Otsubo Yasuto
Division of Medical Economics, Bureau of Health Insurance, Ministry of Health, Labor, and Welfare, Tokyo, Japan.
Clin Ther. 2015 Aug;37(8):1627-31. doi: 10.1016/j.clinthera.2015.04.010. Epub 2015 May 8.
Pharmacogenomics (PGx) and biomarkers have been utilized for improving the benefit/risk ratios of drugs and the efficiency of drug development. In the development of drugs for Alzheimer disease (AD), a number of clinical trials have failed to demonstrate clinical efficacy. To overcome this circumstance, the importance of using PGx/biomarkers for enhancing recruitment into clinical trials and for evaluating the efficacy of treatments has been increasingly recognized. In this article, the current status and examples of the use of PGx/biomarkers in Japan for drug development are explained.
Guidelines, notifications, and administrative notices related to PGx/biomarkers were downloaded from the Web sites of the Pharmaceuticals and Medical Devices Agency (PMDA), the US Food and Drug Administration, and the European Medicines Agency. Data from clinical studies of AD drugs were obtained from the review reports of the PMDA. To analyze the current status of the use of PGx/biomarkers in Japan, "Issues to Consider in the Clinical Evaluation and Development of Drugs for Alzheimer's Disease (Interim Summary)" was also downloaded from PMDA Web site.
There are 2 major measures of utilizing PGx/biomarkers for drug development: (1) biomarker qualification and (2) companion diagnostics. Recently, the PMDA issued a number of guidelines and notifications for their practical use. Although examples of qualified PGx/biomarkers and approved companion diagnostics are limited at present, it is expected that the use of PGx/biomarkers for the development of drugs against AD would increase.
For promoting the use of PGx/biomarkers in the development of drugs against AD, PGx/biomarkers should be qualified as early as possible. To that end, accumulating data on PGx/biomarkers from nonclinical or clinical trials and the concurrent development of reliable diagnostics in the early stage of the development process are indispensable. It is important to strengthen collaboration among the academia, industries, and regulatory agencies, followed by the establishment of an effective guideline in the area of AD.
药物基因组学(PGx)和生物标志物已被用于改善药物的效益/风险比以及提高药物研发效率。在阿尔茨海默病(AD)药物的研发中,许多临床试验未能证明临床疗效。为克服这一情况,使用PGx/生物标志物以增加临床试验受试者招募及评估治疗效果的重要性已得到越来越多的认可。本文阐述了日本PGx/生物标志物在药物研发中的应用现状及实例。
从药品和医疗器械管理局(PMDA)、美国食品药品监督管理局及欧洲药品管理局的网站下载了与PGx/生物标志物相关的指南、通知和行政公告。AD药物临床研究的数据来自PMDA的审评报告。为分析日本PGx/生物标志物的应用现状,还从PMDA网站下载了《阿尔茨海默病药物临床评价与研发中需考虑的问题(临时总结)》。
利用PGx/生物标志物进行药物研发有两大主要措施:(1)生物标志物鉴定;(2)伴随诊断。最近,PMDA发布了多项关于其实际应用的指南和通知。尽管目前合格的PGx/生物标志物和获批的伴随诊断实例有限,但预计PGx/生物标志物在AD药物研发中的应用将会增加。
为促进PGx/生物标志物在AD药物研发中的应用,应尽早对PGx/生物标志物进行鉴定。为此,在研发过程的早期阶段积累来自非临床或临床试验的PGx/生物标志物数据以及同步开发可靠的诊断方法是必不可少的。加强学术界、产业界和监管机构之间的合作,随后在AD领域建立有效的指南非常重要。