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基于人用经验的中药新药证候研发策略

[Research and development strategy of new traditional Chinese medicine drugs for syndromes based on human use experience].

作者信息

Yang Zhong-Qi, He Xing-Ling, Liu Dong-Hua, Tang Ya-Qin, Tang Hui-Min, Ling Yan, DU Yan-Ping

机构信息

First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou 510407, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2024 Feb;49(3):849-852. doi: 10.19540/j.cnki.cjcmm.20231106.501.

Abstract

Chinese drug registration laws and regulations have always reserved a place for the new traditional Chinese medicine(TCM) drugs for syndromes, but so far no such new drugs have been approved for registration. This paper expounded on the relevant policies, regulations, and technologies of new TCM drugs for syndromes in China and pointed out that the application of the animal model of TCM syndromes to carry out pharmacodynamics research and clinical efficacy evaluation criteria of TCM syndromes were the main technical difficulties in the research and development of new TCM drugs for syndromes. Not all syndromes are suitable for developing new drugs, and the indications for new TCM drugs should be constant syndromes. Among the three research and development models of simple syndrome, syndrome-unified disease, and combined disease and syndrome, the research and development model of combined disease and syndrome is recommended. Clinical positioning is the key to new TCM drugs for syndromes. It is encouraged to conduct high-quality human use experience studies to determine the clinical positioning of new TCM drugs for syndromes, as well as the target population, dose, course of treatment, and initial therapeutic and safety, and apply for exemption from non-clinical effectiveness studies. Clinical trials of new TCM drugs for syndromes should take the target symptoms or signs as the main efficacy index and the efficacy of TCM syndromes as the secondary efficacy index. Clinical research program design should implement the "patient-centered" concept and introduce clinical outcome evaluation indicators. In the clinical safety evaluation, special conditions such as characteristic syndromes and changes should be considered. With the construction of the human use experience technology system and the promotion of the TCM registration and evaluation evidence system featuring the "combination of TCM theory, human use experience, and clinical trials", it is believed that many high-quality new TCM drugs for syndromes will be developed in the future.

摘要

中国药品注册法律法规一直为新型中医证候类中药新药预留了一席之地,但迄今为止尚无此类新药获批注册。本文阐述了我国新型中医证候类中药新药的相关政策、法规及技术,指出应用中医证候动物模型开展药效学研究及中医证候临床疗效评价标准是新型中医证候类中药新药研发的主要技术难点。并非所有证候都适合开发新药,新型中医证候类中药新药的适应证应为稳定的证候。在单纯证候、证病结合、病证结合三种研发模式中,推荐病证结合的研发模式。临床定位是新型中医证候类中药新药的关键。鼓励开展高质量的人用经验研究,以确定新型中医证候类中药新药的临床定位、目标人群、剂量、疗程以及初始治疗效果和安全性,并申请免做非临床有效性研究。新型中医证候类中药新药的临床试验应以目标症状或体征为主疗效指标,以中医证候疗效为次要疗效指标。临床研究方案设计应贯彻“以患者为中心”的理念,引入临床结局评价指标。在临床安全性评价中,应考虑特征性证候及变化等特殊情况。随着人用经验技术体系的构建以及“中医理论、人用经验、临床试验相结合”的中药注册审评证据体系的推进,相信未来会研发出众多高质量的新型中医证候类中药新药。

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