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[加速从临床前到临床阶段开发进程的临床药理学方面/第二次交流:有前景的策略]

[Clinical-pharmacological aspects to accelerate the development process from the preclinical to the clinical phase/2nd communication: promising strategies].

作者信息

Kuhlmann Jochen

机构信息

Bayer HealthCare AG, Pharma Research Center, Institute of Clinical Pharmacology, Wuppertal, Germany.

出版信息

Arzneimittelforschung. 2004;54(6):307-13. doi: 10.1055/s-0031-1296976.

Abstract

To improve the transition from research to development a critical evaluation of the individual project by research and disease area teams is required to include input from pharmacology, toxicology, pharmacokinetics, galenics, clinical pharmacology, clinical as well as regulatory experts and marketing. Decisions on the individual development strategy should be made prior to the start of development and all projects should be reviewed at predefined stages throughout the product development life cycle. This ensures consistency of decision-making not only during the development of individual products but throughout the entire development pipeline. Studies in the exploratory stage of drug development should be designed for decision making in contrast to later clinical trials in the confirmatory stage that require power for proof-of-safety and proof-of-efficacy. The more thorough and profound studies have been carried out during this exploratory stage of drug development, the earlier a decision can be made on the continuation or discontinuation of further development, thus saving development time and money and assessing and considerably reducing the risk for the patients and increasing the success rate of the project in the later confirmatory effectiveness trial with an adequate number of subjects receiving the new therapy under typical conditions of use. Strategies which may be helpful to improve the quality of decisions in drug discovery and drug development are: discovery experiments should be done to critically evaluate the compound, the "killer" experiments should be done as early as possible, continuous effort on preclinical disease models is necessary to improve predictability of efficacy in patients ("humanized" research): genomic technology should be used to identify novel, disease-related targets and to characterise preclinical test systems, improvement of knowledge and experience concerning the relevance of new technologies for the clinical picture, genotyping of clinical trial patients to select patient groups which are likely to respond to treatment (pharmacogenomics), modelling and simulation of preclinical and clinical trials, integration of pharmacokinetic and pharmacodynamic principles into drug development, assessment of the interaction potential (CYP-450, trasporter proteins and others), increasing use of biomarker/surrogate marker for rapid clinical feedback, involvement of the target population as soon as possible, applying statistical data analysis techniques for proving effectiveness, co-operation with high quality centers. To reach this goal clinical pharmacology must be fully integrated in the whole process from the candidate selection to its positioning within the market.

摘要

为了改善从研究到开发的过渡,研究团队和疾病领域团队需要对单个项目进行严格评估,评估应纳入药理学、毒理学、药代动力学、药剂学、临床药理学、临床以及监管专家和市场营销等方面的意见。关于单个开发策略的决策应在开发开始前做出,并且在整个产品开发生命周期的预定义阶段应对所有项目进行审查。这不仅确保了单个产品开发过程中决策的一致性,而且确保了整个开发流程的一致性。与后期确证阶段需要证明安全性和有效性的临床试验不同,药物开发探索阶段的研究应旨在做出决策。在药物开发的探索阶段进行的研究越全面、越深入,就能越早决定是否继续进一步开发,从而节省开发时间和资金,并评估并大幅降低患者风险,在后期确证有效性试验中,让足够数量的受试者在典型使用条件下接受新疗法,提高项目的成功率。有助于提高药物发现和药物开发决策质量的策略包括:进行发现实验以严格评估化合物,尽早进行“关键”实验,持续致力于临床前疾病模型以提高对患者疗效的预测性(“人源化”研究);应使用基因组技术识别新的疾病相关靶点并表征临床前测试系统,提高对新技术与临床情况相关性的知识和经验,对临床试验患者进行基因分型以选择可能对治疗有反应的患者群体(药物基因组学),对临床前和临床试验进行建模和模拟,将药代动力学和药效学原理整合到药物开发中,评估相互作用潜力(CYP - 450、转运蛋白等),更多地使用生物标志物/替代标志物以获得快速临床反馈,尽早让目标人群参与,应用统计数据分析技术证明有效性,与高质量中心合作。为实现这一目标,临床药理学必须完全融入从候选药物选择到其在市场中的定位的整个过程。

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