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Is Pharmacogenetic Testing a Vital Tool for Enhancing Therapeutic Management of Patients Worldwide? 药物基因检测是加强全球患者治疗管理的重要工具吗?
IF 6.3 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-17 DOI: 10.1002/cpt.3404
Kathleen M. Giacomini, Piet H. van der Graaf
<p>Clinical pharmacology is a discipline that includes education, research, and the implementation of knowledge into clinical practice, which ranges from precision dosing to therapeutic drug monitoring, and most recently, to the implementation of pharmacogenetic/pharmacogenomic (PGx) testing services to precisely administer drugs based on an individual's genetic make-up. In fact, PGx has become one of the core scientific pillars of the American Society for Clinical Pharmacology and Therapeutics (<i>ASCPT</i>) and its flagship journal, Clinical Pharmacology & Therapeutics (<i>CPT</i>). PGx implementation services have been rapidly adopted in academic healthcare centers throughout the United States and in Europe. These services are grounded in the availability of new genetic technologies and a wealth of scientific discoveries, generally describing the influence of genetic variants on drug responses in European ancestral populations. With the availability of PGx information, the Clinical Pharmacogenetics Implementation Consortium (<i>CPIC</i>) was established to develop guidelines on drug and dose selection for individuals based on their genetic information.<span><sup>1</sup></span> These guidelines, published in <i>CPT</i>,<span><sup>2, 3</sup></span> are increasingly being incorporated into clinical decision support systems, and used to advise providers on how to use PGx information in drug or dose selection.<span><sup>1</sup></span> However, despite of their widespread adoption in academic medical centers, there remains a resistance to PGx testing among healthcare providers. This can be attributed to various factors, such as cost of testing, requirements for expensive infrastructure, lack of provider education, and skepticism that there is any major benefit of testing.<span><sup>4</sup></span> </p><p>With the goal of stimulating discussion among clinical pharmacologists and others, the editors of <i>CPT</i> sponsored a session at the 2024 annual meeting of <i>ASCPT</i>, entitled: “Is pharmacogenetic testing a vital tool for enhancing therapeutic management of patients worldwide?” (Colorado Springs CO, March 28, 2024). The session, which was moderated by <i>CPT</i> Editor-in-Chief, Piet van der Graaf, and Deputy Editor, Kathleen Giacomini, included four clinical pharmacologists or geneticists who brought different types of expertise to the panel discussion: Karen E. Brown, PharmD (University of Montana), David J. Greenblatt, MD (Tufts University School of Medicine), Henk-Jan Guchelaar, PharmD PhD (Leiden University Medical Center), and Neal Hanchard, MD PhD (National Institute of Health). To spark audience engagement, the moderators designed a survey (<b>Supplementary Materials</b> <b>S1</b> )—distributed to the membership of the ASCPT a month before the annual meeting—with the aim to gain insight into the attitudes of clinical pharmacologists towards PGx testing.</p><p>The results of the survey, with
临床药理学是一门包括教育、研究和将知识应用于临床实践的学科,其范围从精确用药到治疗药物监测,以及最近的药物基因学/药物基因组学(PGx)检测服务,以根据个人的基因构成精确用药。事实上,PGx 已成为美国临床药理学与治疗学学会(ASCPT)及其旗舰期刊《临床药理学与治疗学》(CPT)的核心科学支柱之一。PGx 实施服务已在美国和欧洲的学术医疗保健中心迅速普及。这些服务的基础是新基因技术的可用性和大量科学发现,这些发现通常描述了欧洲祖先人群中基因变异对药物反应的影响。随着 PGx 信息的出现,临床药理遗传学实施联合会(CPIC)成立了,目的是根据遗传信息为个人制定药物和剂量选择指南。1 这些指南发表在《CPT》2, 3 上,正被越来越多地纳入临床决策支持系统,并用于指导医疗服务提供者如何在药物或剂量选择中使用 PGx 信息。1 然而,尽管 PGx 检测已在学术医疗中心广泛采用,但医疗服务提供者对 PGx 检测仍有抵触情绪。这可归因于多种因素,如检测成本、对昂贵基础设施的要求、缺乏对医疗服务提供者的教育,以及对检测是否有任何重大益处持怀疑态度。4 为了激发临床药理学家及其他人士的讨论,CPT 编辑在 2024 年 ASCPT 年会上赞助了一场题为 "药物基因检测是加强全球患者治疗管理的重要工具吗?(科罗拉多斯普林斯,2024 年 3 月 28 日)。会议由 CPT 主编皮特-范德格拉夫(Piet van der Graaf)和副主编凯瑟琳-贾科米尼(Kathleen Giacomini)主持,包括四位临床药理学家或遗传学家,他们为小组讨论带来了不同类型的专业知识:Karen E. Brown,药学博士(蒙大拿大学)、David J. Greenblatt,医学博士(塔夫茨大学医学院)、Henk-Jan Guchelaar,药学博士(莱顿大学医学中心)和 Neal Hanchard,医学博士(美国国立卫生研究院)。为了激发听众的参与热情,主持人设计了一份调查问卷(补充材料 S1),在年会召开前一个月分发给 ASCPT 的会员,目的是深入了解临床药理学家对 PGx 试验的态度。大约一半的受访者认为 PGx 检测 "有用但价值不大",同样,大多数受访者认为在对患者进行基因检测之前,需要进行前瞻性临床试验,尽管这并非必须(图 1)。实际上,所有受访者都认为需要在 PGx 检测方面开展更多发现性研究,大多数人认为 PGx 检测(不包括体细胞突变)对肿瘤学的治疗管理比对心脏病学和神经病学等其他领域的治疗管理更有益。Hanchard 博士指出,欧洲人常见的许多基因变异在其他人群中极为罕见。重要的是,他描述了非洲大陆各种遗传变异等位基因频率的巨大差异。事实上,在 2023 年发表于《CPT》6 的手稿中,Hanchard 博士及其同事描述了葡萄糖-6-磷酸脱氢酶(G6PD)在非洲的巨大差异。G6PD 缺乏症在包括非洲国家在内的疟疾多发国家很常见,当服用某些药物(如伯氨喹)时,G6PD 缺乏症患者会出现急性溶血性贫血,并伴有疲劳和黄疸等其他症状。虽然 G6PD 缺乏症一直被认为是一种 X 连锁隐性遗传病,主要发生在男性身上,但它也可发生在男性和女性身上:半合子男性、同卵双生女性和由于 X 连锁嵌合而导致的杂合子女性。在非洲,G6PD A 组型(包括 rs1050828 T 等位基因和 rs1050829 C)与 G6PD 缺乏症有关。有趣的是,在非洲,尽管聪加人(16%)和科萨人(0.8%)都分布在南非,但他们的 rs1050828 T 频率明显高于科萨人。Hanchard 博士及其团队指出,在非洲,在使用这些药物之前进行 G6PD 检测至关重要。 CYP2B6等位基因导致酶功能减弱在非洲也很常见,而且在非洲大陆差异很大。他和他的研究小组指出,CYP2B6 是决定艾滋病药物依非韦伦的药代动力学的关键因素,这再次强调了在非洲进行药物基因检测的必要性。所有小组成员一致认为,显然需要在非欧洲人群中开展更多研究,以确定药物代谢酶和转运体中常见的有害等位基因或功能增益等位基因。调查的一个惊人发现是,大多数调查对象认为 PGx 检测对全球健康公平产生了积极影响。主持人将这一回答解释为,如果包括中低收入国家在内的世界各地都能进行药物基因检测,全球健康公平性将受到积极影响。布朗博士强调,即使在美国和加拿大等发达国家,也需要让包括土著居民在内的所有社区参与进来。她和她的团队参与了土著社区的 PGx 研究。她强调了美国印第安人和阿拉斯加原住民与研究人员之间长期合作的重要性,认为这对于向历来在 PGx 研究中代表性不足的人群提供医疗保健服务至关重要。7 PGx 会议的听众参与度很高,与会者提醒专家组成员注意在基因变异的背景下研究药物间相互作用的重要必要性,以及治疗和药物不良反应受患者基础疾病、伴随药物和遗传学影响的多因素事实。总之,尽管与会者对题为 "药物基因检测是否是加强全球患者治疗管理的重要工具?然而,解决医生超负荷工作的问题至关重要,这可能会通过药剂师等其他医护人员来实现。此外,小组成员、调查参与者和听众普遍认为亟需开展研究,包括更多的发现研究、前瞻性临床试验和针对 PGx 检测成本效益比的研究。随着药物基因组学检测服务越来越多地被医疗保健系统采用,分享实施的最佳实践对于减少医疗保健中的差异至关重要。印第安纳大学精准健康计划(Indiana University Precision Health Initiative)的舒格(Shugg)和同事8 的教程详细介绍了一个多方面的 PGx 实施计划,可为其他临床机构和医疗服务提供者提供指导。药物基因组学实施服务需要通过指南(如 CPIC 共同撰写的指南)或专家咨询服务对可操作的药物基因组学变异进行解释。在本期杂志中,Donnelly 等人1 和 Ingelman-Sundberg4 以两份新的 CPIC 指南2、3 为案例,对已发布的 PGx 指南的价值和临床影响进行了讨论。正如在 ASCPT 会议之前进行的题为 "药物基因检测是加强全球患者治疗管理的重要工具吗?药物基因变异联盟(PharmVar)最新发布的两篇 "GeneFocus "综述全面概述了两种重要药物代谢酶 CYP2A6 9 和 CYP4F2 10 的基因变异,这将有助于进一步研究它们对临床的影响。药物基因组学检测在很大程度上依赖于欧洲血统人群的临床研究数据,通常是针对接受特定药物治疗的人群,如服用他汀类药物的血脂异常患者。然而,特殊人群和代表性不足的群体在药物基因组学研究中仍未得到充分研究。在本期的《CPT》中,有几篇手稿介绍了在特殊和代表性不足的患者群体中进行精准用药的情况。例如,有两项研究关注非洲人群的药物基因组学。11, 12 这两项研究中的一项涉及基因多态性和妊娠及产后患者,结果显示妊娠状态和 CYP2B6 多态性都会影响依非韦伦的暴露量。
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引用次数: 0
External Controls to Study Treatment Effects in Rare Diseases: Challenges and Future Directions 研究罕见病治疗效果的外部对照:挑战与未来方向
IF 6.7 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-17 DOI: 10.1002/cpt.3443
Janick Weberpals, Shirley V. Wang
Regulators increasingly rely on real‐world evidence generated from routine‐care health data to evaluate novel therapies. Particularly, external control arms are increasingly used to supplement and contextualize efficacy and safety claims of single arm clinical trials for rare disease therapies. However, there are a number of methodological issues that may affect the validity of results derived from such comparisons. In this mini‐review, we briefly summarize frequently used approaches and outline some of the most important criticisms and paths forward.
监管机构越来越依赖于从日常护理健康数据中生成的真实世界证据来评估新型疗法。特别是,外部对照臂越来越多地被用来补充罕见病疗法单臂临床试验的疗效和安全性要求,并使之符合实际情况。然而,有一些方法学问题可能会影响此类比较结果的有效性。在这篇小型综述中,我们简要总结了常用的方法,并概述了一些最重要的批评意见和前进方向。
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引用次数: 0
An Innovative Approach to Optimize First‐In‐Human Minimal Anticipated Biological Effect Level Based Starting Dose in Oncology Trials for Bispecific T‐Cell Engagers: Experience from A Solid Tumor Bispecific T‐Cell Engager 在双特异性 T 细胞靶向药物的肿瘤学试验中,优化基于最小预期生物效应水平的首次人体试验起始剂量的创新方法:来自实体瘤双特异性 T 细胞参与疗法的经验
IF 6.7 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-17 DOI: 10.1002/cpt.3431
Di Zhou, Roman Kischel, Sabine Stienen, Danielle Townsley, Alexander Sternjak, Michael Lutteropp, Julie Bailis, Matthias Friedrich, Benno Rattel, Khamir Mehta, Vijay V. Upreti
Bispecific T‐cell engagers (Bi‐TCEs) have revolutionized the treatment and management of both hematological and solid tumor indications with opportunities to become best‐in‐class therapeutics for cancer. However, defining the dose and dosing regimen for the first‐in‐human (FIH) studies of Bi‐TCEs can be challenging, as a high starting dose can expose subjects to serious toxicity while a low starting dose based on traditional minimal anticipated biological effect level (MABEL) approach could lead to lengthy dose escalations that exposes seriously ill patients to sub‐therapeutic dosing. Leveraging our in‐depth and broad clinical development experience across three generations of Bi‐TCEs across both liquid and solid tumor indications, we developed an innovative modified MABEL approach for starting dose selection that integrates knowledge based on the target biology, indication, toxicology, in vitro, in vivo pharmacological evaluations, and translational pharmacokinetic/pharmacodynamic (PK/PD) modeling, together with anticipated safety profile. Compared to the traditional MABEL approach in which high effector to target (E:T) cell ratios are typically used, our innovative approach utilized an optimized E:T cell ratio that better reflects the tumor microenvironment. This modified MABEL approach was successfully applied to FIH dose selection for a half‐life extended (HLE) Bi‐TCE for gastric cancer. This modified MABEL approach enabled a 10‐fold higher starting dose that was deemed safe and well tolerated and saved at least two dose‐escalation cohorts before reaching the projected efficacious dose. This approach was successfully accepted by global regulatory agencies and can be applied for Bi‐TCEs across both hematological and solid tumor indications for accelerating the clinical development for Bi‐TCEs.
双特异性 T 细胞吸引剂(Bi-TCEs)彻底改变了血液病和实体瘤的治疗和管理,有机会成为一流的癌症治疗药物。然而,为双T细胞捕获剂的首次人体(FIH)研究确定剂量和给药方案具有挑战性,因为高起始剂量会使受试者面临严重毒性,而基于传统最小预期生物效应水平(MABEL)方法的低起始剂量则可能导致漫长的剂量升级,使重症患者面临亚治疗剂量。利用我们在液体和实体瘤适应症方面三代 Bi-TCE 深入而广泛的临床开发经验,我们开发了一种创新的修正 MABEL 方法,用于起始剂量的选择,该方法综合了基于靶点生物学、适应症、毒理学、体外和体内药理学评估、转化药代动力学/药效学 (PK/PD) 模型以及预期安全性的知识。传统的 MABEL 方法通常使用较高的效应细胞与靶细胞(E:T)比例,相比之下,我们的创新方法采用了优化的 E:T 细胞比例,能更好地反映肿瘤微环境。这种改良的 MABEL 方法被成功应用于胃癌半衰期延长 (HLE) BiTCE 的 FIH 剂量选择。这种改进的 MABEL 方法使起始剂量提高了 10 倍,被认为是安全且耐受性良好的,并且在达到预计有效剂量之前至少节省了两个剂量递增队列。这种方法已成功获得全球监管机构的认可,可用于血液病和实体瘤适应症的双 TCE,以加快双 TCE 的临床开发。
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引用次数: 0
Highlighted Articles 重点文章
IF 6.3 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-17 DOI: 10.1002/cpt.3411
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引用次数: 0
Concomitant Use of Oral Anticoagulants with Oral Dipeptidyl Peptidase‐4 Inhibitors and Serious Bleeding Events 口服抗凝剂与口服二肽基肽酶-4 抑制剂同时使用与严重出血事件
IF 6.7 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-12 DOI: 10.1002/cpt.3442
Thanh Phuong Pham Nguyen, Charles E. Leonard, Colleen M. Brensinger, Warren B. Bilker, Sophie P. Chung, John R. Horn, Kacie Bogar, Todd A. Miano, Sean Hennessy
In a prior screening study, saxagliptin, a dipeptidyl peptidase‐4 inhibitor (DPP‐4i), was found to have an increased rate of serious bleeding when used concomitantly with several oral anticoagulants (OACs). We aimed to confirm or refute the associations between concomitant use of individual OACs and DPP‐4is and serious bleeding in a large US database, using self‐controlled case series (SCCS) and case‐crossover (CCO) designs. The study population was eligible Medicare beneficiaries co‐exposed to a DPP‐4i (precipitant) and either an OAC (object drug) or lisinopril (negative control object drug) in 2016–2020. For the SCCS, we used conditional Poisson regression to estimate adjusted rate ratios (RRs) between each co‐exposure (vs. not) and serious bleeding and divided the RR by the adjusted RR for the corresponding lisinopril + precipitant pair to obtain ratios of RRs (RRRs). For the CCO, we estimated the adjusted odds ratios (ORs) of exposure to the precipitant in the focal window vs. referent window using multivariable conditional logistic regression and divided the ORs in the object drug‐exposed cases over the ORs in negative object drug‐exposed cases to obtain the ratios of ORs (RORs). The adjusted RRRs for serious bleeding ranged from 0.32 (0.05–1.91) for apixaban/lisinopril + saxagliptin to 3.49 (1.29–9.48) for warfarin/lisinopril + linagliptin. The adjusted RORs ranged from 0.01 (0.00–0.20) for rivaroxaban/lisinopril + saxagliptin to 2.99 (0.74–12.11) for apixaban/lisinopril + linagliptin. While we could not confirm previously identified signals because of statistical imprecision, several numerically elevated estimates still warrant caution in concomitant use and further examination.
在之前的一项筛选研究中,发现二肽基肽酶-4 抑制剂 (DPP-4i) 沙格列汀与几种口服抗凝剂 (OAC) 同时使用时,严重出血的发生率会增加。我们的目的是利用自控病例系列(SCCS)和病例交叉(CCO)设计,在一个大型美国数据库中证实或反驳同时使用个别 OACs 和 DPP-4is 与严重出血之间的关联。研究对象是在 2016-2020 年期间共同接触过 DPP-4i(诱导剂)和 OAC(目标药物)或赖欣诺普利(阴性对照目标药物)的符合条件的医疗保险受益人。对于 SCCS,我们使用条件泊松回归来估算每种共同暴露(与未共同暴露)和严重出血之间的调整率比 (RR),并将 RR 除以相应的利辛普利 + 促效剂配对的调整率比,以获得 RR 比 (RRR)。对于 CCO,我们使用多变量条件逻辑回归估算了病灶窗与参照窗暴露于沉淀剂的调整后几率比(ORs),并将对象药物暴露病例的几率比除以对象药物阴性暴露病例的几率比,得出几率比(RORs)。阿哌沙班/利辛普利+沙格列汀的严重出血调整RRR为0.32(0.05-1.91),华法林/利辛普利+利拉利汀的严重出血调整RRR为3.49(1.29-9.48)。利伐沙班/利辛普利+沙格列汀的调整ROR为0.01(0.00-0.20),阿哌沙班/利辛普利+利拉利汀的调整ROR为2.99(0.74-12.11)。虽然由于统计不精确,我们无法确认之前确定的信号,但几个数值升高的估计值仍值得在同时使用时谨慎对待,并进行进一步检查。
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引用次数: 0
Characteristics of Drugs from Non‐Global Companies for Hematologic Malignancies and Impact on Global Regulatory Approval 非全球公司血液恶性肿瘤药物的特点及其对全球监管审批的影响
IF 6.7 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-10 DOI: 10.1002/cpt.3440
Kensuke Matsuda, Sumimasa Nagai, Koichi Sugimoto
The number of drugs developed by non‐global companies, including biotech start‐ups, has increased; however, their characteristics and impact on global regulatory approval are not well understood. Using a public database, we identified new molecular entities (NMEs) approved for hematologic malignancies in the US from January 2011 to December 2022. They were divided into those submitted by non‐global companies (non‐global group) and those by global companies (global group). We identified 48 NMEs, of which 19 (40%) were classified as non‐global. Of these, 13 (68%) were from US‐based companies. In the non‐global group, 63% (12/19) of the NMEs had received accelerated approval in the US, of which only 50% (6/12) had a post‐approval confirmatory trial by September 2023. Regarding the impact on the approval in the European Union (EU) and Japan, the unapproval rate of 2 years after US approval was higher in the non‐global group than in the global group in the EU (56% vs. 21%) and Japan (94% vs. 64%). In conclusion, many NMEs from non‐global companies had received accelerated approval in the US based on phase I/II trials. NMEs from non‐global companies had a higher unapproval rate at 2 years in both the EU and Japan.
非全球性公司(包括新成立的生物技术公司)开发的药物数量有所增加;然而,人们对这些药物的特点及其对全球监管审批的影响还不甚了解。利用公共数据库,我们确定了2011年1月至2022年12月期间美国批准的血液系统恶性肿瘤新分子实体(NME)。这些药物分为非全球公司(非全球组)提交的药物和全球公司(全球组)提交的药物。我们确定了 48 个 NME,其中 19 个(40%)被归类为非全球性公司。其中 13 家(68%)来自美国公司。在非全球组中,63%(12/19)的非处方药已在美国获得加速批准,其中只有 50%(6/12)的非处方药在 2023 年 9 月前进行了批准后的确证试验。关于对欧盟(EU)和日本批准的影响,在欧盟(56% 对 21%)和日本(94% 对 64%),非全球组在美国批准后 2 年的未批准率高于全球组。总之,许多来自非全球公司的非处方药在美国获得了基于I/II期试验的加速批准。在欧盟和日本,来自非全球公司的 NME 在 2 年后的未批准率较高。
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引用次数: 0
A User-Driven Framework for Dose Selection in Pregnancy: Proof of Concept for Sertraline. 用户驱动的妊娠期剂量选择框架:舍曲林的概念验证。
IF 6.3 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-09 DOI: 10.1002/cpt.3429
Charlotte Koldeweij, Caroline Dibbets, Bryony D Franklin, Hubertina C J Scheepers, Saskia N de Wildt

Despite growing knowledge of pregnancy-induced changes in physiology that may alter maternal and fetal pharmacokinetics, evidence-based antenatal doses are lacking for most drugs. Pharmacokinetic modeling and expanding clinical data in pregnancy may support antenatal doses. We aimed to develop and pilot a comprehensive and user-driven Framework for Dose Selection in Pregnancy to support the clinical implementation of a best-evidence antenatal dose for sertraline. After initial development and evaluation by experts, the framework prototype was piloted to formulate an antenatal dosing strategy for sertraline in depression and anxiety disorders. Next, the framework was reviewed and assessed for usability by a multidisciplinary working committee of end-users comprising healthcare practitioners, experts from other disciplines including pharmacometrics, reproductive toxicology and medical ethics, alongside pregnant women and a partner. The resulting framework encompasses the following: rationale for drug selection, a comprehensive analysis of pharmacokinetic and dose-related efficacy and safety data, and implementation aspects including feasibility and desirability of the recommended antenatal dose based on a structured maternal and fetal benefit-risk assessment. An antenatal dose recommendation for sertraline, as a case study, was formulated using this approach and endorsed for clinical use by the working committee. Future applications of the framework for other drugs can further demonstrate its suitability for developing best evidence, acceptable and clinically feasible antenatal doses.

尽管人们对妊娠引起的生理变化有了越来越多的了解,这些变化可能会改变母体和胎儿的药代动力学,但大多数药物都缺乏以证据为基础的产前剂量。妊娠期药代动力学建模和不断扩大的临床数据可为产前剂量提供支持。我们旨在开发并试行一个全面的、用户驱动的妊娠期剂量选择框架,以支持舍曲林最佳循证产前剂量的临床实施。经过专家的初步开发和评估后,我们对该框架原型进行了试用,以制定抑郁症和焦虑症患者舍曲林的产前剂量策略。接下来,由医疗保健从业人员、药物计量学、生殖毒理学和医学伦理学等其他学科的专家以及孕妇和一名伴侣组成的最终用户多学科工作委员会对该框架进行了审查和可用性评估。最终形成的框架包括以下内容:药物选择的基本原理、药代动力学和剂量相关的疗效和安全性数据的综合分析,以及实施方面的内容,包括根据结构化的孕产妇和胎儿获益风险评估所推荐的产前剂量的可行性和可取性。以舍曲林为例,我们采用这种方法制定了产前剂量建议,并得到了工作委员会的认可,可用于临床。未来将该框架应用于其他药物,可进一步证明其适用于制定最佳证据、可接受且临床可行的产前剂量。
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引用次数: 0
Utility of Biomarker-Informed Drug Interaction Evaluation in Drug Development and Regulatory Decision Making. 以生物标志物为依据的药物相互作用评估在药物开发和监管决策中的实用性。
IF 6.3 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-09 DOI: 10.1002/cpt.3436
Akihiro Ishiguro, Hiroyuki Kusuhara, Emi Kimoto, So Miyoshi, Katsuhiko Mizuno, Motohiro Hoshino, Hiroshi Suzuki

The measurement of endogenous biomarkers in plasma and urine before and after administration of an investigational drug in a clinical study may provide an early indication of its drug-drug interaction (DDI) potential via a specific pathway. In the first international harmonized guideline on drug interaction studies, the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) M12, endogenous biomarkers have been recognized as an emerging approach in the transporter- and enzyme-based DDI risk assessment. Clinical Pharmacology Roundtable Conference 2024 held at Pharmaceuticals and Medical Devices Agency (PMDA) brought together experts from regulatory agencies, academia, and industries to discuss potential advantages and challenges of the biomarkers approach in drug development and regulatory decision making. This meeting report facilitates stakeholders involved in drug development in better understanding the utility of biomarker approaches and promotes early implementation of biomarker-informed DDI evaluation in regulatory use.

在临床研究中给药前后对血浆和尿液中的内源性生物标记物进行测量,可及早显示药物通过特定途径发生药物相互作用(DDI)的可能性。国际人用药品技术要求协调理事会 (ICH) M12 是国际上第一份关于药物相互作用研究的协调指南,其中内源性生物标志物被认为是基于转运体和酶的 DDI 风险评估的一种新兴方法。药品和医疗器械管理局(PMDA)举办的 2024 年临床药理学圆桌会议汇聚了来自监管机构、学术界和工业界的专家,共同讨论生物标记物方法在药物开发和监管决策中的潜在优势和挑战。这份会议报告有助于参与药物开发的利益相关者更好地了解生物标志物方法的效用,并促进在监管使用中尽早实施以生物标志物为依据的DDI评估。
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引用次数: 0
Partial Residual Plots as an Integrated Model Diagnostic Tool in Model-Based Meta-Analysis. 将部分残差图作为基于模型的 Meta 分析中的综合模型诊断工具》(Partial Residual Plots as an Integrated Model Diagnostic Tool in Model-Based Meta-Analysis)。
IF 6.3 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-08 DOI: 10.1002/cpt.3418
John Maringwa, Paul Matthias Diderichsen, Chandni Valiathan

The use of partial residual plots (PRPs) was explored as a model diagnostic tool in Model-based Meta-Analysis (MBMA). Mathematical derivations illustrating the concepts were followed by an MBMA example using publicly available literature data of anti-depressive treatments with fluoxetine and venlafaxine. An Emax dose-response model was identified for venlafaxine while a constant drug effect combining all dose levels vs. placebo was identified for fluoxetine. The larger the mean baseline Hamilton Depression Rating (HAMD) score, the larger the expected drug effect (P = 0.0122), based on the likelihood ratio test. Mean baseline HAMD score (range) was 25.4 (23.5, 29.4) and 20.8 (15, 26) while mean placebo change from baseline (range) was -9.02 (-12.2, -4.8) and - 6.22 (-10.9, -1.3) for venlafaxine and fluoxetine, respectively. Average baseline HAMD score appeared larger for venlafaxine compared to fluoxetine, albeit a wider range for fluoxetine. Placebo response seemed lower but also more variable in fluoxetine compared to venlafaxine studies. Observed data points tended to deviate from model predictions when the mean baseline HAMD and placebo response values associated with those data points differed substantially from the corresponding values used for the model prediction. Normalizing observed data addressed this, providing a "like-to-like" comparison with model predictions in PRP when assessing the effect of one covariate (dose) after normalizing for other covariates/effects (placebo response and mean baseline). PRPs provide a robust integrated diagnostic tool in MBMA that uses all data to show the correlation between response and any covariate while controlling for other covariates included in the model.

在基于模型的元分析(MBMA)中,部分残差图(PRP)作为一种模型诊断工具得到了探讨。在对概念进行数学推导之后,使用公开文献数据对氟西汀和文拉法辛的抗抑郁治疗进行了 MBMA 示例。为文拉法辛确定了一个最大剂量反应模型,而为氟西汀确定了一个结合所有剂量水平与安慰剂的恒定药物效应模型。根据似然比检验,平均基线汉密尔顿抑郁评分(HAMD)越高,预期药物效应越大(P = 0.0122)。文拉法辛和氟西汀的平均基线 HAMD 评分(范围)分别为 25.4(23.5,29.4)和 20.8(15,26),而安慰剂与基线相比的平均变化(范围)分别为-9.02(-12.2,-4.8)和-6.22(-10.9,-1.3)。与氟西汀相比,文拉法辛的平均基线HAMD评分似乎更高,尽管氟西汀的评分范围更广。与文拉法辛研究相比,氟西汀的安慰剂反应似乎更低,但变化也更大。当与数据点相关的 HAMD 和安慰剂反应平均基线值与模型预测所用的相应值相差很大时,观察数据点往往会偏离模型预测值。对观察到的数据进行归一化处理可解决这一问题,在对其他协变量/效应(安慰剂反应和平均基线)进行归一化处理后,在 PRP 中评估一个协变量(剂量)的效应时,可与模型预测进行 "相似 "比较。PRP 在 MBMA 中提供了一个强大的综合诊断工具,它使用所有数据显示响应与任何协变量之间的相关性,同时控制模型中包含的其他协变量。
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引用次数: 0
Rare Diseases Linked to Mutations in Vitamin Transporters Expressed in the Human Blood-Brain Barrier. 与人类血脑屏障中表达的维生素转运体突变有关的罕见疾病
IF 6.3 2区 医学 Q1 PHARMACOLOGY & PHARMACY Pub Date : 2024-09-05 DOI: 10.1002/cpt.3433
Sook Wah Yee, Joanne Wang, Kathleen M Giacomini

Recent advances have significantly enhanced our understanding of the role of membrane transporters in drug disposition, particularly focusing on their influence on pharmacokinetics, and consequently, pharmacodynamics. The relevance of these transporters in clinical pharmacology is well acknowledged. Recent research has also underscored the critical role of membrane transporters as targets in human diseases, including their involvement in rare genetic disorders. This review focuses on transporters for water-soluble B vitamins, such as thiamine, riboflavin, and biotin, essential cofactors for metabolic enzymes. Mutations in transporters, such as SLC19A3 (thiamine), SLC52A2, and SLC52A3 (riboflavin), and SLC5A6 (multiple B vitamins including pantothenic acid and biotin) are linked to severe neurological disorders due to their role in the blood-brain barrier, which is crucial for brain vitamin supply. Current treatments, mainly involving vitamin supplementation, often result in variable response. This review also provides a short perspective on the role of the transporters in the blood-cerebrospinal fluid barrier and highlights the potential development of pharmacologic treatments for rare disorders associated with mutations in these transporters.

最近的研究进展大大提高了我们对膜转运体在药物处置中的作用的认识,尤其是它们对药物动力学的影响,进而对药效学的影响。这些转运体与临床药理学的相关性已得到公认。最近的研究还强调了膜转运体作为人类疾病靶点的关键作用,包括它们在罕见遗传疾病中的参与。本综述重点关注水溶性 B 族维生素(如硫胺素、核黄素和生物素)的转运体,它们是代谢酶的重要辅助因子。SLC19A3(硫胺素)、SLC52A2 和 SLC52A3(核黄素)以及 SLC5A6(多种 B 族维生素,包括泛酸和生物素)等转运体的突变与严重的神经系统疾病有关,因为它们在血脑屏障中起着重要作用,而血脑屏障对脑部维生素的供应至关重要。目前的治疗方法主要是补充维生素,但往往效果不一。这篇综述还从一个简短的角度阐述了转运体在血-脑脊液屏障中的作用,并强调了针对与这些转运体突变有关的罕见疾病的药物治疗的潜在发展。
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引用次数: 0
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Clinical Pharmacology & Therapeutics
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