Pharmacovigilance overview
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Pharmacovigilance overview Pharmacovigilance overview Presentation Transcript

  • 1 Overview of Pharmacovigilence By SUNILBOREDDY
  • 2  Introduction  Definitions: Drug, PV, AE  Drug Development  Adverse Event  Need for PV-Clinical Trails and Post  Marketing  PV in countries  Reporting  Benefits- Public and drug manufacturer  Rationale  Recall
  • Day 1 Overview : POP Quiz 1. Name the drug regulatory body which governs the approval process in India? CDSCO (central drugs standards and control organization) 2. Which Clinical Trial phase involves giving drug to large group 100-300 people? PHASE II 3. Which Clinical Trial Phase takes about 3 years to complete? PHASE III 4. NDA stands for? New Drug Application 5. What are the 4 stages of drug development process? Pre-clinical, Clinical, NDA Review, Post-marketing 3
  • 4 Introduction • Early 20th century there were no controls over the drug development process. • Claims over treating diseases and uncontrolled marketing. • Safety or effectiveness of the drug- NOT a concern for government. • 1883 Dr. Harvey Wiley initiated the campaign for Federal law for Food and Drugs Act that was finally passed in 1906. • The law was further tightened following incidents such as poisoning of children by Sulphanilamide and the Thalidomide tragedy. • 1938 Federal Food, Drug, and Cosmetic Act.
  • Drug 5 Substance or mixture of substances used for diagnosis, treatment, mitigation or prevention of disease or disorders. Used for restoring correcting or modifying organic functions in human beings or animals.
  • Drug development 6 Preclinical Testing IND Application Clinical Testing – Phase I Clinical Testing – Phase II Clinical Testing – Phase III New Drug Application Clinical Testing–Phase IV IB,ICF, AE, Placebo, Blinding, randomized, Serious, Concomitant medication, Causality,
  • IB- comprehensive document summarizing information about an investigational product obtained during a drug trial. critical importance throughout the drug development process and is updated with new information as it becomes available. The purpose of the IB is to compile data relevant to studies of the IP in human subjects gathered during preclinical and other clinical trials. An IB is intended to provide the investigator with insights necessary for management of study conduct and study subjects throughout a clinical trial. An IB may introduce key aspects and safety measures of a clinical trial protocol, such as: Dose (of the study drug) Frequency of dosing interval Methods of administration Safety monitoring procedures7
  • An IB contains a "Summary of Data and Guidance for the Investigator" section, of which the overall aim is to "provide the investigator with a clear understanding of the possible risks and adverse reactions, and of the specific tests, observations, and precautions that may be needed for a clinical trial. This understanding should be based on the available physical, chemical, pharmaceutical, pharmacological, toxicological, and clinical information on the IP. Guidance should also be provided to the clinical investigator on the recognition and treatment of possible overdose and adverse drug reactions that is based on previous human experience and on the pharmacology of the investigational product". 8
  • •ICF- subject voluntarily confirms to participate, made aware of all aspects •Placebo- A substance containing no medication, given to reinforce a patient's expectation to get well (an inactive substance or preparation used as a control to determine the effectiveness of a medicinal drug) GUIDELINES (declaration of helsinki) •Blinding/Masking- one or more parties kept unaware of the treatment assignment •-Single blinding subjects unaware •-double blinding subjects, investigators, monitor, data analysts are also unaware •Randomized- subjects assigned randomly to treatment or control ( chance to reduce bias) •Serious- death, LT, hospitalization, disability, birth defect •Concomitant medication- medications used by patients in a clinical trial, other than the investigational drug. ( also to treat AE) investigational drug. •Causality- that AE was due to the medicine in question 9
  • Adverse event 10 Any unfavorable and unintended sign, symptom or a disease temporarily associated with the use of medicinal product (drug), whether or not considered related to the medicinal product. can be lab finding too or symptom or disease temporally associated with use of IP, whether or not related to the IP
  • 11 Need of pharmacovigilance There is a need to monitor the effects of drugs during the clinical trials and after its launch in a market. Because adverse events can even happen during the clinical trials and event after its launch market.
  • pharmakon-a drug or medicine vigilans-watchful or careful 12 World health organization (WHO, 2004) defines “pharmacovigilance” as the science and activities relating to the detection, assessment, understanding, and prevention of adverse drug reactions (ADRs), or any other medicine-related problems. Safety monitoring and evaluation throughout whole life- cycle of a product  Encompasses non-clinical, clinical, post-marketing safety data
  • 13 Day:2 Overview: POP QUIZ! 1.When was the Food drug and cosmetic Act passed? 1938 2. When can a case be called Serious? When the outcome of the event is death, LT, hospitalization, disability, birth defect. 3. In which phase is the likelihood of an adverse event maximum of all the 4 phases? Trick question!!! All phases of preclinical and clinical. 4. What does IB stand for? Investigator’s Brochure. 5. What are the uses of Thalidomide? Initially discovered as an painkiller on soldiers, later used on pregnant women for its antiemetic use. Also treats leprosy- but banned now. Anti cancer property exploited by Celgene to treat multiple myeloma marketed as lenalidomide (less sideeffects)
  • Why pharmacovigilance in clinical trials 14 After the completing preclinical studies in animals, first time trial drug will be administered to the human. At this time the drug will act in different way to the human body. Chances of adverse will also persist.
  • Pharmacovigilance in post marketing – Why? 15 At the time of approval, clinical trial data are available on limited numbers of patients treated for relatively short periods Once a product is marketed, large numbers of patients may be exposed, including: Patients with co-morbid illnesses Patients using concomitant medications Patients with chronic exposure Genetic diversity in large population
  • 16 The evaluation of risk must be conducted in the context of the  patient benefit derived from treatment, the severity of the condition being treated, and other objective and subjective factors (such as the patient’s values).
  • Pharmacovigilance – Why? 17 After marketing, new safety information may become available: Through use of the product domestically or in other countries Through use of other drugs in the same class From preclinical studies From pharmacologic studies From clinical trials
  • Importance of Pharmacovigilance in every country 18 There are differences among countries ( and even within countries ) in the occurrence of ADRs (Adverse drug reactions) and other drug related problems  Differences in diseases  Prescribing practices  Genetics  Diet  Traditions/lifestyle of people  Drug manufacturing processes  Drug distribution  The use of drugs ( dose, indications and availability)
  • Who reports about adverse events in Clinical Trials? 19
  • Who reports about adverse events in clinical Trials 20
  • Who reports in post marketing adverse events 21
  • SPONTANEOUS REPORTING 22
  • 23 Spontaneous reporting of suspected adverse drug effects is central to pharmacovigilance— which is the systematic search for signals of drug toxicity. When such a signal is detected it has to be verified, explored, and understood—realizing that the drug may be acceptably safe if used by individuals who are not at especially high risk by virtue of genetic constitution, metabolism, or other characteristics that could alter individual risk.
  • Partners in Pharmacovigilance 24  Government  Pharmaceutical Industry  Hospitals and academia  Medical and pharmaceutical associations  medicines information centers  Health professionals  Patients  Consumers  The media??  World Health Organization
  • 25 Each of the stakeholders—the patient, physician, pharmaceutical company, academic investigator, government—may have a different perspective on the same set of evidence.  For example, • A patient may be willing to accept a high risk of side-effects for benefits of the treatment for a condition that might be considered trivial by others. • A regulatory agency may consider the burden of the same side effects to be too high, given their view of the risk–benefit equation. • A governmental or third-party payer might see the issue from an even different perspective, since a payer may not wish to bear the cost of the treatment or the cost of treating an adverse event. • It is not surprising that each group may take a different view of the same evidence. • These pressures may lead to early decisions based on incomplete scientific data.
  • What is the role of pharmacovigilance? 26 The goal of pharmacovigilance is to: Monitor the quality of drugs Identify the health risks involved in the administration of certain drugs Prevent harm to patients Research the efficacy of drugs
  • How does pharmacovigilance help the public? 27 Pharmacovigilance helps save thousands of lives each year. By monitoring the adverse effects of drugs right from the lab to the pharmacy and then on for many years, pharmacovigilance keeps track of any drastic effects of drugs. This way, it prevents harm to patients using those drugs.
  • How does pharmacovigilance help drug manufacturers? 28 Pharmaceutical companies spend millions of dollars and a considerably long-time in developing new drugs. They again spend a lot of money in conducting clinical trials before the drugs are approved and launched in the market. But after all this, if there are adverse effects to the drugs, the company again loses millions of dollars in sales and litigations. Furthermore, the reputation of the company is also severely damaged. Pharmacovigilance monitors the development of the drug across various stages and assesses its effectiveness after its launch for many years. This way it may reduce the adverse risk from drugs, thereby aiding the drug manufacturers.
  • The Need 29 Regulatory agencies are increasingly proactive in seeking out potential safety issues with marketed drugs - you must be ready to respond quickly Political and social pressures have increased along with faster communication channels Failure to practice pharmacovigilance can lead to the suspension or withdrawal of license
  • Rationale for pharmacovigilance 30 Prevents Disasters Builds up customer confidence Ensures Compliance and retention Builds brand image
  • Rationale for pharmacovigilance 31 What to report? ADR associated vaccines, diagnostics, drugs used in traditional medicine, herbal remedies, cosmetics, medical devices and equipment lack of efficacy and suspected pharmaceutical defects overdose (because may cast doubt on safety of a drug)
  • Rationale for pharmacovigilance 32 What to report? Every single problem related to the use of a drug, because probably nobody else is collecting such information! NOTE: When in doubt- Always report!!
  • 33