Safe vaccination of children with a virosomal adjuvanted influenza vaccine

A post-marketing study was conducted in 26 paediatric practices in Germany to collect safety information on the virosomal adjuvanted influenza vaccine Inflexal^® V (in Germany marketed as Infectovac Flu^®). Children aged 6 months to 6 years received one or two doses. Adverse events were documented by parents/legal guardians in a questionnaire for four days after vaccination. The rates of adverse events were low: 14% of vaccine exposures were associated with systemic and 25% with local adverse events. Most symptoms were mild to moderate and resolved within a few days. Nearly 100% of parents/legal guardians would agree to have their child vaccinated again with Inflexal^® V. Vaccination with Inflexal^® V was safe, well tolerated and highly accepted by parents/legal guardians.     

中药鉴定学的学习方法与技巧

中药鉴定学内容多、散、杂，学习起来难度较大。本文从心理学的角度出发，结合中药鉴定学课程内容实际，归纳出十一种促进记忆的方法和技巧。     

Recommendations for the validation of cell-based assays used for the detection of neutralizing antibody immune responses elicited against biological therapeutics

The administration of biological therapeutics may result in the development of anti-drug antibodies (ADAs) in treated subjects. In some cases, ADA responses may result in the loss of therapeutic efficacy due to the formation of neutralizing ADAs (NAbs). An important characteristic of anti-drug NAbs is their direct inhibitory effect on the pharmacological activity of the therapeutic. Neutralizing antibody responses are of particular concern for biologic products with an endogenous homolog whose activity can be potentially dampened or completely inhibited by the NAbs leading to an autoimmune-type deficiency syndrome. Therefore, it is important that ADAs are detected and characterized appropriately using sensitive and reliable methods. The design, development and optimization of cell-based assays used for detection of NAbs have been published previously by Gupta et al. 2007 [1]. This paper provides recommendations on best practices for the validation of cell-based NAb assay and suggested validation parameters based on the experience of the authors.     

Report from the EPAA workshop: In vitro ADME in safety testing used by EPAA industry sectors

There are now numerous in vitro and in silico ADME alternatives to in vivo assays but how do different industries incorporate them into their decision tree approaches for risk assessment, bearing in mind that the chemicals tested are intended for widely varying purposes? The extent of the use of animal tests is mainly driven by regulations or by the lack of a suitable in vitro model. Therefore, what considerations are needed for alternative models and how can they be improved so that they can be used as part of the risk assessment process? To address these issues, the European Partnership for Alternative Approaches to Animal Testing (EPAA) working group on prioritisation, promotion and implementation of the 3Rs research held a workshop in November, 2008 in Duesseldorf, Germany. Participants included different industry sectors such as pharmaceuticals, cosmetics, industrial- and agro-chemicals. This report describes the outcome of the discussions and recommendations (a) to reduce the number of animals used for determining the ADME properties of chemicals and (b) for considerations and actions regarding in vitro and in silico assays. These included: standardisation and promotion of in vitro assays so that they may become accepted by regulators; increased availability of industry in vivo kinetic data for a central database to increase the power of in silico predictions; expansion of the applicability domains of in vitro and in silico tools (which are not necessarily more applicable or even exclusive to one particular sector) and continued collaborations between regulators, academia and industry. A recommended immediate course of action was to establish an expert panel of users, developers and regulators to define the testing scope of models for different chemical classes. It was agreed by all participants that improvement and harmonization of alternative approaches is needed for all sectors and this will most effectively be achieved by stakeholders from different sectors sharing data.     

完善我国基本药物供给保障政策的建议

通过文献研究的方法,探讨我国基本药物供给保障政策的现状,提出完善我国相应对策的建议,通过优化基本药物目录,建立合理的生产企业招标标准,完善药品定价机制和各种补偿机制等措施来保障我国基本药物供给政策的实施.     

The European Medicines Agency review of Tegafur/Gimeracil/Oteracil (Teysuno™) for the treatment of advanced gastric cancer when given in combination with cisplatin: summary of the Scientific Assessment of the Committee for medicinal products for human use (CHMP)

The product Teysuno™ (S-1) contains tegafur, a prodrug of 5-fluorouracil (5-FU), and two modulators of 5-FU metabolism, gimeracil and oteracil.The main clinical study in this application was a randomized controlled study comparing S-1 plus cisplatin with 5-FU plus cisplatin. In this study, median overall survival times of 8.6 months and 7.9 months for S-1 plus cisplatin and 5-FU plus cisplatin, respectively, were observed (hazard ratio, 0.92; 95% confidence interval, 0.80–1.05). The Committee for Medicinal Products for Human Use of the European Medicines Agency concluded that S-1 in combination with cisplatin (75 mg/m²) was noninferior to 5-FU plus cisplatin (100 mg/m²) in patients with advanced gastric cancer and adopted a positive opinion recommending the marketing authorization for this product for the treatment of advanced gastric cancer when given in combination with cisplatin. The recommended dose of S-1 is 25 mg/m² (expressed as tegafur content) twice a day, for 21 consecutive days followed by 7 days rest (one treatment cycle), in combination with 75 mg/m² cisplatin i.v. administered on day 1. This treatment cycle is repeated every 4 weeks.The most common side effects reported in the pivotal study were anemia, neutropenia, vomiting, diarrhea, abdominal pain, weight decrease, anorexia, and fatigue.The objective of this paper is to summarize the scientific review of the application leading to approval in the EU. The full scientific assessment report and the summary of product characteristics are available on the European Medicines Agency website (http://www.ema.europa.eu).     

Efficacy and safety of immunosuppressive drugs approved in EU through the centralised procedure

INTRODUCTION: The aim of the present work is to evaluate the efficacy and safety data used by the European Medicines Agency (EMEA) between 1995 and June 2006 to approve new immunosuppressive drugs with indications in solid organ transplantation. MATERIALS AND METHODS: The information about the approval of new agents was retrieved mainly from the European Public Assessment Report (EPAR) and Summary of Product Characteristics (SPC) on the EMEA web site. The design, type of control, primary endpoints, duration of follow-up, and safety profile of pivotal trials were examined. RESULTS: Four immunosuppressive drugs belonging to three different therapeutic classes, with different clinical uses, were identified. Not all pivotal clinical trials compared the investigational agent with cyclosporin/corticosteroid/azathioprine triple therapy, which was the best therapeutic option available at the time of approval. Acute rejection, graft survival and efficacy failure at 6 months or 1 year post-transplant were the most frequent endpoints. Although some of the new agents reduce calcineurin inhibitor-associated nephrotoxicity, their adverse cardiovascular profile is of particular concern. DISCUSSION: Recent improvements in the short-term efficacy of immunosuppressive therapy make short-term outcome measures inadequate for predicting long-term clinical benefit. Clinical outcomes such as 3- or 5-year graft and patient survival should be used in clinical trials in order to take into account non-immunosuppressive-related morbidity and to assess better whether the therapeutic advantage of the new agents over standard therapy is maintained in the long term.     

A systematic review of the clinical and economic impact of drug information services on patient outcome

Aim: to establish what is known about the clinical and economic impact of drug information (DI) services on patient outcome. Method: a systematic review and critical appraisal of world literature on work conducted by Drug Information Centres and UK Schools of Pharmacy.Results: six relevant published articles were recovered – three from the UK, two from the US and one from Canada; just one was prospective in design. Four were single-centre and two were multi-centre studies. Four studies relied heavily on questionnaire surveys of the enquirer to establish an effect; only one monitored patient outcome independently and used peer review to assess impact.Conclusion: the clinical and economic impact of drug information consultation and provision on patient care has not been investigated rigorously. A research methodology for such an investigation is suggested.     

Measuring the impact of medicines information services on patient care: methodological considerations

Introduction: Medicines information services (MISs) aim to promote the safe, effective and economic use of medicines. Results from published studies suggest that they provide effective information, which in many cases results in improved patient outcome. However, there are several methodological issues that are important in the interpretation of such studies.Aim: To address methodological issues in the evaluation of MISsObjectives: To carry out a critical appraisal of papers assessing the impact on patient outcome of passive information given to health care professionals, to identify the key methodological issues and to make recommendations for future research in Europe. Methods: Literature search to identify relevant papers meeting the inclusion criteria, critical evaluation of the methods usedResults: Most studies have been conducted in the United States. Various methodological considerations were identified: study design, sampling, data collection, choice of outcome measures, and validity. The results of each study are interpreted in view of the methods used. In addition, the implications of the methods selected on the validity, reliability and generalisability of the results are discussed. Finally, suggestions for future studies are provided, in order to maximise validity and reliability.     

Identification of nevadensin as an important herb-based constituent inhibiting estragole bioactivation and physiology-based biokinetic modeling of its possible in vivo effect

Estragole is a natural constituent of several herbs and spices including sweet basil. In rodent bioassays, estragole induces hepatomas, an effect ascribed to estragole bioactivation to 1′-sulfooxyestragole resulting in DNA adduct formation. The present paper identifies nevadensin as a basil constituent able to inhibit DNA adduct formation in rat hepatocytes exposed to the proximate carcinogen 1′-hydroxyestragole and nevadensin. This inhibition occurs at the level of sulfotransferase (SULT)-mediated bioactivation of 1′-hydroxyestragole. The Ki for SULT inhibition by nevadensin was 4 nM in male rat and human liver fractions. Furthermore, nevadensin up to 20 μM did not inhibit 1′-hydroxyestragole detoxification by glucuronidation and oxidation. The inhibition of SULT by nevadensin was incorporated into the recently developed physiologically based biokinetic (PBBK) rat and human models for estragole bioactivation and detoxification. The results predict that co-administration of estragole at a level inducing hepatic tumors in vivo (50 mg/kg bw) with nevadensin at a molar ratio of 0.06, representing the ratio of their occurrence in basil, results in almost 100% inhibition of the ultimate carcinogen 1′-sulfooxyestragole when assuming 100% uptake of nevadensin. Assuming 1% uptake, inhibition would still amount to more than 83%. Altogether these data point at a nevadensin-mediated inhibition of the formation of the ultimate carcinogenic metabolite of estragole, without reducing the capacity to detoxify 1′-hydroxyestragole via glucuronidation or oxidation. These data also point at a potential reduction of the cancer risk when estragole exposure occurs within a food matrix containing SULT inhibitors compared to what is observed upon exposure to pure estragole.