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Haslund-Krog SS, Jorgensen IM, Henriksen TB, Dalhoff K, Debes NM, van den Anker J, Holst H. Challenges in conducting paediatric trials with off-patent drugs. Contemp Clin Trials Commun 2021; 23:100783. [PMID: 34258467 PMCID: PMC8253945 DOI: 10.1016/j.conctc.2021.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/28/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction For more than two decades several initiatives have emerged to increase recruitment of paediatric patients in drug trials. While trials of newly approved drugs have successfully included paediatric patients in their drug development plan, the collection of safety and efficacy data in paediatric patients treated with off-patent drugs poses a major challenge. Aim This paper aims to draw attention to problems and solutions across countries in investigator-initiated trials with off-patent drugs and recommendations for improvement. Discussion Off-patent drugs represent a particular challenge when they are included in a paediatric trial; these trials are frequently investigator-initiated and have limited resources, off-patent drugs are used in clinical settings and the trial protocol must accommodate e.g. flexible dosing and specimen sampling schedules, off-patent drugs typically exist in few formulations and concentrations which necessitates special or imported formulations. Paediatric trials are in some countries confined by e.g. consent from both parents, regardless of whether the Investigational Medicinal Product (IMP) is a well-known drug or a new experimental drug. Conclusion Facilitation of research in off-patent drugs can improve evidence-based and safe treatment for the paediatric population. The following supportive initiatives are recommended: Harmonised regulatory change that improves the consent process in low risk trials to prevent inadequate recruitment. Pharmaceutical expertise should be prioritized to secure the best choice of IMP and supply. Constant focus on flexibility in design to accommodate a multifaceted paediatric population and ensure that trial protocols fit in well with routine clinical care and family life.
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Affiliation(s)
- S S Haslund-Krog
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.,Department of Paediatric and Adolescent Medicine, Nordsjællands University Hospital, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - I M Jorgensen
- Department of Paediatric and Adolescent Medicine, Nordsjællands University Hospital, Hillerød, Dyrehavevej 29, 3400, Hillerød, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - T B Henriksen
- Neonatal Intensive Care Unit, Department of Paediatrics, Aarhus University Hospital, Palle Juul- Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - K Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - N M Debes
- Department of Paediatric and Adolescent Medicine, Herlev Hospital, Borgmester Ib Juuls Vej 25C, 2730, Herlev, Denmark
| | - J van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, 20010, USA.,Division of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Switzerland
| | - H Holst
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
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Macerollo A, Martino D, Cavanna AE, Gulisano M, Hartmann A, Hoekstra PJ, Hedderly T, Debes NM, Muller-Vahl K, Neuner I, Porta M, Rickards H, Rizzo R, Cardona F, Roessner V. Refractoriness to pharmacological treatment for tics: A multicentre European audit. J Neurol Sci 2016; 366:136-138. [PMID: 27288792 DOI: 10.1016/j.jns.2016.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 04/05/2016] [Accepted: 05/02/2016] [Indexed: 11/17/2022]
Affiliation(s)
- A Macerollo
- Sobell Department of Motor Neuroscience and Movement Disorders, The National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, London, United Kingdom
| | - D Martino
- International Parkinson's Centre of Excellence, King's College and King's College Hospital, Denmark Hill Campus, London, United Kingdom; Queen Elizabeth Hospital, Woolwich, Lewisham & Greenwich NHS Trust, London, United Kingdom.
| | - A E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom
| | - M Gulisano
- Section of Child Neuropsichiatry, Dipartimento di Scienze Mediche e Pediatriche, Catania University, Catania, Italy
| | - A Hartmann
- Centre de Référence National Maladie Rare: Syndrome Gilles de la Tourette, Département de Neurologie, Pôle des Maladies du Système Nerveux, France
| | - P J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T Hedderly
- TANDeM Clinic-Evelina London Children's Hospital at Guys and St. Thomas', Kings Health Partners AHSC, London, United Kingdom
| | - N M Debes
- Pediatric Department, Glostrup University Hospital, Glostrup, Denmark
| | - K Muller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Street 1, D-30625 Hannover, Germany
| | - I Neuner
- Institute of Neuroscience and Medicine 4, (INM 4), Forschungszentrum, Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA-BRAIN - Translational Medicine, Germany
| | - M Porta
- Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy
| | - H Rickards
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom
| | - R Rizzo
- Section of Child Neuropsichiatry, Dipartimento di Scienze Mediche e Pediatriche, Catania University, Catania, Italy
| | - F Cardona
- Department of Psychology, University of Rome, La Sapienza, Rome, Italy
| | - V Roessner
- Klinik und Poliklinikfür Kinder- und Jugendpsychiatrie und -psychotherapie, TechnischeUniversität Dresden, Germany
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