{"title":"Current Use of Physiologically Based Pharmacokinetic modeling in New Medicinal Product Approvals at EMA.","authors":"Polly Paul, Pieter J Colin, Flora Musuamba Tshinanu, Carolien Versantvoort, Efthymios Manolis, Kevin Blake","doi":"10.1002/cpt.3525","DOIUrl":"https://doi.org/10.1002/cpt.3525","url":null,"abstract":"<p><p>Physiologically Based Pharmacokinetic (PBPK) Models are routinely used in drug development and therefore appear frequently in marketing authorization applications (MAAs) to the European Medicines Agency (EMA). For a model to be a key source of evidence for a regulatory decision, it must be considered qualified for the intended use. Advice on the data expected to allow qualification of a PBPK model or platform is provided in the EMA Guideline on the reporting of PBPK modeling and simulation. The present study is an EMA review of the use of PBPK models in submitted MAAs in 2022 and 2023 focussing on the concept of qualification and the reasons why models were not considered qualified. A review of the 95 MAAs with a \"full\" legal basis approved during these years showed that 25 of them contained PBPK modeling. There were 65 proposed general areas of intended use for PBPK modeling identified across the applications, with the most common being a prediction of drug-drug interactions with enzymes or transporters (69%). Finally, this review showed that most of the models submitted in applications to EMA were not considered qualified for the intended use(s). The reasons identified for this are reported and the need for further EMA guidance, particularly around requirements for qualification of PBPK models, are discussed.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicki M Kyriacou, Annette S Gross, Andrew J McLachlan
{"title":"Green Tea Catechins as Perpetrators of Drug Pharmacokinetic Interactions.","authors":"Nicki M Kyriacou, Annette S Gross, Andrew J McLachlan","doi":"10.1002/cpt.3547","DOIUrl":"https://doi.org/10.1002/cpt.3547","url":null,"abstract":"<p><p>Green tea (Camellia sinensis) is a commonly consumed beverage or dietary supplement. As a natural product with a myriad of proposed health benefits, patients are likely to consume green tea while taking their medications unaware of its potential to interact with drugs and influence drug efficacy and safety. Catechins are the abundant polyphenolic compounds in green tea (e.g., (-)-epigallocatechin-3-gallate), which are reported to influence determinants of drug pharmacokinetics, such as drug solubility and the activity of drug transporters and drug metabolizing enzymes. This review summarized the results of clinical studies investigating the influence of green tea catechins on the pharmacokinetics of clinically used medications. The majority of analyses (72%) reported significant decreases (by 18-99%) in systemic drug exposure with green tea consumption (atorvastatin, celiprolol, digoxin, fexofenadine, folic acid, lisinopril, nadolol, nintedanib, raloxifene, and rosuvastatin). One analysis (6%) reported a 50% increase in drug systemic exposure (sildenafil) and for 22% of analyses drug pharmacokinetics were not affected by green tea consumption (fluvastatin, pseudoephedrine, simvastatin, and tamoxifen). For most drugs reporting an interaction, green tea catechins were proposed to decrease intestinal drug absorption by inhibiting OATP uptake (particularly OATP1A2), enhancing P-gp efflux activity or reducing drug solubility. Case reports have associated changes in drug pharmacokinetics with green tea consumption to changes in drug efficacy or safety (e.g., nadolol and erlotinib). These findings prompt the need for further research in relating evidence from existing literature to predict additional clinically important green tea-drug interactions and to provide appropriate recommendations for patients and clinicians.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yu-Jou Lin, Louvina E van der Laan, Mats O Karlsson, Anthony J Garcia-Prats, Anneke C Hesseling, Elin M Svensson
{"title":"Model-Informed Once-Daily Dosing Strategy for Bedaquiline and Delamanid in Children, Adolescents and Adults with Tuberculosis.","authors":"Yu-Jou Lin, Louvina E van der Laan, Mats O Karlsson, Anthony J Garcia-Prats, Anneke C Hesseling, Elin M Svensson","doi":"10.1002/cpt.3536","DOIUrl":"https://doi.org/10.1002/cpt.3536","url":null,"abstract":"<p><p>The complexity of the currently registered dosing schedules for bedaquiline and delamanid is a barrier to uptake in drug-resistant tuberculosis treatment across all ages. A simpler once-daily dosing schedule is critical to ensure patient-friendly regimens with good adherence. We assessed expected drug exposures with proposed once-daily doses for adults and compared novel model-informed once-daily dosing strategies for children with current World Health Organization (WHO) recommended dosing. A reference individual and virtual pediatric population were generated to simulate exposures in adults and children, respectively. Published population models characterizing the exposures of bedaquiline and its metabolite M2, delamanid, and its metabolite DM-6705 were utilized. During simulation, child growth during treatment along with several CYP3A4 ontogeny profiles was accounted for. Exposures in children were compared with simulated adult targets to assess the expected treatment efficacy and safety. In adults, the proposed bedaquiline once-daily dosing (400 mg daily for 2 weeks followed by 100 mg daily for 22 weeks) yielded 14% higher exposures of bedaquiline and M2 compared to the labeled dosing scheme at 24 weeks; for delamanid and DM-6705, the suggested 300 mg daily dose provided 13% lower exposures at steady state. For children, the cumulative proportions of exposures of both drugs showed < 5% difference between WHO-recommended and proposed once-daily dosing. This study demonstrated the use of model-informed approaches to propose rational and simpler regimens for bedaquiline and delamanid in adults and children. The new once-daily dosing strategies will be tested in the PARADIGM4TB and IMPAACT 2020 trials in adults and children, respectively.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Corey M Benedum, Somnath Sarkar, Selen Bozkurt, Ruma Bhagat, Nicole Richie, Bea Lavery, Sandra D Griffith
{"title":"POP-REFINE: A Comprehensive Framework for Evaluating and Optimizing Representativeness in Clinical Trials.","authors":"Corey M Benedum, Somnath Sarkar, Selen Bozkurt, Ruma Bhagat, Nicole Richie, Bea Lavery, Sandra D Griffith","doi":"10.1002/cpt.3543","DOIUrl":"https://doi.org/10.1002/cpt.3543","url":null,"abstract":"<p><p>Clinical research has historically failed to include representative levels of historically underrepresented populations and these inequities continue to persist. Ensuring representativeness in clinical trials is crucial for patients to receive clinically appropriate treatment and have equitable access to novel therapies; enhancing the generalizability of study results; and reducing the need for post-marketing commitments focused on underrepresented groups. As demonstrated by recent legislation and guidance documents, regulatory agencies have shown an increased interest in understanding how novel therapies will impact the patient population that will receive them. Despite these efforts, a systematic approach to measure and optimize representativeness remains underdeveloped. Here, we introduce the novel Population Optimization, Representativeness Evaluation, and Fine-tuning Framework, designed to quantify and enhance representativeness. Our framework includes methods for evaluating overall and subgroup representativeness, identifying drivers of non-representativeness, and optimizing eligibility criteria to achieve representative populations. We demonstrate our framework by selecting patients who met the eligibility criteria for nine oncology clinical trials from a nationwide electronic health record-derived de-identified database and quantifying the representativeness of each trial's eligible population. This framework addresses gaps in current literature by providing a comprehensive, data-driven approach to enhance the representativeness of clinical trials, thereby supporting regulatory and internal decision-making processes. This framework is adaptable to various disease indications and can be extended to evaluate enrolled study samples, ensuring that clinical trials are representative.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Progress, Pitfalls, and Impact of AI-Driven Clinical Trials.","authors":"Dominika Wilczok, Alex Zhavoronkov","doi":"10.1002/cpt.3542","DOIUrl":"https://doi.org/10.1002/cpt.3542","url":null,"abstract":"<p><p>Since the deep learning revolution of the early 2010s, significant efforts and billions of dollars have been invested in applying artificial intelligence (AI) to drug discovery and development (AIDD). However, despite high expectations, few AI-discovered or AI-designed drugs have entered human clinical trials, and none have achieved clinical approval. In this perspective, we examine the challenges impeding progress and highlight opportunities to harness AI's potential in transforming drug discovery and development.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yoo Jin Jang, Doh Kwan Kim, Shinn-Won Lim, Eunjin Hong
{"title":"Impact of CYP2C19 Phenotype on Escitalopram Response in Geriatrics: Based on Physiologically-Based Pharmacokinetic Modeling and Clinical Observation.","authors":"Yoo Jin Jang, Doh Kwan Kim, Shinn-Won Lim, Eunjin Hong","doi":"10.1002/cpt.3537","DOIUrl":"https://doi.org/10.1002/cpt.3537","url":null,"abstract":"<p><p>Escitalopram is commonly prescribed for depressive and anxiety disorders in elderly patients, who often show variable drug responses and face higher risks of side effects due to age-related changes in organ function. The CYP2C19 polymorphism may further affect escitalopram pharmacokinetics in elderly patients, complicating dose optimization for this group. Previous pharmacogenetic studies examining the impact of CYP2C19 phenotype on escitalopram treatment outcomes have primarily focused on younger adults, leaving a gap in understanding its effects on the elderly. The aim of this investigation is to determine the impact of CYP2C19 phenotypes on escitalopram exposure in geriatrics using a physiologically-based pharmacokinetic (PBPK) model with geriatric-specific parameters and our clinical sample of 88 elderly patients with major depressive disorder. Based on PBPK simulations, the exposure of escitalopram in CYP2C19 poor metabolizers (PMs) was 2.1-fold higher compared with CYP2C19 extensive metabolizers (EMs). In line with PBPK results, the dose-normalized trough concentration in our clinical sample varied according to CYP2C19 phenotype (P = 0.0132), with PMs having a 1.6-fold higher concentration than EMs. Based on simulated and observed results, it is suggested that an escitalopram dose of 10 mg/day maybe appropriate for PMs, while a maximum dose of 20 mg/day could be used for EMs and IMs who do not achieve therapeutic responses at 10 mg/day. These findings suggest that CYP2C19 genotyping in elderly patients could be beneficial for tailoring dosing regimens in clinical practice, potentially improving treatment outcomes and reducing the risk of adverse drug reactions associated with escitalopram in this vulnerable group.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elodie Baumfeld Andre, Matthew Gee, Carsten Magnus, Stephanie Greeman, Pipper White, Maryellen de Mars, Brad Spring
{"title":"The Open Hand Initiative: Facilitating the Use of Real-World Evidence in Regulatory Submissions Through Collaboration and Transparency.","authors":"Elodie Baumfeld Andre, Matthew Gee, Carsten Magnus, Stephanie Greeman, Pipper White, Maryellen de Mars, Brad Spring","doi":"10.1002/cpt.3539","DOIUrl":"https://doi.org/10.1002/cpt.3539","url":null,"abstract":"<p><p>Real-world data (RWD) collected to generate real-world evidence (RWE) holds promise for expediting patient and healthcare provider access to new in vitro diagnostics (IVDs) by serving as evidence to demonstrate test performance or utility. However, uncertainties remain for IVD developers (device manufacturers), regulators, and other healthcare stakeholders on the specifics of collecting fit-for-purpose RWD and using RWE for regulatory decision-making. We report on a unique approach to medical device regulatory review called the Open Hand Initiative, by which the US Food and Drug Administration (FDA) and device manufacturers collaborate to ensure the appropriate use of RWD/RWE to support regulatory decision-making. Normally, regulatory submission interactions are confidential; in the Open Hand approach, device manufacturers share high-level learnings from pre-submission interactions to advance the use of reliable and relevant RWD/RWE for regulatory decision-making. In a pilot study, the Open Hand approach was applied to pre-submission interactions regarding the use of RWD/RWE for transition of SARS-CoV-2 serology IVDs with Emergency Use Authorization (EUA) to full market authorization. Participants in the pilot agreed that the candid discussions were key to identifying barriers to efficient, timely, and robust RWE generation for IVD premarket submissions. The pilot also led to valuable lessons learned around current regulatory requirements for RWE, SARS-CoV-2 testing complexities, and the impact that the rapidly evolving COVID-19 pandemic had on RWD availability and quality. The Open Hand Initiative can be applied more broadly to guide device manufacturers in collecting high-quality RWD to generate RWE for premarket applications.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fan Huang, Dingyuan Hu, Huaying Fan, Binyi Hu, Yian Liu, Wenliang Dong, Xiangxing Liu, Yanting Li, Diqin Yan, Rui Ding, Suping Niu, Liming Chen, Xiaoyan Nie, Yi Fang
{"title":"Efficacy and Safety of Janus Kinase Inhibitors in Patients with Vitiligo: A Systematic Review and Meta-Analysis.","authors":"Fan Huang, Dingyuan Hu, Huaying Fan, Binyi Hu, Yian Liu, Wenliang Dong, Xiangxing Liu, Yanting Li, Diqin Yan, Rui Ding, Suping Niu, Liming Chen, Xiaoyan Nie, Yi Fang","doi":"10.1002/cpt.3538","DOIUrl":"https://doi.org/10.1002/cpt.3538","url":null,"abstract":"<p><p>Although several case reports and small clinical trials have reported promising outcomes with Janus kinase (JAK) inhibitors for vitiligo, high-quality evidence and guidelines are lacking. We evaluated the efficacy and safety of JAK inhibitors for the treatment of vitiligo using a meta-analysis of randomized controlled trials (RCTs). We searched the PubMed, Embase, and Cochrane Library databases up to August 2023, with additional studies from ClinicalTrials.gov and company websites. We assessed outcomes, including percentage improvement in total vitiligo area score index (TVASI) and facial vitiligo area score index (FVASI); the proportion of patients achieving 50% improvement in TVASI (TVASI50) and 50% and 75% improvement in FVASI (FVASI50 and FVASI75); the risk of treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), infections, and skin-related adverse events (AEs). Five studies with 1,550 participants were included. JAK inhibitors were associated with a higher proportion of TVASI50 (relative risk [RR] 2.67, 95% confidence interval [CI] 1.24-5.78) and FVASI75 (RR 3.97, 95%CI 2.62-6.02) responders than placebo. JAK inhibitors significantly increased the risk of skin-related AEs (RR 1.96, 95% CI 1.29-2.98) compared with placebo. However, the risk of TEAEs, SAEs, and infections was not significantly different between the JAK inhibitor and placebo groups. Subgroup analysis showed that JAK1 and JAK1/2 inhibitors were more effective than JAK3 inhibitors. However, there was insufficient evidence to suggest that the route of administration affects the efficacy and safety of JAK inhibitors in vitiligo. These findings indicate that JAK inhibitors are effective in repigmentation and well tolerated in patients with vitiligo.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yan-Ou Yang, Victor Sokolov, Alina Volkova, Xing Liu, Cristina Leon, Yuri Kosinsky, Breann Barker, Xuecheng Zhang, Peter Ordentlich, Jennifer Sheng, Xuejun Chen
{"title":"Semimechanistic Population PK/PD Modeling of Axatilimab in Healthy Participants and Patients With Solid Tumors or Chronic Graft-Versus-Host Disease.","authors":"Yan-Ou Yang, Victor Sokolov, Alina Volkova, Xing Liu, Cristina Leon, Yuri Kosinsky, Breann Barker, Xuecheng Zhang, Peter Ordentlich, Jennifer Sheng, Xuejun Chen","doi":"10.1002/cpt.3503","DOIUrl":"https://doi.org/10.1002/cpt.3503","url":null,"abstract":"<p><p>Axatilimab, a high-affinity humanized immunoglobulin G4 monoclonal antibody against colony-stimulating factor 1 receptor (CSF-1R), is approved for the treatment of chronic graft-versus-host disease (cGVHD), and under investigation for idiopathic pulmonary fibrosis and solid tumors. The population pharmacokinetics (PK) and pharmacodynamics (PD) of axatilimab were characterized in healthy participants and patients with solid tumors or cGVHD using data from four clinical studies with 325 participants, including 278 patients with cGVHD. The model structure reflected the mechanism of action of axatilimab: blocking CSF-1R signaling with axatilimab reduces the circulating levels of cells in the mononuclear phagocytic cell lineage (including nonclassical monocytic cells (NCMCs) and Kupffer cells), resulting in increases in circulating enzymes owing to reduced clearance by Kupffer cells. The structural model consisted of a two-compartment axatilimab PK model and turnover PD models for CSF-1, NCMCs, aspartate transaminase (AST), and creatine phosphokinase (CPK). Axatilimab PK and CSF-1 equations also included saturable clearance components to reflect the competitive binding of axatilimab and CSF-1 to CSF-1R. Covariate search was conducted with the conditional sampling use for the stepwise approach based on correlation tests (COSSAC) approach. Covariate effects on model parameters, steady-state axatilimab exposure, and NCMC concentrations were assessed. The final population PK/PD model was mathematically described with 6 ordinary differential equations and 39 model parameters. Among the 11 statistically significant covariates, one (body weight) and two (participant population type and baseline CPK) covariates affected axatilimab steady-state exposure and steady-state NCMC levels by > 20%, respectively. These results informed the axatilimab dosing strategy in patients with cGVHD.</p>","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to \"The Effect of Low-Dose Colchicine on the Phenotype and Function of Neutrophils and Monocytes in Patients with Chronic Coronary Artery Disease: A Double-Blind Randomized Placebo-Controlled Cross-over Study\".","authors":"","doi":"10.1002/cpt.3541","DOIUrl":"https://doi.org/10.1002/cpt.3541","url":null,"abstract":"","PeriodicalId":153,"journal":{"name":"Clinical Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}