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Daujatas DM, Eischen E, Quinn AL. REMS: Time to reevaluate. Am J Health Syst Pharm 2024; 81:e206-e207. [PMID: 38146990 DOI: 10.1093/ajhp/zxad338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/20/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
| | - Edward Eischen
- Northwestern Medicine Palos Hospital, Palos Heights, IL, USA
| | - Andrea L Quinn
- Northwestern Medicine Palos Hospital, Palos Heights, IL, USA
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2
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Neill S, Hoe E, Fortin J, Goldberg AB, Janiak E. Management of early pregnancy loss among obstetrician-gynecologists in Massachusetts and barriers to mifepristone use. Contraception 2023; 126:110108. [PMID: 37394110 DOI: 10.1016/j.contraception.2023.110108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To measure the prevalence of early pregnancy loss management types among obstetrician-gynecologists in Massachusetts, and delineate barriers, facilitators, demographic and practice-related factors associated with mifepristone use for early pregnancy loss. STUDY DESIGN We surveyed a census of obstetrician-gynecologists in Massachusetts. Descriptive statistics measured the prevalence of offering expectant, misoprostol-alone, mifepristone and misoprostol, dilation and curettage in the office and operating room, and multivariate logistic regression analysis evaluated barriers and facilitators to mifepristone use. Data were weighted to account for nonresponders. RESULTS 198 obstetrician-gynecologists responded to the survey (response rate=29%). Participants most commonly offered expectant management (98%), dilation and curettage in the operating room (94%), and misoprostol-only medication management (80%). Fewer offered mifepristone-misoprostol (51%) or dilation and curettage in an office setting (45%). Those in private practice or other practice types had lower odds of offering mifepristone-misoprostol than those in academic practice (private practice: aOR 0.34, 95% confidence interval [CI] [0.19, 0.61]). Female physicians had higher odds of offering mifepristone-misoprostol (aOR 1.97, 95% CI [1.11, 3.49]). Obstetrician-gynecologists who included medication abortion in their practice had much higher odds of using mifepristone for early pregnancy loss (aOR 25.06, 95% CI [14.52, 43.24]). The Food and Drug Administration Risk and Evaluation Management Strategies Program was a primary barrier among those not using mifepristone (54%). CONCLUSIONS Many obstetrician-gynecologists do not offer mifepristone-based regimens for early pregnancy loss, which are more efficacious than misoprostol-only regimens. The Food and Drug Administration Risk Evaluation and Mitigation Strategies Program is a major barrier to mifepristone use. IMPLICATIONS Half of obstetrician-gynecologists in Massachusetts do not use mifepristone for early pregnancy loss management. Major barriers include lack of experience with mifepristone and the Food and Drug Administration Risk Evaluation and Mitigation Strategies Program regulations. Removing medically unnecessary regulations and increasing education on mifepristone via access to abortion care experts may increase uptake of this practice.
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Affiliation(s)
- Sara Neill
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily Hoe
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer Fortin
- ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Elizabeth Janiak
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA; ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
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3
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Fink M, Akra B. Comparison of the international regulations for medical devices-USA versus Europe. Injury 2023; 54 Suppl 5:110908. [PMID: 37365092 DOI: 10.1016/j.injury.2023.110908] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023]
Abstract
In May 2021, the new Medical Device Regulation in the EU came into force. While the US has a centralized governmental authority, the Food and Drug Administration (FDA), the EU implemented a system of different Notified Bodies responsible for the approval process of medical devices. Both regions have a similar system to classify medical devices based on their overall risks but specific devices, like joint prostheses, are classified differently in the US and the EU. Depending on the risk class, there are differences in the quality and quantity of clinical data required to obtain market approval. In both regions, it is possible to place a new device on the market based on the demonstration of equivalence to an already marketed device, but the MDR significantly increased the regulatory requirements for the equivalence pathway. While an approved medical device in the US in most cases only requires general post-market surveillance activities, manufacturers in the EU must continuously collect clinical data and submit specific reports to the Notified Bodies. In this article, we will compare the regulatory requirements between the US and Europe and provide an overview of similarities and differences.
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Affiliation(s)
- Matthias Fink
- Akra Team GmbH, Am Penzinger Feld 17a, 86899 Landsberg am Lech, Germany.
| | - Bassil Akra
- Akra Team GmbH, Am Penzinger Feld 17a, 86899 Landsberg am Lech, Germany
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4
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Kanti SY, Csóka I, Adalbert L, Jójárt-Laczkovich O. Analysis of the renewed European Medical Device Regulations in the frame of the non - EU regulatory landscape during the COVID facilitated change. J Pharm Sci 2022; 111:2674-2686. [PMID: 35872025 DOI: 10.1016/j.xphs.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Abstract
The term "Medical devices" includes technology-based devices or articles, both basic and complex. Due to these types of variations, a strict, robust, transparent, and sustainable regulatory framework is required. In recent clinical practice, incidents including the breast implant and the hip replacement crisis have made it necessary to improve the regulatory and compliance approaches for the industry to ensure the manufacturing and distribution of safe and innovative MDs within the EU. In response to this, the EU revised the laws governing medical devices and in vitro diagnostics to align with the developments of the sector, address critical safety issues and support innovation. The new regulation (EU) 2017/745 on Medical Devices (MDR) is now applicable from May 26 2021 and the In Vitro Diagnostic Medical Devices Regulation (EU) 2017/746 will take effect from May 2022.In this review, we aim to provide an update on the new Medical Device Regulations in the context of the current medical needs of the world, and also to give a glimpse at the non-EU regulatory landscape. Finally, we take a look at the closed-system transfer devices (CSTD) and COVID facilitated changes promoting demand for continuous improvement and trends in the pharmaceutical and medical industry related areas.
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Affiliation(s)
- Sp Yamini Kanti
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary.
| | - Ildikó Csóka
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
| | - Lívia Adalbert
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
| | - Orsolya Jójárt-Laczkovich
- Institute of Pharmaceutical Technology and Regulatory Affairs, University of Szeged, Szeged, Hungary
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5
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Guleria I, de Los Angeles Muñiz M, Wilgo M, Bapat A, Cui W, Hsu YMS, Jeyaraman M, Muthu S, Rodriguez F, Fesnak A, Celluzzi C, Sesok-Pizzini D, Reich-Slotky R, Spitzer T. How do I: Evaluate the safety and legitimacy of unproven cellular therapies? Transfusion 2022; 62:518-532. [PMID: 35143051 DOI: 10.1111/trf.16814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Unproven cellular therapies are being offered to patients for a variety of conditions and diseases for which other treatments have failed. The use of untested cellular therapies is a worldwide problem. Practitioners (e.g., physicians, scientists, QA/QI facility managers, and policy advocates) are perhaps unaware of the risks involved with such therapies. Therefore, a critical need exists to bring attention to the potential limitations and adverse effects of these therapies to inform and limit misinformation. STUDY DESIGN AND METHODS We describe the extent of the unproven cellular therapy problem through a search of scientific literature and social media coverage. We also describe the regulatory framework that can be used by the practitioner to review and evaluate both proven and unproven cellular therapies. RESULTS We report on the current state of unproven cellular therapies across the globe. A workflow to facilitate an understanding of the regulatory processes involved in the approval of cellular therapies is provided as well as a list of warnings required by regulatory agencies on various products. It is hoped that this article will serve as a tool kit to educate the practitioner on navigating the field of unproven cellular therapy products. DISCUSSION Increasing awareness of the issues associated with unproven therapies through education is important to help in reducing misinformation and risks to patients.
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Affiliation(s)
- Indira Guleria
- Renal Transplant Program, Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Maria de Los Angeles Muñiz
- Transfusion Medicine and Cellular Therapy Division, Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Wilgo
- New England Cord Blood Bank, Inc., New England Cryogenic Center. Inc., Marlborough, Massachusetts, USA
| | - Asawari Bapat
- Department of Quality and Regulatory Affairs, Infohealth FZE and Questar Enterprises, Dubai, UAE
| | - Wanxing Cui
- Cell Therapy Manufacturing Facility, Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Gerorgetown, Washington, District of Columbia, USA
| | - Yen-Michael Sheng Hsu
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Madhan Jeyaraman
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, India
| | - Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, India
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul, India
| | - Federico Rodriguez
- Collections and Processing Facility, Bone Marrow Transplant Program, UF Health Shands Cancer Hospital, Gainsville, Florida, USA
| | - Andrew Fesnak
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Celluzzi
- Department of Biotherapies, Association for the Advancement of Blood and Biotherapies, Bethesda, Maryland, USA
| | - Deborah Sesok-Pizzini
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronit Reich-Slotky
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Thomas Spitzer
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Hematology-Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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6
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Rothenberg ME, Hottinger SK, Gonsalves N, Furuta GT, Collins MH, Talley NJ, Peterson K, Menard-Katcher C, Smith M, Hirano I, Genta RM, Chehade M, Gupta SK, Spergel JM, Aceves SS, Dellon ES. Impressions and aspirations from the FDA GREAT VI Workshop on Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis and Perspectives for Progress in the Field. J Allergy Clin Immunol 2022; 149:844-853. [PMID: 34953790 PMCID: PMC8901475 DOI: 10.1016/j.jaci.2021.12.768] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
The US Food and Drug Administration hosted a workshop on July 21, 2021, to discuss the disease characteristics, natural history, and end points to assess treatment benefit in patients with eosinophilic gastrointestinal disorders (EGIDs) beyond eosinophilic esophagitis (EoE). Notably, EGIDs beyond EoE, such as eosinophilic gastritis, eosinophilic enteritis, and eosinophilic colitis, herein referred to as non-EoE EGIDs, are understudied relative to EoE. This workshop provided a forum for open discussion among stakeholders-medical professionals (including their societies and research groups), Food and Drug Administration representatives, an industry representative, and a patient representative-to facilitate drug development. Experts in many disciplines related to EGIDs, including allergy, immunology, epidemiology, gastroenterology, and pathology, and both adult and pediatric clinicians contributed. Herein, we discuss some of the insights of the material presented at the meeting and present perspectives on moving the field forward toward drug approval.
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Affiliation(s)
- Marc E. Rothenberg
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Shawna K.B. Hottinger
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Nirmala Gonsalves
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Glenn T. Furuta
- Digestive Health Institute, Children’s Hospital Colorado, Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, Colorado
| | - Margaret H. Collins
- Division of Pathology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Nicholas J. Talley
- University of Newcastle, Callaghan, Newcastle, New South Wales, Australia
| | - Kathryn Peterson
- Division of Gastroenterology, The University of Utah, Salt Lake City, Utah
| | - Calies Menard-Katcher
- Digestive Health Institute, Children’s Hospital Colorado, Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, Colorado
| | - Macie Smith
- Aims Community College, University of Northern Colorado, Greeley, Colorado
| | - Ikuo Hirano
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert M. Genta
- Pathology and Medicine (Gastroenterology), Baylor College of Medicine, Houston, Texas
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sandeep K. Gupta
- Indiana University School of Medicine/Community Health Network, Indianapolis, Indiana
| | - Jonathan M. Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Seema S. Aceves
- University of California, San Diego and Rady Children’s Hospital, San Diego, California
| | - Evan S. Dellon
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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7
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Jun J, Zhang N, Zain A, Mohammadi E. Social Media Discussions on the FDA's Modified Risk Tobacco Product Authorization of IQOS. Subst Use Misuse 2022; 57:472-480. [PMID: 34986075 DOI: 10.1080/10826084.2021.2019777] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: The U.S. Food and Drug Administration (FDA) authorized the marketing of the IQOS tobacco heating system as a modified risk tobacco product (MRTP) in July 2020, permitting its 'reduced exposure' marketing. This decision is accompanied by much controversy among the global health community. We provide a preliminary analysis of Twitter conversations regarding the MRTP authorization of IQOS by identifying the authors, valence towards the policy decision, source of cited link, and focused topic. Methods: We analyzed 548 tweets mentioning MRTP posted between July 2016 (when PMI submitted the proposal) and October 2020. Results: We found a higher proportion of pro-MRTP valence (25.4%) than anti-MRTP (16.2%). Nearly half of the tweets (47.2%) expressing personal opinions presented pro-MRTP valence (vs. anti-MRTP = 23.9%). The FDA website was more frequently cited in pro-MRTP tweets (30.8% vs. anti = 4.8%), while tobacco control advocates' websites were cited only in anti-MRTP tweets (77.4% vs. pro = 0). Pro-MRTP valence appeared more frequently in tweets mentioning health (53.1% vs. anti =38.5%) and cessation (100% vs. anti = 0). Nearly 42% of tweets showed a bot score greater than .43, indicating a possibility of automation. Conclusion: Continuous efforts are needed to surveil the industry's attempts to create a climate of false consensus and circulate misinformation regarding MRTP on social media, as well as to assist non-scientific audiences' understanding of MRTP.
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Affiliation(s)
- Jungmi Jun
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Nanlan Zhang
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Ali Zain
- School of Journalism and Mass Communications, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
| | - Ehsan Mohammadi
- School of Information Science, College of Information and Communications, University of South Carolina, Columbia, South Carolina, USA
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8
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Corneli A, Dombeck CB, McKenna K, Calvert SB. Stakeholder Experiences with the Single IRB Review Process and Recommendations for Food and Drug Administration Guidance. Ethics Hum Res 2021; 43:26-36. [PMID: 34019339 PMCID: PMC8251897 DOI: 10.1002/eahr.500092] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 11/10/2022]
Abstract
The revised Common Rule requires using a single institutional review board (sIRB) for U.S.-based, multisite, nonexempt, federally conducted or supported research with human participants. The 21st Century Cures Act directs the Department of Health and Human Services (HHS) to harmonize differences between HHS and the U.S. Food and Drug Administration (FDA) regulations governing research with humans. Anticipating that the FDA may update its 2006 centralized IRB guidance, we conducted interviews with 34 stakeholders engaged in FDA-regulated clinical research to identify benefits and challenges of using sIRBs and to gather recommendations for revising the FDA's guidance. The main benefits were consistency and standardization, speed and efficiency, and streamlining and simplification. The main challenges were uncertainty at local institutions, including addressing local context; decreased timeliness of the research review process; variable processes; and insufficient communication. Several recommendations for FDA guidance focused on the local context and communication plans. Findings suggest that the sIRB review process may be gaining efficiency although challenges remain.
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Affiliation(s)
- Amy Corneli
- Associate professor in the Department of Population Health Sciences at Duke University School of Medicine, a lead social scientist for the Clinical Trials Transformation Initiative, and a faculty member of the Duke Clinical Research Institute
| | - Carrie B Dombeck
- Research program leader in the Department of Population Health Sciences at Duke University School of Medicine and a research associate of the Clinical Trials Transformation Initiative
| | - Kevin McKenna
- Research program leader in the Department of Population Health Sciences at Duke University School of Medicine and a research associate of the Clinical Trials Transformation Initiative
| | - Sara B Calvert
- Clinical trials project leader III at Duke Clinical Research Institute and a senior project manager of the Clinical Trials Transformation Initiative
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Zhi K, Raji B, Nookala AR, Khan MM, Nguyen XH, Sakshi S, Pourmotabbed T, Yallapu MM, Kochat H, Tadrous E, Pernell S, Kumar S. PLGA Nanoparticle-Based Formulations to Cross the Blood-Brain Barrier for Drug Delivery: From R&D to cGMP. Pharmaceutics 2021; 13:pharmaceutics13040500. [PMID: 33917577 PMCID: PMC8067506 DOI: 10.3390/pharmaceutics13040500] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/24/2022] Open
Abstract
The blood–brain barrier (BBB) is a natural obstacle for drug delivery into the human brain, hindering treatment of central nervous system (CNS) disorders such as acute ischemic stroke, brain tumors, and human immunodeficiency virus (HIV)-1-associated neurocognitive disorders. Poly(lactic-co-glycolic acid) (PLGA) is a biocompatible polymer that is used in Food and Drug Administration (FDA)-approved pharmaceutical products and medical devices. PLGA nanoparticles (NPs) have been reported to improve drug penetration across the BBB both in vitro and in vivo. Poly(ethylene glycol) (PEG), poly(vinyl alcohol) (PVA), and poloxamer (Pluronic) are widely used as excipients to further improve the stability and effectiveness of PLGA formulations. Peptides and other linkers can be attached on the surface of PLGA to provide targeting delivery. With the newly published guidance from the FDA and the progress of current Good Manufacturing Practice (cGMP) technologies, manufacturing PLGA NP-based drug products can be achieved with higher efficiency, larger quantity, and better quality. The translation from bench to bed is feasible with proper research, concurrent development, quality control, and regulatory assurance.
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Affiliation(s)
- Kaining Zhi
- Plough Center for Sterile Drug Delivery Solutions, University of Tennessee Health Science Center, 208 South Dudley Street, Memphis, TN 38163, USA; (B.R.); (H.K.)
- Correspondence: (K.Z.); (S.K.)
| | - Babatunde Raji
- Plough Center for Sterile Drug Delivery Solutions, University of Tennessee Health Science Center, 208 South Dudley Street, Memphis, TN 38163, USA; (B.R.); (H.K.)
| | | | - Mohammad Moshahid Khan
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Memphis, TN 38163, USA;
| | - Xuyen H. Nguyen
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN 38163, USA; (X.H.N.); (S.S.); (E.T.); (S.P.)
| | - Swarna Sakshi
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN 38163, USA; (X.H.N.); (S.S.); (E.T.); (S.P.)
| | - Tayebeh Pourmotabbed
- Department of Microbiology, Immunology and Biochemistry, College of Medicine, University of Tennessee Health Science Center, 858 Madison Avenue, Memphis, TN 38163, USA;
| | - Murali M. Yallapu
- Department of Immunology and Microbiology, University of Texas Rio Grande Valley, McAllen, TX 78504, USA;
| | - Harry Kochat
- Plough Center for Sterile Drug Delivery Solutions, University of Tennessee Health Science Center, 208 South Dudley Street, Memphis, TN 38163, USA; (B.R.); (H.K.)
| | - Erene Tadrous
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN 38163, USA; (X.H.N.); (S.S.); (E.T.); (S.P.)
| | - Shelby Pernell
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN 38163, USA; (X.H.N.); (S.S.); (E.T.); (S.P.)
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN 38163, USA; (X.H.N.); (S.S.); (E.T.); (S.P.)
- Correspondence: (K.Z.); (S.K.)
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10
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Csóka I, Ismail R, Jójárt-Laczkovich O, Pallagi E. Regulatory considerations, challenges and risk-based approach in nanomedicine development. Curr Med Chem 2021; 28:7461-7476. [PMID: 33823761 DOI: 10.2174/0929867328666210406115529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022]
Abstract
The translation of nanomedicines from the lab level into marketed product face several challenges including characterization of physicochemical properties, pharmacodynamics, pharmacokinetics, process control, biocompatibility and nanotoxicity, scale-up as well as reproducibility. The challenges of nanomedicine development are in connection with the different requirements from the patient (clinical and therapeutic use), industry (production) and regulatory bodies (authorization process). This paper aims at reviewing the status and regulatory aspects of nano-based drug delivery systems with a focus on the Food and Drug Administration (FDA) and the European Medicine Agency (EMA) regulations. In addition to discussing the risks accompanied by the development of nanomedicine, the potential of following a risk-based methodology from the early stage of the R&D phase is emphasized here to ensure safety and efficacy when developing novel nano-based dosage forms. Nanomedicines R&D is a complex and multidisciplinary approach and there are still many challenges in their regulation and legislation. In general, the most critical considerations for nanomedicines are the product quality assessment (physicochemical characteristics, quality control, manufacturing process) and product safety assessment (pharmacokinetics, biodegradation, accumulation and nanotoxicity). The paper presents a promising paradigm in the development and marketing authorization of nanomedicines, namely the Quality by Design (QbD) approach. Sufficient knowledge on the quality, safety, and efficacy of nanomedicines is necessary to obtain with a significant focus on establishing robust, standardized methods to evaluate the critical quality attributes of nanomedicines. The QbD-based submission is highly recommended and required by the regulatory authorities and will enable a smooth clinical translation of the novel nanomedicines.
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Affiliation(s)
- Ildikó Csóka
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös str. 6, H-6720 Szeged. Hungary
| | - Ruba Ismail
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös str. 6, H-6720 Szeged. Hungary
| | - Orsolya Jójárt-Laczkovich
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös str. 6, H-6720 Szeged. Hungary
| | - Edina Pallagi
- Institute of Pharmaceutical Technology and Regulatory Affairs, Faculty of Pharmacy, University of Szeged, Eötvös str. 6, H-6720 Szeged. Hungary
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11
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Vieira I, Sousa JJ, Vitorino C. Paediatric Medicines - Regulatory Drivers, Restraints, Opportunities and Challenges. J Pharm Sci 2021; 110:1545-1556. [PMID: 33421435 DOI: 10.1016/j.xphs.2020.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/22/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022]
Abstract
The investment in the pharmaceutical development of medicines for paediatric use represents a minority when compared to that one made for adult population. Which reasons lie behind this status quo? Which policies have been implemented to reverse such asymmetry? Is there room to new regulatory initiatives? The creation of regulations establishing the obligation to conduct paediatric trials was deemed necessary as a means of producing products of proven quality, safety and efficacy and, in addition, to set forth financial incentives for the pharmaceutical industry reduce this delay. The first regulatory initiatives were carried out by the Food and Drug Administration (FDA) at the end of the 20th century. Later on, the European Medicines Agency (EMA) issued the Paediatric Regulation, which has boosted a closer collaboration between both regulatory agencies. Along with the implemented legislation, pharmaceutical dosage forms, more adapted to the paediatric population have emerged, increasing the availability of age-appropriate formulations. However, a case-by-case analysis is required to ensure the best therapeutic option for the specific child. This review aims at discussing the development of medicines for paediatric use from a regulatory perspective, comparing the policies adopted by the EMA and FDA, following an overview of the drivers, restraints, opportunities and challenges.
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Affiliation(s)
- Isa Vieira
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - João José Sousa
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Coimbra Chemistry Centre, Department of Chemistry, University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal
| | - Carla Vitorino
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Coimbra Chemistry Centre, Department of Chemistry, University of Coimbra, Rua Larga, 3004-535 Coimbra, Portugal; Centre for Neurosciences and Cell Biology (CNC), University of Coimbra, Faculty of Medicine, Rua Larga, Pólo I, 1st Floor, 3004-504 Coimbra, Portugal.
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Witkowski P, Philipson LH, Buse JB, Robertson RP, Alejandro R, Bellin MD, Kandeel F, Baidal D, Gaglia JL, Posselt AM, Anteby R, Bachul PJ, Al-Salmay Y, Jayant K, Perez-Gutierrez A, Barth RN, Fung JJ, Ricordi C. Islets Transplantation at a Crossroads - Need for Urgent Regulatory Update in the United States: Perspective Presented During the Scientific Sessions 2021 at the American Diabetes Association Congress. Front Endocrinol (Lausanne) 2021; 12:789526. [PMID: 35069442 PMCID: PMC8772267 DOI: 10.3389/fendo.2021.789526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022] Open
Abstract
Clinical islet allotransplantation has been successfully regulated as tissue/organ for transplantation in number of countries and is recognized as a safe and efficacious therapy for selected patients with type 1 diabetes mellitus. However, in the United States, the FDA considers pancreatic islets as a biologic drug, and islet transplantation has not yet shifted from the experimental to the clinical arena for last 20 years. In order to transplant islets, the FDA requires a valid Biological License Application (BLA) in place. The BLA process is costly and lengthy. However, despite the application of drug manufacturing technology and regulations, the final islet product sterility and potency cannot be confirmed, even when islets meet all the predetermined release criteria. Therefore, further regulation of islets as drugs is obsolete and will continue to hinder clinical application of islet transplantation in the US. The Organ Procurement and Transplantation Network together with the United Network for Organ Sharing have developed separately from the FDA and BLA regulatory framework for human organs under the Human Resources & Services Administration to assure safety and efficacy of transplantation. Based on similar biologic characteristics of islets and human organs, we propose inclusion of islets into the existing regulatory framework for organs for transplantation, along with continued FDA oversight for islet processing, as it is for other cell/tissue products exempt from BLA. This approach would reassure islet quality, efficacy and access for Americans with diabetes to this effective procedure.
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Affiliation(s)
- Piotr Witkowski
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, United States
- *Correspondence: Piotr Witkowski,
| | - Louis H. Philipson
- Section of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL, United States
- Kovler Diabetes Center, University of Chicago, Chicago, IL, United States
| | - John B. Buse
- Division of Endocrinology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - R. Paul Robertson
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Rodolfo Alejandro
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL, United States
| | - Melena D. Bellin
- Department of Pediatrics, Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Fouad Kandeel
- Department of Translational Research and Cellular Therapeutics, Diabetes and Metabolism Research Institute, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - David Baidal
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL, United States
| | - Jason L. Gaglia
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Andrew M. Posselt
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Roi Anteby
- Harvard School of Public Health, Harvard University, Boston, MA, United States
| | - Piotr J. Bachul
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Yaser Al-Salmay
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Kumar Jayant
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, United States
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Angelica Perez-Gutierrez
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Rolf N. Barth
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - John J. Fung
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Camillo Ricordi
- Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL, United States
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13
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Strickland LH, Murray DW, Pandit HG, Jenkinson C. Development of a patient-reported outcome measure (PROM) and change measure for use in early recovery following hip or knee replacement. J Patient Rep Outcomes 2020; 4:91. [PMID: 33159610 PMCID: PMC7648815 DOI: 10.1186/s41687-020-00262-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/08/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Background Hip and knee replacement are effective procedures for end-stage arthritis that has not responded to medical management. However, until now, there have been no validated, patient-reported tools to measure early recovery in this growing patient population. The process of development and psychometric evaluation of the Oxford Arthroplasty Early Recovery Score (OARS), a 14-item patient-reported outcome measure (PROM) measuring health status, and the Oxford Arthroplasty Early Change Score (OACS) a 14-item measure to assess change during the first 6 weeks following surgery is reported. Patients and methods A five-phased, best practice, iterative approach was used. From a literature based starting point, qualitative interviews with orthopaedic healthcare professionals, were then performed ascertaining if and how clinicians would use such a PROM and change measure. Analysis of in-depth patient-interviews in phase one identified important patient-reported factors in early recovery which were used to provide questionnaire themes. In Phase two, candidate items from Phase One interviews were generated and pilot questionnaires developed and tested. Exploratory factor analysis with item reduction and final testing of the questionnaires was performed in phase three. Phase Four involved validation testing. Results Qualitative interviews (n = 22) with orthopaedic healthcare professionals, helped determine views of potential users, and guide structure. In Phase One, factors from patient interviews (n = 30) were used to find questionnaire themes and generate items. Pilot questionnaires were developed and tested in Phase Two. Items were refined in the context of cognitive debrief interviews (n = 34) for potential inclusion in the final tools. Final testing of questionnaire properties with item reduction (n = 168) was carried out in phase three. Validation of the OARS and OACS was performed in phase four. Both measures were administered to consecutive patients (n = 155) in an independent cohort. Validity and reliability were assessed. Psychometric testing showed positive results, in terms of internal consistency and sensitivity to change, content validity and relevance to patients and clinicians. In addition, these measures have been found to be acceptable to patients throughout early recovery with validation across the 6 week period. Conclusions These brief, easy-to-use tools could be of great use in assessing recovery pathways and interventions in arthroplasty surgery.
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Affiliation(s)
- Louise H Strickland
- Oxford Orthopaedic Engineering Centre (OOEC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX37LD, England.
| | - David W Murray
- Oxford Orthopaedic Engineering Centre (OOEC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX37LD, England
| | - Hemant G Pandit
- Oxford Orthopaedic Engineering Centre (OOEC), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX37LD, England.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Chapel Allerton Hospital, Leeds, LS7 4SA, England
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Headington, Oxford, OX37LF, England
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Sader HS, Streit JM, Mendes RE. Update on the in vitro activity of dalbavancin against indicated species (Staphylococcus aureus, Enterococcus faecalis, β-hemolytic streptococci, and Streptococcus anginosus group) collected from United States hospitals in 2017-2019. Diagn Microbiol Infect Dis 2020; 99:115195. [PMID: 32977116 DOI: 10.1016/j.diagmicrobio.2020.115195] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 01/14/2023]
Abstract
This study updates dalbavancin activity against contemporary (2017-2019) isolates of indicated species/groups (n = 16,451). Isolates from 71 hospitals were tested by broth microdilution method. All isolates were susceptible to dalbavancin. Dalbavancin MIC50/90 values remained stable for Staphylococcus aureus, vancomycin-susceptible Enterococcus faecalis, β-hemolytic streptococci, and Streptococcus anginosus group since its clinical approval.
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Abstract
In 2019, the US Food and Drug Administration (FDA) approved 48 novel drugs. Thirty of the 48 (62.5%) novel drug approvals were reviewed and approved through an expedited review pathway while 20 of the 48 (41.7%) were approved for treatment of a rare disease. This review includes a summary of the novel drugs approved by the FDA in 2019.
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Affiliation(s)
- Alex M Ebied
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, NC
| | | | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Fla.
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16
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Buchmeier AD. US Food and Drug Administration Clinical Investigator Inspections. Semin Oncol Nurs 2020; 36:151000. [PMID: 32253049 DOI: 10.1016/j.soncn.2020.151000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the US Food and Drug Administration (FDA) Bioresearch Monitoring clinical investigator inspection process from start to final classification to support clinical research nurses in practice. DATA SOURCES Published articles, websites, and author's expertise with FDA inspections. CONCLUSION Clinical research nurses should conduct and manage every clinical trial as if it were to be inspected by the FDA. This recommendation is considered best practice for clinical research nurses to prevent last-minute preparations to organize and clean up research data and records retrospectively. IMPLICATIONS FOR NURSING PRACTICE This article will assist the oncology research nurse and interdisciplinary research members at the research site in the preparedness for an FDA inspection.
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18
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McCarrell JL, Bailey TA, Duncan NA, Covington LP, Clifford KM, Hall RG, Blaszczyk AT. A review of citalopram dose restrictions in the treatment of neuropsychiatric disorders in older adults. Ment Health Clin 2019; 9:280-286. [PMID: 31293848 PMCID: PMC6607952 DOI: 10.9740/mhc.2019.07.280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Neuropsychiatric disorders affect millions of older adults. Despite this, there are relatively few older adults included in clinical trials evaluating treatments for psychiatric disorders. Citalopram has been evaluated in older adults with neuropsychiatric disorders and has largely been found beneficial, making the 2011 US Food and Drug Administration (FDA) safety advisory on citalopram extremely impactful. Methods A literature search was completed using the PubMed database. Results were limited to clinical trials conducted in older adults that were published in English. Results Review of the literature confirms the efficacy of citalopram in depression, anxiety, depression associated with Parkinson disease, and behavioral and psychological symptoms of dementia. Additionally, no adverse cardiac outcomes have been described related to citalopram. Discussion The FDA's evidence for applying this safety advisory to citalopram is minimal and largely based on surrogate markers, such as the QTc interval rather than clinical and safety outcomes. Citalopram is known to increase the QTc, but this increase has not been linked to adverse cardiac outcomes. The evidence for efficacy and against adverse outcomes suggests that a reevaluation of the dosing restrictions in older adults with neuropsychiatric disorders is needed.
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Souza INO, Barros-Aragão FGQ, Frost PS, Figueiredo CP, Clarke JR. Late Neurological Consequences of Zika Virus Infection: Risk Factors and Pharmaceutical Approaches. Pharmaceuticals (Basel) 2019; 12:E60. [PMID: 30999590 PMCID: PMC6631207 DOI: 10.3390/ph12020060] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 12/16/2022] Open
Abstract
Zika virus (ZIKV) infection was historically considered a disease with mild symptoms and no major consequences to human health. However, several long-term, late onset, and chronic neurological complications, both in congenitally-exposed babies and in adult patients, have been reported after ZIKV infection, especially after the 2015 epidemics in the American continent. The development or severity of these conditions cannot be fully predicted, but it is possible that genetic, epigenetic, and environmental factors may contribute to determine ZIKV infection outcomes. This reinforces the importance that individuals exposed to ZIKV are submitted to long-term clinical surveillance and highlights the urgent need for the development of therapeutic approaches to reduce or eliminate the neurological burden of infection. Here, we review the epidemiology of ZIKV-associated neurological complications and the role of factors that may influence disease outcome. Moreover, we discuss experimental and clinical evidence of drugs that have shown promising results in vitro or in vitro against viral replication and and/or ZIKV-induced neurotoxicity.
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Affiliation(s)
- Isis N O Souza
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
| | - Fernanda G Q Barros-Aragão
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
| | - Paula S Frost
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
| | - Claudia P Figueiredo
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
| | - Julia R Clarke
- School of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21944-590, Brazil.
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Bonson KR, Dalton T, Chiapperino D. Scheduling synthetic cathinone substances under the Controlled Substances Act. Psychopharmacology (Berl) 2019; 236:845-60. [PMID: 30969348 DOI: 10.1007/s00213-018-5129-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND RATIONALE Cathinones are amphetamine analogues that produce stimulant effects with rewarding properties. For many decades, synthetic cathinones have been used in the United States (USA) for abuse purposes, leading to concern about public safety by the federal government. Under the Controlled Substances Act (CSA), the federal government may place drugs with high abuse potential but no currently accepted medical use into Schedule I of the CSA. The process of scheduling an abusable drug involves both the Department of Health and Human Services (HHS), through the Food and Drug Administration (FDA) and the National Institute on Drug Abuse (NIDA), and the Department of Justice, through the Drug Enforcement Administration (DEA). RESULTS This paper details how numerous synthetic cathinones were placed under CSA control between 1973 and 2018, with an emphasis on 10 cathinones that were placed into Schedule I in 2017 (butylone, naphyrone, pentylone, pentedrone, 3-fluoro-N-methylcathinone (FMC), 4-FMC, 4-methyl-N-ethylcathinone, 4-methyl-pyrrolidinopropiophenone, alpha-pyrrolidinobutiophenone, and α-pyrrolidinopentiophenone). A summary is provided of the scientific and medical analysis performed by HHS, in the form of an Eight-Factor Analysis (8FA), as prescribed by the CSA. This 8FA was then evaluated and signed by the Assistant Secretary for Health at HHS and transmitted to DEA, which permanently placed the 10 cathinones into Schedule I after public notices were published into the Federal Register. DISCUSSION AND CONCLUSIONS Understanding the scientific data, analysis, and complex process utilized by the US federal government in the CSA scheduling of cathinones with abuse potential and no accepted medical use is important for transparency in governmental decision-making.
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Gnanasakthy A, Barrett A, Evans E, D'Alessio D, Romano CD. A Review of Patient-Reported Outcomes Labeling for Oncology Drugs Approved by the FDA and the EMA (2012-2016). Value Health 2019; 22:203-209. [PMID: 30711065 DOI: 10.1016/j.jval.2018.09.2842] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 04/12/2018] [Revised: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To compare US Food and Drug Administration (FDA) and European Medicines Agency (EMA) labeling for evidence based on patient-reported outcomes (PROs) of new oncology treatments approved by both agencies. METHODS Oncology drugs and indications approved between 2012 and 2016 by both the FDA and the EMA were identified. PRO-related language and analysis reported in US product labels and drug approval packages and EMA summaries of product characteristics were compared for each indication. RESULTS In total, 49 oncology drugs were approved for a total of 64 indications. Of the 64 indications, 45 (70.3%) included PRO data in either regulatory submission. No FDA PRO labeling was identified. PRO language was included in the summary of product characteristics for 21 (46.7%) of 45 indications. European Organisation for Research and Treatment of Cancer and Functional Assessment of Cancer Therapy measures were used frequently in submissions. FDA's comments suggest that aspects of study design (eg, open labels) or the validity of PRO measures was the primary reason for the lack of labeling based on PRO endpoints. Both agencies identified missing PRO data as problematic for interpretation. CONCLUSIONS During this time period, the FDA and the EMA used different evidentiary standards to assess PRO data from oncology studies, with the EMA more likely to accept data from open-label studies and broad concepts such as health-related quality of life. An understanding of the key differences between the agencies may guide sponsor PRO strategy when pursuing labeling. Patient-focused proximal concepts are more likely than distal concepts to receive positive reviews.
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Affiliation(s)
| | - Amy Barrett
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Emily Evans
- RTI Health Solutions, Research Triangle Park, NC, USA
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Monden R, Roest AM, van Ravenzwaaij D, Wagenmakers EJ, Morey R, Wardenaar KJ, de Jonge P. The comparative evidence basis for the efficacy of second-generation antidepressants in the treatment of depression in the US: A Bayesian meta-analysis of Food and Drug Administration reviews. J Affect Disord 2018; 235:393-8. [PMID: 29677603 DOI: 10.1016/j.jad.2018.04.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies have shown similar efficacy of different antidepressants in the treatment of depression. METHOD Data of phase-2 and -3 clinical-trials for 16 antidepressants (levomilnacipran, desvenlafaxine, duloxetine, venlafaxine, paroxetine, escitalopram, vortioxetine, mirtazapine, venlafaxine XR, sertraline, fluoxetine, citalopram, paroxetine CR, nefazodone, bupropion, vilazodone), approved by the FDA for the treatment of depression between 1987 and 2016, were extracted from the FDA reviews that were used to evaluate efficacy prior to marketing approval, which are less liable to reporting biases. Meta-analytic Bayes factors, which quantify the strength of evidence for efficacy, were calculated. In addition, posterior pooled effect-sizes were calculated and compared with classical estimations. RESULTS The resulted Bayes factors showed that the evidence load for efficacy varied strongly across antidepressants. However, all tested drugs except for bupropion and vilazodone showed strong evidence for their efficacy. The posterior effect-size distributions showed variation across antidepressants, with the highest pooled estimated effect size for venlafaxine followed by paroxetine, and the lowest for bupropion and vilazodone. LIMITATIONS Not all published trials were included in the study. CONCLUSIONS The results illustrate the importance of considering both the effect size and the evidence-load when judging the efficacy of a treatment. In doing so, the currently employed Bayesian approach provided clear insights on top of those gained with traditional approaches.
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Yano K, Speidel AT, Yamato M. Four Food and Drug Administration draft guidance documents and the REGROW Act: A litmus test for future changes in human cell- and tissue-based products regulatory policy in the United States? J Tissue Eng Regen Med 2018; 12:1579-1593. [PMID: 29702746 PMCID: PMC6055862 DOI: 10.1002/term.2683] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 11/13/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 11/08/2022]
Abstract
Modern regenerative medicine research has expanded well past the development of traditional drugs and medical devices with many promising new therapies encompassing an increasingly diverse range of substances, notably cell-based therapies. These substantial recent developments and the progress in the health care and therapeutics fields necessitate a new regulatory framework agile enough to accommodate these unique therapies and acknowledge their differences with traditional pharmaceuticals. In the United States, recent proposed changes in the regulatory framework for autologous human cells, tissues, and cellular and tissue-based products (HCT/Ps) and their perceived risk-benefit analysis for patients remain controversial in the scientific field. To provide perspective on of the current status of the most recent attempts to redefine and conceptualize these changes in the United States, we will examine 4 draft guidance documents implemented by the Food and Drug Administration in interpreting relevant concepts and terminology pertaining to HCT/Ps: the Bipartisan Policy Center think tank report, "Advancing Regenerative Cellular Therapy: Medical Innovation for Healthier Americans," the proposed REGROW Act for HCT/Ps, and the current 24 Food and Drug Administration-approved HCT/Ps and related products in the United States.
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Affiliation(s)
- Kazuo Yano
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women's Medical UniversityTokyoJapan
- Research Institute for Science and EngineeringWaseda UniversityTokyoJapan
- Cooperative Major in Advanced Biomedical SciencesJoint Graduate School of Tokyo Women's Medical University and Waseda UniversityTokyoJapan
| | - Alessondra T. Speidel
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women's Medical UniversityTokyoJapan
| | - Masayuki Yamato
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women's Medical UniversityTokyoJapan
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Abstract
Cell-based therapies have become a major focus in preclinical research that leads to clinical application of a therapeutic product. Since 1990, scientists at the Miami Project to Cure Paralysis have generated extensive data demonstrating that Schwann cell (SC) transplantation supports spinal cord repair in animals with spinal cord injury. After preclinical efforts in SC transplantation strategies, efficient methods for procuring large, essentially pure populations of SCs from the adult peripheral nerve were developed for rodent and pig studies. This chapter describes a series of simple procedures to obtain and cryopreserve large cultures of highly purified adult nerve-derived SCs without the need for additional purification steps. This protocol permits the derivation of ≥90% pure rodent and porcine SCs within 2-4 weeks of culture.
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Affiliation(s)
- Adriana E Brooks
- The Miami Project to Cure Paralysis and Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gagani Athauda
- Department of Cellular Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Mary Bartlett Bunge
- The Miami Project to Cure Paralysis and Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aisha Khan
- The Miami Project to Cure Paralysis and Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Vogenberg FR, Smart M. Regulatory Change Versus Legislation Impacting Health Care Decisions and Delivery. P T 2018; 43:34-38. [PMID: 29290674 PMCID: PMC5737251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite the president's urging, congressional efforts to repeal the Patient Protection and Affordable Care Act (PPACA) have been repeatedly unsuccessful. The authors explore key actions taken by the administration and department heads that have resulted in delayed enforcement of the PPACA and relaxation of the law.
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Wu X, Wang Y, Wan S, Zhang J. Investigation on the binding mechanism of loratinib with the c-ros oncogene 1 (ROS1) receptor tyrosine kinase via molecular dynamics simulation and binding free energy calculations. J Biomol Struct Dyn 2017; 36:3106-3113. [PMID: 28893136 DOI: 10.1080/07391102.2017.1378127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The c-ros oncogene 1 (ROS1) has proven to be an important cancer target for the treatment of various human cancers. The anaplastic lymphoma kinase inhibitor crizotinib has been granted approval for the treatment of patients with ROS1 positive metastatic non-small-cell lung cancer by the Food and Drug Administration on 2016. However, serious resistance due to the secondary mutation of glycine 2032 to arginine (G2032R) was developed in clinical studies. Loratinib (PF-06463922), a macrocyclic analog of crizotinib, showed significantly improved inhibitory activity against wild-type (WT) ROS1 and ROS1G2032R mutant. To provide insights into the inhibition mechanism, molecular dynamics simulations and free energy calculations were carried out for the complexes of loratinib with WT and G2032R mutated ROS1. The apo-ROS1WT and apo-ROS1G2032R systems showed similar RMSF distributions, while ROS1G2032R-loratinib showed significantly higher than that of WT ROS1-loratinib, which revealed that the binding of loratinib to ROS1G2032R significantly interfered the fluctuation of protein. Calculations of binding free energies indicate that G2032R mutation significantly reduces the binding affinity of loratinib for ROS1, which arose mostly from the increase of conformation entropy and the decrease of solvation energy. Furthermore, detailed per-residue binding free energies highlighted the increased and decreased contributions of some residues in the G2032R mutated systems. The present study revealed the detailed inhibitory mechanism of loratinib as potent WT and G2032R mutated ROS1 inhibitor, which was expected to provide a basis for rational drug design.
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Affiliation(s)
- Xiaoyun Wu
- a Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences , Southern Medical University , Guangzhou 510515 , PR China
| | - Yuanyuan Wang
- a Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences , Southern Medical University , Guangzhou 510515 , PR China
| | - Shanhe Wan
- a Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences , Southern Medical University , Guangzhou 510515 , PR China
| | - Jiajie Zhang
- a Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences , Southern Medical University , Guangzhou 510515 , PR China
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Kempf L, Goldsmith JC, Temple R. Challenges of developing and conducting clinical trials in rare disorders. Am J Med Genet A 2017; 176:773-783. [PMID: 28815894 DOI: 10.1002/ajmg.a.38413] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [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: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022]
Abstract
Rare disease drug development is a rapidly expanding field. Clinical researchers in rare diseases face many challenges when conducting trials in small populations. Disease natural history is often poorly understood and the ability to detect clinically meaningful outcomes requires understanding of their rate of occurrence and variability, both of which contribute to difficulties in powering a study. Standard trial designs are not optimized to obtain adequate safety and efficacy data from small numbers of patients, so alternative designs (enrichment, crossover, adaptive, N-of 1) need to be considered. The affected patients can be hard to identify, especially early in the course of their disease, are generally geographically dispersed, and are often children. Trials are frequently conducted on an international scale and may be subject to complex or multiple regulatory agency oversights and may be affected by local customs, cultures, and practices. A basic understanding of the FDA programs supporting development of drugs for rare diseases is provided by this review and the role of early consultation with the FDA is emphasized. Of recent FDA New Molecular Entities (NME) approvals, 41% (17 approvals) in 2014, 47% (21 approvals) in 2015, and 41% (9 approvals) in 2016 were for rare disease indications. Through effective interactions and collaborations with physicians, institutions, and patient groups, sponsors have been successful in bringing new treatments to market for individuals affected by rare diseases. Challenges to drug development have been overcome through the focused efforts of patients/families, non-profit patient advocacy groups, drug developers, and regulatory authorities.
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Affiliation(s)
- Lucas Kempf
- Rare Diseases Program, Silver Spring, Maryland
| | | | - Robert Temple
- Office of Drug Evaluation I/Office of New Drugs/CDER/FDA, Silver Spring, Maryland
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Zhu S, Xu X. [United States Medical Device Postmarket Surveillance System Operational Experience and Learning]. Zhongguo Yi Liao Qi Xie Za Zhi 2017; 41:123-126. [PMID: 29862685 DOI: 10.3969/j.issn.1671-7104.2017.02.013] [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: 06/08/2023]
Abstract
To learn the progress, structure and the latest development of medical device postmarket surveillance system in United States, endeavor to get a meaningful approach for Chinese medical device manufacturers. Sort out the recentyear guidance documents issued by US FDA, analyze the current situation after the implementation of postmarket surveillance system (PMS). The all-aspect linkage, multiple data sources and the coordination communication mechanism between various departments implemented by FDA are worthy of learning.
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Affiliation(s)
- Shumin Zhu
- International and Pharmaceutical Business School of China Pharmaceutical University, Nanjing, 211198
| | - Xiaoyuan Xu
- International and Pharmaceutical Business School of China Pharmaceutical University, Nanjing, 211198
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Abstract
Over 30 years ago, the United States (US) Congress passed the Orphan Drug Act (ODA) to encourage the development of products for rare diseases or conditions ("orphan products"). The Act provided incentives to sponsors for developing products with orphan designation and established a grant program to fund studies of orphan products. Since its enactment in 1983, the ODA has been credited for bringing more than 590 orphan drugs to the market, inspiring the implementation of orphan legislation globally, and enabling the creation of other programs that extend existing knowledge of the natural history of rare diseases and stimulate the development of medical devices for children and patients with rare diseases. This chapter provides a brief overview of the main features and successes of 5 of the orphan incentive programs administered by the US Food and Drug Administration (FDA): the Orphan Drug Designation Program, the Humanitarian Use Device (HUD) Designation Program, the Orphan Products Clinical Trials Grants Program, the Pediatric Device Consortia (PDC) Grant Program, and the Orphan Products Natural History Grants Program.
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Affiliation(s)
- Tran T Le
- Office of Orphan Products Development, U.S. Food and Drug Administration, Silver Spring, MD, 20993, USA.
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Selzman KA, Fellman M, Farb A, de Del Castillo S, Zuckerman B. New technology in electrophysiology: FDA process and perspective. J Interv Card Electrophysiol 2016; 47:11-18. [PMID: 27020440 DOI: 10.1007/s10840-016-0127-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
The Food and Drug Administration (FDA) is a large regulatory agency that monitors everything from food, tobacco, and veterinary medicine to pharmaceutical drugs and medical devices. The Mission statement of the CDRH, one of the Centers of the FDA, in its most succinct form is to protect and promote public health. This is accomplished through timely and continued access to safe, effective, and high quality medical devices. This paper aims to review the overarching principles of the Agency's review process for cardiac devices as well as highlight some of the newer programs that FDA has engaged in to facilitate innovation, device development, research, and timely market approval.
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Affiliation(s)
- Kimberly A Selzman
- Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Implantable Electrophysiological Devices Branch, WO66, Silver Spring, MD, 20993, USA.
| | - Mark Fellman
- Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Implantable Electrophysiological Devices Branch, WO66, Silver Spring, MD, 20993, USA
| | - Andrew Farb
- Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Implantable Electrophysiological Devices Branch, WO66, Silver Spring, MD, 20993, USA
| | - Sergio de Del Castillo
- Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Implantable Electrophysiological Devices Branch, WO66, Silver Spring, MD, 20993, USA
| | - Bram Zuckerman
- Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Implantable Electrophysiological Devices Branch, WO66, Silver Spring, MD, 20993, USA
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Wanasika I. The Conundrum of Online Prescription Drug Promotion Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters". Int J Health Policy Manag 2016; 5:391-2. [PMID: 27285519 DOI: 10.15171/ijhpm.2016.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/13/2016] [Indexed: 11/09/2022] Open
Abstract
This commentary discusses pertinent issues from Hyosun Kim's paper on online prescription drug promotion. The study is well-designed and the findings highlight some of the consequences of the Food and Drug Administration's (FDA's) decision to deregulate online advertising of prescription drugs. While Kim's findings confirm some of the early concerns, they also provide a perspective of implementation challenges in the ever-changing technological environment.
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Affiliation(s)
- Isaac Wanasika
- Moffort College of Business, University of Northern Colorado, Greeley, CO, USA
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Mintzes B. The Tip of the Iceberg of Misleading Online Advertising Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters". Int J Health Policy Manag 2016; 5:329-31. [PMID: 27239883 DOI: 10.15171/ijhpm.2016.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/24/2015] [Accepted: 02/17/2016] [Indexed: 11/09/2022] Open
Abstract
Kim's overview of Food and Drug Administration (FDA) regulatory actions from 2005 to 2014 is a comprehensive analysis of the US regulatory experience with online direct-to-consumer advertising (DTCA) of prescription medicines. This experience is of relevance internationally as online DTCA reaches the English-speaking public globally, despite the illegality of DTCA in most countries. The most common violations were omissions or minimizations of risk information, overstatements of efficacy, unsubstantiated claims, and promotion of unapproved ("off-label") use. Nearly one fourth of violations involved cancer drugs, raising additional concerns about patient vulnerability, limited treatment advance, and high costs. Based on content analyses of online DTCA, these cases likely reflect a small proportion of unbalanced and misleading promotional information available on the web. The FDA is only able to review a small proportion of promotional materials submitted to them, due to limited staffing, and the delay between first posting and regulatory action means that many people may be exposed to messages that are found to be inaccurate and misleading. The sheer volume of online DTCA, combined with the ability for content to shift continually, poses unique regulatory challenges.
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Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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Rollins BL. Still the Great Debate - "Fair Balance" in Direct-to-Consumer Prescription Drug Advertising Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters". Int J Health Policy Manag 2016; 5:287-8. [PMID: 27239875 DOI: 10.15171/ijhpm.2016.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/08/2016] [Indexed: 11/09/2022] Open
Abstract
The above titled paper examined the Food and Drug Administration's (FDA's) warning letters and notice of violations (NOV) over a 10-year period. Findings from this content analysis reinforced what has been the primary issue for prescription direct-to-consumer advertising (DTCA) since its beginning, the fair balance of risk and benefit information. As opposed to another analysis in 2026 about this still being an issue, is there anything that can be done to prevent this problem from continuing?
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Affiliation(s)
- Brent L Rollins
- School of Pharmacy, Philadelphia College of Osteopathic Medicine (PCOM), Suwanee, GA, USA
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Mackey TK. Digital Direct-to-Consumer Advertising: A Perfect Storm of Rapid Evolution and Stagnant Regulation Comment on "Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters". Int J Health Policy Manag 2016; 5:271-4. [PMID: 27239871 DOI: 10.15171/ijhpm.2016.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/02/2016] [Indexed: 11/09/2022] Open
Abstract
The adoption and use of digital forms of direct-to-consumer advertising (also known as "eDTCA") is on the rise. At the same time, the universe of eDTCA is expanding, as technology on Internet-based platforms continues to evolve, from static websites, to social media, and nearly ubiquitous use of mobile devices. However, little is known about how this unique form of pharmaceutical marketing impacts consumer behavior, public health, and overall healthcare utilization. The study by Kim analyzing US Food and Drug Administration (FDA) notices of violations (NOVs) and warning letters regarding online promotional activities takes us in the right direction, but study results raise as many questions as it does answers. Chief among these are unanswered concerns about the unique regulatory challenges posed by the "disruptive" qualities of eDTCA, and whether regulators have sufficient resources and oversight powers to proactively address potential violations. Further, the globalization of eDTCA via borderless Internet-based technologies raises larger concerns about the potential global impact of this form of health marketing unique to only the United States and New Zealand. Collectively, these challenges make it unlikely that regulatory science will be able to keep apace with the continued rapid evolution of eDTCA unless more creative policy solutions are explored.
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Affiliation(s)
- Tim K Mackey
- Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, CA, USA.,Department of Medicine, Division of Global Public Health, San Diego School of Medicine, University of California, San Diego, CA, USA.,Joint Masters Program in Health Policy and Law, San Diego School of Medicine and California Western School of Law, University of California, San Diego, CA, USA.,Global Health Policy Institute, San Diego, CA, USA
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Kim H. Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters. Int J Health Policy Manag 2015; 4:813-21. [PMID: 26673465 DOI: 10.15171/ijhpm.2015.157] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/21/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND For the purpose of understanding the Food and Drug Administration's (FDA's) concerns regarding online promotion of prescription drugs advertised directly to consumers, this study examines notices of violations (NOVs) and warning letters issued by the FDA to pharmaceutical manufacturers. METHODS The FDA's warning letters and NOVs, which were issued to pharmaceutical companies over a 10-year period (2005 to 2014) regarding online promotional activities, were content-analyzed. RESULTS Six violation categories were identified: risk information, efficacy information, indication information, product labeling, material information issues, and approval issues. The results reveal that approximately 95% of the alleged violations were found on branded drug websites, in online paid advertisements, and in online videos. Of the total 179 violations, the majority of the alleged violations were concerned with the lack of risk information and/or misrepresentation of efficacy information, suggesting that achieving a fair balance of benefit versus risk information is a major problem with regard to the direct-to-consumer advertising (DTCA) of prescription drugs. In addition, the character space limitations of online platforms, eg, sponsored links on search engines, pose challenges for pharmaceutical marketers with regard to adequately communicating important drug information, such as indication information, risk information, and product labeling. CONCLUSION Presenting drug information in a fair and balanced manner remains a major problem. Industry guidance should consider addressing visibility and accessibility of information in the web environment to help pharmaceutical marketers meet the requirements for direct-to-consumer promotion and to protect consumers from misleading drug information. Promotion via social media warrants further attention, as pharmaceutical manufacturers have already begun actively establishing a social media presence, and the FDA has thus begun to keep tabs on social media promotions of prescription drugs.
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Affiliation(s)
- Hyosun Kim
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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36
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Alqahtani S, Seoane-Vazquez E, Rodriguez-Monguio R, Eguale T. Priority review drugs approved by the FDA and the EMA: time for international regulatory harmonization of pharmaceuticals? Pharmacoepidemiol Drug Saf 2015; 24:709-15. [PMID: 26013294 DOI: 10.1002/pds.3793] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 01/27/2015] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The US Food and Drug Administration (FDA) priority review process applies to a drug that is considered a significant improvement over the available alternatives. The European Medicines Agency (EMA) accelerated approval applies to a product that is of major public health interest. This study assessed differences in the characteristics of priority review new molecular entities and new therapeutic biologic products approved by the FDA and the EMA. METHODS This study includes regulatory information on drug applications, approvals, indications, and orphan designations of all priority review drugs approved by the FDA and the EMA in the period 1999-2011. Descriptive statistics, t-tests, and chi-squared and Wilcoxon tests were performed. RESULTS Overall, 100 FDA priority review new molecular entities and new therapeutic biologics were approved by both agencies; 87.0% of the products were first approved by the FDA. The average FDA review time (9.2 ± 8.4 months) was significantly lower than the EMA average review time (14.6 ± 4.0 months) (p < 0.0001). The FDA and the EMA granted orphan designation to 43.0% and 33.0%, respectively, of the applications. There were differences in the administration route (1.0% of all products), dosage (8.0%), strength (23%), posology (51.0%), indications (30.0%), restrictions of use (52.0%), limitations of use (19.0%), and outcomes limitations (28.0%) approved by both regulatory agencies. CONCLUSION Significant differences exist in the characteristics of the priority review drugs approved by the FDA and the EMA. Harmonization of the US and European regulatory frameworks may facilitate timely approval of pharmaceutical products.
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Affiliation(s)
- Saad Alqahtani
- International Center for Pharmaceutical Economics and Policy, Massachusetts College of Pharmacy and Health Sciences (MCPHS University), Boston, MA, USA
| | - Enrique Seoane-Vazquez
- International Center for Pharmaceutical Economics and Policy, Massachusetts College of Pharmacy and Health Sciences (MCPHS University), Boston, MA, USA.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Rosa Rodriguez-Monguio
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.,The Institute for Global Health, University of Massachusetts, Amherst, MA, USA
| | - Tewodros Eguale
- International Center for Pharmaceutical Economics and Policy, Massachusetts College of Pharmacy and Health Sciences (MCPHS University), Boston, MA, USA.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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Otuyelu E, Foldvari A, Szabo E, Sipos V, Edafiogho P, Szucs M, Dome P, Rihmer Z, Sandor J. Antidepressant drugs and teenage suicide in Hungary: Time trend and seasonality analysis. Int J Psychiatry Clin Pract 2015; 19:221-5. [PMID: 26058968 DOI: 10.3109/13651501.2015.1061017] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to analyze the relationship between increasing utilization of antidepressants and lithium, and suicide rate of persons less than 20 years of age in Hungary, with particular regard to seasonal patterns. METHODS Time trend analysis was carried out to determine the correlation between antidepressant and lithium prescription patterns in Hungarian persons under age of 20 years as well as seasonal variations within the study period from January 1998 to December 2006. RESULTS There was a significant correlation (P = 0.03) between the eight-fold increase in antidepressant + lithium prescriptions and decreasing suicides in young Hungarian people under 20 years of age within the study period. Lithium, selective serotonin reuptake inhibitors (SSRIs) and the group of "other antidepressant drugs" rather than nonselective monoamine reuptake inhibitors and monoamine oxidase-A inhibitors were responsible for this association. No significant association could be drawn from seasonal variation with boys (P = 0.964), girls (P = 0.140), or both genders (P = 0.997). LIMITATION Ecological study design. CONCLUSION Our findings are in good agreement with large-scale ecological studies showing that the beneficial effect of more widely used antidepressants at a given point could appear on the level of suicide rate of the general population even among patients under the age of 20 years.
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Affiliation(s)
- Ekundayo Otuyelu
- a Department of Epidemiology and Biostatistics , School of Public Health, University of Debrecen, Medical and Health Science Center , Debrecen , Hungary
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Abou-El-Enein M, Bauer G, Reinke P, Renner M, Schneider CK. A roadmap toward clinical translation of genetically-modified stem cells for treatment of HIV. Trends Mol Med 2014; 20:632-42. [PMID: 25262540 DOI: 10.1016/j.molmed.2014.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 12/21/2022]
Abstract
During the past decade, successful gene therapies for immunodeficiencies were finally brought to the clinic. This was accomplished through new gene therapy vectors and improved procedures for genetic modification of autologous hematopoietic stem cells. For HIV, autologous hematopoietic stem cell (HSC) gene therapy with 'anti-HIV genes' promises a functional cure for the disease. However, to develop such a therapy and translate it into a clinical application is rather challenging. The risks and benefits of such a therapy have to be understood, and regulatory hurdles need to be overcome. In this joint paper by academic researchers and regulators, we are, therefore, outlining a high level roadmap for the early stage development of HSC gene therapy as a potential functional cure for HIV.
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Affiliation(s)
- Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany.
| | - Gerhard Bauer
- University of California Davis, Institute For Regenerative Cures (IRC) Sacramento, CA, USA
| | - Petra Reinke
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Matthias Renner
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany
| | - Christian K Schneider
- Formerly Committee for Advanced Therapies, European Medicines Agency, 7, Westferry Circus E14 4HB, London, UK; Danish Health and Medicines Authority, Axel Heides Gade 1, 2300 Copenhagen, Denmark; Twincore Centre for Experimental and Clinical Infection Research, Feodor-Lynen-Straße 730625 Hannover, Germany
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Curtis CM, Kost GJ, Louie RF, Sonu RJ, Ammirati EB, Sumner S. POINT-OF-CARE HEMATOLOGY AND COAGULATION TESTING IN PRIMARY, RURAL EMERGENCY, AND DISASTER CARE SCENARIOS. Point Care 2012; 11:140-5. [PMID: 23843728 DOI: 10.1097/POC.0b013e31825a9d3a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this article is to review current principles and criteria for obtaining Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) waiver, identify existing point-of-care (POC) coagulation and hematology technologies, and analyze regulatory challenges regarding CLIA-waiver for those and future devices. CLIA '88 documentation requires tests performed by laboratories with a Certificate of Waiver to be so simple that the likelihood of erroneous results by the user is negligible, or poses no unreasonable risk of harm to the patient if performed incorrectly as determined by the Secretary of Health and Human Services. "Simple" means that the test uses unprocessed samples, has a direct read-out of test results, does not have specifications for user training, and includes instructions for confirmatory testing when advisable. Currently the CLIA-waived hematology and coagulation POC devices only test for hemoglobin (Hb), hematocrit (Hct), and prothrombin time/international normalized ratio (PT/INR). The problem with these devices is the lack of multiplexing. POC coagulation and hematology devices face challenges for obtaining a waiver. These challenges include the lack of clinical needs assessment, miniturized assays that correct for interfering substances, and assays simple enough to be combined in a multiplex platform. Several scenarios demonstrate how POC coagulation or hematology devices can improve crisis care. Industry should perform needs assessment on clinicians and emergency responders to determine which analytes to incorporate on multiplex POC coagulation and hematology devices, and produce devices that address confounding factors.
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