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Ghosh R, Mohanasundaram S, Shetty S, Menon S. Preparing for the Next Normal: Transformation in the Role of Medical Affairs Following the COVID-19 Pandemic. Pharmaceut Med 2021; 35:197-202. [PMID: 34224113 PMCID: PMC8256774 DOI: 10.1007/s40290-021-00392-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
The medical affairs function represents one of the scientific interfaces in a pharmaceutical organization. Over the last two decades, medical affairs has evolved from being a support function to a strategic pillar within organizational business units. The COVID-19 pandemic has given rise to unforeseen circumstances resulting in a dramatic change in external stakeholder engagements, catapulting the medical affairs function into leading the way on scientific engagements and patient-centric endeavors. The changes in stakeholder interactions and behavior as a result of the pandemic last year are likely to persist in the foreseeable future for which medical affairs professionals need to enhance existing skill sets and acquire expertise in newer domains. In this paper, the transformation of the medical affairs team to a key strategic partner and the skills required to strengthen this transition, in the next normal of a post-COVID world, is explored.
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Affiliation(s)
- Romik Ghosh
- Medical Affairs, Sanofi India Limited, Mumbai, India
| | | | | | - Shalini Menon
- Medical Affairs, Sanofi India Limited, Mumbai, India
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2
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Abstract
With Covid‐19 vaccines being developed at a rapid pace, Josh Loeb and Julienne Wooster ask why the most sought‐after vaccines for animal diseases cannot be developed as quickly
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3
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Affiliation(s)
- Vrushab Gowda
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Harvard Law School, Cambridge, MA, USA
| | - Reed F Beall
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Cummings School of Medicine and O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ameet Sarpatwari
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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4
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Abstract
In the last few years, several new direct-acting influenza antivirals have been licensed, and others have advanced in clinical development. The increasing diversity of antiviral classes should allow an adequate public health response should a resistant virus to one agent or class widely circulate. One new antiviral, baloxavir marboxil, has been approved in the United States for treatment of influenza in those at high risk of developing influenza-related complications. Except for intravenous zanamivir in European Union countries, no antivirals have been licensed specifically for the indication of severe influenza or hospitalized influenza. This review addresses recent clinical developments involving selected polymerase inhibitors, neuraminidase inhibitors, antibody-based therapeutics, and host-directed therapies. There are many knowledge gaps for most of these agents because some data are not published and multiple pivotal studies are in progress at present. This review also considers important clinical research issues, including regulatory pathways, study designs, endpoints, and target populations encountered during the clinical development of novel therapeutics.
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Affiliation(s)
- John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland 20892-9826, USA
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
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5
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Rayner CR, Smith PF, Andes D, Andrews K, Derendorf H, Friberg LE, Hanna D, Lepak A, Mills E, Polasek TM, Roberts JA, Schuck V, Shelton MJ, Wesche D, Rowland‐Yeo K. Model-Informed Drug Development for Anti-Infectives: State of the Art and Future. Clin Pharmacol Ther 2021; 109:867-891. [PMID: 33555032 PMCID: PMC8014105 DOI: 10.1002/cpt.2198] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
Model-informed drug development (MIDD) has a long and rich history in infectious diseases. This review describes foundational principles of translational anti-infective pharmacology, including choice of appropriate measures of exposure and pharmacodynamic (PD) measures, patient subpopulations, and drug-drug interactions. Examples are presented for state-of-the-art, empiric, mechanistic, interdisciplinary, and real-world evidence MIDD applications in the development of antibacterials (review of minimum inhibitory concentration-based models, mechanism-based pharmacokinetic/PD (PK/PD) models, PK/PD models of resistance, and immune response), antifungals, antivirals, drugs for the treatment of global health infectious diseases, and medical countermeasures. The degree of adoption of MIDD practices across the infectious diseases field is also summarized. The future application of MIDD in infectious diseases will progress along two planes; "depth" and "breadth" of MIDD methods. "MIDD depth" refers to deeper incorporation of the specific pathogen biology and intrinsic and acquired-resistance mechanisms; host factors, such as immunologic response and infection site, to enable deeper interrogation of pharmacological impact on pathogen clearance; clinical outcome and emergence of resistance from a pathogen; and patient and population perspective. In particular, improved early assessment of the emergence of resistance potential will become a greater focus in MIDD, as this is poorly mitigated by current development approaches. "MIDD breadth" refers to greater adoption of model-centered approaches to anti-infective development. Specifically, this means how various MIDD approaches and translational tools can be integrated or connected in a systematic way that supports decision making by key stakeholders (sponsors, regulators, and payers) across the entire development pathway.
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Affiliation(s)
- Craig R. Rayner
- CertaraPrincetonNew JerseyUSA
- Monash Institute of Pharmaceutical SciencesMonash UniversityMelbourneVictoriaAustralia
| | | | - David Andes
- University of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Kayla Andrews
- Bill & Melinda Gates Medical Research InstituteCambridgeMassachusettsUSA
| | | | | | - Debra Hanna
- Bill & Melinda Gates FoundationSeattleWashingtonUSA
| | - Alex Lepak
- University of Wisconsin‐MadisonMadisonWisconsinUSA
| | | | - Thomas M. Polasek
- CertaraPrincetonNew JerseyUSA
- Centre for Medicines Use and SafetyMonash UniversityMelbourneVictoriaAustralia
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Jason A. Roberts
- Faculty of MedicineUniversity of Queensland Centre for Clinical ResearchThe University of QueenslandBrisbaneQueenslandAustralia
- Departments of Pharmacy and Intensive Care MedicineRoyal Brisbane and Women’s HospitalBrisbaneQueenslandAustralia
- Division of Anaesthesiology Critical Care Emergency and Pain MedicineNîmes University HospitalUniversity of MontpellierMontpellierFrance
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Abstract
The increased risk of harm from COVID-19 infection in pregnancy highlights the importance of including pregnant people in COVID-19 vaccine development and deployment. Promising vaccines being developed include replication-competent platforms, which are typically contraindicated during pregnancy because of theoretical risk. However, replicating vaccines are administered in and around pregnancy, either inadvertently because of unknown pregnancy status or when recommended.The historical cases of Ebola virus, yellow fever, and rubella demonstrate that contradictory messages around the safety of live vaccines in pregnancy have critical public health costs. First, restricting study or use of replicating vaccines in pregnancy may delay or deny access to the only available protection against deadly diseases. Additionally, not vaccinating pregnant people may slow epidemic control. Finally, uncertainty and worry around the safety of live vaccines may lead to terminations of otherwise desired pregnancies after inadvertent vaccination in pregnancy.If one of the vaccines deployed to combat the current global COVID-19 pandemic is replication competent, historical cases offer important lessons for ethical and effective protection for pregnant populations.
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Affiliation(s)
- Elana Jaffe
- Elana Jaffe is with the Center for Bioethics, Department of Social Medicine, School of Medicine, and the Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ilona Telefus Goldfarb is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Anne Drapkin Lyerly is with the Center for Bioethics, Department of Social Medicine, and the Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill
| | - Ilona Telefus Goldfarb
- Elana Jaffe is with the Center for Bioethics, Department of Social Medicine, School of Medicine, and the Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ilona Telefus Goldfarb is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Anne Drapkin Lyerly is with the Center for Bioethics, Department of Social Medicine, and the Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill
| | - Anne Drapkin Lyerly
- Elana Jaffe is with the Center for Bioethics, Department of Social Medicine, School of Medicine, and the Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ilona Telefus Goldfarb is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Anne Drapkin Lyerly is with the Center for Bioethics, Department of Social Medicine, and the Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill
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Dockendorf MF, Hansen BJ, Bateman KP, Moyer M, Shah JK, Shipley LA. Digitally Enabled, Patient-Centric Clinical Trials: Shifting the Drug Development Paradigm. Clin Transl Sci 2021; 14:445-459. [PMID: 33048475 PMCID: PMC7993267 DOI: 10.1111/cts.12910] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022] Open
Abstract
The rapidly advancing field of digital health technologies provides a great opportunity to radically transform the way clinical trials are conducted and to shift the clinical trial paradigm from a site-centric to a patient-centric model. Merck's (Kenilworth, NJ) digitally enabled clinical trial initiative is focused on introduction of digital technologies into the clinical trial paradigm to reduce patient burden, improve drug adherence, provide a means of more closely engaging with the patient, and enable higher quality, faster, and more frequent data collection. This paper will describe the following four key areas of focus from Merck's digitally enabled clinical trials initiative, along with corresponding enabling technologies: (i) use of technologies that can monitor and improve drug adherence (smart dosing), (ii) collection of pharmacokinetic (PK), pharmacodynamic (PD), and biomarker samples in an outpatient setting (patient-centric sampling), (iii) use of digital devices to collect and measure physiological and behavioral data (digital biomarkers), and (iv) use of data platforms that integrate digital data streams, visualize data in real-time, and provide a means of greater patient engagement during the trial (digital platform). Furthermore, this paper will discuss the synergistic power in implementation of these approaches jointly within a trial to enable better understanding of adherence, safety, efficacy, PK, PD, and corresponding exposure-response relationships of investigational therapies as well as reduced patient burden for clinical trial participation. Obstacle and challenges to adoption and full realization of the vision of patient-centric, digitally enabled trials will also be discussed.
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Kluetz PG, Bhatnagar V. The FDA's patient-focused drug development initiative. Clin Adv Hematol Oncol 2021; 19:70-72. [PMID: 33596186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Paul G Kluetz
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD
| | - Vishal Bhatnagar
- Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, MD
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9
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Pandey A, Belbase P, Parajuli A. COVID-19 Vaccine Development to Vaccination. J Nepal Health Res Counc 2021; 18:807-809. [PMID: 33510536 DOI: 10.33314/jnhrc.v18i4.3351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
In the race for a safe and effective vaccine against Coronavirus disease-19 manufacturer plays a critical role throughout the development, clinical trial, manufacturing, supply, and vaccination phases. For the efficacy of Coronavirus disease-19 vaccine, proper transport, storage, vaccine carrier, adjuvant, dosage form and route of vaccine administration plays a crucial role for immune response. In the context of no more people were willing to pay for a Coronavirus disease-19 vaccine the logistics of manufacturing, storing and distributing the vaccine, and mass vaccination are essential. It is urgent to improve health promotion and reduce the barriers to Coronavirus disease-19 vaccination. Keywords: COVID-19; vaccine development; vaccination.
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Affiliation(s)
- Ashok Pandey
- Nepal Health Research Council, Ramshah Path Kathmandu, Nepal
| | - Pradeep Belbase
- Nepal Health Research Council, Ramshah Path Kathmandu, Nepal
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10
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Abstract
The global desire to produce and deploy a safe and effective vaccine to protect against SARS-CoV-2 infection and the morbidity and mortality subsequent to COVID-19 is unprecedented. The unparalleled speed of research development and access to funding is perhaps equally unique in the history of therapeutic achievement. This article, the third in a series of dedicated to exploring the origins and developments of SARS-CoV-2 within the context of the strategies of infection prevention and control, investigates the theatre behind the extraordinary efforts underpinning the research for therapeutic interventions to halt the COVID-19 pandemic. The Chair of the UK Vaccine Taskforce has stated that the exit strategy depends on a vaccine that is effective in reducing mortality, improving population health by reducing serious disease and protecting the NHS and social care system. This article introduces the major COVID-19 vaccine contenders and considers the challenges and opportunities of an effective global vaccination strategy.
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Affiliation(s)
- Alison Phillis
- Deputy Director Infection Prevention and Control, Practice Plus Group, Reading
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11
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Molenberghs G, Buyse M, Abrams S, Hens N, Beutels P, Faes C, Verbeke G, Van Damme P, Goossens H, Neyens T, Herzog S, Theeten H, Pepermans K, Abad AA, Van Keilegom I, Speybroeck N, Legrand C, De Buyser S, Hulstaert F. Infectious diseases epidemiology, quantitative methodology, and clinical research in the midst of the COVID-19 pandemic: Perspective from a European country. Contemp Clin Trials 2020; 99:106189. [PMID: 33132155 PMCID: PMC7581408 DOI: 10.1016/j.cct.2020.106189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023]
Abstract
Starting from historic reflections, the current SARS-CoV-2 induced COVID-19 pandemic is examined from various perspectives, in terms of what it implies for the implementation of non-pharmaceutical interventions, the modeling and monitoring of the epidemic, the development of early-warning systems, the study of mortality, prevalence estimation, diagnostic and serological testing, vaccine development, and ultimately clinical trials. Emphasis is placed on how the pandemic had led to unprecedented speed in methodological and clinical development, the pitfalls thereof, but also the opportunities that it engenders for national and international collaboration, and how it has simplified and sped up procedures. We also study the impact of the pandemic on clinical trials in other indications. We note that it has placed biostatistics, epidemiology, virology, infectiology, and vaccinology, and related fields in the spotlight in an unprecedented way, implying great opportunities, but also the need to communicate effectively, often amidst controversy.
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Affiliation(s)
- Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | - Marc Buyse
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; International Drug Development Institute, Belgium; CluePoints, Belgium.
| | - Steven Abrams
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Christel Faes
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | - Pierre Van Damme
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | | | - Thomas Neyens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | - Sereina Herzog
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Heidi Theeten
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Koen Pepermans
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Ariel Alonso Abad
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | | | | | - Catherine Legrand
- Institute of Statistics, Biostatistics and Actuarial Sciences, UC Louvain, Belgium
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12
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Chan AYL, Chan VKY, Olsson S, Fan M, Jit M, Gong M, Zhang S, Ge M, Pathadka S, Chung CCY, Chung BHY, Chui CSL, Chan EW, Wong GHY, Lum TY, Wong ICK, Ip P, Li X. Access and Unmet Needs of Orphan Drugs in 194 Countries and 6 Areas: A Global Policy Review With Content Analysis. Value Health 2020; 23:1580-1591. [PMID: 33248513 DOI: 10.1016/j.jval.2020.06.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 01/09/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Three hundred million people living with rare diseases worldwide are disproportionately deprived of in-time diagnosis and treatment compared with other patients. This review provides an overview of global policies that optimize development, licensing, pricing, and reimbursement of orphan drugs. METHODS Pharmaceutical legislation and policies related to access and regulation of orphan drugs were examined from 194 World Health Organization member countries and 6 areas. Orphan drug policies (ODPs) were identified through internet search, emails to national pharmacovigilance centers, and systematic academic literature search. Texts from selected publications were extracted for content analysis. RESULTS One hundred seventy-two drug regulation documents and 77 academic publications from 162 countries/areas were included. Ninety-two of 200 countries/areas (46.0%) had documentation on ODPs. Thirty-four subthemes from content analysis were categorized into 6 policy themes, namely, orphan drug designation, marketing authorization, safety and efficacy requirements, price regulation, incentives that encourage market availability, and incentives that encourage research and development. Countries/areas with ODPs were statistically wealthier (gross national income per capita = $10 875 vs $3950, P < .001). Country/area income was also positively correlated with the scope of the respective ODP (correlation coefficient = 0.57, P < .001). CONCLUSIONS Globally, the number of countries with an ODP has grown rapidly since 2013. Nevertheless, disparities in geographical distribution and income levels affect the establishment of ODPs. Furthermore, identified policy gaps in price regulation, incentives that encourage market availability, and incentives that encourage research and development should be addressed to improve access to available and affordable orphan drugs.
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Affiliation(s)
- Adrienne Y L Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Vivien K Y Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Sten Olsson
- International Society of Pharmacovigilance, London, United Kingdom
| | - Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom; Modelling and Economics Unit, National Infections Service, Public Health England, London, United Kingdom; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Mengchun Gong
- National Rare Diseases Registry System of China, Beijing, China; Rare Diseases Research Center, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyang Zhang
- Rare Diseases Research Center, Chinese Academy of Medical Sciences, Beijing, China; Peking Union Medical College Hospital, Beijing, China
| | - Mengqin Ge
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Swathi Pathadka
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Claudia C Y Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Celine S L Chui
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Terry Y Lum
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Centre for Medicines Optimisation Research and Education, Research Department of Policy and Practice, University College London School of Pharmacy and University College London Hospital, London, United Kingdom
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong.
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13
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Connor J, Madhavan S, Mokashi M, Amanuel H, Johnson NR, Pace LE, Bartz D. Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Soc Sci Med 2020; 266:113364. [PMID: 32950924 PMCID: PMC7487147 DOI: 10.1016/j.socscimed.2020.113364] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [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] [Subscribe] [Scholar Register] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Covid-19 pandemic is straining healthcare systems in the US and globally, which has wide-reaching implications for health. Women experience unique health risks and outcomes influenced by their gender, and this narrative review aims to outline how these differences are exacerbated in the Covid-19 pandemic. OBSERVATIONS It has been well described that men suffer from greater morbidity and mortality once infected with SARS-CoV-2. This review analyzed the health, economic, and social systems that result in gender-based differences in the areas healthcare workforce, reproductive health, drug development, gender-based violence, and mental health during the Covid-19 pandemic. The increased risk of certain negative health outcomes and reduced healthcare access experienced by many women are typically exacerbated during pandemics. We assess data from previous disease outbreaks coupled with literature from the Covid-19 pandemic to examine the impact of gender on women's SARS-CoV-2 exposure and disease risks and overall health status during the Covid-19 pandemic. CONCLUSIONS Gender differences in health risks and implications are likely to be expanded during the Covid-19 pandemic. Efforts to foster equity in health, social, and economic systems during and in the aftermath of Covid-19 may mitigate the inequitable risks posed by pandemics and other times of healthcare stress.
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Affiliation(s)
| | | | | | | | - Natasha R Johnson
- Harvard Medical School, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Lydia E Pace
- Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Deborah Bartz
- Harvard Medical School, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA
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14
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Liu M, Li Q, Lin J, Lin Y, Hoffman E. Innovative trial designs and analyses for vaccine clinical development. Contemp Clin Trials 2020; 100:106225. [PMID: 33227451 PMCID: PMC7834363 DOI: 10.1016/j.cct.2020.106225] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 01/21/2023]
Abstract
In the past decades, the world has experienced several major virus outbreaks, e.g. West African Ebola outbreak, Zika virus in South America and most recently global coronavirus (COVID-19) pandemic. Many vaccines have been developed to prevent a variety of infectious diseases successfully. However, several infections have not been preventable so far, like COVID-19, which induces an immediate urgent need for effective vaccines. These emerging infectious diseases often pose unprecedent challenges for the global heath community as well as the conventional vaccine development paradigm. With a long and costly traditional vaccine development process, there are extensive needs in innovative vaccine trial designs and analyses, which aim to design more efficient vaccines trials. Featured with reduced development timeline, less resource consuming or improved estimate for the endpoints of interests, these more efficient trials bring effective medicine to target population in a faster and less costly way. In this paper, we will review a few vaccine trials equipped with adaptive design features, Bayesian designs that accommodate historical data borrowing, the master protocol strategy emerging during COVID-19 vaccine development, Real-World-Data (RWD) embedded trials and the correlate of protection framework and relevant research works. We will also discuss some statistical methodologies that improve the vaccine efficacy, safety and immunogenicity analyses. Innovative clinical trial designs and analyses, together with advanced research technologies and deeper understanding of the human immune system, are paving the way for the efficient development of new vaccines in the future.
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Affiliation(s)
- Mengya Liu
- Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States.
| | - Qing Li
- Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States.
| | - Jianchang Lin
- Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States.
| | - Yunzhi Lin
- Sanofi, 50 Binney Street, Cambridge, MA 02142, United States
| | - Elaine Hoffman
- Takeda Pharmaceuticals, 300 Massachusetts Ave, Cambridge, MA 02139, United States
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15
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Affiliation(s)
- Moncef Slaoui
- From Operation Warp Speed, Department of Health and Human Services, Washington, DC
| | - Matthew Hepburn
- From Operation Warp Speed, Department of Health and Human Services, Washington, DC
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16
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Affiliation(s)
- Shalin S Patel
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeremy Kalma
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, Michigan
| | - Eric M Bluman
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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17
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Naci H, Kesselheim AS, Røttingen JA, Salanti G, Vandvik PO, Cipriani A. Producing and using timely comparative evidence on drugs: lessons from clinical trials for covid-19. BMJ 2020; 371:m3869. [PMID: 33067179 DOI: 10.1136/bmj.m3869] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - John-Arne Røttingen
- Research Council of Norway, Oslo, Norway
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Per O Vandvik
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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18
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Abstract
RNA-based therapies, including RNA molecules as drugs and RNA-targeted small molecules, offer unique opportunities to expand the range of therapeutic targets. Various forms of RNAs may be used to selectively act on proteins, transcripts, and genes that cannot be targeted by conventional small molecules or proteins. Although development of RNA drugs faces unparalleled challenges, many strategies have been developed to improve RNA metabolic stability and intracellular delivery. A number of RNA drugs have been approved for medical use, including aptamers (e.g., pegaptanib) that mechanistically act on protein target and small interfering RNAs (e.g., patisiran and givosiran) and antisense oligonucleotides (e.g., inotersen and golodirsen) that directly interfere with RNA targets. Furthermore, guide RNAs are essential components of novel gene editing modalities, and mRNA therapeutics are under development for protein replacement therapy or vaccination, including those against unprecedented severe acute respiratory syndrome coronavirus pandemic. Moreover, functional RNAs or RNA motifs are highly structured to form binding pockets or clefts that are accessible by small molecules. Many natural, semisynthetic, or synthetic antibiotics (e.g., aminoglycosides, tetracyclines, macrolides, oxazolidinones, and phenicols) can directly bind to ribosomal RNAs to achieve the inhibition of bacterial infections. Therefore, there is growing interest in developing RNA-targeted small-molecule drugs amenable to oral administration, and some (e.g., risdiplam and branaplam) have entered clinical trials. Here, we review the pharmacology of novel RNA drugs and RNA-targeted small-molecule medications, with a focus on recent progresses and strategies. Challenges in the development of novel druggable RNA entities and identification of viable RNA targets and selective small-molecule binders are discussed. SIGNIFICANCE STATEMENT: With the understanding of RNA functions and critical roles in diseases, as well as the development of RNA-related technologies, there is growing interest in developing novel RNA-based therapeutics. This comprehensive review presents pharmacology of both RNA drugs and RNA-targeted small-molecule medications, focusing on novel mechanisms of action, the most recent progress, and existing challenges.
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MESH Headings
- Aptamers, Nucleotide/pharmacology
- Aptamers, Nucleotide/therapeutic use
- Betacoronavirus
- COVID-19
- Chemistry Techniques, Analytical/methods
- Chemistry Techniques, Analytical/standards
- Clustered Regularly Interspaced Short Palindromic Repeats
- Coronavirus Infections/drug therapy
- Drug Delivery Systems/methods
- Drug Development/organization & administration
- Drug Discovery
- Humans
- MicroRNAs/pharmacology
- MicroRNAs/therapeutic use
- Oligonucleotides, Antisense/pharmacology
- Oligonucleotides, Antisense/therapeutic use
- Pandemics
- Pneumonia, Viral/drug therapy
- RNA/adverse effects
- RNA/drug effects
- RNA/pharmacology
- RNA, Antisense/pharmacology
- RNA, Antisense/therapeutic use
- RNA, Messenger/drug effects
- RNA, Messenger/pharmacology
- RNA, Ribosomal/drug effects
- RNA, Ribosomal/pharmacology
- RNA, Small Interfering/pharmacology
- RNA, Small Interfering/therapeutic use
- RNA, Viral/drug effects
- Ribonucleases/metabolism
- Riboswitch/drug effects
- SARS-CoV-2
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Affiliation(s)
- Ai-Ming Yu
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Sacramento, California (A.-M.Y., Y.H.C., M.-J.T.) and College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Goyang-si, Gyonggi-do, Republic of Korea (Y.H.C.)
| | - Young Hee Choi
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Sacramento, California (A.-M.Y., Y.H.C., M.-J.T.) and College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Goyang-si, Gyonggi-do, Republic of Korea (Y.H.C.)
| | - Mei-Juan Tu
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Sacramento, California (A.-M.Y., Y.H.C., M.-J.T.) and College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Goyang-si, Gyonggi-do, Republic of Korea (Y.H.C.)
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19
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Bobrowski T, Melo-Filho CC, Korn D, Alves VM, Popov KI, Auerbach S, Schmitt C, Moorman NJ, Muratov EN, Tropsha A. Learning from history: do not flatten the curve of antiviral research! Drug Discov Today 2020; 25:1604-1613. [PMID: 32679173 PMCID: PMC7361119 DOI: 10.1016/j.drudis.2020.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 01/20/2023]
Abstract
Here, we explore the dynamics of the response of the scientific community to several epidemics, including Coronavirus Disease 2019 (COVID-19), as assessed by the numbers of clinical trials, publications, and level of research funding over time. All six prior epidemics studied [bird flu, severe acute respiratory syndrome (SARS), swine flu, Middle East Respiratory Syndrome (MERS), Ebola, and Zika] were characterized by an initial spike of research response that flattened shortly thereafter. Unfortunately, no antiviral medications have been discovered to date as treatments for any of these diseases. By contrast, the HIV/AIDS pandemic has garnered consistent research investment since it began and resulted in drugs being developed within 7 years of its start date, with many more to follow. We argue that, to develop effective treatments for COVID-19 and be prepared for future epidemics, long-term, consistent investment in antiviral research is needed.
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Affiliation(s)
- Tesia Bobrowski
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Cleber C Melo-Filho
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Daniel Korn
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA; Department of Computer Science, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Vinicius M Alves
- Office of Data Science, National Toxicology Program, NIEHS, Morrisville, NC 27560, USA
| | - Konstantin I Popov
- Department of Biochemistry and Biophysics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Scott Auerbach
- Toxicoinformatics Group, National Toxicology Program, NIEHS, Morrisville, NC 27560, USA
| | - Charles Schmitt
- Office of Data Science, National Toxicology Program, NIEHS, Morrisville, NC 27560, USA
| | - Nathaniel J Moorman
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Eugene N Muratov
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA; Department of Pharmaceutical Sciences, Federal University of Paraiba, Joao Pessoa, PB, Brazil.
| | - Alexander Tropsha
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA.
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20
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Moreno L, Barone G, DuBois SG, Molenaar J, Fischer M, Schulte J, Eggert A, Schleiermacher G, Speleman F, Chesler L, Geoerger B, Hogarty MD, Irwin MS, Bird N, Blanchard GB, Buckland S, Caron H, Davis S, De Wilde B, Deubzer HE, Dolman E, Eilers M, George RE, George S, Jaroslav Š, Maris JM, Marshall L, Merchant M, Mortimer P, Owens C, Philpott A, Poon E, Shay JW, Tonelli R, Valteau-Couanet D, Vassal G, Park JR, Pearson ADJ. Accelerating drug development for neuroblastoma: Summary of the Second Neuroblastoma Drug Development Strategy forum from Innovative Therapies for Children with Cancer and International Society of Paediatric Oncology Europe Neuroblastoma. Eur J Cancer 2020; 136:52-68. [PMID: 32653773 DOI: 10.1016/j.ejca.2020.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/16/2020] [Accepted: 05/12/2020] [Indexed: 01/18/2023]
Abstract
Only one class of targeted agents (anti-GD2 antibodies) has been incorporated into front-line therapy for neuroblastoma since the 1980s. The Neuroblastoma New Drug Development Strategy (NDDS) initiative commenced in 2012 to accelerate the development of new drugs for neuroblastoma. Advances have occurred, with eight of nine high-priority targets being evaluated in paediatric trials including anaplastic lymphoma kinase inhibitors being investigated in front-line, but significant challenges remain. This article reports the conclusions of the second NDDS forum, which expanded across the Atlantic to further develop the initiative. Pre-clinical and clinical data for 40 genetic targets and mechanisms of action were prioritised and drugs were identified for early-phase trials. Strategies to develop drugs targeting TERT, telomere maintenance, ATRX, alternative lengthening of telomeres (ALT), BRIP1 and RRM2 as well as direct targeting of MYCN are high priority and should be championed for drug discovery. Promising pre-clinical data suggest that targeting of ALT by ATM or PARP inhibition may be potential strategies. Drugs targeting CDK2/9, CDK7, ATR and telomere maintenance should enter paediatric clinical development rapidly. Optimising the response to anti-GD2 by combinations with chemotherapy, targeted agents and other immunological targets are crucial. Delivering this strategy in the face of small patient cohorts, genomically defined subpopulations and a large number of permutations of combination trials, demands even greater international collaboration. In conclusion, the NDDS provides an internationally agreed, biologically driven selection of prioritised genetic targets and drugs. Improvements in the strategy for conducting trials in neuroblastoma will accelerate bringing these new drugs more rapidly to front-line therapy.
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Affiliation(s)
- Lucas Moreno
- Paediatric Haematology & Oncology Division, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Giuseppe Barone
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA, USA
| | - Jan Molenaar
- Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Matthias Fischer
- Experimental Pediatric Oncology, University Children's Hospital, Cologne, Germany; Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Johannes Schulte
- Department of Pediatric Oncology & Hematology, Charité University Hospital, Berlin, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology & Hematology, Charité University Hospital, Berlin, Germany; German Cancer Consortium (DKTK Berlin), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Gudrun Schleiermacher
- SIREDO, Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, Paris, France
| | - Frank Speleman
- Center for Medical Genetics Ghent (CMGG), Department of Biomolecular Medicine, Cancer Research Institute Ghent (CRIG), Belgium
| | - Louis Chesler
- Paediatric Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, University Paris-Saclay & Inserm U1015, Villejuif, France
| | - Michael D Hogarty
- Division of Oncology, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, USA
| | - Meredith S Irwin
- Department of Paediatrics, Medical Biophysics and Laboratory Medicine & Pathobiology, The Hospital for Sick Kids, Toronto, Canada
| | - Nick Bird
- Solving Kids' Cancer, UK and National Cancer Research Institute Children's Cancer & Leukaemia Clinical Studies Group, UK
| | - Guy B Blanchard
- Neuroblastoma UK & Department of Physiology, Development & Neuroscience, University of Cambridge, UK
| | | | | | | | - Bram De Wilde
- Center for Medical Genetics Ghent (CMGG), Department of Biomolecular Medicine, Cancer Research Institute Ghent (CRIG), Belgium
| | - Hedwig E Deubzer
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Emmy Dolman
- Department of Translational Research, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martin Eilers
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Germany
| | - Rani E George
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA, USA
| | - Sally George
- Paediatric Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Štěrba Jaroslav
- Pediatric Oncology Department, University Hospital Brno, School of Medicine Masaryk University Brno, Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, ICRC Brno, St Anna University Hospital Brno, Czech Republic
| | - John M Maris
- Division of Oncology, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, USA
| | - Lynley Marshall
- Paediatric Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Melinda Merchant
- Astrazeneca, Early Clinical Projects, Oncology Translation Medicines Unit, Innovative Medicines Unit, Cambridge, UK
| | - Peter Mortimer
- Astrazeneca, Early Clinical Projects, Oncology Translation Medicines Unit, Innovative Medicines Unit, Cambridge, UK
| | - Cormac Owens
- Department of Paediatric Haemaology/Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | | | - Evon Poon
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Jerry W Shay
- Department of Cell Biology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Roberto Tonelli
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Dominique Valteau-Couanet
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Center, University Paris-Saclay & Inserm U1015, Villejuif, France
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
| | - Julie R Park
- Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Hospital, USA
| | - Andrew D J Pearson
- Paediatric Drug Development, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
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21
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Abstract
FDA has launched a Real World Evidence (RWE) Program for using real-world evidence (RWE) to help support new indications for already approved drugs or biologics and postapproval studies. The plan also includes stakeholder engagement efforts, demonstration projects, leadership activities, and development of guidance documents to assist developers interested in using real-world data (RWD) to develop RWE to support FDA regulatory decisions. This plan was mandated by the Cures Act passed in 2016. Over the 24-month period from passage of the law until FDA officially announced their program, FDA has gone to considerable efforts to educate the public about the benefits of RWE and encourage researchers to consider situations where RWE trials can generate useful information. Through a variety of stakeholder engagement projects, including publication of articles in medical journals, participation in public meetings, and development of initiatives, FDA has put more effort into preparing the medical community for its new emphasis on RWE than any other new policy that I can recall.
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Affiliation(s)
- David C. Klonoff
- Diabetes Research Institute;
Mills-Peninsula Health Services, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin),
Fellow AIMBE, Diabetes Research Institute, Mills-Peninsula Health Services, 100
S San Mateo Dr, Rm 5147, San Mateo, CA 94401, USA.
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22
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Ahmed MA, Patel C, Drezner N, Helms W, Tan W, Stypinski D. Pivotal Considerations for Optimal Deployment of Healthy Volunteers in Oncology Drug Development. Clin Transl Sci 2020; 13:31-40. [PMID: 31674150 PMCID: PMC6951451 DOI: 10.1111/cts.12703] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/26/2019] [Indexed: 12/01/2022] Open
Abstract
Oncology drug development is among the most challenging of any therapeutic area, with first-in-human trials expected to deliver information on both safety and activity. Until recently, therapeutic approaches in oncology focused on cytotoxic chemotherapy agents, ruling out even the possibility of enrolling normal healthy volunteers (NHVs) in clinical trials due to safety considerations. The emergence of noncytotoxic modalities, including molecularly targeted agents with more favorable safety profiles, however, has led to increasing numbers of clinical pharmacology studies of these agents being conducted in NHVs. Beyond rapid enrollment and cost savings, there are other advantages of conducting specific types of studies in NHVs with the goal of more appropriate dosing decisions in certain subsets of the intended patient populations, allowing for enrollment of such patients in therapeutic trials from which they might otherwise have been excluded. Nevertheless, the decision must be carefully weighed against potential disadvantages, and although the considerations surrounding conduct of clinical trials using NHVs are generally well-defined in most other therapeutic areas, they are less well-defined in oncology.
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Affiliation(s)
- Mariam A. Ahmed
- Center of Drug Evaluation and ResearchUS Food and Drug Administration
| | - Chirag Patel
- Quantitative Clinical PharmacologyTakeda Pharmaceutical International Company Ltd.
| | - Nicole Drezner
- Center of Drug Evaluation and ResearchUS Food and Drug Administration
| | - Whitney Helms
- Center of Drug Evaluation and ResearchUS Food and Drug Administration
| | - Weiwei Tan
- Global Clinical PharmacologyPfizer IncSan DiegoCaliforniaUSA
| | - Daria Stypinski
- Global Clinical PharmacologyPfizer IncSan DiegoCaliforniaUSA
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23
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24
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Solomon GM, Nichols DP. Taskforce recommends coordinated effort to improve clinical research conduct and find highly effective CFTR-directed treatment for rare mutations. J Cyst Fibros 2019; 18:579-580. [PMID: 31279576 DOI: 10.1016/j.jcf.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- G M Solomon
- Department of Medicine, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA..
| | - D P Nichols
- Department of Pediatrics, CF Therapeutics Development Network Coordinating Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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25
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Kelly LE, Richer L, Ali S, Plint AC, Poonai N, Freedman SB, Knisley L, Shimmin C, Hickes S, 't Jong GW, Pechlivanoglou P, Offringa M, Lacaze T, Klassen TP. Innovative approaches to investigator-initiated, multicentre paediatric clinical trials in Canada. BMJ Open 2019; 9:e029024. [PMID: 31253625 PMCID: PMC6609139 DOI: 10.1136/bmjopen-2019-029024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 01/17/2023] Open
Abstract
Data from clinical trials are needed to guide the safe and effective use of medicines in children. Clinical trials are challenging to design and implement in all populations, and children present additional considerations. Several regions including the UK, USA and Europe have established clinical trial infrastructure to capitalise on expertise and promote clinical trials enrolling children. Our objective is to describe the partnerships and operational considerations for the development of paediatric clinical trials infrastructure in Canada. We describe the design and conduct of four emergency room paediatric trials, with four separate sponsors, across four provinces in parallel. Operations discussed include multisite contract development, centralised risk-based data monitoring, ethical review and patient engagement. We conclude with lessons learnt, additional challenges and potential solutions to facilitate drug development for children in Canada.
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Affiliation(s)
- Lauren E Kelly
- Pediatrics and Child Health, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada
- Clinical Trials Platform, George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Richer
- Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Paediatrics and Emergency Medicine, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Amy C Plint
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Departments of Paediatrics and Emergency Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Naveen Poonai
- Paediatrics and Internal Medicine, Schulich School of Medicine & Dentistry, London Health Sciences Centre, London, Ontario, Canada
| | | | - Lisa Knisley
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Carolyn Shimmin
- Patient Engagement Lead, Knowledge Translation Platform, George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Serena Hickes
- Parent Partner, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Geert W 't Jong
- Pediatrics and Child Health, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Petros Pechlivanoglou
- Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin Offringa
- Peter Gilgan Centre for Research and Learning, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thierry Lacaze
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Terry P Klassen
- Pediatrics and Child Health, University of Manitoba, College of Medicine, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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26
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27
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Noel GJ, Nambiar S, Bradley J. Advancing Pediatric Antibacterial Drug Development: A Critical Need to Reinvent our Approach. J Pediatric Infect Dis Soc 2019; 8:60-62. [PMID: 29438520 PMCID: PMC6450364 DOI: 10.1093/jpids/piy001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 11/13/2022]
Abstract
The Clinical Trials Transformation Initiative convened with several groups in the pediatric antibacterial drug development community with the goal of identifying challenges and recommending ways to improve current practice. Attention to 5 major areas hold the promise of making new antibiotics available for use in children as soon as possible after they are approved for use in adults.
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Affiliation(s)
| | | | - John Bradley
- University of California, San Diego, Rady Children’s Hospital, California
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28
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Anderson RL, Balasas T, Callaghan J, Coombes RC, Evans J, Hall JA, Kinrade S, Jones D, Jones PS, Jones R, Marshall JF, Panico MB, Shaw JA, Steeg PS, Sullivan M, Tong W, Westwell AD, Ritchie JWA. A framework for the development of effective anti-metastatic agents. Nat Rev Clin Oncol 2019; 16:185-204. [PMID: 30514977 PMCID: PMC7136167 DOI: 10.1038/s41571-018-0134-8] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most cancer-related deaths are a result of metastasis, and thus the importance of this process as a target of therapy cannot be understated. By asking 'how can we effectively treat cancer?', we do not capture the complexity of a disease encompassing >200 different cancer types - many consisting of multiple subtypes - with considerable intratumoural heterogeneity, which can result in variable responses to a specific therapy. Moreover, we have much less information on the pathophysiological characteristics of metastases than is available for the primary tumour. Most disseminated tumour cells that arrive in distant tissues, surrounded by unfamiliar cells and a foreign microenvironment, are likely to die; however, those that survive can generate metastatic tumours with a markedly different biology from that of the primary tumour. To treat metastasis effectively, we must inhibit fundamental metastatic processes and develop specific preclinical and clinical strategies that do not rely on primary tumour responses. To address this crucial issue, Cancer Research UK and Cancer Therapeutics CRC Australia formed a Metastasis Working Group with representatives from not-for-profit, academic, government, industry and regulatory bodies in order to develop recommendations on how to tackle the challenges associated with treating (micro)metastatic disease. Herein, we describe the challenges identified as well as the proposed approaches for discovering and developing anticancer agents designed specifically to prevent or delay the metastatic outgrowth of cancer.
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Affiliation(s)
- Robin L Anderson
- Translational Breast Cancer Program, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia
- Cancer Therapeutics Cooperative Research Centre (CTx), Melbourne, Victoria, Australia
| | - Theo Balasas
- Commercial Partnerships, Cancer Research UK (CRUK), London, UK
| | - Juliana Callaghan
- Research and Innovation Services, University of Portsmouth, Portsmouth, Hampshire, UK
| | - R Charles Coombes
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Jeff Evans
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Jacqueline A Hall
- Research and Development, Vivacitv Ltd, Chesham, Buckinghamshire, UK
| | - Sally Kinrade
- Cancer Therapeutics Cooperative Research Centre (CTx), Melbourne, Victoria, Australia
- Medicines Development for Global Health, Southbank, Victoria, Australia
| | - David Jones
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | - Rob Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - John F Marshall
- Queen Mary University of London, Barts Cancer Institute, London, UK
| | | | - Jacqui A Shaw
- Leicester Cancer Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Patricia S Steeg
- Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mark Sullivan
- Cancer Therapeutics Cooperative Research Centre (CTx), Melbourne, Victoria, Australia
- Medicines Development for Global Health, Southbank, Victoria, Australia
| | - Warwick Tong
- Cancer Therapeutics Cooperative Research Centre (CTx), Melbourne, Victoria, Australia
| | - Andrew D Westwell
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - James W A Ritchie
- Commercial Partnerships, Cancer Research UK (CRUK), London, UK.
- Centre for Drug Development, CRUK, London, UK.
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29
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Abstract
The World Health Organization (WHO) has published a global priority list of antibiotic-resistant bacteria to guide research and development (R&D) of new antibiotics. Every pathogen on this list requires R&D activity, but some are more attractive for private sector investments, as evidenced by the current antibacterial pipeline. A "pipeline coordinator" is a governmental/non-profit organization that closely tracks the antibacterial pipeline and actively supports R&D across all priority pathogens employing new financing tools.
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Affiliation(s)
- Enrico Baraldi
- Enrico Baraldi, Ph.D., is Professor of Industrial Engineering and Management at Uppsala University. His research focuses on innovation studies, business strategy, industrial marketing and purchasing, and commercialization of science. Olof Lindahl, Ph.D., is an Assistant Professor of International Business at Uppsala University. His research focuses on multinational corporations, managing innovation, and strategy. Miloje Savic, Ph.D., is a senior adviser on public health and antimicrobial resistance at the Norwegian Institute of Public Health. David Findlay, M.B.A., was a Global Commercial Director for anti-infectives at GSK and has a B.Sc. in Experimental Psychology from Reading University and an M.B.A. specializing in international business strategy from the University of Bradford's Management Centre. Christine Årdal, Ph.D., is a Senior Advisor at the Norwegian Institute of Public Health, co-lead for the DRIVE-AB research project, and co-lead on the European Union's Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections. Her research focuses are within antibiotic and neglected disease policy, particularly in regards to innovation and access
| | - Olof Lindahl
- Enrico Baraldi, Ph.D., is Professor of Industrial Engineering and Management at Uppsala University. His research focuses on innovation studies, business strategy, industrial marketing and purchasing, and commercialization of science. Olof Lindahl, Ph.D., is an Assistant Professor of International Business at Uppsala University. His research focuses on multinational corporations, managing innovation, and strategy. Miloje Savic, Ph.D., is a senior adviser on public health and antimicrobial resistance at the Norwegian Institute of Public Health. David Findlay, M.B.A., was a Global Commercial Director for anti-infectives at GSK and has a B.Sc. in Experimental Psychology from Reading University and an M.B.A. specializing in international business strategy from the University of Bradford's Management Centre. Christine Årdal, Ph.D., is a Senior Advisor at the Norwegian Institute of Public Health, co-lead for the DRIVE-AB research project, and co-lead on the European Union's Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections. Her research focuses are within antibiotic and neglected disease policy, particularly in regards to innovation and access
| | - Miloje Savic
- Enrico Baraldi, Ph.D., is Professor of Industrial Engineering and Management at Uppsala University. His research focuses on innovation studies, business strategy, industrial marketing and purchasing, and commercialization of science. Olof Lindahl, Ph.D., is an Assistant Professor of International Business at Uppsala University. His research focuses on multinational corporations, managing innovation, and strategy. Miloje Savic, Ph.D., is a senior adviser on public health and antimicrobial resistance at the Norwegian Institute of Public Health. David Findlay, M.B.A., was a Global Commercial Director for anti-infectives at GSK and has a B.Sc. in Experimental Psychology from Reading University and an M.B.A. specializing in international business strategy from the University of Bradford's Management Centre. Christine Årdal, Ph.D., is a Senior Advisor at the Norwegian Institute of Public Health, co-lead for the DRIVE-AB research project, and co-lead on the European Union's Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections. Her research focuses are within antibiotic and neglected disease policy, particularly in regards to innovation and access
| | - David Findlay
- Enrico Baraldi, Ph.D., is Professor of Industrial Engineering and Management at Uppsala University. His research focuses on innovation studies, business strategy, industrial marketing and purchasing, and commercialization of science. Olof Lindahl, Ph.D., is an Assistant Professor of International Business at Uppsala University. His research focuses on multinational corporations, managing innovation, and strategy. Miloje Savic, Ph.D., is a senior adviser on public health and antimicrobial resistance at the Norwegian Institute of Public Health. David Findlay, M.B.A., was a Global Commercial Director for anti-infectives at GSK and has a B.Sc. in Experimental Psychology from Reading University and an M.B.A. specializing in international business strategy from the University of Bradford's Management Centre. Christine Årdal, Ph.D., is a Senior Advisor at the Norwegian Institute of Public Health, co-lead for the DRIVE-AB research project, and co-lead on the European Union's Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections. Her research focuses are within antibiotic and neglected disease policy, particularly in regards to innovation and access
| | - Christine Årdal
- Enrico Baraldi, Ph.D., is Professor of Industrial Engineering and Management at Uppsala University. His research focuses on innovation studies, business strategy, industrial marketing and purchasing, and commercialization of science. Olof Lindahl, Ph.D., is an Assistant Professor of International Business at Uppsala University. His research focuses on multinational corporations, managing innovation, and strategy. Miloje Savic, Ph.D., is a senior adviser on public health and antimicrobial resistance at the Norwegian Institute of Public Health. David Findlay, M.B.A., was a Global Commercial Director for anti-infectives at GSK and has a B.Sc. in Experimental Psychology from Reading University and an M.B.A. specializing in international business strategy from the University of Bradford's Management Centre. Christine Årdal, Ph.D., is a Senior Advisor at the Norwegian Institute of Public Health, co-lead for the DRIVE-AB research project, and co-lead on the European Union's Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections. Her research focuses are within antibiotic and neglected disease policy, particularly in regards to innovation and access
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