抗体偶联药物的分子特点及其药代动力学研究考虑

随着我国药物研发和临床试验水平的不断提高,近年来抗体偶联药物(Antibody-Drug Conjugate, ADC)的相关研究和注册申报也正在增多。ADC类药物由抗体、连接子和小分子毒素组成,在兼具高度靶向性和高细胞毒性优势的同时,由于其结构的多样性和复杂性,以及循环系统中释放的小分子毒素含量较低等特殊性,给其药代动力学研究带来了诸多挑战。本文将从ADC药物的分子设计、药代动力学特征和目标分析物等方面讨论,以期帮助读者更好的理解ADC药物的药代动力学研究。     

临床试验尿液成瘾药物筛查探讨

尿液成瘾药物筛查是目前药物Ⅰ期临床试验和生物等效性试验纳入健康受试者的关键操作之一,也是保证受试者的安全、试验结果准确可靠的必要措施之一。虽然《化学药物临床药代动力学研究技术指导原则》等指南提出临床试验需要筛查成瘾药物,但都未明确指出尿液成瘾药物筛查的品种以及在临床试验中的意义。本文根据北京大学第一医院药物Ⅰ期临床试验研究室近几年开展的项目中尿液成瘾药物筛查品种以及筛查结果,分析与探讨尿液滥用药物筛查在临床试验中的必要性及重要意义。     

创新药物的药代动学研究策略

在新药临床试验中，药代动力学研究占有非常重要的地位。为此，本文对临床药理学研究范畴、药代动力学策略、临床试验开发策略等进行了分析与讨论。     

脂质体制剂的Ⅰ期临床药代动力学研究进展

目的:回顾新型递药系统脂质体制剂的Ⅰ期临床药代动力学研究现状和研究方法。方法:在国际临床试验注册网站和PubMed数据库中检索有关脂质体制剂Ⅰ期临床药代动力学研究的试验或文献,总结目前研究现状;根据FDA和EMA发布的指导原则,并结合发表最多且较成熟的阿霉素脂质体研究实例,概述主要研究方法和特点。结果和结论:目前多数脂质体制剂仍处于临床前和各期临床试验中,且逐年递增;由于脂质体会改变包裹后药物在体内的药动学和组织分布特点,因此Ⅰ期临床药动学研究至关重要,除进行脂质体制剂和非脂质体制剂的单剂量比较研究或多剂量药动学研究外,还可开展质量平衡研究、组织分布研究、药动学/药效学研究等,分析包裹化或非包裹化的药物及其代谢产物药动学参数,为开展后续临床试验提供药动学信息。     

生物等效性现场核查要点及常见问题介绍

生物等效性（Bioequivalence,BE）是指药学等效制剂或可替换药物在相同试验条件下,给予相同的剂量,其活性成分吸收速度和程度的差异无统计学意义。《药品注册管理办法》将生物等效性试验归于临床试验,指用生物利用度研究的方法,以药代动力学参数为指标,比较同一种药物的相同或者不同剂型的制剂,在相同的实验条件下,其活性成分吸收程度和速度无统计学差异的人体试验。     

药代动力学比例化剂量反应关系的研究方法及其线性评价

目的 探讨药代动力学比例化剂量反应关系的研究方法及其线性评价.方法 利用比例化剂量反应关系可判断药物在体内是否呈线性药代动力学特征,是新药早期临床试验中的基础研究,可为后继的临床试验及剂量调整提供依据.结果 基于安全性考虑,早期临床试验的受试者例数较少,给此类研究的设计带来挑战;且几乎所有的药物达到足够高的剂量时,都会呈现非线性特征;评价比例化剂量反应关系不仅检验其是否成立,更重要的是定量评价药代动力学参数和剂量之间的关系.结论 目前常用的研究方法有多种,不同方法得出的结论也不尽相同.     

注射剂说明书中儿童用药信息标注情况与儿童用药风险分析

目的：调查注射剂药品说明书中关于儿童用药安全信息的标注情况，分析儿童用药风险。方法：统计我院141份常用注射剂说明书，分析儿童用药安全信息标注情况。结果：儿童专用药品说明书4份，占2.8%。国产药和外资药儿童临床试验数据和儿童药代动力学的数据标注率分别为4.7%、40.0%和11.3%、34.3%，儿童用法用量标注率分别为51.9%、68.6%，外资药高于国产药；抗感染类药物说明书儿童临床试验项、儿童药代动力学项标注率分别为29.4%、37.3%，明显高于其他类别。限制级抗菌药物的儿童临床试验项、儿童药代动力学项标注率分别为77.8%、77.8%，明显高于其他类别。外资西药和国产西药的儿童临床试验项、儿童药代动力学项标注率分别为40.0%、34.3%和4.9%、11.8%，西药高于中成药。儿童专用药品未出现儿童用药安全信息的标注缺失情况；非儿童专用药品的儿童用法用量项、儿童药代动力学项标注率分别为54.7%和17.5%，非儿童专用药品标注率低于儿童专用药品。部分国产西药与外资西药说明书儿童用药项存在差异。结论：注射剂中儿童专用药品较少，非儿童专用药品中儿童用药安全信息标注不充分，儿童用药存在风险隐患     

我国药品技术转让时机及应对策略分析

目的:探讨新药、仿制药与进口药不同技术转让时机的风险、利弊与应对策略,为医药企业发展战略的提升提供依据。方法:根据与药品注册和转让有关的规定,分析新药、仿制药与进口药注册申请过程中可转让的项目,探讨其相应的转让时机及风险,并提出应对策略。结果与结论:药品注册过程中可转让的项目包括知识性产权(专利权、专利申请权、技术秘密、申请资料、未披露数据等)与权力性产权(临床批件、新药证书、药品批准文号、医药产品注册证、进口产品注册证等)。药品技术转让有4个时机,时机1为转让方在完成药理学、毒理学等临床前研究后,申请临床批件前;时机2为转让方取得临床批件后,启动临床试验前;时机3为新药技术转让;时机4为药品生产技术转让。新药有4个转让时机,仿制药与进口药在时机1、2、4可进行转让。不同时机的转让风险与利益各不相同,随着药品注册进程推进,风险逐渐降低,但创新性也随之降低。企业应结合政策、市场和自身特点选择合适的产品和转让时机。     

《中华人民共和国药品注册管理办法》新法规与原法规技术要求的比较

本文从药品临床试验的定义、生物等效性试验、临床研究病例数、临床试验的对照药、速释、缓释、控释制剂的临床要求等方面,介绍并分析了《中华人民共和国药品注册管理办法》和《中华人民共和国新药审批办法》中对药品临床研究相关要求的主要变化,旨在帮助药品研发的相关人员加深对国家药品注册管理办法的理解。     

药物动力学和药效动力学在抗菌药物新药开发和临床治疗上的应用

制定合理的给药方案是抗菌药物开发中临床试验成败的关键。近十年来群体药物动力学和药效动力学的发展和在抗菌药新药开发上的应用，对抗菌药物合理给药方案的制定有了突破性进展，已基本上形成了抗菌药物新药开发的一个模式。这一模式以药动药效学理论指导下的体外动力学模型、动物体内感染模型和Ⅰ期临床药动学试验为基础，以随机化统计模型和蒙地卡罗模拟为手段对Ⅲ期临床试验的给药方案进行统计比较以确定最佳的给药剂量和频率。本文系统性地描述如何从临床前和临床试验中获得准确可靠的数据进而建立药动药效学数学模型，着重于阐述抗菌药物药效学的基本概念、试验方法学的基本原理并简单介绍药动药效学的计算方法.     

欧美与我国的临床试验用药品管理法规、指南及相关要求的比较分析

目的:为完善我国临床试验用药品管理的法规及相关要求提供参考与借鉴.方法:比较国内外临床试验中试验用药品的法规、指南及相关要求的异同点,并以"临床试验""药品管理""pharmacy-based investigational drug service"等为关键词或主题词,查询中国知网、万方数据、PubMed、OVID等...     

Discovery of INCB9471, a Potent,Selective, and Orally Bioavailable CCR5 Antagonist with Potent Anti-HIV-1 Activity

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我国鼓励仿制药品目录清单（第一批）品种特征及口服固体制剂生物等效性研究要求分析

为及时满足国内临床用药需求，2019年10月，国家卫生健康委员会正式发布《关于印发第一批鼓励仿制药品目录的通知》。检索并整理了全部纳入品种的适应症、批准文号数量、临床试验登记等信息，结合美国食品药品管理局（FDA）发布的生物等效性研究个药指南，对目录中涉及的固体口服制剂生物等效性研究要求进行梳理，并结合涉及品种的相关特征与生物等效性研究要求进行分析，以期为国内研究机构及原研企业开展相关研究提供科学依据与参考。     

Octocog alfa, antihaemophilic factor (recombinant), plasma/albumin free method (Advate®): a review of its use in the management of patients with haemophilia A

Octocog alfa, antihaemophilic factor, plasma/albumin free method (Advate?) is a recombinant, human, full-length coagulation factor VIII that does not contain human- or animal-derived plasma proteins. It is indicated for the control and prevention of bleeding episodes, for perioperative management and for routine prophylaxis in children and adults with haemophilia A. This article reviews the pharmacological properties, therapeutic efficacy and tolerability of Advate? in these patients. In previously treated paediatric and adult patients with moderately severe or severe haemophilia A, Advate? administered prophylactically, on demand or during surgery was effective for the prevention and treatment of bleeding episodes in three pivotal, uncontrolled clinical trials. The haemostatic efficacy of Advate? in these trials was rated as 'excellent' or 'good' in most bleeding episodes, with the majority of episodes being managed with one infusion. These findings were supported by pooled analyses of clinical trials and routine clinical practice studies, including the Post-Authorization Safety Study. Additionally, in a comparative study, routine prophylaxis with Advate? administered in a standard regimen or in a pharmacokinetic-tailored regimen was effective for the prevention of bleeding episodes in patients with moderately severe or severe haemophilia A, with no significant difference between the two regimens in terms of efficacy. Moreover, any routine prophylaxis with Advate? was found to be more effective in preventing bleeding episodes than on-demand therapy with Advate?. Advate? was generally well tolerated in clinical trials and postmarketing studies, with the most common treatment-emergent adverse events being pyrexia and headache. Serious adverse events with Advate? therapy are development of high-titre factor VIII inhibitors (usually in previously untreated patients) and hypersensitivity reactions. As expected, the incidence of factor VIII inhibitors (any titre) appeared to be lower in previously treated patients (≤ 1.8%) than in previously untreated patients (≤ 20%). There are no head-to-head comparative trials of Advate? and other factor VIII concentrates. Nevertheless, current evidence indicates that Advate? is an effective option for the management of paediatric and adult patients with haemophilia A.     

基于“5P-3L”创新管理模式的泌尿外科新药临床试验团队建设及培训经验浅谈

目的：随着国家对新药临床试验核查要求的提高，建立一支专业化的新药临床试验研究团队和形成一套完善的管理模式，成为提高新药临床评价质量的有效途径。本文结合近些年泌尿外科专业组的工作经验逐渐摸索形成了一个"5P-3L"新药临床试验创新管理模式，制定了一套较为完善的培训体系，从人员管理、培训、奖励机制等各个方面加强人才培养和团队建设，最终提高新药临床试验研究水平。     

新药临床试验期间药物警戒和风险控制研究三:药物临床试验期间个例安全性报告监管要求研究

目的：通过比较分析国内外关于临床试验期间个例安全性报告的相关法规和指导原则要求的异同点,为加强我国药物警戒监管体系中个例安全性报告的监管要求提供理论依据。方法：通过分析ICH、 美国及欧盟临床试验期间个例安全性报告相关的法规以及指导原则情况,与我国相应的监管要求进行比较,研究各国家/地区对试验用药物临床试验期间个例安全性报告监管要求的差异。结果与结论：与其他国家、组织相比,我国已初步建立了临床试验中个例安全性报告快速报告的制度和工作程序,相应的指导原则内容全面,基本涵盖了国际指导原则的核心技术要求,其中基本原则要求一致,但操作细节方面尚缺少详细的指导意见。     

Parecoxib: new preparation. A NSAID for postoperative pain: no proven advantage

(1) Parecoxib is the second nonsteroidal antiinflammatory drug, after ketoprofen, to be marketed in France for the treatment of postoperative pain. (2) Another injectable NSAID, ketorolac, was marketed briefly in the 1990s. It was shown to be no more effective than ketoprofen, but was withdrawn from the French market because it provoked bleeding. (3) The clinical evaluation dossier on parecoxib contains no data from comparative trials with ketoprofen. The three trials versus ketorolac failed to show that parecoxib was more effective. (4) The two trials comparing parecoxib with morphine are biased by the use of a too low dose of morphine (4 mg). Four trials show that adding parecoxib reduces morphine requirements in patients injecting the opiate on demand. There is no evidence that this reduction translates into a lower risk of adverse reactions to opiates. (5) Parecoxib is marketed as "Cox-2-specific inhibitor", but follow-up is too short to show whether this property avoids the severe adverse effects seen with other NSAIDs, such as renal failure, gastrointestinal haemorrhage, and delayed wound healing. Parecoxib, like its principal metabolite valdecoxib, can cause severe hypersensitivity reactions. (6) Parecoxib is 10 times more expensive than injectable ketoprofen in France. (7) In practice, ketoprofen is still the best choice for parenteral NSAID-based pain relief in the postoperative setting.     

Drugs in early clinical development for the treatment of female sexual dysfunction

Introduction: There is growing recognition of female sexual dysfunction (FSD) as an important women’s health concern. Despite an increased awareness of the pathophysiologic components to FSD, currently, there are no drugs approved for the most common sexual complaint in women–decreased sexual desire. In response to an overwhelming demand for therapy for FSD, several drugs are undergoing development and testing.

Areas covered: The aim of this paper is to provide the latest data on pharmacological treatments for FSD currently in Phase I and II clinical trials. These include topical alprostadil, bremelanotide (BMT), intranasal testosterone (TBS-2), intravaginal dehydroepiandrosterone (DHEA), sublingual testosterone with sildenafil, apomorphine (APO), bupropprion and trazodone. It should be noted that the definitions of FSD have recently been revised in the diagnostic and statistical manual for mental disorders (DSM) 5, with merging of hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) into female sexual interest/arousal disorder (FSIAD). However, it is noted that the majority of clinical trials discussed in this paper use the DSM IV-R diagnoses of HSDD and FSAD.

Expert opinion: Medications in early phase trials show promise for the treatment of FSD. These therapies focus on treating many possible causes of FSD. Concerns over gender bias within the FDA need to be resolved given the need for new treatment options for FSD.     

中国鼓励仿制药品目录（第二批）品种特征及生物等效性研究要求

为及时满足国内临床用药需求，国家卫生健康委员会分别于2019年10月、2021年2月发布2批《鼓励仿制药品目录清单》。检索并整理了《鼓励仿制药品目录（第二批）》纳入品种的适应证、批准文号数量、临床试验登记等信息，结合美国食品药品监督管理局（FDA）发布的生物等效性研究个药指南，对目录中涉及的相关品种生物等效性研究要求进行梳理，结合品种特征与生物等效性研究要求进行了初步分析，以期为国内研究机构及企业开展相关研究提供科学依据与参考。     

Emerging chemical therapies targeting 5-hydroxytryptamine in the treatment of Alzheimer’s disease

Introduction: Alzheimer’s disease (AD) is a major neuropsychiatric disorder affecting more than 5 million Americans over age 65. By the year 2050, AD is expected to affect over 30 million. Characterized by neuronal cell death accompanied by the accumulation of neurofibrillary tangles and neuritic plaques, AD results in devastating clinical symptomatology with a lasting psychosocial and financial impact. Studies have shown that the current treatments for AD, cholinesterase inhibitors (ChEI’s) and NMDA receptor antagonists, have limited efficacy. The 5-HT-6 receptor antagonists Idalopirdine and Intepirdine have shown the most progress in current clinical trials and warrant consideration as emerging treatments for AD.

Areas covered: This review discusses 5-HT6 antagonists currently in clinical trials as potential treatments for AD symptomatology and how 5-HT6 physiology may play a positive role in alleviating AD symptom pathophysiology. A literature search using PubMed was conducted using the terms Idalopirdine, Intepirdine, 5-HT-6 antagonist, and AD as keywords. Clinicaltrials.gov and Alzforum were also used to obtain information on clinical trials.

Expert opinion: If current Phase-3 trials are positive, 5-HT6 antagonists such as Idalopirdine and Intepirdine may be considered as supplementary treatments to ChEI’s and NMDA receptor antagonists for the symptomatic treatment of AD.