The document summarizes the European Medicines Agency's recent experience approving two artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria. Two different regulatory pathways were used - Pyramax received approval under Article 58, while Eurartesim followed the orphan drug designation process. Both drugs demonstrated non-inferiority to comparator ACTs in clinical trials. Pyramax was also prequalified by the WHO, allowing procurement for resource-limited countries. The approval of these two ACTs provides additional treatment options that meet WHO recommendations and could help address antimalarial drug resistance issues in certain regions.
This document discusses pharmacovigilance, which refers to monitoring the safety of drugs. It provides definitions of key terms like adverse drug reaction. The aims of pharmacovigilance include improving patient safety, assessing drug risks/benefits, and informing regulators. Major events like the thalidomide disaster led to stricter drug regulations. India has a national pharmacovigilance program involving 150 centers. The document then describes establishing a pharmacovigilance program at JPNATC hospital to monitor adverse drug reactions, provide training to healthcare professionals, and support national drug safety efforts. An initial training session for nurses improved their knowledge and awareness of pharmacovigilance.
Enfermedad minoritaria, terapias nuevas. Una patología que afecta a menos de cinco personas por cada 10.000 habitantes es considerada una enfermedad rara o minoritaria. 35 millones de europeos se ven afectados por alguna de ellas. El 80% son de origen genético y conseguir un diagnóstico rápido es vital para asegurar la calidad de vida futura. La clave, una vez más, es apostar y potenciar la investigación biomédica. Se revisarán los resultados obtenidos los últimos 14 años, en el marco científico y regulador impulsado por la UE desde el año 2000. Sin embargo, se analizarán las dificultades y oportunidades para impulsar la investigación traslacional en estas enfermedades.
Sigue la presentación en Youtube: https://www.youtube.com/watch?v=d4U4a8xFCzA&
Regulatory terminologies used in PV (Pharmacovigilance)MubasheeraMg
This document defines various regulatory terminologies used in pharmacovigilance (PV). It defines key terms like pharmacovigilance, adverse drug reactions, clinical trials, causality assessment, and data mining. It also provides definitions for terms related to evaluating drug safety like absolute risk, incidence, benefits, harms, and effectiveness/risk analysis. Regulatory organizations involved in PV like CIOMS, ICH, and MedDRA are also defined.
A brief description about Pharmacovigilance, aims and scope, need of pharmacovigilance, programs by WHO for international drug safety monitoring, UMC, VIGIBASE, WHO causality assessment scale and specific regulatory bodies of various countries
- Zehra Ashraf presented on the topic of pharmacovigilance.
- Pharmacovigilance involves assessing, detecting, understanding, and preventing adverse drug reactions. It works through processes like adverse drug reaction reporting and analysis.
- The history of pharmacovigilance began in the early 1900s with laws being passed in response to drug safety issues. Global pharmacovigilance systems have developed and expanded since the mid-1900s.
- Methods of pharmacovigilance include spontaneous reporting of adverse reactions, cohort event monitoring, and periodic safety update reports. Pharmacovigilance is also important during clinical trials and after drug approval.
The WHO plays several key roles in pharmaceutical management:
1) It issues norms and standards through expert committees and supports regulatory capacity building for drug regulation.
2) It ensures quality of essential medicines through prequalification programs.
3) It facilitates information exchange between countries on drug safety and efficacy through tools like the International Conference of Drug Regulatory Authorities and a network of national drug information officers.
Pharmacovigilance a general overview most updatedpeter donik
The document provides an overview of the Pharmacovigilance Programme of India (PvPI) and adverse drug reaction (ADR) reporting. It defines key pharmacovigilance terminology and introduces PvPI, which aims to improve patient safety through ADR monitoring. PvPI has established 220 ADR Monitoring Centers to collect reports from healthcare professionals and consumers via forms or a mobile app. Reported ADRs are assessed for causality and signals to support regulatory decision making. The goal is rational medicine use and reducing health risks.
The Pharmacovigilance Program in India (PvPI) was initiated in July 2010 by the Central Drugs Standard Control Organization (CDSCO) in New Delhi to monitor adverse drug reactions. The program aims to ensure the benefits of medicine use outweigh the risks by monitoring adverse reactions. It operates through a network of ADR monitoring centers across India which report adverse reactions using the Vigiflow reporting system. The program is coordinated by the Indian Pharmacopoeia Commission and overseen by steering and advisory committees with technical support from review panels. The program has expanded over the years to include more monitoring centers and now also includes haemovigilance and biovigilance programs.
This document discusses pharmacovigilance, which refers to monitoring the safety of drugs. It provides definitions of key terms like adverse drug reaction. The aims of pharmacovigilance include improving patient safety, assessing drug risks/benefits, and informing regulators. Major events like the thalidomide disaster led to stricter drug regulations. India has a national pharmacovigilance program involving 150 centers. The document then describes establishing a pharmacovigilance program at JPNATC hospital to monitor adverse drug reactions, provide training to healthcare professionals, and support national drug safety efforts. An initial training session for nurses improved their knowledge and awareness of pharmacovigilance.
Enfermedad minoritaria, terapias nuevas. Una patología que afecta a menos de cinco personas por cada 10.000 habitantes es considerada una enfermedad rara o minoritaria. 35 millones de europeos se ven afectados por alguna de ellas. El 80% son de origen genético y conseguir un diagnóstico rápido es vital para asegurar la calidad de vida futura. La clave, una vez más, es apostar y potenciar la investigación biomédica. Se revisarán los resultados obtenidos los últimos 14 años, en el marco científico y regulador impulsado por la UE desde el año 2000. Sin embargo, se analizarán las dificultades y oportunidades para impulsar la investigación traslacional en estas enfermedades.
Sigue la presentación en Youtube: https://www.youtube.com/watch?v=d4U4a8xFCzA&
Regulatory terminologies used in PV (Pharmacovigilance)MubasheeraMg
This document defines various regulatory terminologies used in pharmacovigilance (PV). It defines key terms like pharmacovigilance, adverse drug reactions, clinical trials, causality assessment, and data mining. It also provides definitions for terms related to evaluating drug safety like absolute risk, incidence, benefits, harms, and effectiveness/risk analysis. Regulatory organizations involved in PV like CIOMS, ICH, and MedDRA are also defined.
A brief description about Pharmacovigilance, aims and scope, need of pharmacovigilance, programs by WHO for international drug safety monitoring, UMC, VIGIBASE, WHO causality assessment scale and specific regulatory bodies of various countries
- Zehra Ashraf presented on the topic of pharmacovigilance.
- Pharmacovigilance involves assessing, detecting, understanding, and preventing adverse drug reactions. It works through processes like adverse drug reaction reporting and analysis.
- The history of pharmacovigilance began in the early 1900s with laws being passed in response to drug safety issues. Global pharmacovigilance systems have developed and expanded since the mid-1900s.
- Methods of pharmacovigilance include spontaneous reporting of adverse reactions, cohort event monitoring, and periodic safety update reports. Pharmacovigilance is also important during clinical trials and after drug approval.
The WHO plays several key roles in pharmaceutical management:
1) It issues norms and standards through expert committees and supports regulatory capacity building for drug regulation.
2) It ensures quality of essential medicines through prequalification programs.
3) It facilitates information exchange between countries on drug safety and efficacy through tools like the International Conference of Drug Regulatory Authorities and a network of national drug information officers.
Pharmacovigilance a general overview most updatedpeter donik
The document provides an overview of the Pharmacovigilance Programme of India (PvPI) and adverse drug reaction (ADR) reporting. It defines key pharmacovigilance terminology and introduces PvPI, which aims to improve patient safety through ADR monitoring. PvPI has established 220 ADR Monitoring Centers to collect reports from healthcare professionals and consumers via forms or a mobile app. Reported ADRs are assessed for causality and signals to support regulatory decision making. The goal is rational medicine use and reducing health risks.
The Pharmacovigilance Program in India (PvPI) was initiated in July 2010 by the Central Drugs Standard Control Organization (CDSCO) in New Delhi to monitor adverse drug reactions. The program aims to ensure the benefits of medicine use outweigh the risks by monitoring adverse reactions. It operates through a network of ADR monitoring centers across India which report adverse reactions using the Vigiflow reporting system. The program is coordinated by the Indian Pharmacopoeia Commission and overseen by steering and advisory committees with technical support from review panels. The program has expanded over the years to include more monitoring centers and now also includes haemovigilance and biovigilance programs.
This gives you a basic role pharmacovigilance and how it works before and after drug approval .It totally work for human needs.And what are governing bodies for pharmacovigilance and how to write Adverse Drug Reaction (ADR) Reporting Procedure.
The WHO International Drug Monitoring Program was established in 1963 in response to the thalidomide disaster. It currently has 143 member countries that submit adverse drug reaction reports to the global pharmacovigilance database VigiBase managed by the Uppsala Monitoring Centre (UMC) as a WHO collaborating center. The UMC analyzes VigiBase data to identify new safety signals, conducts research, and provides tools and training to support member countries' pharmacovigilance activities. The overall goals are to identify unknown adverse drug reactions and ensure medicines are used safely worldwide.
Pharmacovigilance is the monitoring of medicines to detect adverse effects and improve patient safety. The document discusses the importance of pharmacovigilance in identifying unknown risks, encouraging safe drug use, and preventing withdrawal of medicines from the market. It outlines how pharmacovigilance involves spontaneous reporting from healthcare professionals, analysis of safety data, and information sharing to improve clinical practice and drug regulation. Students can contribute through reporting adverse drug reactions, creating drug alerts and bulletins, and presenting information on pharmacovigilance.
Pharmacovigilance involves monitoring the safety of drugs at all stages, from development through post-marketing. It aims to detect, understand, and prevent adverse drug reactions through activities like adverse event reporting, drug monitoring, and studying medication errors and drug-related deaths. Pharmacovigilance is important for protecting public health as patterns of drug use change over time with globalization and advances in technology and medicine.
HERE I INCLUDED HISTORY, RESPONSIBILITIES, TERMINOLOGY AND METHODS INVOLVED .
HOPE IT WILL BE USEFUL FOR YOU TO UNDERSTAND THE BASICS OF PHARMACOVIGILANCE.
The Committee for Advanced Therapies (CAT) is responsible for assessing advanced therapy medicinal products (ATMPs) at the European Medicines Agency. The CAT evaluates gene therapy, cell therapy, and tissue-engineered products. It provides scientific advice, classification, certification, and evaluation of marketing authorization applications for ATMPs. Patients' and healthcare professionals' organizations are represented within the CAT to provide perspectives on regulatory processes and product development for ATMPs.
Pharmacovigilance is the science of monitoring the effects of pharmaceutical products after they have been licensed for use, especially in order to identify and evaluate previously unreported adverse reactions. Herb-drug interactions can occur when herbs are taken concurrently with prescription or over-the-counter medications. Some common herb-drug interactions include garlic increasing the breakdown of antiviral drugs, green tea increasing the side effects of oral contraceptives, and liquorice decreasing the effectiveness of antihypertensives. It is important to report any suspected adverse reactions to medications to help ensure safe and effective use of drugs and herbs.
Pharmacovigilance is the science of monitoring the safety of medicines. It plays a key role in identifying adverse drug reactions and preventing harm to patients. The goal of pharmacovigilance is to monitor drug safety, identify health risks, and prevent harm through careful tracking of side effects from clinical trials through a drug's entire lifecycle on the market. Major organizations like the FDA, EMEA, and WHO work to coordinate pharmacovigilance efforts internationally and protect public health.
pharmacovigilance from pharmaceutical administration topic presented by konatham kumar reddy from chilkur balaaji college of pharmacy hyderabad telangana
Novartis is launching a new lung cancer drug, ASA404, in Austria. ASA404 has shown promising results in clinical trials, extending median survival time for lung cancer patients. Novartis must consider Austria's political, economic, cultural and competitive environment to successfully introduce ASA404. The report provides an analysis of these factors and recommends a marketing strategy including product positioning, pricing, promotion, and distribution tactics.
Pharmacovigilance is the science of detecting adverse effects of pharmaceutical drugs. It became important after the thalidomide incident in the 1960s which caused birth defects. The key goals of pharmacovigilance are to improve patient safety, assess benefits and risks of drugs, and promote their rational use. Individual case safety reports are a primary data source and are collected, processed, and shared using systems like VigiFlow and the global database VigiBase. India established the Pharmacovigilance Programme of India in 2010 to monitor drug safety at a national level through regional centers and collaborations with medical organizations.
Pharmacovigilance - Defination, Aim, Need ,Importance ,history, workflow, co...MADHAV JAJNURE
pharmacovigilance(PV)
Defination of pharmacovigilance
Aims of pharmacovigilance
Origin of pharmacovigilance
History of pharmacovigilance
Importance of pharmacovigilance
Work flow of Pharmacovigilance
Conclusion
Pharmacovigilance involves monitoring the safety of drugs on the market and preventing adverse drug reactions. It is important to assess risks and benefits of medicines to improve patient outcomes and public health. Pharmacovigilance activities include identifying, evaluating, and taking action on adverse drug events reported by healthcare professionals and the public to regulatory authorities. The goal is to communicate safety information to optimize safe use of medicines.
2019 10-14 2nd Int Congress on Precision Medicine, Munich, Alain van GoolAlain van Gool
Opening lecture at the 2nd International Congress on Precision Medicine in Munich, outlining progress in omics-based biomarkers for rare diseases, biomarker innovation gaps and multi-partner initiatives to bridge those gaps to applications. Also reviewed the highlights of our recently published Handbook of Biomarkers and Precision Medicine.
This document provides guidelines for reporting adverse drug reactions (ADRs). It outlines the essential information to include in an ADR report under five sections: (1) patient information including demographics, medical history, and test results; (2) suspected drugs and their details; (3) suspected ADR description, treatment, outcomes, and seriousness; (4) other medications; and (5) reporter information. For a valid report, the mandatory fields that must be included are patient initials, age, gender, reaction details, suspected drug name and dosage, seriousness, and outcomes as well as the reporter's name and date of reporting. Complete information is ideal but at minimum the mandatory fields should be reported.
Tennis is an Olympic sport played worldwide by people of all ages and abilities. It can be played individually or as a doubles team on a court with a net, where the objective is to earn points by hitting the ball over the net without error. While originally played by hand, tennis evolved into modern play with rackets and different court surfaces like grass, clay, and hard courts. It is now a popular professional sport with Grand Slam and other international tournaments.
O documento discute diferentes tipos de educação parental e suas consequências para o desenvolvimento das crianças. São descritos os tipos permissivo, negligente, autoritário e elucidativo, sendo este último associado a resultados mais positivos como maior autoestima e responsabilidade social. Também são apresentados dados de pesquisas que apontam riscos da superproteção e da punição física, defendendo-se uma educação baseada no diálogo e na explicação das normas.
Jazz originated in the early 20th century from African American communities in the southern United States. It has many subgenres including blues, swing, and Latin jazz. Blues jazz is based on blues notes and repetitive patterns that follow a 12 bar structure depicting sadness and depression. Swing jazz uses a strong rhythm section, medium to fast tempos, and a swinging rhythm for a more sophisticated yet exciting sound. Latin jazz rarely uses backbeats and employs clave rhythms, featuring percussion and soloists over a standard melody. Examples of different jazz styles are provided.
This gives you a basic role pharmacovigilance and how it works before and after drug approval .It totally work for human needs.And what are governing bodies for pharmacovigilance and how to write Adverse Drug Reaction (ADR) Reporting Procedure.
The WHO International Drug Monitoring Program was established in 1963 in response to the thalidomide disaster. It currently has 143 member countries that submit adverse drug reaction reports to the global pharmacovigilance database VigiBase managed by the Uppsala Monitoring Centre (UMC) as a WHO collaborating center. The UMC analyzes VigiBase data to identify new safety signals, conducts research, and provides tools and training to support member countries' pharmacovigilance activities. The overall goals are to identify unknown adverse drug reactions and ensure medicines are used safely worldwide.
Pharmacovigilance is the monitoring of medicines to detect adverse effects and improve patient safety. The document discusses the importance of pharmacovigilance in identifying unknown risks, encouraging safe drug use, and preventing withdrawal of medicines from the market. It outlines how pharmacovigilance involves spontaneous reporting from healthcare professionals, analysis of safety data, and information sharing to improve clinical practice and drug regulation. Students can contribute through reporting adverse drug reactions, creating drug alerts and bulletins, and presenting information on pharmacovigilance.
Pharmacovigilance involves monitoring the safety of drugs at all stages, from development through post-marketing. It aims to detect, understand, and prevent adverse drug reactions through activities like adverse event reporting, drug monitoring, and studying medication errors and drug-related deaths. Pharmacovigilance is important for protecting public health as patterns of drug use change over time with globalization and advances in technology and medicine.
HERE I INCLUDED HISTORY, RESPONSIBILITIES, TERMINOLOGY AND METHODS INVOLVED .
HOPE IT WILL BE USEFUL FOR YOU TO UNDERSTAND THE BASICS OF PHARMACOVIGILANCE.
The Committee for Advanced Therapies (CAT) is responsible for assessing advanced therapy medicinal products (ATMPs) at the European Medicines Agency. The CAT evaluates gene therapy, cell therapy, and tissue-engineered products. It provides scientific advice, classification, certification, and evaluation of marketing authorization applications for ATMPs. Patients' and healthcare professionals' organizations are represented within the CAT to provide perspectives on regulatory processes and product development for ATMPs.
Pharmacovigilance is the science of monitoring the effects of pharmaceutical products after they have been licensed for use, especially in order to identify and evaluate previously unreported adverse reactions. Herb-drug interactions can occur when herbs are taken concurrently with prescription or over-the-counter medications. Some common herb-drug interactions include garlic increasing the breakdown of antiviral drugs, green tea increasing the side effects of oral contraceptives, and liquorice decreasing the effectiveness of antihypertensives. It is important to report any suspected adverse reactions to medications to help ensure safe and effective use of drugs and herbs.
Pharmacovigilance is the science of monitoring the safety of medicines. It plays a key role in identifying adverse drug reactions and preventing harm to patients. The goal of pharmacovigilance is to monitor drug safety, identify health risks, and prevent harm through careful tracking of side effects from clinical trials through a drug's entire lifecycle on the market. Major organizations like the FDA, EMEA, and WHO work to coordinate pharmacovigilance efforts internationally and protect public health.
pharmacovigilance from pharmaceutical administration topic presented by konatham kumar reddy from chilkur balaaji college of pharmacy hyderabad telangana
Novartis is launching a new lung cancer drug, ASA404, in Austria. ASA404 has shown promising results in clinical trials, extending median survival time for lung cancer patients. Novartis must consider Austria's political, economic, cultural and competitive environment to successfully introduce ASA404. The report provides an analysis of these factors and recommends a marketing strategy including product positioning, pricing, promotion, and distribution tactics.
Pharmacovigilance is the science of detecting adverse effects of pharmaceutical drugs. It became important after the thalidomide incident in the 1960s which caused birth defects. The key goals of pharmacovigilance are to improve patient safety, assess benefits and risks of drugs, and promote their rational use. Individual case safety reports are a primary data source and are collected, processed, and shared using systems like VigiFlow and the global database VigiBase. India established the Pharmacovigilance Programme of India in 2010 to monitor drug safety at a national level through regional centers and collaborations with medical organizations.
Pharmacovigilance - Defination, Aim, Need ,Importance ,history, workflow, co...MADHAV JAJNURE
pharmacovigilance(PV)
Defination of pharmacovigilance
Aims of pharmacovigilance
Origin of pharmacovigilance
History of pharmacovigilance
Importance of pharmacovigilance
Work flow of Pharmacovigilance
Conclusion
Pharmacovigilance involves monitoring the safety of drugs on the market and preventing adverse drug reactions. It is important to assess risks and benefits of medicines to improve patient outcomes and public health. Pharmacovigilance activities include identifying, evaluating, and taking action on adverse drug events reported by healthcare professionals and the public to regulatory authorities. The goal is to communicate safety information to optimize safe use of medicines.
2019 10-14 2nd Int Congress on Precision Medicine, Munich, Alain van GoolAlain van Gool
Opening lecture at the 2nd International Congress on Precision Medicine in Munich, outlining progress in omics-based biomarkers for rare diseases, biomarker innovation gaps and multi-partner initiatives to bridge those gaps to applications. Also reviewed the highlights of our recently published Handbook of Biomarkers and Precision Medicine.
This document provides guidelines for reporting adverse drug reactions (ADRs). It outlines the essential information to include in an ADR report under five sections: (1) patient information including demographics, medical history, and test results; (2) suspected drugs and their details; (3) suspected ADR description, treatment, outcomes, and seriousness; (4) other medications; and (5) reporter information. For a valid report, the mandatory fields that must be included are patient initials, age, gender, reaction details, suspected drug name and dosage, seriousness, and outcomes as well as the reporter's name and date of reporting. Complete information is ideal but at minimum the mandatory fields should be reported.
Tennis is an Olympic sport played worldwide by people of all ages and abilities. It can be played individually or as a doubles team on a court with a net, where the objective is to earn points by hitting the ball over the net without error. While originally played by hand, tennis evolved into modern play with rackets and different court surfaces like grass, clay, and hard courts. It is now a popular professional sport with Grand Slam and other international tournaments.
O documento discute diferentes tipos de educação parental e suas consequências para o desenvolvimento das crianças. São descritos os tipos permissivo, negligente, autoritário e elucidativo, sendo este último associado a resultados mais positivos como maior autoestima e responsabilidade social. Também são apresentados dados de pesquisas que apontam riscos da superproteção e da punição física, defendendo-se uma educação baseada no diálogo e na explicação das normas.
Jazz originated in the early 20th century from African American communities in the southern United States. It has many subgenres including blues, swing, and Latin jazz. Blues jazz is based on blues notes and repetitive patterns that follow a 12 bar structure depicting sadness and depression. Swing jazz uses a strong rhythm section, medium to fast tempos, and a swinging rhythm for a more sophisticated yet exciting sound. Latin jazz rarely uses backbeats and employs clave rhythms, featuring percussion and soloists over a standard melody. Examples of different jazz styles are provided.
Este documento fornece orientações sobre como se preparar e se comportar em entrevistas de emprego. Ele aborda questões como como falar sobre si mesmo, a empresa pretendida, experiências e objetivos profissionais de forma a se adequar às expectativas e valores da empresa.
This document provides instructions for a lesson on using loops and angles to create basic shapes and patterns in a programming environment. The lesson objectives are to become familiar with translating algorithms into code, understanding nested loops, and using procedures. Students are tasked with using a repeat loop to create shapes like triangles, hexagons and stars based on the number of sides and degrees of rotation. They also create a circular pattern using a nested loop. Keywords covered include repeat, nested loops, angles, and the "rule of turn" to calculate rotation degrees.
This document discusses poker abilities and provides a link to a YouTube video about poker. It mentions definition, English deck, combinations and abilities in poker as topics without providing details on any of the points. The document gives an overview of poker concepts and strategies in a very brief manner.
This document introduces Scratch, a programming environment for creating computer programs and interactive stories. It outlines four lesson objectives: identifying the major parts of the Scratch environment; understanding how sprites and blocks work; understanding the concept of a computer program; and working with simple animation and sound. The document guides the reader through creating their first program involving a cat walking on a stage using sprites, costumes, scripts, and blocks. It also discusses parallel processing and tasks the reader with creating a dancing sprite program.
El documento describe diferentes tipos de plantas, incluyendo árboles y arbustos leñosos, herbáceas y palmeras. También discute las aplicaciones de los árboles en jardinería como árboles aislados, alineaciones y macizos. Explica las características ornamentales de los árboles como su forma, textura y color de la corteza y las hojas. Finalmente, cubre las características funcionales de los árboles para formar primeros términos, fondos, perímetros y enmarcar elementos
Potential advantages of steam ablation of varicose veinsMichał Molski
This document discusses endovenous steam ablation (SVS) of saphenous veins and tributaries. SVS allows for treatment of the great saphenous vein, small saphenous vein, tributaries, and perforating veins in a single procedure without additional techniques. The document presents two case studies and results from 730 patients treated with SVS showing high efficacy and low complication rates like skin pigmentation, minor burns, and paresthesia. It provides tips for catheter navigation and burn prevention. The conclusion is that SVS is an effective and safe ablation technique useful for large varicosities, saphenous trunks, recurrent varicosities, and incompetent perforators.
Como conquistar um homem recem separadopassguygjh145
O documento fornece dicas para mulheres sobre como conquistar e manter um homem feliz no relacionamento, listando 5 coisas que os homens necessitam: 1) Sentir desejo, 2) Saber que é respeitado, 3) Se sentir emocionalmente seguro, 4) Ser desafiado, 5) Se sentir admirado. Também discute a importância do respeito, confiança e vulnerabilidade na relação.
La publicidad y la promoción tienen como propósito identificar productos y tiendas, proveer información sobre productos, y persuadir a la gente a comprar cosas. La publicidad es una forma pagada de comunicación persuasiva que usa medios masivos e interactivos para llegar a grandes públicos con el fin de conectar un patrocinador identificado con compradores potenciales, proveer información sobre productos, e interpretar las características de los productos en términos de las necesidades y deseos de los consumidores.
Este documento es una oda a los zapatos escrita por una mujer llamada Candy. En él se describen diferentes tipos de zapatos y las experiencias asociadas a ellos, incluyendo zapatos de tacón, tenis, sandalias, botas y zapatos de baile. También se mencionan temas como la producción de zapatos, el significado que les dan a las personas y la importancia de los zapatos en la vida cotidiana y cultural.
Siglos enteros de civilización, guerras, hambrunas, epidemias, el nacimiento de las ciudades o la vida campesina bajo el feudalismo se han contado sin incluir a las mujeres: la historia de los varones era extensiva a la historia de la humanidad. Las mujeres podrían considerarse como las grandes olvidadas de la historia.
O documento discute o transtorno chamado mutismo seletivo, fornecendo informações sobre sua definição, causas, sintomas, diagnóstico e tratamento. O mutismo seletivo é caracterizado pela incapacidade de falar em certas situações sociais, apesar de a criança falar normalmente em casa. A causa mais comum é elevada ansiedade. O tratamento envolve terapia cognitivo-comportamental e exposição gradual a situações que provocam ansiedade.
O documento discute a teoria das necessidades humanas básicas de Abraham Maslow, que organiza as necessidades em uma pirâmide hierárquica com necessidades fisiológicas na base e necessidade de auto-realização no topo. Também discute os princípios da enfermagem de prestar cuidado holístico ao ser humano, considerando seus aspectos físicos, psicológicos, sociais e espirituais.
A Doença de Alzheimer (DA) é um transtorno neurodegenerativo progressivo e fatal do sistema nervoso central irreversível, incurável mas que possui tratamento. Caracterizada pelo comprometimento de duas ou mais funções cognitivas como: memória, atenção, orientação e linguagem. Os cientistas não sabem ao certo o que causa a morte de células e a perda de tecido em um cérebro com Alzheimer, mas as placas senil, emaranhados e são os principais suspeitos.
Michael Schumacher - The King of Formula 1peterwaters
Michael Schumacher is considered one of the greatest Formula 1 drivers of all time. He is a German racing driver who won seven World Drivers' Championships, more than any other driver, five of which were consecutive with Ferrari between 2000-2004. Some of his key achievements include being German and European Karting Champion in 1987, winning the Formula 1 World Championship in 1994 and 1995 with Benetton, and winning five consecutive titles between 2000-2004 during his time with Ferrari, also winning another title with them in 2003.
O documento discute o uso e abuso de drogas no contexto familiar. Apresenta como a família pode ser fator de proteção ou risco para o uso de drogas, dependendo de como lida com estressores, fornece informações e apoio. Também descreve razões comuns para o uso de drogas entre adolescentes, como curiosidade, busca de prazer ou alívio do sofrimento, e como a família pode ajudar na prevenção e tratamento.
This document discusses the costs associated with increasing access to artemisinin combination therapy (ACT) for malaria treatment in Cambodia. It finds that in addition to the costs of ACT drugs, substantial investments are needed for appropriate delivery systems, including:
- The cost of blister packaging ACT drugs locally, which was higher than estimated due to low production rates.
- The annual costs per capita of $0.44-0.69 for malaria outreach teams and village malaria workers who improved access to diagnosis and treatment in remote communities.
- The total annual costs of $19.31 and $11.28 per patient treated for the outreach teams and village workers respectively, which included costs of rapid diagnostic tests and drugs
This document outlines Ghana's national anti-malaria drug policy. It notes that malaria is a major public health problem in Ghana, especially among children and pregnant women. The policy aims to provide prompt, safe, and effective treatment for all cases of malaria. It endorses the "TEST, TREAT, AND TRACK" initiative to diagnose and treat malaria based on testing rather than presumptively. The policy recommends artemisinin-based combination therapies as first-line treatment and identifies appropriate medications for uncomplicated malaria, severe malaria, and malaria in pregnancy based on the latest evidence and WHO guidelines. It also provides guidance on intermittent preventive treatment in pregnancy.
The study aimed to compare the efficacy and safety of artesunate-mefloquine (AS+MEF) versus artemether-lumefantrine (AL) for treating uncomplicated Plasmodium falciparum malaria in Mali. Results showed that both treatments achieved high cure rates (>95%) at 14 and 28 days, with no early treatment failures. However, AS+MEF showed superior efficacy over AL in terms of lower reinfection rate at 28 days and higher fever clearance rate on day 1. Both treatments were well-tolerated overall, with similar safety profiles except for higher vomiting reports with AS+MEF. The study concluded that AS+MEF and AL are equally effective in treating
Comparative study of the effectiveness of combination therapies based on atem...Open Access Research Paper
The National Malaria Control Program recommended in 1993, the use of Chloroquina (CQ) as first line drug for malaria treatment, and sulfadoxin pyrimethamin as second drug. After years, Benin knows resistance about these antimalarials. Quinina was to treat gravities. In 2004, the strategy of treatment changed. Treatment of malaria cases is based on use of arteminisinia therapeutic combination. The goal of this study is to be sure that these drugs are efficace before general use in the country and in some regions as Dassa Zounmè where the resistance is up (61. 3% for Chloroquina CQ and 45.9% for SP in 2002).The study is based on: comparison of therapeutic efficacy of artemether Lumefantrine and Artesunate Amodiaquine. Results show that all of the tested drugs have good therapeutic efficacy. Most important rate failure is in Dassa Zounmè (33, 86%) than Parakou (23, 44%). They are parasitologic failure and are probably due to the reinfestation of children. Two drugs have a good parasitological clearance and eliminate fever after 2 days of treatment.
Quality of Antimalarials at the Epicenter of Antimalarial Drug Resistance- Re...Mikhael de Souza
This study analyzed the quality of artemisinin-containing antimalarials (ACAs) collected from drug outlets in Cambodia using two methods: open surveyors and mystery clients. A total of 291 ACA samples were collected and analyzed. The majority (69%) were found to contain the stated active pharmaceutical ingredient within the specified quality range. Few oral artemisinin monotherapies were found. No suspected falsified medicines were identified. While medicine quality did not differ significantly between the two collection methods, open surveyors were less likely than mystery clients to obtain oral artemisinin monotherapies. The results indicate that Cambodia's efforts to improve antimalarial drug quality have had a positive impact.
This document describes a "reverse pharmacology" approach used to develop an anti-malarial herbal medicine in Mali over six years. The key steps were:
1. A retrospective treatment outcome study identified Argemone mexicana as having the best statistical correlation with reported recovery from malaria.
2. In vitro and literature reviews supported Argemone mexicana's safety.
3. A dose-escalating clinical trial was conducted to determine the safest and most effective dose, showing a dose-response effect.
4. A randomized controlled trial then compared the herbal medicine to standard antimalarial treatment.
This process resulted in a new standardized herbal antimal
This document outlines Ghana's national anti-malaria drug policy. It notes that malaria is a major public health problem in Ghana, especially among children and pregnant women. The policy recommends artemisinin-based combination therapies (ACTs) as the first-line treatment for uncomplicated malaria, with alternatives including artemether-lumefantrine and dihydroartemisinin-piperaquine. For severe malaria, the policy recommends parenteral artesunate as the treatment of choice. It provides detailed guidance on drug regimens for different populations, including recommendations for intermittent preventive treatment in pregnant women. The objective of the policy is to provide prompt, safe, effective and appropriate anti-malarial
This document provides a summary of the fourth edition of the Malaysian Clinical Practice Guidelines for the Management of Tuberculosis. It includes information on the development process, key recommendations, levels of evidence, and the guideline contents. The guideline covers the diagnosis and treatment of both active tuberculosis and latent tuberculosis infection. It provides recommendations for treating various types of tuberculosis, as well as managing tuberculosis in special populations and drug interactions. Treatment regimens and durations are outlined for both pulmonary and extrapulmonary tuberculosis. The guideline also addresses latent tuberculosis testing and treatment options in both adults and children.
ADR MONITORING IN COMMUNITY PHARMACY.pdfAmeena Kadar
This document discusses the role of community pharmacists in adverse drug reaction (ADR) monitoring. It outlines how community pharmacists can identify ADRs, assess causality, document reactions, and report serious reactions. It also describes India's Pharmacovigilance Program of India and how it coordinates ADR monitoring and reporting nationally. The document advocates for continuous pharmacy education programs to train pharmacists in proper ADR monitoring and reporting.
Novartis is developing a new lung cancer drug called ASA404, which is currently in Phase III clinical trials. Previous trials showed increased median survival time and tumor response rates for patients receiving ASA404 in combination with chemotherapy compared to chemotherapy alone. Lung cancer is the leading cause of cancer death worldwide, with 85-90% being non-small cell lung cancer. This report provides an analysis of the Austrian market and recommendations for Novartis' marketing strategy to successfully launch ASA404, including consideration of political, economic, cultural and competitive factors.
This document summarizes a study assessing the therapeutic efficacy of chloroquine (CQ) for treating Plasmodium vivax malaria among outpatients in southern Ethiopia. Sixty-three patients with confirmed P. vivax infection were treated with CQ over 3 days and monitored for 28 days. Two patients experienced recurrent parasitemia within 28 days, indicating a 96.7% efficacy of CQ. While CQ showed high efficacy in this study, some previous studies in Ethiopia found increasing chloroquine resistance in P. vivax, highlighting the need for ongoing monitoring of resistance.
Pharmacoepidemiology is the study of the use and effects of drugs in large populations. The document discusses the definition, origins, need and applications of pharmacoepidemiology. Specifically, it notes that pharmacoepidemiology applies epidemiological techniques to study drug use and effects in populations. It also discusses limitations of pre-marketing drug trials that pharmacoepidemiology aims to address through post-marketing surveillance and other techniques.
1) Malaria remains a major global health problem, with an estimated 247 million cases and 619,000 deaths in 2021.
2) Diagnosis of malaria relies on microscopy or rapid diagnostic tests (RDTs) to confirm the presence of the parasite. Treatment of uncomplicated P. falciparum malaria involves artemisinin-based combination therapy (ACT).
3) Prevention efforts include intermittent preventive treatment for pregnant women and high-risk groups, seasonal malaria chemoprevention for children, and—for the first time—the RTS,S/AS01 malaria vaccine which has been recommended by WHO for use in children living in moderate to high transmission areas.
Malaria vaccines cum antimalaria drugs, by bdollarbernard bahaah
This presentation slides give an upto date information on antimalaria drugs and vaccines. It can be used for academic purpose or some other purpose. It highlights some of the successes and potentials of antimalaria drugs.
Population-based resistance of Mycobacterium tuberculosis
isolates to pyrazinamide and fl uoroquinolones: results from
a multicountry surveillance project
The document summarizes recent developments in vaccines:
1) The FDA approved Sanofi Pasteur's Quadracel vaccine for children aged 4-6, protecting against diphtheria, tetanus, pertussis and polio with fewer injections.
2) A Phase I trial found an Ebola vaccine based on the 2014 outbreak strain was safe and provoked an immune response in 95-100% of recipients.
3) An 80-patient Phase II trial launched to test a diabetes vaccine in children at high risk of Type 1 diabetes to see if it can prevent or delay onset.
This document presents the study protocol for a randomized clinical trial evaluating the efficacy and safety of adding metformin to standard antituberculosis treatment regimens. The trial aims to determine if metformin can help achieve sputum culture conversion faster when added to initial treatment for drug-sensitive pulmonary tuberculosis. Over 300 participants with newly diagnosed, smear-positive pulmonary TB will be randomized to receive either standard antituberculosis treatment or the same treatment plus metformin for the first two months. The primary outcome is time to sputum culture conversion, with secondary outcomes including time to detection of TB in culture, pharmacokinetic measures, safety, and immune responses. The results could provide evidence for a shorter, more effective TB treatment regimen.
Similar to Artemisinin-based combination therapy in the treatment of uncomplicated malaria - review 2015 (20)
2. the use of these registration routes for new pharmaceuticals
against tropical infections.
Regulatory evaluation of both ACTs
Pyramax film-coated tablets, fixed dose combination containing
pyronaridine tetraphosphate and artesunate (P/A) (Shin Poong
Pharmaceutical Co., Ltd, Korea), received a positive scientific
opinion from CHMP in February 2012, for treatment of acute,
uncomplicated malaria infections caused by P. falciparum or P.
vivax in adults and children weighing 20 kg and more.10
CHMP
recommended a positive benefit-risk for use only as a single treat-
ment course (once daily for three consecutive days) in any given
patient and is limited to delineated geographic areas of low trans-
mission with evidence of resistance to artemisinin containing
therapy in line with the ‘Global Plan for Artemisinin Resistance
Containment Project’ recently launched by WHO.11
Following confirmation of eligibility by WHO, the application
submitted in April 2010 in accordance with Article 58, had
similar structure and content as applications intended for Euro-
pean marketing authorisations, but with caveat of being
exempted from legally submitting any environmental risk assess-
ment report or paediatric investigation plan (PIP). Nevertheless,
paediatric subjects were adequately represented in the majority
of these trials. Furthermore, at scientific opinion stage, the
pharmaceutical sponsor committed to further develop an age ap-
propriate dose formulation, suitable to the youngest (infants and
children with a body weight ≥5 kg and <20 kg). Since then, an
application for supplemental approval of a fixed-dose granule
formulation has indeed been received.
At the time of initial evaluation, two pivotal multicentre non-
inferiority studies had been conducted in patients with uncompli-
cated P. falciparum malaria. These involved a total of 2543 adults
and children weighing 20 kg and over and compared P/A with
other artemisinin combinations (artesunate plus mefloquine [AS
+MQ] or artemether/lumefantrine [A/L]).12,13
The main efficacy
endpoint was PCR-corrected ‘adequate clinical and parasitological
response (ACPR) at day 42, defined as the absence of parasitaemia,
irrespective of body temperature, without the patient meeting any
of the criteria of early treatment failure, late clinical failure or late
parasitological failure according to WHO.14
As depicted in Table 1,
non-inferiority was shown between treatments.15
Another study involved a total of 456 adults and children
weighing 20 kg and over, suffering acute, uncomplicated P. vivax
malaria.16
This non-inferiority trial, conducted at five sites in
Asia, compared P/A with chloroquine standard treatment. In the
efficacy evaluable population, 97.1% (202/208) of patients
taking P/A were cleared of P. vivax parasites after 28 days com-
pared with 97.0% (192/198) of patients treated with chloroquine
(95% two sided CI for treatment difference=−3.5 to 3.9).15
Hepatotoxicity (increased liver transaminases) was the car-
dinal risk identified in these studies. Hence, the effect of repeat
treatment courses of P/A needed first to be studied before pos-
sible introduction of this new ACT in high transmission settings,
e.g., Equatorial Africa. An ad hoc expert group, which included in-
dependent advisors to WHO and an observer from an African
regulatory authority, concluded though that in the meantime
P/A could be an important gain to the therapeutic armamentar-
ium in geographic areas of low transmission with recognised/
rapidly emerging ACT resistance, involving resistance to the
partner component (e.g., amodiaquine, lumefantrine, mefloquine
and piperaquine). As such, its initial use has been restricted to a
few areas within the Asia Pacific region. Cohort Event Monitoring
for liver function is planned in the initial launch countries whilst
focus is also placed on enhanced post-marketing surveillance in
special populations (e.g., patients with HIV/AIDS, severely mal-
nourished patients and pregnant women). A pregnancy register
will be set up to monitor the outcomes of treated pregnant
women in Africa, once the terms of use have been broadened
Box 1. Regulatory framework
WHO prequalification7
Prequalification of new medicines is a WHO initiative, first
established in 2001, to facilitate access to medicines that meet
unified standards of quality, safety and efficacy and thus
addressing an unmet need in countries with limited access to
quality medicines. Although initially focused on HIV drugs, it has
since expanded to encompass medicines for priority disease
programmes.
Assessment of product data, by WHO staff and national
regulatory authorities, is undertaken following voluntary
submission of data by applicants, provided the medicines are on
the WHO invitation list for ‘Expression of Interest’.
Article 588
Article 58 of Regulation (EC) No 726/2004 of the European
Parliament and of the Council was established for the purpose of
scientific opinion by CHMP in the context of cooperation with the
WHO. The applicability is limited to prevent or treat diseases of
major public interest, notably medicinal products for WHO target
diseases (e.g., malaria, tuberculosis, HIV/AIDS, lymphatic filariasis,
trachoma, leishmaniasis, schistosomiasis, African
trypanosomiasis, onchocerciasis, dengue fever, Chagas disease,
leprosy and intestinal helminths), vaccines used or of possible use
in the WHO Expanded Programme on Immunization (EPI),
vaccines for protection against a WHO public health priority
disease and vaccines that are part of a WHO managed stockpile
for emergency response. It is meant exclusively for markets
outside the EEA, but does not preclude a subsequent application
for European Marketing Authorisation.
Orphan drug designation9
EU Centralised Marketing Application route forms the obligatory
licensing pathway for a Community recognised Orphan Drug. The
criteria of such designation as set out in Regulation (EC) No 141/
2000, require that the proposed medicinal product is intended for
the treatment, prevention or diagnosis of a disease that is
life-threatening or chronically debilitating; the prevalence of the
condition in the EU must not be more than five in ten thousand
or it must be unlikely that marketing of the medicine would
generate sufficient returns to justify the investment needed for its
development; and no satisfactory method of diagnosis,
prevention or treatment of the condition concerned is already
authorised, or, if such a method exists, the medicinal product
must be of significant benefit to those affected by the condition.
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3. (based on further, recently submitted data) to make that region
eligible for treatment.
In May 2012, three months following CHMP opinion, the WHO
prequalification programme added Pyramax to its list of recom-
mended medicines. Since then, based on WHO prequalification,
National Regulatory Authorisations for Pyramax have been sub-
mitted in countries of the Greater Mekong subregion.
Eurartesim (piperaquine tetraphosphate/dihydroartemisinin;
PQ/DHA) film-coated tablets (Sigma-Tau Industrie Farmaceutiche
Riunite s.p.a., Italy) received an EU Commission Decision in
October 2011 (approving its use in the European Economic Area
[EEA]), indicated for the treatment of uncomplicated P. falciparum
malaria in adults, children and infants 6 months and over and
weighing 5 kg or more. This followed a positive scientific opinion
issued by CHMP in June 2011.17
PQ/DHA was designated as an orphan medicinal product during
August 2007 for the indication ‘treatment of malaria’, based on as-
sessment that the condition is rare (mainly to be viewed as ‘import
pathology’ in returning travellers from endemic areas and migrants
returning from visiting friends and relatives) though potentially life
threatening to those affected and although other satisfactory
treatment has been authorised in the EU Community, presumptive
justifications were that the product may be of significant benefit to
those affected by the condition.
The marketing application dossier contained an EMA Decision
on the agreement of a PIP, with some measures deferred at
time of submission of the marketing application (July 2009). As
per agreed PIP, a separate paediatric formulation will be submit-
ted in future covering the vulnerable group of children, aged six
months to five years.
The effects of PQ/DHA were first tested in experimental models
before being studied in humans.18
Also, as part of the require-
ments, the applicant conducted an environmental risk assess-
ment for both active substances.
This fixed dose ACT was further investigated in two main studies
in patients with uncomplicated P. falciparum malaria.19,20
In the
first trial, conducted in 1150 predominantly adult Asian patients,
the aim was to demonstrate that the PCR-corrected cure rate of
PQ/DHA was non-inferior to that of the comparator (AS+MQ).
This cure rate was defined as the proportion of patients with
ACPR at Day 63 plus those treatment failures identified as new
P. falciparum (by PCR) and non-falciparum infections. Those
patients lost-to-follow up for unknown reasons before Day 63,
were excluded from intent-to-treat (ITT) population (m-ITT ana-
lysis). Non-inferiority was shown if the lower limit of the one-sided
97.5% CI for the difference between groups was greater than −5%.
In the second trial, PQ/DHA was compared with another anti-
malarial ACT, containing A/L (tablets 20 mg/120 mg) in 1553
African children (minimum age of 6 months; mean age 2.4
years). The main measure of efficacy was the proportion of patients
who were cured at day 28 of follow-up (PCR corrected results).
Those patients lost-to-follow up for unknown reasons before day
28, were excluded from ITT population (m-ITT analysis). For both
trials, non-inferiority outcome was derived (Table 2).
Table 1. PCR-corrected ACPR in EE population (Pyramax pivotal trials - Plasmodium falciparum)15
Study SP-C-004–06 Study SP-C-005–06
Pyramax AS+MQ Pyramax A/L
n=698 n=339 n=746 n=342
Patients excluded from the EE population 150 (17.9%) 84 (19.8%) 103 (12.1%) 81 (19.1%)
PCR-corrected ACPR on Day 42
Available observations 698 339 746 342
Number of patients cured (cure rate) 661 (94.7%) 329 (97.1%) 729 (97.7%) 337 (98.5%)
Between group comparison
Difference −2.4 −0.8
95% CIa
−4.7 to 0.4 −2.4 to 1.3
Conclusionb
Non-inferiority Non-inferiority
p-valuec
0.088 0.374
ACPR: adequate clinical and parasitological response; AS+MQ: artesunate + mefloquine; A/L: artemether–lumefantrine; EE: efficacy evaluable
(all randomized patients who received any amount of study treatment, excluding those with new infections and those lost to follow-up prior
to analysis time point).
Study SP-C-004–06: A Phase III Comparative, Open-Label, Randomised, Multi-Centre, Clinical Study to Assess the Safety and Efficacy of Fixed
Dose Formulation Oral Pyronaridine/Artesunate (180:60 mg Tablet) Versus Mefloquine (250 mg Tablet) Plus Artesunate (100 mg Tablet) in
Children and Adult Patients With Acute Uncomplicated Plasmodium falciparum Malaria.
Study SP-C-005–06: A Phase III Comparative, Double-Blind, Double-Dummy, Randomised, Multi-Centre, Clinical Study to Assess the Safety and
Efficacy of Fixed Dose Formulation of Oral Pyronaridine/Artesunate Tablet (180:60 mg) Versus Coartem (artemether/lumefantrine) in Children
and Adult Patients With Acute Uncomplicated Plasmodium falciparum Malaria.
a
The two-sided CI for between group comparison was calculated using Newcombe-Wilson method.
b
Non-inferiority was concluded if the lower limit of the two-sided 95% CI for the difference was above -5%.
c
χ2
test for superiority (performed only when non-inferiority had been demonstrated).
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4. Electrocardiographic QT interval prolongation (corrected for in-
fluence of heart rate; prolongation defined as QTcB or QTcF >450
msec in adult males and children up to 12 years of age or >470
msec in adult females), albeit asymptomatic in all cases observed
during clinical trials, has been identified as principal safety concern.
The QTc effect and associated clinical outcomes (torsade de
pointes, sustained arrhythmias, sudden death) are flagged as im-
portant identified concerns in the risk management plan. During
the marketing application process, an ad hoc expert committee
gathered to discuss the cardiac safety aspects of PQ/DHA and con-
cluded that the fixed dose ACT poses an unpredictable risk for a
small proportion of people, but that based on pharmacokinetic
considerations, cardiac risk could be further contained by adminis-
tering PQ/DHA in fasting state.
Clinical data were missing from some patient populations, such
as pregnant and lactating women, children younger than 6 months
of age or below 5 kg body weight, elderly, HIV infected and malaria
patients with Caucasian ethnicity. Regarding the latter, results from
a pharmacokinetic study revealed there were no significant differ-
ences in exposure between healthy Caucasian and healthy Asian
volunteers. Also, the effects in pregnant women exposed to PQ/
DHA are to be monitored in a European multi-centre pregnancy
registry, whilst PQ/DHA has also been included in the PREGACT
project, which studies safety and effectiveness of various ACTs for
African pregnant women with malaria.21
On obtaining the marketing authorisation, the orphan drug cri-
teria were re-assessed, mainly to confirm the significant benefit
over existing therapy. At that time, first line treatment for the con-
dition in the EEA mainly offered choice between fixed combinations
atovaquone/proguanil and artemether/lumefantrine oral treat-
ment, with the latter being the only previously approved ACT for
use in the European market.22
It was argued that PQ/DHA fasting
dosing regimen may offer an advantage in clinical practice, since
malaria patients are frequently nauseated. Further on, the
sponsor considered that PQ/DHA could provide a valuable alterna-
tive treatment option for the returning traveller, even from regions
with recognised artemisinin resistance (Cambodia and border
regions of Thailand with Myanmar),22
since such resistance is con-
sidered fluid, largely influenced by the partner drug used in the ACT
and thus patients will still recover, provided that they are treated
with an ACT containing an effective partner drug.23
However,
prior to completion of this evaluation, the applicant requested to re-
linquish the orphan designation status for this new ACT.
By the end of October 2012, Eurartesim was marketed in eight
EU countries. Outside the EU, it was first launched in Cambodia in
September 2012, whilst Ghana became the first African country to
approve Eurartesim during early 2013. Since then it has become
available in other key African states taking part in the African re-
search phase IV INESS programme, gathering data on safety
and effectiveness of new ACTs.24
Table 2. PCR-corrected ACPR in m-ITT population (Eurartesim pivotal trials - Plasmodium falciparum)18
Study DM040010 Study DM040011
Eurartesim AS+MQ Eurartesim A/L
n=726 n=361 n=1027 n=497
Patients excluded from the m-ITT population 43 (5.6%) 20 (5.3%) 12 (1.2%) 17 (3.3%)
PCR-corrected ACPR
Available observations 726a
361a
1027b
497b
Number of patients cured (cure rate) 704 (97.0%)a
344 (95.3%)a
952 (92.7%)b
471 (94.8%)b
Between group comparison
Difference 1.7 −2.1
LL 97.5% CIc
−0.8 −4.6
Conclusiond
Non-inferiority Non-inferiority
p-valuee
0.161 0.128
ACPR: adequate clinical and parasitological response; AS+MQ: artesunate + mefloquine; A/L: artemether–lumefantrine; LL: lower limit; m-ITT:
modified intent-to-treat (all randomized patients who received at least one dose of study treatment, excluding those lost to follow-up for
unknown reasons).
Study DM040010: A Phase III, Randomised, Non-Inferiority Trial, to Assess the Efficacy and Safety of Dihydroartemisinin + Piperaquine
Phosphate (DHA/PQP, Artekin) in Comparison with Artesunate + Mefloquine (AS+MQ) in Patients Affected by Acute, Uncomplicated
Plasmodium falciparum Malaria.
Study DM040011: A Phase III, Randomised, Non-Inferiority Trial, to Assess the Efficacy and Safety of Dihydroartemisinin + Piperaquine
Phosphate (DHA/PQP, Artekin) in Comparison with Artemether + Lumefantrine (A/L, Coartem) in Children with Uncomplicated Plasmodium
falciparum Malaria.
a
PCR-corrected ACPR on day 63.
b
PCR-corrected ACPR on day 28.
c
The one-sided CI for between group comparison was calculated using the normal approximation (Wald method).
d
Non-inferiority was concluded if the lower limit of the one-sided 97.5% CI for the difference was above -5%.
e
χ2
test for superiority (performed only when non-inferiority had been demonstrated).
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5. A dossier was submitted to WHO in June 2012 to add Eurarte-
sim to its list of recommended medicines in the WHO prequalifica-
tion programme.
Discussion
Article 58
WHO prequalification guides procurement decisions of United
Nations agencies and otherauthorities (e.g., allowing disbursement
by the Global Fund to Fight AIDS, Tuberculosis and Malaria) primar-
ily for medicines used in treating HIV/AIDS, malaria, tuberculosis
and for reproductive health.7
As a general principle, the approval
requirements for prequalification are aligned to those set by strin-
gent medicines regulatory agencies. Indeed, if a product has
been previously assessed and approved by such a regulatory au-
thority, an abbreviated evaluation procedure helps speed medi-
cines through the prequalification process. Moreover, it is noted
that no further assessment is required if scientific opinion was
obtained under Article 58 of EU Pharmaceutical Regulation (No
726/2004), as demonstrated by the experience with Pyramax,
which received quasi instant prequalification approval following
its assessment by CHMP. This is in line with agreed EMA and WHO
alignment evaluation procedures facilitating early access of such
medicines of high public health need and underscores the aim of
the Article 58 process. So far however, the Agency’s experience
with Article 58 has received a mixed reception. Earlier approvals
were mainly intended to prevent re-importation into Europe of
already available products (e.g., antiretroviral lopinavir/ritonavir
fixed combination). Recently though, more substantial regulatory
experience was gained, in relation to a hexavalent childhood im-
munisation vaccine (Hexaxim, Sanofi Pasteur, Lyon, France), miso-
prostol indicated to reduce post-partum bleeding due to uterine
atony, in situations where intravenous oxytocin is not available
(Hemoprostol, Linepharma, Paris, France) and also for Pyramax.
The Article 58 process encourages early regulatory interaction
with WHO experts in order to fully elucidate the benefit-risk
within the applicable epidemiological context. Feedback obtained
to date, also identified a further need to engage representatives
of national regulatory agencies drawn from countries of intended
use, to build understanding and trust in the purpose of the Article
58 procedure. This also chimes with the recent review by Doua
and Van Geertruyden25
covering registration of medicines for low-
income countries, stressing the need for participation of such local
expertise.
Of note, during the Article 58 evaluation of Pyramax, close col-
laboration took place with independent experts advising WHO on
malaria. This guided the CHMP to reach a fully informed opinion on
the benefit-risk balance of the product, specifically to its intended
use in populations residing in endemic areas. Mainly guided by the
uncertainties in the safety profile, carefully weighed against the
obtained clinical trial efficacy data and the need of further ACTs,
the experts recommended its initial use to be limited to areas
with low malaria transmission and with evidence of resistance
to ACTs, and this in conjunction to the adherence of stringent
risk minimisation measures.
In parallel to authorised products for EU Community use,
Article 58 products are indeed subject to ongoing obligations,
e.g., regular periodic safety update reports and risk management
plan updates.26
The feasibility in collecting reliable data might be
challenging though in some target endemic countries. Therefore,
the effectiveness of routine pharmacovigilance (expedited report-
ing) and of enhanced pharmacovigilance activities (registry and
close monitoring) in the recipient countries need to be sufficiently
reassuring prior to receiving a scientific opinion from CHMP. Once
available in endemic areas, and in light of possible emerging
safety signals, CHMP also retains the option to amend the initial
scientific opinion provided to WHO.
A drawback though concerning the Article 58 scheme is the
lack of incentives offered to the pharmaceutical industry.
Indeed, no automatic fee reductions or exemptions are in place
although these can be granted on a discretional basis, by Execu-
tive Decision.26
At least this is perceived as cumbersome, since in-
dependent requests for such fee reduction have to be made at
various stages of the product’s life cycle, e.g., in relation to scien-
tific advice, main application fee, different inspection fees and
annual retention dues. Motivated reasons have to be provided in
terms of public health need and minimal financial returns poten-
tial for the commercial sponsor relative to the substantial devel-
opment costs.
Orphan drugs
In contrast to the above, the European pharmaceutical legislation
offers multiple incentives within the framework of the orphan
drug designation,9
as illustrated in Table 3. If granted orphan
drug designation by the European Commission, regulatory scien-
tific assistance (protocol assistance) may be offered partially or
totally free of charge and various regulatory fees be waived in
part or in total. In addition, on re-examining and reconfirming
the orphan status at time of licensing, the product obtains mar-
keting exclusivity in the EU for 10 years duration; i.e., ‘the Commu-
nity and the Member States shall not, for a period of 10 years,
accept another application for a marketing authorisation, or
grant a marketing authorisation or accept an application to
extend an existing marketing authorisation, for the same thera-
peutic indication, in respect of a “similar” medicinal product’.9
Regarding Eurartesim, this new ACT easily fulfilled the first two
criteria of the orphan drug designation by the fact that acute
malaria has an annual disease incidence rate of around three
new cases per hundred thousand population in the EEA27
and
that the condition can rapidly progress to a complicated course
and be fatal, especially if left untreated in non-immune European
patients.28–30
The innovator also argued significant benefit over
existing therapy already authorised in the EU, based on adminis-
tration advantage (fasting) and by offering an alternative treat-
ment option to the returning traveller, even if returning from
areas with recognised artemisinin resistance. Prior to completion
of the re-assessment of the orphan drug criteria by the Agency’s
Orphan Committee though, the commercial sponsor of Eurarte-
sim voluntary chose to withdraw the orphan drug status, fore-
going subsequent market exclusivity. In this context, it has
previously been questioned if market exclusivity afforded to
orphan medicinal products indicated for tropical infectious dis-
eases indeed serves the best interest of the wider community,
since arguably it may rather hinder the development of new
medicines in the same therapeutic area.31
So far, this concern
seems not yet borne out in practice. Conversely, experience shows
that the orphan drug legislation had some catalysing effect, espe-
cially on smaller sized companies with new business models
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6. (partnerships with non-profit organisations) and academic insti-
tutions in their quest to develop new medicines combatting
tropical infectious diseases.32
It is also stressed that market au-
thorisation would only be denied if there would be similarity in
structure and mechanism of action to a previously licensed
orphan medicine with the same therapeutic indication. In case
of confirmed similarity, derogation rules exist based on obtained
consent from the marketing authorisation holder of the earlier
approved orphan product, supply shortages for that product
already on the market or if the newer product is safer, more effect-
ive or otherwise proves to be clinically superior over the previously
authorised orphan medicinal product.33
With regards to EU licensing (either as orphan or non-orphan
drug), it is however remarked that the benefit-risk balance
derived on the use of a product directed against a tropical infec-
tious pathology shows inherent relevance to the European popu-
lation. Hence, it does not necessarily account for the local context
encountered in low/middle-income countries (e.g., in relation to
implementation of the safety specificities), although large study
data gathering would normally only be feasible outside the EU
Community, i.e., within endemic areas.
Specifically, in relation to studies on malaria treatment, adult
and paediatric patients enrolled in regions, characterised by low,
seasonal transmission (Australasia, Central and South America),
can act as a valuable proxy and thus be predictive for outcome
in non-immune European travellers. This is though in contrast to
the situation in sub-Saharan Africa, with its perennial and intense
transmission dynamics, rendering most adults and older children
(semi)-immune to clinical attacks. Therefore, non-immune chil-
dren under five years of age are usually the segment of the
African population most susceptible to symptomatic malaria.34
They act as further proxy for EU patients with malaria and lend
additional support to the paediatric extension of the therapeutic
indication. Nevertheless, the pharmacokinetic profile may differ
substantially between ethnic populations, largely due to genetic
polymorphism.35
Differences can either result in poor treatment
outcome associated with sub-optimal drug exposure or observed
increased toxicity based on overexposure.36
Hence, bridging
pharmacological data form a standard requirement in support
of a European authorisation.37
Such supplementary data were
obtained for Eurartesim, comparing the pharmacokinetics of
piperaquine tetraphosphate and dihydroartemisinin between
subjects grouped by ethnic origin (Caucasian versus Asian).
Also, the European marketing authorisation requires a paediat-
ric plan to be submitted for assessment and opinion by the
Agency’s paediatric scientific committee, prior to submission of
the main marketing application. The agreed PIP will set out the
conditions and further tests to be undertaken in the paediatric
Table 3. Article 58 versus Orphan Designation: comparison of requirements and incentives
Regulatory aspects Article 58 Orphan Medicinal Product
Medicinal Product
Pre-submission phase
Eligibility Needed (in collaboration with WHO) Needed (assessed by COMP)
SME status Can be granted Can be granted
Scientific advice Possible Possible
PIP Not legally required Legally required (compliance check prior
to MAA submission)
Accelerated review request Possible Possible
Evaluation phase
Environmental risk assessment Not legally required Legally required
Data applicable to EU population Not required Required
Application fee reduction Eligible (case-by-case) Yesa
Inspections fee reduction Eligible (case-by-case) Full fee reduction
CHMP opinion
Conditional or exceptional circumstances Possible Possible
Post-opinion phase
Marketing authorisation (EEA) No (allows future MAA submission in the EU) Yes
Market exclusivity No (since no EU MAA) Yes
PhV system / RMP Needed (adapted to local use) Needed
PSUR Submission mandatory Submission mandatory
Fee reductions Eligible (case-by-case) Yesa
COMP: Committee for Orphan Medicinal Products; EEA: European Economic Area; EMA: European Medicines Agency; MAA: marketing
authorisation application; PhV: pharmacovigilance; PIP: paediatric investigation plan; PSUR: periodic safety update report; RMP: risk
management plan; SME: micro, small and medium-sized enterprises.
a
See details in the explanatory fee note: http://www.ema.europa.eu/docs/en_GB/document_library/Other/2014/04/WC500164415.pdf
E. Pelfrene et al.
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7. subpopulations, with often these measures initially deferred. Spe-
cifically, in aid of the youngest, a separate paediatric formulation
might need to be developed.
Finally, notwithstanding the consideration by a given pharma-
ceutical innovator to bring the newly approved anti-infective
agent to the market in a non-EU endemic area, using the EU au-
thorisation as a valid basis (e.g. for subsequent prequalification
process), the European licensing route puts the obligation to actu-
ally place the medicinal product on the EU Community market,
within 3 years following its authorisation. Failure to do so, would
lead for the marketing authorisation to be ceased within the EU.
Conclusions
Article 58 scientific opinion and orphan drug marketing applica-
tion are two valuable tools facilitating authorisation of medicinal
products indicated for treatment or prevention of infectious dis-
eases, burdensome to endemic areas outside Europe. As such,
they form basis for WHO prequalification, allowing subsequent
purchase agreements for use in resource limited countries.
Both regulatory options provide their own set of real and per-
ceived regulatory advantages and drawbacks. Hence, the ultim-
ate choice of regulatory route taken by the innovator will need
to be aligned with their overall strategic objectives.
So far, in reference to tropical infectious diseases, both proce-
dures remain largely untested. As such, the present contribution
aims to disseminate our experience to date and to invite further
interest in these regulatory pathways.
Authors’ disclaimers: The views expressed in this article are the personal
views of the authors and may not be understood or quoted as being made
on behalf of or reflecting the position of the European Medicines Agency or
one of its committees or working parties.
Authors’ contributions: EP wrote the first draft. All authors have
contributed to the subsequent drafts of the manuscript and have read
and approved the final version. EP is the guarantor of the paper.
Funding: None
Competing interests: None declared.
Ethical approval: Not required
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