Regulatory aspects of pharmacokinetic profiling in special populations: a European perspective
- PMID: 18840025
- DOI: 10.2165/00003088-200847110-00001
Regulatory aspects of pharmacokinetic profiling in special populations: a European perspective
Abstract
The clinical efficacy and safety profile of a new medicinal product is established in phase III studies, which are usually restricted to a well defined patient population. This population may not fully represent the population in which the product will be used once it is on the market. Pharmacokinetic studies in special populations are performed to estimate drug exposure in subpopulations of patients with characteristics that may affect drug exposure. The clinical consequences of altered exposure are then assessed, taking pharmacokinetic/pharmacodynamic relationships into consideration. If needed, specific treatment recommendations should be developed.Recommendations regarding pharmacokinetic characterization in special populations are given in a number of European guidelines. The pharmacokinetic characteristics, therapeutic window and intended use of the medicinal product influence the need for pharmacokinetic studies of a new medicinal product. There are a number of methodological issues to be considered when designing pharmacokinetic studies in special populations: the study design, study population and control group, the dosing regimen to be used, the analytes to be measured, and the distribution and range of the factor to be studied. The data should be presented in sufficient detail to enable assessment by regulatory authorities of the conducted analysis and conclusions drawn. Assessment of the data should include an evaluation of how and to what extent the pharmacokinetics in specific subpopulations deviate from the exposure at the therapeutic dose in the clinical efficacy and safety studies, and if there is a need for specific treatment recommendations. Based on the available information on the pharmacokinetic/pharmacodynamic relationships for efficacy and safety and/or the exposure at the therapeutic dose in the phase III population where efficacy and safety have been demonstrated, target criteria (a target exposure range) should be defined. Within the target exposure range, there should be no clinically relevant difference in efficacy and safety. Should the exposure in a specific group fall outside the defined target criteria, appropriate treatment recommendations need to be developed. The aim should be to develop dosing recommendations that will allow the majority of the patients to obtain exposure within the defined target range. If it is not possible to develop suitable dosing recommendations in a subgroup of patients, there may be a need for specific warnings or wordings regarding monitoring of the patients. It may also be an option to exclude that patient group from the indication. The resulting treatment recommendations should ensure safe and effective use of the drug in the entire population for which it has been approved.
Similar articles
-
Clinical pharmacokinetics: current requirements and future perspectives from a regulatory point of view.Xenobiotica. 1993 Nov;23(11):1159-93. doi: 10.3109/00498259309059432. Xenobiotica. 1993. PMID: 8310705 Review.
-
Information on new drugs at market entry: retrospective analysis of health technology assessment reports versus regulatory reports, journal publications, and registry reports.BMJ. 2015 Feb 26;350:h796. doi: 10.1136/bmj.h796. BMJ. 2015. PMID: 25722024 Free PMC article.
-
Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone).Pain Pract. 2008 Jul-Aug;8(4):287-313. doi: 10.1111/j.1533-2500.2008.00204.x. Epub 2008 May 23. Pain Pract. 2008. PMID: 18503626
-
[Therapeutic monitoring: analytic, pharmacokinetic and clinical aspects].Acta Clin Belg. 1999;53 Suppl 1:2-12. Acta Clin Belg. 1999. PMID: 10216973 Review. French.
-
Changes and determination of dosing recommendations for medicinal products recently authorised in the European Union.Expert Opin Pharmacother. 2015 Apr;16(6):903-11. doi: 10.1517/14656566.2015.1025050. Epub 2015 Mar 14. Expert Opin Pharmacother. 2015. PMID: 25773468 Review.
Cited by
-
Pharmacokinetics and dosage adjustment in patients with renal dysfunction.Eur J Clin Pharmacol. 2009 Aug;65(8):757-73. doi: 10.1007/s00228-009-0678-8. Epub 2009 Jun 20. Eur J Clin Pharmacol. 2009. PMID: 19543887 Review.
-
Dose selection method for pharmacokinetic study in hemodialysis patients using a subpharmacological dose: oseltamivir as a model drug.BMC Nephrol. 2014 Mar 17;15:46. doi: 10.1186/1471-2369-15-46. BMC Nephrol. 2014. PMID: 24636040 Free PMC article. Clinical Trial.
-
Role of modelling and simulation: a European regulatory perspective.Clin Pharmacokinet. 2012 Feb 1;51(2):69-76. doi: 10.2165/11596650-000000000-00000. Clin Pharmacokinet. 2012. PMID: 22257148 Review.
References
-
- Clin Pharmacol Ther. 1999 Aug;66(2):201-4 - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical