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Medicines Counterfeiting in Africa: A View from Zimbabwe 非洲药品造假:来自津巴布韦的观点
Pub Date : 2017-05-10 DOI: 10.5301/maapoc.0000017
S. D. Gwatidzo, Petronella K. Murambinda, Zivanai Makoni
With the sprouting of unregulated outlets on the streets of Zimbabwe, common questions that are raised include: (i) what is the Medicines Control Authority of Zimbabwe (MCAZ) doing about these street vendors? and (ii) is the law against unregulated markets and proliferation of substandard and falsified (SF) medicines being actively enforced? There is no doubt that this is a new challenge for MCAZ because of the risks involved with SF medicines. Notwithstanding the rather strong regulatory framework for the regulated market that the MCAZ has major control over, and its demonstrable regulatory prowess over the last 20 years as a National Medicines Regulatory Authority (NMRA), MCAZ is increasingly challenged to take a leading role in addressing this rising phenomenon. MCAZ has attempted to address the problem through collaboration with the Zimbabwe Republic Police (ZRP), public education and inspections by port officials at ports of entry. However, the problem still persists. A general lack of concrete qualitative and quantitative data on the commonly encountered SF medicinal products on the Zimbabwe market is another major issue. This is evidently a multi-layered problem and as the Shona adage goes “chara chimwe hachitswanye inda” (loosely translated “one thumb cannot crush all lice”), there is need for engaging local and regional partners in a bid to fulfil the MCAZ's mandate of protecting public health by ensuring medicines and medical devices intended for sale and distribution in Zimbabwe, are safe, effective and of good quality.
随着津巴布韦街头不受管制的销售点的涌现,人们提出的常见问题包括:(i)津巴布韦药品管制局(MCAZ)对这些街头摊贩采取了什么措施?(ii)针对不受监管的市场和伪劣药品扩散的法律是否得到积极执行?毫无疑问,由于SF药物的风险,这对MCAZ来说是一个新的挑战。尽管MCAZ对受监管的市场有着相当强大的监管框架,并且在过去20年里,作为国家药品监管局(NMRA), MCAZ在解决这一日益上升的现象方面发挥主导作用的挑战越来越大。津巴布韦移民局试图通过与津巴布韦共和国警察合作、公共教育和港口官员在入境口岸进行检查来解决这一问题。然而,这个问题仍然存在。津巴布韦市场上常见的顺丰药品普遍缺乏具体的定性和定量数据,这是另一个主要问题。这显然是一个多层次的问题,正如绍纳谚语所说的"一个拇指不能压碎所有虱子"(大意为"一个拇指不能压碎所有虱子"),有必要让当地和区域伙伴参与,以履行MCAZ的任务,即通过确保在津巴布韦销售和分销的药品和医疗设备安全、有效和高质量来保护公众健康。
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引用次数: 7
The Critical Role of the Clinical Research Coordinator for Clinical Trials: A Survey in Oncology 临床试验临床研究协调员的关键作用:肿瘤学综述
Pub Date : 2017-05-10 DOI: 10.5301/MAAPOC.0000015
M. Cinefra, C. Cagnazzo, L. McMahon, F. Arizio, S. Campora, R. Camisa, G. Canzanella, M. Contu, P. Frati, R. Sottile, S. Gori, G. Procopio, O. Nanni
Introduction Access to innovative medicine requires proper evidence from clinical trials with the growing demand of qualified and experienced personnel. The clinical research coordinator (CRC) plays an important role in the conduction of research activities and provides a strong support to the research team. In Italy, this role is not recognized at any institutional level and its professional outline is still indefinite. Several national associations (Associazione Italiana di Oncologia Medica, Collegio Italiano dei Primari Oncologi Medici Ospedalieri, Gruppo Italiano Data Manager) are committed to promoting the enhancement and recognition of the professional status of CRCs, underlining their role as fundamental. Methods A web survey, proposed by the AIOM CRC Working Group, was submitted to 319 Italian oncology sites with items focusing on the organization of sites, the research activities, the staff composition, and the presence of coordinators and the multidisciplinary team. Results A total of 115 sites (35.9%) responded to the web survey. Clinical studies were carried out at 88.7% of the investigated sites, and coordinators were on staff at 75.5% of the active investigational sites. Interestingly, there was a direct association between the number of clinical studies and the number of coordinators, whose contribution to the research activities is believed to be essential for trial conduct in 82.4% of cases. Most sites retain that the quality of clinical research has absolutely improved (83.3%) after the implementation of a coordinator as member of the team. Conclusions Given the constant growth of the number of clinical trials performed at Italian oncology sites, the CRC proves to be an essential component of the research team. However, there is an urgent need to institute the professional role alongside the need to standardize the training of coordinators to establish the minimum requirements enhanced by qualifying courses.
获得创新药物需要来自临床试验的适当证据,对合格和有经验的人员的需求日益增长。临床研究协调员(CRC)在研究活动的开展中发挥着重要作用,为研究团队提供了强有力的支持。在意大利,这一作用没有得到任何机构级别的承认,其专业大纲仍然是不确定的。几个国家协会(Associazione Italiana di Oncologia Medica, Collegio Italiano dei Primari Oncologi Medici Ospedalieri, Gruppo Italiano Data Manager)致力于促进crc专业地位的提升和认可,强调其作为基础的作用。方法采用AIOM CRC工作组提出的网络调查方法,对意大利319家肿瘤中心进行调查,调查内容包括中心组织、研究活动、工作人员构成、协调员和多学科团队的存在情况。结果共有115家网站(35.9%)参与了网络调查。88.7%的调查地点开展了临床研究,75.5%的活跃研究地点有协调员。有趣的是,临床研究的数量与协调员的数量之间存在直接关联,在82.4%的病例中,协调员对研究活动的贡献被认为对试验进行至关重要。大多数网站认为,实施协调员作为团队成员后,临床研究质量绝对提高(83.3%)。鉴于在意大利肿瘤中心进行的临床试验数量不断增长,CRC被证明是研究团队的重要组成部分。但是,迫切需要确立专业人员的作用,同时也需要使协调员的培训标准化,以确定通过合格课程加强的最低要求。
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引用次数: 8
What's in a Word? Falsified/Counterfeit/Fake Medicines - The Definitions Debate 单词里有什么?伪造/假冒/假药-定义辩论
Pub Date : 2017-04-04 DOI: 10.5301/MAAPOC.0000008
M. Isles
There is a rising tide of criminal activity to manufacture and distribute falsified, counterfeit, or fake medicines. The exact size of this problem is unknown but estimates vary from US$75 billion to US$200 billion per year, and evidence clearly demonstrates it is on the increase. Depending on the world region, infiltration into the legitimate supply chain versus the illegitimate (e.g., the internet) varies greatly. However, what is certain is that the direction of travel by regulatory agents is to develop supply chains that allow access to medicines via the World Wide Web. Within this context, there has been a long-running debate about how to correctly describe the various forms of medicines that are fraudulently or otherwise manufactured and distributed. This article attempts to describe the evolution of the definitions and recommends that a consensus be formed to describe such medicines that reach the public: • Falsified medicine: This being the term used and defined in the Falsified Medicines Directive and which is primarily concerned with public health. • Counterfeit medicine: This is closely associated and legally defined within intellectual property legislation and concentrates on trademark protection. • Fake medicine: This is the term that best serves to communicate with the public to raise awareness about the phenomenon.
制造和分销伪造、假冒或假药的犯罪活动呈上升趋势。这一问题的确切规模尚不清楚,但估计每年的规模从750亿美元到2000亿美元不等,而且有证据清楚地表明,这一问题正在增加。根据世界地区的不同,对合法供应链和非法供应链(如互联网)的渗透差别很大。然而,可以肯定的是,监管机构的方向是发展供应链,允许通过万维网获得药品。在此背景下,关于如何正确描述欺诈或以其他方式制造和销售的各种形式的药物一直存在长期争论。本文试图描述定义的演变,并建议形成共识,以描述公众接触到的此类药物:•伪造药物:这是在伪造药品指令中使用和定义的术语,主要与公共卫生有关。•假药:这是与知识产权立法密切相关并在法律上定义的,主要集中在商标保护上。•假药:这个词最能与公众沟通,提高人们对这一现象的认识。
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引用次数: 14
Earlier Patient Access – the UK Early Access to Medicines Scheme (EAMS) 早期患者获取-英国早期药物获取计划(EAMS)
Pub Date : 2017-03-30 DOI: 10.5301/MAAPOC.0000009
D. O’Connor, K. McDonald, S. Lam
The Early Access to Medicines Scheme (EAMS) was launched in the UK in April 2014 following a public consultation and government response, which outlined the scope of a potential scheme. The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for two pivotal milestone decisions in the EAMS process: the Promising Innovative Medicine (PIM) designation and the EAMS scientific opinion, described in an EAMS public assessment report and 3 EAMS treatment protocols. In the 3 years since its launch, hundreds of patients with life-threatening or seriously debilitating conditions have benefited from EAMS medicines in a variety of mainly oncology indications. This editorial describes some of the achievements of the scheme over the past 3 years and provides insight into how the scheme may evolve over the coming years.
在公众咨询和政府回应后,英国于2014年4月启动了早期获得药品计划(EAMS),该计划概述了潜在计划的范围。药品和医疗保健产品监管局(MHRA)负责EAMS过程中的两个关键里程碑决策:有前景的创新药物(PIM)指定和EAMS科学意见,如EAMS公共评估报告和3个EAMS治疗方案所述。自推出以来的3年里,数百名患有危及生命或严重衰弱疾病的患者从EAMS药物中受益,这些药物主要用于肿瘤适应症。这篇社论描述了该计划在过去3年中取得的一些成就,并深入了解了该计划未来几年的发展情况。
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引用次数: 3
Timeline of Authorization and Reimbursement for Oncology Drugs in Italy in the Last 3 Years 最近3年意大利肿瘤药物的授权和报销时间表
Pub Date : 2017-03-11 DOI: 10.5301/maapoc.0000007
M. Prada, M. Ruggeri, C. Sansone, Dalila De Fazio, A. Tettamanti, M. Mantovani
Introduction The main purpose of this analysis was to quantify the time elapsed between the validation date of European Medicines Agency (EMA) centralized procedure and the first purchase of a product by at least 1 Italian health care structure, evaluating different variables that affect the process, the number of products approved by the Committee for Medicinal Products for Human Use (CHMP) that are available on the Italian market (July 2016), and the impact of the Cnn class for oncology drugs in Italy. Methods A panel of oncology products has been defined, which considered drugs approved by the EMA between January 2013 and December 2015, and authorized for the treatment of oncology diseases, excluding generics. Data were obtained via the EMA website by the Agenzia Italiana del Farmaco (AIFA; the Italian Medicine Agency) meeting reports, by official administrative acts of marketing authorization, and the date of the first purchase (first day of the first handling month). Results The mean time of EMA evaluation for the considered panel of medicines was about 441 days (standard deviation (SD) 108; range 266-770); the average approval time for AIFA was about 248 days (SD 131; range 85-688). Interestingly, the mean AIFA evaluation time decreased significantly from 264 days for products submitted to AIFA assessment in 2013-2014 to 219 days for products evaluated in 2015-2016. Focusing on the regional access, both the timing and the number of drugs available for patients were widely different from region to region. Discussion A reduction in the approval time in the last 2 years has been observed in Italy. However, several variables influence the efficiency of the process and need to be addressed to make the access to drugs timely and efficient.
本分析的主要目的是量化从欧洲药品管理局(EMA)集中程序的验证日期到至少一个意大利医疗机构首次购买产品之间的时间,评估影响该过程的不同变量,意大利市场上可获得人用药品委员会(CHMP)批准的产品数量(2016年7月)。以及Cnn课堂对意大利肿瘤药物的影响。方法定义了一个肿瘤产品小组,该小组考虑了2013年1月至2015年12月EMA批准的用于治疗肿瘤疾病的药物,不包括仿制药。数据是由意大利农业机构(AIFA;意大利药品管理局)会议报告,经官方行政行为批准上市,以及首次购买日期(第一个办理月的第一天)。结果所考虑的药品组的EMA评价平均时间约为441 d(标准差(SD) 108;射程266 - 770);AIFA的平均审批时间约为248天(SD 131;范围85 - 688)。有趣的是,平均AIFA评估时间从2013-2014年提交AIFA评估的产品的264天显著减少到2015-2016年评估的产品的219天。在区域可及性方面,各地区患者可获得药物的时间和数量存在很大差异。在过去两年中,意大利的审批时间有所减少。然而,有几个变量影响到这一过程的效率,需要加以解决,以便及时和有效地获得药物。
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引用次数: 11
Unlicensed Medicines in the UK - Legal Frameworks, Risks, and their Management 英国的无证药品——法律框架、风险及其管理
Pub Date : 2017-03-04 DOI: 10.5301/maapoc.0000006
Ian M. Bourns
The UK laws regarding the licensing of medicines have been developed to reduce the likelihood of harm through their use. Unlicensed medicines lie outside that harm management process; they have additional risks and require professional responsibilities that are complex. Therefore, pharmacy practice applies risk management tactics that are specific to how it manages unlicensed medicines, especially in hospitals, where the risks of their use is at its highest. Due to increasing demand and costs - but static funding - healthcare in the UK's National Health Service is under stress and undergoing a period of transformation and cost savings. That transformation affects all areas of pharmacy practice and medicines procurement. Service leaders need to keep a focus on maintaining safety systems for unlicensed medicines through a period of change, including potential changes in roles and responsibilities.
英国制定有关药品许可的法律是为了减少使用药品造成伤害的可能性。无证药品不在危害管理程序之内;他们有额外的风险,需要复杂的专业责任。因此,药房实践采用的风险管理策略是专门针对如何管理无证药品的,特别是在使用无证药品风险最高的医院。由于不断增长的需求和成本——但资金不变——英国国民健康服务体系的医疗保健面临压力,正在经历一段转型和成本节约的时期。这种转变影响到药学实践和药品采购的所有领域。服务机构领导人需要在一段时期内(包括角色和职责的潜在变化)继续关注维持无证药品的安全系统。
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引用次数: 4
Alternatives When an Authorized Medicinal Product is Not Available 当无法获得授权药品时的替代方案
Pub Date : 2017-02-08 DOI: 10.5301/maapoc.0000005
F. Selmin, U. Musazzi, F. Cilurzo, P. Minghetti
The industrialization of medicinal products has permitted us to reach important results in terms of quality, efficacy, safety, and availability of drugs; however, not all the legitimate expectations of patients are met. When an authorized medicinal product is not available on the market, the physician can prescribe other pharmacological treatments in the following scenario: off-label prescriptions, extemporaneous preparations, compassionate use of medicinal products, and medicinal products authorized in foreign countries. The best solution among these alternatives should be evaluated case-by-case on the basis of good scientific evidence, expert medical judgement, and published literature, also keeping an eye on the availability, the cost, and the regulatory requirements at a national level.
医药产品的工业化使我们在药品的质量、疗效、安全性和可获得性方面取得了重要成果;然而,并不是所有患者的合理期望都得到了满足。当批准的药品在市场上买不到时,医生可以在以下情况下开其他药物治疗:超说明书处方、临时制剂、同情用药以及在国外获得批准的药品。应根据良好的科学证据、专家的医学判断和已发表的文献逐一评估这些替代方案中的最佳解决方案,同时还要关注可获得性、成本和国家一级的监管要求。
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引用次数: 3
Access to Oncology Drugs in Brazil: Juggling Innovation and Sustainability in Developing Countries 在巴西获得肿瘤药物:兼顾发展中国家的创新和可持续性
Pub Date : 2017-01-20 DOI: 10.5301/maapoc.0000004
F. Ades
Brazil is a developing country of continental proportions and faces challenges in organizing an effective, universal, and affordable public health system. In a context of limited resources, the budget allocation to health care must be consistent with the health priorities of each population. The Brazilian population is ageing and the number of new cancer cases is likely to steadily increase in the near future. To deal with the extra cancer burden, strategies to match this future health necessity must be proactively put in place. Keeping the balance between the incorporation of a new drug and the sustainability of the public health system is a complex matter. Decisions for incorporation must be assessed, taking into consideration the ability of the drug to improve the public health in relation to its monetary impact. This is a societal discussion, and multiple stakeholders are involved in this process - from health authorities to pharmaceutical companies, researchers, and civil society. This article discusses the issues of incorporating a drug into the public health system and the strategies to improve access to innovative medicines, from the regulatory to the drug development perspectives.
巴西是一个非洲大陆的发展中国家,在组织一个有效、普遍和负担得起的公共卫生系统方面面临挑战。在资源有限的情况下,卫生保健的预算分配必须与每个人口的卫生优先事项相一致。巴西人口正在老龄化,癌症新增病例可能在不久的将来稳步增加。为了应对额外的癌症负担,必须积极制定与未来健康需求相匹配的战略。在新药的使用和公共卫生系统的可持续性之间保持平衡是一个复杂的问题。必须评估纳入的决定,同时考虑到药物改善公众健康的能力及其货币影响。这是一场社会讨论,从卫生当局到制药公司、研究人员和民间社会,多个利益相关者都参与了这一过程。本文从监管到药物开发的角度讨论了将药物纳入公共卫生系统的问题,以及改善创新药物获取的战略。
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引用次数: 7
Medicines Regulatory Harmonization: International Collaboration as a Key to Improve Public Health 药品管理协调:国际合作是改善公共卫生的关键
Pub Date : 2017-01-01 DOI: 10.5301/MAAPOC.0000001
V. Reggi
Over the past 30 years, many national drug regulatory authorities have embarked on a process of gradual harmonization of all the technical aspects of studies, processes, and tests that generate the data necessary to support claims of quality, safety, and efficacy of medicines. This has been mainly a trade-driven process characterized by “region-specific” harmonization initiatives; the less-resourced authorities started this processes much later than the better-resourced ones. The immediate outcome of harmonized requirements is the eliminating of country-specific tests and studies, and the narrowing of gaps in the interpretation of data. This reduced the costs for pharmaceutical companies by enabling them to develop one single set of data and documentation to be submitted to several different countries. In addition, the harmonization processes are beneficial for public health: open-minded technical discussions and the exchange of ideas and experience among regulators of different countries contributes to strengthening the capacity of national authorities to expedite the assessment of priority medicines, and to filter out unsafe or substandard products.
在过去30年中,许多国家药品监管当局已开始逐步统一研究、过程和测试的所有技术方面,这些研究、过程和测试产生必要的数据,以支持药物的质量、安全性和有效性声明。这主要是一个贸易驱动的过程,其特点是“具体区域”协调倡议;资源较少的当局启动这一进程的时间比资源较多的当局晚得多。统一需求的直接结果是消除了针对具体国家的测试和研究,并缩小了数据解释方面的差距。这降低了制药公司的成本,使它们能够开发一套数据和文件,提交给几个不同的国家。此外,统一进程有利于公共卫生:不同国家的监管机构之间开放的技术讨论以及思想和经验的交流有助于加强国家主管部门的能力,以加快对重点药品的评估,并过滤掉不安全或不合标准的产品。
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引用次数: 10
Facing Unmet Needs in Medicine Access at the Point of Care 面对医疗点未满足的药物获取需求
Pub Date : 2017-01-01 DOI: 10.5301/maapoc.0000003
G. Zuanetti
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引用次数: 0
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Medicine access @ point of care
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