刍议FDA米多君片审评审批历程及对我国药品监管的启示

美国食品药品管理局（FDA）在聚焦临床需求的监管理念和策略的实践中,不断调整修正监管在法规和措施上不适应,对我国完善药品监管制度有借鉴价值。采用文献研究法,通过查找相关文献以及FDA网站发布的一些信息和数据以及专家访谈,研究分析产品的临床治疗特点和审评审批历程,并就其存在的现象进行思考,旨在分析心血管疾病治疗药物盐酸米多君片在美国获得加快审评审批、上市、撤市、再次批准上市等全过程,探讨FDA聚焦临床需求的风险-获益平衡的药品监管理念及相关策略和措施,以期对我国药品审评审批的理念调整和监管制度的完善提供借鉴。     

FDA加快新药审批程序及突破性治疗药物分析

FDA注重加快审批治疗人类严重疾病的新药,尤其是可填补空白或优于现有治疗的药物。为加快这类药物的审批,FDA已经建立了3种不同但很成功的方法,即快速通道指定、优先审评途径、加速批准指定。2012年7月9日,《FDA安全与创新法案》正式实施,法案中制定了一个新的加快药物开发审批的方式,即突破性治疗药物指定。突破性治疗药物指定自实施以来得到多方面的认可,截止到2014年5月5日,FDA共收到186项突破性治疗药物指定申请,其中授予48项,拒绝96项,另外42处正在审核过程中。这些药物涵盖小分子化学药、抗体、蛋白类、反义寡核苷酸类等。它们治疗多种疾病,尤其是癌症、丙型肝炎和囊性纤维化。授予突破性治疗药物指定资格后获得FDA批准上市的有5项。综述FDA的4种加快重要药物审批的程序以及突破性治疗药物指定的情况,以期为我国完善药物审批方式提供一定的参考。     

中国与日本对新药注册特殊审批管理的比较

我国和日本药品主管当局对新药注册中特殊审批的管理,均有相关的法律、局令及规定等予以支持。本文简介两国的相关管理体制,旨在达到相互借鉴、不断优化管理方式及最终利于患者用药的目的。     

问答式审评体系在药品技术转让评价的应用探索

目的探索问答式审评质量评价体系(QbR)在药品技术转让审评的应用。方法识别现有药品技术转让的审评过程的核心问题,结合现有我国药品技术转让的法规和相关技术指导原则要求,制定药品技术转让审评提问问题提纲。结果与结论通过借鉴和吸取问答式审评质量评价体系的优点和长处,可以提高药品技术转让审评的质量与效率。     

An overview of molecular hybrids in drug discovery

ABSTRACT

Introduction: The hybridization of biologically active molecules is a powerful tool for drug discovery used to target a variety of diseases. It offers the prospect of better drugs for the treatment of a number of illnesses including cancer, malaria, tuberculosis and AIDS. Hybrid drugs can provide combination therapies in a single multi-functional agent and, by doing so, be more specific and powerful than conventional classic treatments. This research field is in great expansion and attracts many researchers worldwide.

Area covered: This review covers the main research published between early 2013 to mid-2015 and takes into account several previous reviews on the subject. Its intention is to showcase the most recent advances reported towards the development of molecular hybrids in drug discovery. Particular attention is given to anticancer hybrids throughout the review.

Expert opinion: Current advances show that molecular hybrids of biologically active molecules can lead to powerful therapeutics. Natural products play a key role in this field. It is also believed that toxin hybrids present a great opportunity for future progress and should be further explored. Furthermore, the synthesis of hybrid organometallics should be systematically studied as it can lead to potent drugs. The crucial requirement for growth still remains the efficacy of synthesis. Hence, the development of efficient synthetic methods allowing rapid access to diverse series of hybrids must be further investigated by researchers.     

Effect of drug law enforcement on drug market violence: a systematic review

Violence is amongst the primary concerns of communities around the world and research has demonstrated links between violence and the illicit drug trade, particularly in urban settings. Given the growing emphasis on evidence-based policy-making, and the ongoing severe drug market violence in Mexico and other settings, we conducted a systematic review to examine the impacts of drug law enforcement on drug market violence. We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Specifically, we undertook a search of English language electronic databases (Academic Search Complete, PubMed, PsycINFO, EMBASE, Web of Science, Sociological Abstracts, Social Service Abstracts, PAIS International and Lexis-Nexis), the Internet (Google, Google Scholar), and article reference lists, from database inception to January 24, 2011. Overall, 15 studies were identified that evaluated the impact of drug law enforcement on drug market violence, including 11 (73%) longitudinal analyses using linear regression, 2 (13%) mathematical drug market models, and 2 (13%) qualitative studies. Fourteen (93%) studies reported an adverse impact of drug law enforcement on levels of violence. Ten of the 11 (91%) studies employing longitudinal qualitative analyses found a significant association between drug law enforcement and drug market violence. Our findings suggest that increasing drug law enforcement is unlikely to reduce drug market violence. Instead, the existing evidence base suggests that gun violence and high homicide rates may be an inevitable consequence of drug prohibition and that disrupting drug markets can paradoxically increase violence. In this context, and since drug prohibition has not meaningfully reduced drug supply, alternative regulatory models will be required if drug supply and drug market violence are to be meaningfully reduced.     

Institutional changes of China's drug regulation and improvement solutions

Drug regulation is the most important policy to ensure drug safety. In this article, we analyzed institutional changes and problems in China’s drug regulation. In addition, suggestions were provided to enhance the capacity of drug regulation, including a clearer functional positioning for drug regulation, increased resource inputs in drug regulation at central level, a more rational allocation of vertical drug regulatory functions, and an improved supervision mechanism for regulatory departments.     

Regulatory issues with multiplicity in drug approval: Principles and controversies in a changing landscape

ABSTRACT

Recently, new draft guidelines on multiplicity issues in clinical trials have been issued by European Medicine Agency (EMA) and Food and Drug Administration (FDA), respectively. Multiplicity is an issue in clinical trials, if the probability of a false-positive decision is increased by insufficiently accounting for testing multiple hypotheses. We outline the regulatory principles related to multiplicity issues in confirmatory clinical trials intended to support a marketing authorization application in the EU, describe the reasons for an increasing complexity regarding multiple hypotheses testing and discuss the specific multiplicity issues emerging within the regulatory context and being relevant for drug approval.     

Ethical approval and informed consent reporting in ASEAN journals: a systematic review

Abstract

Background and objective: Scientific publication is a way to disseminate knowledge to the scientific community. However, an article usually has very little information on how and why ethical approval (EA) and informed consent (IC) was obtained, which can make it very difficult for a reader to evaluate the ethical validity of the study. While many internationally recognized journals and publishers have already adopted a high EA/IC reporting standard, many journals still fail to do so. The aim of this study was to explore the EA/IC reporting standards, as well as their implementation, of the Association of Southeastern Asian Nation (ASEAN) member journals.

Methods: A literature search was performed in PubMed for articles that were published in journals from ASEAN member states in 2016. The articles were then reviewed, categorized into study types, and given two scores—one for their EA statement and one for their IC statement—ranging from 0–4. A list of journals was compiled from the articles retrieved and their instructions to authors regarding EA/IC statements were scored on a scale of 0–2. The data was statistically analyzed using Chi-square test (2-sided) with SPSS (version 21) with p-value < .05 being considered statistically significant.

Results: While a high proportion of articles adequately reported EA, many failed to report IC. Journals with better EA and IC instruction scores had a higher percentage of articles that adequately reported EA/IC. There were significant relationships between EA/IC statement scores and journals’ instructions scores (EA: p?=?.002; IC: p?=?.019).

Conclusions: There may be a need for journals to play key roles in advocating the importance of reporting EA and IC by strictly enforcing high EA/IC reporting standards and refusing the publication of articles that fail to comply.     

医院药库管理模式现状及系统性评价

目的 系统评价医院药库管理现状,为提升药库管理质量提供依据。方法 在中国期刊网全文数据库（CNKI）、中国生物医学文献服务系统（CBM）、万方数据和维普中文科技期刊全文数据库（VIP）等数据库中检索从2000年1月到2022年12月发表的药库管理相关文献,对药库的管理模式及对医院的影响进行描述性分析。结果 在检索的文献中,共有14篇文献纳入研究。包括前后对照研究10篇、经验分享4篇。通过对纳入文献分析显示,我国医院药库管理大致可分为3个方面,包括为降低医院运营成本,采取局部零库存模式;借助品管圈等管理工具精细药库内部管理;利用信息管理方法,借助专用平台系统提高药库工作效率和准确度。结论 药库零库存管理不可避免受到生产企业和配送商业等多方面的限制,不宜成为医院追逐的目标;充分利用现代化信息管理方法对药库质量管理有非常积极的意义。     

FDA在新药注册审批中的研发激励机制研究

美国是世界上新药研发创新能力最强的国家之一,其中FDA在新药注册审批中实施的一系列激励措施对促进美国的新药研发发挥了重要作用。本文首先研究了FDA在临床试验阶段(IND)和新药上市申请阶段(NDA)阶段采取的不同的激励措施,包括IND备案制、探索性IND研究政策、新药审评付费制度、特定药品快速审评机制等;再从新药审批周期、批准上市的新药的数量和质量、研发资金投入强度、风险控制等几个方面对FDA的激励机制进行了评价,最后就FDA在新药注册审批中的研发激励机制得出对我国的启示。     

A fresh perspective on comparing the FDA and the CHMP/EMA: approval of antineoplastic tyrosine kinase inhibitors

We compared and determined the reasons for any differences in the review and approval times of tyrosine kinase inhibitors (TKIs) by the US Food and Drug Administration (FDA) and the European EMA/CHMP. Applications for these novel cancer drugs were submitted to them within a mean of 31.2 days of each other, providing a fair basis for comparison. The FDA had granted priority review to 12 TKIs but the EMA/CHMP did not grant the equivalent accelerated assessment to any. The FDA granted accelerated approvals to six (38%) and CHMP granted (the equivalent) conditional approvals to four (29%) of these agents. On average, the review and approval times were 205.3 days in the US compared with 409.6 days in the European Union (EU). The active review times, however, were comparable (225.4 days in the EU and 205.3 days in the US). Since oncology drug development lasts about 7 years, the 20 days difference in review times between the two agencies is inconsequential. Clock stops during review and the time required to issue an approval had added the extra 184.2 days to review time in the EU. We suggest possible solutions to expedite the EU review and approval processes. However, post-marketing emergence of adverse efficacy and safety data on gefitinib and lapatinib, respectively, indicate potential risks of expedited approvals. We challenge the widely prevalent myth that early approval translates into early access or beneficial impact on public health. Both the agencies collaborate closely but conduct independent assessments and make decisions based on distinct legislation, procedures, precedents and societal expectations.     

Real-world data in drug development strategies for orphan drugs: Tafasitamab in B-cell lymphoma,a case study for an approval based on a single-arm combination trial

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药品市场技术监管中抽验与快检的关系探讨

目的 探索药品市场技术监管体制与机制改革方向,切实保障全民用药安全有效。方法 分析自2006年以来全国药品抽验工作与药品快检工作,研判药品抽验与药品快检职能合并的可行性。结果与结论 药品抽验与快检职能合并是实现快检技术下沉与落地,提高抽验效率与效能的行之有效的方式。将假劣药驱逐出市场,除了要提升检验能力,更应调整技术监管的体制与机制。     

Predictors of orphan drug approval in the European Union

Objective To encourage the development of drugs for rare diseases, orphan drug legislation has been introduced in the USA (1983) and in the EU (2000). Recent literature discusses factors that may influence the development of new orphan medicinal products in the EU. This study aims to identify predictors for successful marketing authorisation of potential orphan drugs in the EU. Methods A comparison between randomly selected authorised and a matched sample of not-yet-authorised orphan drug designations has been performed. Determinants in the study included characteristics of the indication, of the product and of the sponsor. Data were collected from the public domain only. Results Orphan drug approval was strongly associated with previous experience of the sponsor in obtaining approval for another orphan drug (OR = 17.3, 95% CI = 5.6–53.1). Furthermore, existing synthetic entities compared to biotechnology products tended to have a higher likelihood of reaching approval status (OR = 3.9, 95% CI = 0.9–16.6). Conclusion This study showed that experience of a company in developing orphan drugs is an important predictor for subsequent authorisation of other orphan drugs. The same applies for existing (synthetic) molecules, for which much knowledge is available. Further research should be directed towards studying the quality of the clinical development program of those designated orphan medicinal products not reaching approval status.     

2019年FDA批准新药中孤儿药分析

本文对2019年美国食品药品监督管理局（FDA）批准的新药进行了统计分析,通过对新药和孤儿药基本情况、获得优先审批权、临床病例数等进行对比分析,详细了解美国食品药品监督管理局对新药孤儿药的审批优惠政策,提出我国制定孤儿药相关政策的建议,为我国相关政策的制定和企业相关产品研发工作提供思路。     

齐二药、鱼腥草与欣弗:药品安全事件的法律思考

“齐二药”假药事件、鱼腥草注射液事件、欣弗药品不良事件,2006年3个重大的药品安全事件,暴露出我国药品行政监督管理存在的种种问题：重视认证式管理,忽视日常监督检查;假药、劣药概念尚需推敲;行政失职难以界定;药品审评中行政自由裁量权缺乏制约等。问题的解决,不但需要加强监管、完善立法,更要切断药品监管机构与制药企业之间的利益链条,使其真正履行“把关人”职责。     

FDA对药品说明书“要点”部分的产品标题和美国首次批准的撰写要求

美国食品药品管理局（FDA）于2018年1月公布了“人用处方药和生物制品处方资料要点中的产品标题和美国首次批准——内容和格式行业指导原则”,提出了药品说明书中关于人用处方药和生物制品的产品标题和美国首次批准年份的内容和格式的撰写建议。介绍FDA该指导原则的主要内容,为细化我国药品说明书指导原则提供参考。