Pfizer Inc., Sandwich, UK.
Nephron Clin Pract. 2009;113(3):c125-31. doi: 10.1159/000232592. Epub 2009 Aug 12.
Drug development is an expensive, long and high-risk business taking 10-15 years and is associated with a high attrition rate. It is driven by medical need, disease prevalence and the likelihood of success. Drug candidate selection is an iterative process between chemistry and biology, refining the molecular properties until a compound suitable for advancing to man is found. Typically, about one in a thousand synthesised compounds is ever selected for progression to the clinic. Prior to administration to humans, the pharmacology and biochemistry of the drug is established using an extensive range of in vitro and in vivo test procedures. It is also a regulatory requirement that the drug is administered to animals to assess its safety. Later-stage animal testing is also required to assess carcinogenicity and effects on the reproductive system. Clinical phases of drug development include phase I in healthy volunteers to assess primarily pharmacokinetics, safety and toleration, phase II in a cohort of patients with the target disease to establish efficacy and dose-response relationship and large-scale phase III studies to confirm safety and efficacy. Experience tells us that approximately only 1 in 10 drugs that start the clinical phase will make it to the market. Each drug must demonstrate safety and efficacy in the intended patient population and its benefits must outweigh its risks before it will be approved by the regulatory agencies. Strict regulatory standards govern the conduct of pre-clinical and clinical trials as well as the manufacturing of pharmaceutical products. The assessment of the new medicinal product's safety continues beyond the initial drug approval through post-marketing monitoring of adverse events.
药物研发是一项昂贵、漫长且高风险的业务,需要 10-15 年的时间,并且淘汰率很高。它是由医疗需求、疾病流行率和成功的可能性驱动的。药物候选物的选择是化学和生物学之间的一个迭代过程,通过不断改进分子特性,直到找到适合进入人体的化合物。通常,在一千种合成化合物中,只有一种会被选中进入临床研究。在将药物施用于人体之前,需要使用广泛的体外和体内测试程序来确定药物的药理学和生物化学性质。根据监管要求,还需要将药物施用于动物,以评估其安全性。后期的动物测试也需要评估药物的致癌性和对生殖系统的影响。药物开发的临床阶段包括在健康志愿者中进行的 I 期临床试验,主要评估药代动力学、安全性和耐受性;在目标疾病患者队列中进行的 II 期临床试验,以确定疗效和剂量反应关系;以及大规模的 III 期临床试验,以确认安全性和疗效。经验告诉我们,大约只有 10 种开始临床阶段的药物中的 1 种能够进入市场。每种药物都必须在预期的患者群体中证明安全性和疗效,并且其益处必须超过风险,才能获得监管机构的批准。严格的监管标准规范了临床前和临床试验的进行以及药物产品的制造。新药物的安全性评估在初始药物批准后通过上市后不良事件监测继续进行。