints within the craniomandibular system. As only limited information about their interactions can be obtained in vivo, mathematical modeling is a useful alternative. It allows simulation of causal relations between structure and function and the demonstration of hypothetical events in functional or dysfunctional systems. Here, the external force required to reach maximum jaw gape was determined in five relaxed participants, and this information used, with other musculoskeletal data, to construct a dynamic, muscle-driven, three-dimensional mathematical model of the craniomandibular system. The model was programmed to express relations between muscle tensions and articular morphology during wide jaw opening. It was found that a downward force of 5 N could produce wide gape in vivo. When the model's passive jaw-closing muscle tensions were adjusted to permit this, the jaw's resting posture was lower than that normally observed in alert individuals, and low-level active tone was needed in the closer muscles to maintain a typical rest position. Plausible jaw opening to wide gape was possible when activity in the opener muscles increased incrementally over time. When the model was altered structurally by decreasing its angles of condylar guidance, jaw opening required less activity in these muscles. Plausible asymmetrical jaw opening occurred with deactivation of the ipsilateral lateral pterygoid actuator. The model's lateral deviation was limited by passive tensions in the ipsilateral medial pterygoid, which forced the jaw to return towards the midline as opening continued. For all motions, the temporomandibular joint (TMJ) components were maintained in continual apposition and displayed stable pathways despite the absence of constraining ligaments. Compressive TMJ forces were presented in all the cases and increased to maximum at wide gape. Dynamic mathematical modeling appears a useful way to study such events, which as yet are unrecordable in the human craniomandibular system.
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Affiliation(s)
- C C Peck
- Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, BC, V6T 1Z3, Vancouver, Canada
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Lesko LJ, Rowland M, Peck CC, Blaschke TF, Breimer D, de Jong HJ, Grahnen A, Kuhlmann JJ, Stewart B. Optimizing the science of drug development: opportunities for better candidate selection and accelerated evaluation in humans. Eur J Pharm Sci 2000; 10:iv-xiv. [PMID: 11023342 DOI: 10.1016/s0928-0987(00)00092-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- L J Lesko
- Office of Clinical Pharmacology and Biopharmaceutics, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD 20851, USA
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Abstract
Computer simulation of clinical trials has evolved over the past two decades from a simple instructive game to "full" simulation models yielding pharmacologically sound, realistic trial outcomes. The need to make drug development more efficient and informative and the awareness that many industries make extensive use of simulation in product development have advanced considerably the use of simulation of clinical trials in pharmaceutical product development over the past decade. The structural and stochastic components of trial simulation models are explained as a prelude to a listing of representative simulation projects, reflecting investigative applications of statistical methods, trial design comparisons, and full simulation of new drugs being developed. Lessons learned from these projects are reviewed in the context of their current impact and potential for influencing the future of drug development.
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Affiliation(s)
- N H Holford
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, New Zealand.
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Karlsson MO, Schoemaker RC, Kemp B, Cohen AF, van Gerven JM, Tuk B, Peck CC, Danhof M. A pharmacodynamic Markov mixed-effects model for the effect of temazepam on sleep. Clin Pharmacol Ther 2000; 68:175-88. [PMID: 10976549 DOI: 10.1067/mcp.2000.108669] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A hypnogram shows how sleep travels through its various stages in the course of a night. The sleep stage changes can be quantified to study sedative drug effects. METHODS Hypnograms from 21 patients with primary insomnia were collected during a randomized, placebo-controlled crossover study of 20 mg temazepam. A separate daytime session was performed to determine the pharmacokinetics of 20 mg temazepam and its effect on saccadic eye movement and electroencephalogram. A first-order Markov model was developed to describe the probability of sleep stage changes as a function of time after drug intake and time after last sleep stage change. The influence of temazepam concentration on the probability to change sleep stage was incorporated into the model. RESULTS Transitions between sleep stages were profoundly influenced by the time of the night and by the time since the last change of sleep stage. Temazepam reduced the time spent awake. This effect could be attributed to four mechanisms: (1) transition to "deeper" sleep was facilitated, (2) transition to "lighter" sleep was inhibited, (3) regardless of sleep stage, the transition to wake state was inhibited, and (4) return to sleep was facilitated. Daytime sensitivities to temazepam, measured with the surrogate markers saccadic peak velocity and electroencephalogram beta activity, each correlated with one of the transition probabilities influenced by temazepam. CONCLUSIONS By the development of a Markov model for these non-ordered six categorical data, the effect of temazepam on the sleep-wake status could be interpreted in terms of known mechanisms for sleep generation and benzodiazepine pharmacology.
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Affiliation(s)
- M O Karlsson
- Department of Pharmacy, Uppsala University, Sweden.
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Lesko LJ, Rowland M, Peck CC, Blaschke TF. Optimizing the science of drug development: opportunities for better candidate selection and accelerated evaluation in humans. J Clin Pharmacol 2000; 40:803-14. [PMID: 10934664 DOI: 10.1177/00912700022009530] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two international meetings were convened in 1998 to review the current science of drug development and the potential opportunities to optimize the evaluation of new drugs in humans. This report represents a synopsis of these meetings, and focuses on the current state of knowledge pertaining to drug development, future scientific and technical needs, and the relative merits of various strategies intended to accelerate the clinical development of drugs.
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Affiliation(s)
- L J Lesko
- Office of Clinical Pharmacology and Biopharmaceutics, Food and Drug Administration, Rockville, Maryland, USA
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40
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Spyker DA, Harvey ED, Harvey BE, Harvey AM, Rumack BH, Peck CC, Atkinson AJ, Woosley RL, Abernethy DR, Cantilena LR. Assessment and reporting of clinical pharmacology information in drug labeling. Clin Pharmacol Ther 2000; 67:196-200. [PMID: 10741621 DOI: 10.1067/mcp.2000.104737] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- D A Spyker
- Purdue Pharma LP, Norwalk, Conn 06850-3690, USA.
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Abstract
STATEMENT OF PROBLEM During lateral excursive and protrusive jaw movements, condylar points are distant from any instantaneous rotational center. Therefore, it is likely that different condylar points would follow similar trajectories during these movements. PURPOSE This study evaluated the effect of changes in condylar point location on trajectories of condylar points on the nonworking side and during a protrusive jaw movement and compared these changes with the effects described for open-close and working-side condylar movements in the same group of subjects. METHODS The movements of 5 clinically determined condylar points were recorded in 44 subjects during a contralateral excursion and during protrusion (7 radiographically determined condylar points in 2 subjects). RESULTS During any single jaw movement, the trajectory of each condylar point was similar in form and dimension to the other condylar points within that subject. CONCLUSION Changes in condylar point location had little effect on the trajectories of condylar points on the nonworking side and during protrusive jaw movement.
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Affiliation(s)
- C C Peck
- Faculty of Dentistry, Westmead Hospital Dental Clinical School, Westmead, Australia
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Abstract
STATEMENT OF PROBLEM Trajectories of different condylar points provide different interpretations of condylar movement during open-close jaw movements. Movement of the working-side condyle is often assessed clinically by recording the trajectory of a single arbitrary condylar point. PURPOSE This study examined the effect of the differences in condylar point location on condylar point movement trajectories during a working-side movement. METHODS Different points exhibited different trajectories during a single working-side movement in each of 44 subjects. RESULTS Up to 40% of a point's displacement could be attributed simply to the location of the point. CONCLUSIONS Interpretation of condylar movement on the working side within a subject depends on the point chosen.
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Affiliation(s)
- C C Peck
- Faculty of Dentistry, University of Sydney, Westmead, Australia
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45
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Peck CC. A message from the president: The centennial ASCPT meeting—Come to San Antonio, March 18–20, 1999. Clin Pharmacol Ther 1998. [DOI: 10.1016/s0009-9236(98)90060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Warner KE, Peck CC, Woosley RL, Henningfield JE, Slade J. Treatment of tobacco dependence: innovative regulatory approaches to reduce death and disease: preface. Food Drug Law J 1998; 53 suppl:1-8. [PMID: 10342978] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- K E Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
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Tuk B, Oberyé JJ, Pieters MS, Schoemaker RC, Kemp B, van Gerven J, Danhof M, Kamphuisen HA, Cohen AF, Breimer DD, Peck CC. Pharmacodynamics of temazepam in primary insomnia: assessment of the value of quantitative electroencephalography and saccadic eye movements in predicting improvement of sleep. Clin Pharmacol Ther 1997; 62:444-52. [PMID: 9357396 DOI: 10.1016/s0009-9236(97)90123-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Quantitative electroencephalographic parameters and saccadic eye movements are frequently used as pharmacodynamic measures of benzodiazepine effect. We investigated the relationship between these measures and the hypnotic effect. METHODS The correlation between the pharmacodynamic measures and sleep quality was determined in 21 patients with primary insomnia. The pharmacokinetic-pharmacodynamic relationships were characterized after administration of 20 mg oral temazepam. The hypnotic effect was determined on the basis of polysomnographic sleep recordings and a subjective sleep evaluation questionnaire. Correlations between pharmacodynamic measures and the improvement of sleep were investigated. RESULTS The pharmacokinetic-pharmacodynamic relationships for the parameters derived from electroencephalography and saccadic eye movements showed considerable interindividual variability. Administration of temazepam led to a significant improvement in the objective parameters sleep period efficiency, wake time after sleep onset, and sleep efficiency and in the subjective assessment of sleep quality. No significant correlations were observed between the pharmacokinetic-pharmacodynamic-derived parameters and the improvement in objective or subjective sleep parameters. CONCLUSION In subjects with primary insomnia the administration of 20 mg oral temazepam results in changes in both the pharmacodynamic measures and in quality of sleep. No individual correlations between the pharmacodynamic measures and quality of sleep were observed. We concluded that the investigated pharmacodynamic measures are of value in the first assessment of clinical efficacy and for the selection of the dose(s) to be investigated in subsequent trials that aim at showing clinical efficacy. However, the conclusive quantification of clinical efficacy should be performed only on the basis of the clinical end point itself.
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Affiliation(s)
- B Tuk
- Division of Pharmacology, Leiden/Amsterdam Center for Drug Research, The Netherlands
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Abstract
STATEMENT OF PROBLEM Clinical assessments of condylar movement often rely on the movement of a single clinically determined or average value condylar point. PURPOSE The aim of this investigation was to study the effect of differences in condylar point location on recorded movement trajectories with an open-close jaw movement. METHODS Recordings were made of the movements of various condylar points in 44 subjects. The points were identified clinically (average value points) and radiographically. RESULTS The trajectory of each condylar point, whether average value or radiographically determined, was different in form and dimension from any other condylar point within a subject for the same open-close jaw movement. CONCLUSIONS Depending on the point chosen in the vicinity of the condyle, quite different interpretations of condylar movement within a subject could be made. The data underscore the caution that must be exercised when interpreting condylar movement from the movement of a single condylar point.
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Affiliation(s)
- C C Peck
- University of Sydney, Westmead, Australia
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Peck CC. Drug development: improving the process. Food Drug Law J 1997; 52:163-167. [PMID: 10557553] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- C C Peck
- Center for Drug Development Science, Georgetown University, USA
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Smith BD, Peck CC. Implementations, comparisons, and an investigation of heuristic techniques for cone-beam tomography. IEEE Trans Med Imaging 1996; 15:519-531. [PMID: 18215933 DOI: 10.1109/42.511755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A novel cone-beam reconstruction method was proposed in 1985. The first objective of the work reported here is to implement this reconstruction method. The second objective is to compare it with the method developed by Feldkamp et al. (1984). Although the resulting reconstruction was not perfect, the proposed method did eliminate the axial distortion associated with Feldkamp's method. A second cone-beam reconstruction method was proposed in 1987. Two major challenges arise when this method is implemented. One is to minimize the error that results from violating an assumed condition on the distribution of the cones. The second is to minimize the error that results from the convolution of a discontinuous function which is introduced to compensate for the redundancy in the data set. The third objective of the work reported here was to investigate several heuristic techniques to minimize these errors. Techniques were found that did mitigate these errors and using these techniques resulted in images that are more accurate than those resulting from the 1985 method.
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Affiliation(s)
- B D Smith
- Dept. of Electr. & Comput. Eng., Cincinnati Univ., OH
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