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AAPS PharmSciTech Mar 2021Intravitreal (IVT) administration of therapeutics is the standard of care for treatment of back-of-eye disorders. Although a common procedure performed by retinal... (Review)
Review
Intravitreal (IVT) administration of therapeutics is the standard of care for treatment of back-of-eye disorders. Although a common procedure performed by retinal specialists, IVT administration is associated with unique challenges related to drug product, device and the procedure, which may result in adverse events. Container closure configuration plays a crucial role in maintaining product stability, safety, and efficacy for the intended shelf-life. Careful design of primary container configuration is also important to accurately deliver small volumes (10-100 μL). Over- or under-dosing may lead to undesired adverse events or lack of efficacy resulting in unpredictable and variable clinical responses. IVT drug products have been traditionally presented in glass vials. However, pre-filled syringes offer a more convenient administration option by reducing the number of steps required for dose preparation there by potentially reducing the time demand on the healthcare providers. In addition to primary container selection, product development studies should focus on, among other things, primary container component characterization, material compatibility with the formulation, formulation stability, fill volume determination, extractables/leachables, and terminal sterilization. Ancillary components such as disposable syringes and needles must be carefully selected, and a detailed administration procedure that includes dosing instructions is required to ensure successful administration of the product. Despite significant efforts in improving the drug product and administration procedures, ocular safety concerns such as endophthalmitis, increased intraocular pressure, and presence of silicone floaters have been reported. A systematic review of available literature on container closure and devices for IVT administration can help guide successful product development.
Topics: Drug Delivery Systems; Drug Packaging; Humans; Intravitreal Injections; Needles; Pharmaceutical Preparations; Sterilization; Syringes
PubMed: 33709236
DOI: 10.1208/s12249-021-01949-4 -
Expert Opinion on Drug Safety Feb 2023
Topics: Humans; Epilepsy; Drug-Related Side Effects and Adverse Reactions; Drug Labeling
PubMed: 36881668
DOI: 10.1080/14740338.2023.2188189 -
Critical Reviews in Toxicology Feb 2022During the toxicological assessment of extractables and leachables in drug products, localized hazards such as irritation or sensitization may be identified. Typically,... (Review)
Review
During the toxicological assessment of extractables and leachables in drug products, localized hazards such as irritation or sensitization may be identified. Typically, because of the low concentration at which leachables occur in pharmaceuticals, irritation is of minimal concern; therefore, this manuscript focuses on sensitization potential. The primary objective of performing a leachable sensitization assessment is protection against Type IV induction of sensitization, rather than prevention of an elicitation response, as it is not possible to account for the immunological state of every individual. Sensitizers have a wide range of potencies and those which induce sensitization upon exposure at a low concentration (i.e. strong, or extreme sensitizers) pose the highest risk to patients and should be the focus of the risk assessment. The Extractables and Leachables Safety Information Exchange (ELSIE) consortium has reviewed the status of dermal, respiratory, and systemic risk assessment in cosmetic and pharmaceutical industries, and proposes a framework to evaluate the safety of known or potential dermal sensitizers in pharmaceuticals. Due to the lack of specific regulatory guidance on this topic, the science-driven risk-based approach proposed by ELSIE encourages consistency in the toxicological assessment of extractables and leachables to maintain high product quality and ensure patient safety.
Topics: Drug Contamination; Drug Packaging; Humans; Pharmaceutical Preparations; Risk Assessment
PubMed: 35703156
DOI: 10.1080/10408444.2022.2065966 -
Journal of Pharmaceutical Sciences Apr 2022Protein-based biologic drugs encounter a variety of stress factors during drug substance (DS) and drug product (DP) manufacturing, and the subsequent steps that result...
Protein-based biologic drugs encounter a variety of stress factors during drug substance (DS) and drug product (DP) manufacturing, and the subsequent steps that result in clinical administration by the end user. This article is the third in a series of commentaries on these stress factors and their effects on biotherapeutics. It focuses on assessing the potential negative impact from primary packaging, transportation, and handling on the quality of the DP. The risk factors include ingress of hazardous materials such as oxidizing residuals from the sterilization process, delamination- or rubber stopper-derived particles, silicone oil droplets, and leachables into the formulation, as well as surface interactions between the protein and packaging materials, all of which may cause protein degradation. The type of primary packaging container used (such as vials and prefilled syringes) may substantially influence the impact of transportation and handling stresses on DP Critical Quality Attributes (CQAs). Mitigations via process development and robustness studies as well as control strategies for DP CQAs are discussed, along with current industry best practices for scale-down and in-use stability studies. We conclude that more research is needed on postproduction transportation and handling practices and their implications for protein DP quality.
Topics: Drug Packaging; Pharmaceutical Preparations; Proteins; Rubber; Sterilization; Syringes
PubMed: 35081407
DOI: 10.1016/j.xphs.2022.01.011 -
Journal of Pharmaceutical Sciences May 2024Interest in minitablets (MTs) has grown exponentially over the last 20 years and especially the last decade, as evidenced by the number of publications cited in Scopus... (Review)
Review
Interest in minitablets (MTs) has grown exponentially over the last 20 years and especially the last decade, as evidenced by the number of publications cited in Scopus and PubMed. MTs offer significant opportunities for personalized medicine, dose titration and flexible dosing, taste masking, and customizing drug delivery systems. Advances in specialized MT tooling, manufacturing, and characterization instrumentation have overcome many of the earlier development issues. Breakthrough MT swallowability, acceptability, and palatability research have challenged the long-standing idea that only liquids are acceptable dosage forms for infants and young children. MTs have been shown to be a highly acceptable dosage form for infants, small children, and geriatric patients who have difficulty swallowing. This review discusses the current state of MT applications, acceptability in pediatric and geriatric populations, medication adherence, manufacturing processes such as tableting and coating, running powder and tablet characterization, packaging and MT dispensing, and regulatory considerations.
Topics: Infant; Humans; Child; Child, Preschool; Aged; Administration, Oral; Tablets; Drug Delivery Systems; Drug Packaging; Precision Medicine
PubMed: 38369020
DOI: 10.1016/j.xphs.2024.02.016 -
Journal of Clinical Pharmacology Mar 2023Pediatric extrapolation plays a key role in the availability of reliable pediatric use information in approved drug labeling. This review examined the use of pediatric... (Review)
Review
Pediatric extrapolation plays a key role in the availability of reliable pediatric use information in approved drug labeling. This review examined the use of pediatric extrapolation in studies submitted to the US Food and Drug Administration and assessed changes in extrapolation approaches over time. Pediatric studies of 125 drugs submitted to the US Food and Drug Administration that led to subsequent pediatric information in drug labeling between 2015 and 2020 were reviewed. The use of pediatric extrapolation for each drug was identified and categorized as "complete," "partial," or "no" extrapolation. Approaches to pediatric extrapolation of efficacy changed over time. Complete extrapolation of efficacy was the predominantly used approach. "Complete," "partial," or "no" extrapolation was used for 51%, 23%, and 26% of the drugs, respectively. This represents a shift in extrapolation approaches when compared to a previous study that evaluated pediatrics drug applications between 2009 and 2014, which found complete, partial, or no extrapolation was used for 34%, 29%, and 37% of the drugs, respectively. Pediatric extrapolation approaches may continue to shift as emerging science fills gap in knowledge of the fundamental assumptions underlying this scientific tool. The international community continues to collaborate on discussions of pediatric extrapolation of efficacy from adults and other pediatric subpopulations to optimize its use for pediatric drug development.
Topics: Adult; United States; Child; Humans; United States Food and Drug Administration; Drug Development; Pharmaceutical Preparations; Drug Labeling
PubMed: 36150423
DOI: 10.1002/jcph.2160 -
Expert Review of Clinical Pharmacology Oct 2022Off-label drug use embodies a thorough clinical diagnosis and evaluation of treatment needs and should not be confused with unreasonable drug use, but it also faces...
BACKGROUND
Off-label drug use embodies a thorough clinical diagnosis and evaluation of treatment needs and should not be confused with unreasonable drug use, but it also faces potential risks with drug safety and legal issues.
RESEARCH DESIGN AND METHODS
We first established a guideline working group. Following the guideline development process recommended by the World Health Organization Handbook and the Chinese Medical Association, the key questions were determined through literature searches of PubMed, CNKI (Chinese National Knowledge Infrastructure) and other databases. Both the evidence and the clinicians' diagnosis and treatment workload were considered to formulate the initial recommendations. Finally, two rounds of Delphi surveys and one expert seminar were organized to determine the final recommendations of this guideline. Meanwhile, we graded the recommendations based on the body of evidence.
RESULTS
We determined nine questions and proposed a total of 23 recommendations regarding the definition of off-label use of drugs, applicable circumstances, classification of evidence, informed consent, legal basis, adverse drug reaction monitoring and evaluation, management procedure, responsibilities and obligations of different stakeholders, medical insurance reimbursement, and the national approval system.
CONCLUSIONS
This guideline standardized clinical off-label drug use and provided suggestions and references for the management of off-label drug use.
Topics: Humans; Off-Label Use; Evidence-Based Medicine; Drug Labeling; Drug-Related Side Effects and Adverse Reactions; Databases, Factual; China
PubMed: 36047057
DOI: 10.1080/17512433.2022.2120468 -
Experimental Biology and Medicine... Nov 2023The US drug labeling document contains essential information on drug efficacy and safety, making it a crucial regulatory resource for Food and Drug Administration (FDA)...
The US drug labeling document contains essential information on drug efficacy and safety, making it a crucial regulatory resource for Food and Drug Administration (FDA) drug reviewers. Due to its extensive volume and the presence of free-text, conventional text mining analysis have encountered challenges in processing these data. Recent advances in artificial intelligence (AI) for natural language processing (NLP) have provided an unprecedented opportunity to identify key information from drug labeling, thereby enhancing safety reviews and support for regulatory decisions. We developed RxBERT, a Bidirectional Encoder Representations from Transformers (BERT) model pretrained on FDA human prescription drug labeling documents for an enhanced application of drug labeling documents in both research and drug review. RxBERT was derived from BioBERT with further training on human prescription drug labeling documents. RxBERT was demonstrated in several tasks using regulatory datasets, including those involved in the National Institutes of Technology Text Analysis Challenge Dataset (NIST TAC dataset), the FDA Adverse Drug Event Evaluation Dataset (ADE Eval dataset), and the classification of texts from submission packages into labeling sections (US Drug Labeling dataset). For all these tasks, RxBERT reached 86.5 1-scores in both TAC and ADE Eval classification, respectively, and prediction accuracy of 87% for the US Drug Labeling dataset. Overall, RxBERT was shown to be as competitive or have better performance compared to other NLP approaches such as BERT, BioBERT, etc. In summary, we developed RxBERT, a transformer-based model specific for drug labeling that outperformed the original BERT model. RxBERT has the potential to be used to assist research scientists and FDA reviewers to better process and utilize drug labeling information toward the advancement of drug effectiveness and safety for public health. This proof-of-concept study also demonstrated a potential pathway to customized large language models (LLMs) tailored to the sensitive regulatory documents for internal application.
Topics: United States; Humans; Artificial Intelligence; Drug Labeling; Prescription Drugs; Data Mining; Drug-Related Side Effects and Adverse Reactions
PubMed: 38166420
DOI: 10.1177/15353702231220669 -
Journal of Pharmaceutical and... Feb 2024To ensure the efficacy, safety, and quality of drugs, several national and international guidelines and regulatory requirements exist. The most important international... (Review)
Review
To ensure the efficacy, safety, and quality of drugs, several national and international guidelines and regulatory requirements exist. The most important international regulatory framework for quality is the collection of the guidelines ICH Q1-Q14 (International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use), which form the basis for the development and approval of medicinal products. Additionally, international and national pharmacopoeias and national regulatory authorities like Food and Drug Administration (FDA) and European Directory for the Quality of Medicines and HealthCare (EDQM) have to be considered during the lifecycle of a drug. Further, regular updates and optimization of processes and methods together with periodic audits and inspections of the manufacturing plants help to ensure compliance with the complex regulatory requirements for medicinal products. Although the pharmaceutical world seems to be very well regulated and controlled, several drug recalls per year have to be announced and conducted to remove defect products from the market and protect the patient from any potential health risk. This review article provides an overview of the most common reasons for such recalls presenting several historical and current cases with a detailed discussion of root causes. A specific focus lies on quality issues like drug degradation, impurity and nitrosamine contamination, lack of drug stability, occurrence and transformation of polymorphs, contamination with particulates and foreign matters, amongst others. The role of APIs, excipients and packaging will be discussed as well as the analytical challenges to detect, control and mitigate such quality issues. A final chapter will discuss the current situation and an outlook on emerging topics and future challenges for drug quality.
Topics: Humans; Pharmaceutical Preparations; Drug Packaging; Drug Stability
PubMed: 38103416
DOI: 10.1016/j.jpba.2023.115880 -
PDA Journal of Pharmaceutical Science... 2022Nitrosamines have gained unexpected attention again, triggered by their discovery at significant concentrations in some active pharmaceutical ingredients and... (Review)
Review
Nitrosamines have gained unexpected attention again, triggered by their discovery at significant concentrations in some active pharmaceutical ingredients and pharmaceutical products. Regulatory agencies not only expect the marketing authorization holders to include a nitrosamine risk assessment in their drug development process but to also apply it retrospectively to the marketed drug product. As part of this risk assessment, all possible sources of nitrosamines need to be evaluated. This review provides the chemical background of nitrosamines and elastomeric formulations, the current regulatory status in the pharmaceutical and other industries, and discusses analytical challenges of nitrosamine measurement. This evaluation of elastomeric components as a potential nitrosamine source proposes how this information can be used in a drug product risk assessment.
Topics: Drug Packaging; Elastomers; Nitrosamines; Pharmaceutical Preparations; Retrospective Studies
PubMed: 34282037
DOI: 10.5731/pdajpst.2021.012645