上市后临床研究，事半功倍的学术推广

随着中国医药市场在全球发挥出更大的影响，由医生参与主导的上市后临床研究将为制药企业找到更多的产品推广点，同时也加强医生对中国裔病人治疗手段的认知。     

关于医药企业学术推广实施的思考

目的:为国内医药企业建立学术推广模式提供参考。方法:分析目前2种主要的学术推广队伍建立方式的利弊,并对学术推广方案策划的要点进行阐述。结果与结论:企业自建和学术推广外包各有利弊。学术推广方案策划的要点有正确的产品定位与明确的产品推广信息、推广受众的界定、推广活动与市场地位相匹配、推广活动与产品周期相适应等。新形势下,医药企业处方药的销售必将通过建立适合企业发展的学术推广模式来推动。     

我国儿童药物临床试验的困境与对策

儿童药物开发滞后的一个重要原因是儿童药物临床试验开展困难。本文从知情同意和操作实施两个方面对儿童药物临床试验的困境做系统分析,并跳出儿童药物临床试验本身,从研究数据外推和上市后综合评价两个方面来探讨对策。     

美国药品上市后研究的监管制度及其对我国的启示

目的:为完善我国Ⅳ期临床试验的监管提出建议。方法:通过概述美国药品上市后研究制度,分析美国FDA对药品上市后研究的监管(包括关键要素、监管流程、配套监管系统和强制措施),提出完善我国Ⅳ期临床试验监管的建议。结果与结论:美国药品上市后研究包括上市后承诺研究(PMR)和上市后要求研究(PMC)。监管过程中的关键要素包括监管主体(由药品评价和研究中心下属的新药办公室负责)、关键文件(包括帮助FDA和申请人达成研究协议的文件和用于对已确定的研究进行过程跟踪和监督的文件)、重要时间节点(明确提交相关材料的特定节点日期);监管流程包括制订研究草案、审核研究报告;美国FDA建立了PMC/PMR数据库作为配套监管系统,并分别针对PMC和PMR制定了相应的强制措施。我国相关监管部门应转换监管思路、充分发挥政府的引导和监督作用,加强药品上市前、后监管的衔接,制订特色化Ⅳ期临床方案,建立Ⅳ期临床试验数据管理系统,加强全过程监管,借鉴FDA"事前制定计划,事中动态追踪,事后依法处理"的监管方式来完善对我国Ⅳ期临床试验的监管。     

随机对照临床试验设计要点和规范

随机对照临床试验(randomized controlled clinical trial,RCT)是获取高级别循证医学证据的重要研究类别.为提高RCT研究的质量,研究者应在前期根据研究目的规范开展RCT研究设计,并从患者招募、样本量、随机化分组、盲法设置、干预措施实施、疗效评估、质量控制和统计学分析等方面进行综合考量...     

药物研究开发、生产及销售：01089 正在进行Ⅲ期临床试验的药物

近几个月来，有超过30个新药在临床开发阶段。其中有7个已提出上市申请批准、8个进入Ⅲ期临床试验、5个在Ⅱ期临床试验阶段，余下的10个开始了Ⅰ期临床试验。     

学术推广是处方药销售模式更新的重要选择

论述学术推广是新形势下处方药销售的重要模式，学术推广外包则是医药企业的可行选择．指出学术推广外包对医药企业是风险与机遇并存，并提出规避风险的建议。     

基于4R理论的药品学术推广策略

该文通过分析国内医药环境和传统医药销售模式的弊端，阐明学术推广的必要性，并运用4R理论分析学术推广的策略。     

新药的临床安全性评价

新药的临床安全性评价是新药上市前临床研究的核心问题之一；也是药品上市后安全广泛应用最重要的保障。进行新药安全性评价的目的是为了指导临床医师合理、规范用药，治疗疾病，保证患者最大程度获益于新药。     

新药期临床试验方案的拟定

临床试验研究方案是新药临床研究的重要文件之一,科学、周密的研究方案是临床研究取得成功的关键.欧、美国家进行新药临床研究时,研究方案常常是由研制单位(申办者)提供,我国目前暂时仍由临床研究单位制定,研究者应利用新药申办者所提供的"供临床医师参阅的药理、毒理研究结论及有关文献的综述"和国内外有关该药临床研究现状的参考文献,在遵循GCP原则的基础上科学、周密地制定本项临床试验方案.本文根据ICH-E6文件和我国的GCP要求,对新药II期临床试验方案的拟定提出了一些建议,有关III期、IV期临床试验方案可参照执行.     

Comparison of academic and nonacademic sites in multi-center clinical trials

The selection of appropriate subjects is a critical element of successful clinical trials. Failure to properly identify, select, and retain subjects in clinical trials of antidepressant medications may affect the ability to show separation from placebo. Little is known about which type of site, academic or nonacademic, is superior in selecting and retaining appropriate subjects. In the present investigation, the authors conducted a retrospective analysis comparing the performance of academic and nonacademic sites in selecting and retaining appropriate subjects in a recently completed multi-site clinical study of aripiprazole augmentation. The authors used a set of operationalized criteria called the SAFER to identify appropriate study subjects. No significant differences were found in rates of SAFER interview passing, study completion, and clinical outcomes between academic and nonacademic sites. Our findings suggest that academic and nonacademic sites are equally effective in their ability to identify and retain appropriate study participants.     

Bayesian clinical trials

Bayesian statistical methods are being used increasingly in clinical research because the Bayesian approach is ideally suited to adapting to information that accrues during a trial, potentially allowing for smaller more informative trials and for patients to receive better treatment. Accumulating results can be assessed at any time, including continually, with the possibility of modifying the design of the trial, for example, by slowing (or stopping) or expanding accrual, imbalancing randomization to favour better-performing therapies, dropping or adding treatment arms, and changing the trial population to focus on patient subsets that are responding better to the experimental therapies. Bayesian analyses use available patient-outcome information, including biomarkers that accumulating data indicate might be related to clinical outcome. They also allow for the use of historical information and for synthesizing results of relevant trials. Here, I explain the rationale underlying Bayesian clinical trials, and discuss the potential of such trials to improve the effectiveness of drug development.     

Satistical estimates and clinical trials

Crossover designs are widely used in different medical investigations where a number of treatments have to be compared. Sequences of treatments are given to subjects, and in practice the observations within each subject are likely to be correlated. This paper is concerned with the construction of crossover designs for such cases. The design problem is nonlinear in the parameters, and design optimality depends on the parameters defining the correlation structure. When the correlation structure is known, local optimum designs are obtained. When the distribution of its parameters is known, optimum Bayesian crossover designs are constructed. The optimum sizes of the groups of subjects receiving the same sequence of treatments are also determined.     

Gateways to clinical trials

12B75, 274150; Abacavir sulfate/lamivudine, Abatacept, Ad2/HIF-1alpha, Adalimumab, Adefovir, Adefovir dipivoxil, AGN-201904-Z, AIDSVAX, Albinterferon alfa-2b, Alemtuzumab, Aliskiren fumarate, Alvimopan hydrate, Amlodipine besylate/atorvastatin calcium, Amlodipine besylate/Olmesartan medoxomil, Ammonium tetrathiomolybdate, Amodiaquine, Apaziquone, Aprepitant, Arsenic trioxide, Artesunate/Amodiaquine, Ascorbic acid, Atazanavir sulfate, Atazanavir/ritonavir, Atomoxetine hydrochloride, Atrigel-Leuprolide, Axitinib; Bevacizumab, Binodenoson, Bortezomib, Bovine lactoferrin; Calcipotriol/betamethasone dipropionate, Carisbamate, Certolizumab pegol, Ciclesonide, Conivaptan hydrochloride, CP-690550, CP-751871, Cypher; Dapivirine, Darbepoetin alfa, Darunavir, Dasatinib, del-1 Genemedicine, Denosumab, Desloratadine, Dexlansoprazole, DiabeCell, Drospirenone/ethinylestradiol, DTaP-HepB-IPV, Duloxetine hydrochloride, Dutasteride; Eculizumab, Eldecalcitol, Eletriptan, Emtricitabine, Entecavir, Eritoran tetrasodium, Ertapenem sodium, Escitalopram oxalate, Eslicarbazepine acetate, Esomeprazole magnesium, Estradiol acetate, Eszopiclone, ETEC vaccine, Etoricoxib, Exenatide, Ezetimibe; Fluticasone furoate, Fosmidomycin, Fosmidomycin/clindamycin; Glutamine; Heat Shock Protein 10, Hepatitis B hyperimmunoglobulin, HIV vaccine, Hochuekki-to, Human Albumin, Human papillomavirus vaccine; Immune globulin subcutaneous [human], IMP-321, Interferon omega, ISIS-301012, Istaroxime; Japanese encephalitis virus vaccine; Latanoprost/timolol maleate, Lenalidomide, Linaclotide acetate, Lumiracoxib, LY-517717; Malaria vaccine, MAS-063D, Meningitis B vaccine, Mepolizumab, Methylnaltrexone bromide, Micafungin sodium, MK-0822A, Morphine glucuronide, Morphine hydrochloride, Mycophenolic acid sodium salt; Natalizumab, Nesiritide, Norelgestromin/ethinyl estradiol, NT-201; Oblimersen sodium, Olmesartan medoxomil, Olmesartan medoxomil/hydrochlorothiazide, Omalizumab, Otamixaban; Paclitaxel nanoparticles, Panitumumab, Panobinostat, Parathyroid hormone (human recombinant), Parecoxib sodium, Pegfilgrastim, Peginterferon alfa-2a, Peginterferon alfa-2b, Pegvisomant, PI-88, Pimecrolimus, Pneumococcal 7-valent conjugate vaccine, Pneumococcal 9-valent conjugate vaccine, Pneumococcal conjugate vaccine, Poloxamer-188, Prasugrel, Pregabalin, Prulifloxacin; R-109339, Ramipril/amlodipine, Ranolazine, Rasburicase, rHA influenza vaccine, Ro-50-3821, Rosuvastatin calcium, Rotavirus vaccine, Rotigotine, Ruboxistaurin mesilate hydrate; Satavaptan, SC-75416, Solifenacin succinate, Sorafenib, Sugammadex sodium, Sunitinib malate, Synthetic conjugated estrogens B; Tadalafil, Talnetant, Taxus, Tegaserod maleate, Telbivudine, Temsirolimus, Tenofovir disoproxil fumarate, Tetomilast, Tiotropium bromide, Tipifarnib, Tofimilast, Tremelimumab, Trimethoprim; Udenafil, Urocortin 2; Valdecoxib, Vernakalant hydrochloride; XP-828L.     

Gateways to clinical trials

(-)-Epigallocatechin gallate, [188Re]-P2045, 12B75, 89-12; Abacavir sulfate/lamivudine, Abatacept, Abiraterone acetate, ABT-869, Adalimumab, Ad-rh Endostatin, AI-700, Alemtuzumab, Alvimopan hydrate, Amrubicin hydrochloride, AP-12009, Apomab 7.3, Arformoterol tartrate, Aripiprazole, AS-1404, Azacitidine, AZD-0530; Bevacizumab, BHT-3009, Biapenem, Bortezomib, Bosentan, Bremelanotide; CA9-SCAN, Calcitonin gene-related peptide, Canertinib dihydrochloride, Cannabidiol, Carboxyamidotriazole, Caspofungin acetate, Celgosivir, Certolizumab pegol, Cinacalcet hydrochloride, Clevudine, CP-751871, Curcumin, Cx-401, Cypher; Darunavir, Decitabine, Deforolimus, Dexamet, Dipyridamole/prednisolone, Drospirenone, Drospirenone/estradiol, DTPw-HepB-Hib, Duloxetine hydrochloride; Efalizumab, Emtricitabine, Erlotinib hydrochloride, Escitalopram oxalate, Eszopiclone; Ferumoxtran-10, Ferumoxytol, Fondaparinux sodium, Fosaprepitant dimeglumine; gamma-Hydroxybutyrate sodium, Gefitinib, Genistein, Ghrelin (human), Gimatecan, GM-CSF PMED, Golimumab, gp100 PMED; Imatinib mesylate, Immunoglobulin intravenous (human), IV Gamma-globulin; LA-419, Laropiprant, L-BLP-25, Levodopa/carbidopa/entacapone, Lidocaine/prilocaine, Lopinavir/ritonavir, Lumiracoxib, LY-2076962; Mepolizumab, Methylnaltrexone bromide, Mitiglinide calcium hydrate, Mycophenolic acid sodium salt, Myristyl nicotinate; Natalizumab, Nesiritide, Niacin/lovastatin; Oblimersen sodium, Ofatumumab, Olmesartan medoxomil, Olmesartan medoxomil/hydrochlorothiazide, Ozarelix; Palonosetron hydrochloride, Parathyroid hormone (human recombinant), Pazopanib hydrochloride, Pegaptanib octasodium, Pegfilgrastim, Peginterferon alfa- 2a, Peginterferon alfa-2b, Pegvisomant, Pemetrexed disodium, Pexelizumab, Picoplatin, Pimecrolimus, Posaconazole, Pregabalin, PRO-1762, Progesterone caproate, Prulifloxacin; Ramelteon, Ranelic acid distrontium salt, Reparixin, Rosuvastatin calcium; Rotigotine; Satraplatin, Sertraline, Sipuleucel-T, SLIT-cisplatin, SNDX-275, Solifenacin succinate, Sunitinib malate; Tadalafil, Talnetant, Tanespimycin, Taxus, Tegaserod maleate, Telmisartan/hydrochlorothiazide, Tenofovir disoproxil fumarate/emtricitabine, Teriparatide, tgAAC-94, Tiotropium bromide, Tocilizumab, Tolvaptan, Trimethoprim; Vardenafil hydrochloride hydrate, Vatalanib succinate, Vinflunine, Voriconazole, VX-680; XL-880; Yttrium 90 (90Y) ibritumomab tiuxetan.     

Gateways to clinical trials

Aclidinium bromide, AE-37, Alemtuzumab, AMA1-C1/ISA 720, Amlodipine besylate/atorvastatin calcium, Arachidonic acid, Arbaclofen placarbil, Aripiprazole, ARQ-621, Azelnidipine, Azilsartan medoxomil potassium; Bevacizumab, Biphasic insulin aspart, Bortezomib; Choriogonadotropin alfa, CTS-1027; Dapagliflozin, Dasatinib, Deforolimus, Degarelix acetate, Denufosol tetrasodium, Desvenlafaxine succinate, Dronedarone hydrochloride, Duloxetine hydrochloride, Dutasteride; Enfuvirtide, Entecavir, Etaracizumab, Everolimus, Exenatide, Ezetimibe; Ferric carboxymaltose, Fludarabine, Foretinib; Gefitinib, GFT-505, GSK-256066; HPV-6/11/16/18, HuM195/rGel, HyperAcute-Lung cancer vaccine; I5NP, Imatinib mesylate, Imexon, Insulin detemir, Insulin glargine, Ivabradine hydrochloride; L2G7, Lacosamide, Lapatinib ditosylate, Lenalidomide, Lidocaine/prilocaine, Liposomal vincristine, Liraglutide, Lixivaptan; Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine, Methoxy polyethylene glycol-epoetin-β, Mirabegron, Morphine/oxycodone, MR Vaccine, MSC-1936369B, Mycophenolic acid sodium salt; Narlaprevir, N-Desmethylclozapine; Ocriplasmin, Olaparib, Olmesartan medoxomil, Olmesartan medoxomil/azelnidipine, ONO-5334, ONO-8539; Palifermin, Panitumumab, Pardoprunox hydrochloride, PCV7, Peginterferon alfa-2a, Peginterferon alfa-2b, Pemetrexed disodium, Pexelizumab, PF-337210, Pitavastatin calcium; Raltegravir potassium, Recombinant interleukin-7, Regadenoson, Reniale, Roflumilast, Rosuvastatin calcium; Safinamide mesilate, SB-1518, SCH-527123, Selumetinib, Sipuleucel-T, Solifenacin succinate, Sorafenib, Sunitinib malate; Tadalafil, Talaporfin sodium, Tanespimycin, Technosphere/Insulin, Telaprevir, Telatinib, Telcagepant, Telmisartan/hydrochlorothiazide, Teriparatide, Testosterone transdermal gel, TH-302, Tiotropium bromide, Tocilizumab, Trabedersen, Tremelimumab; Valsartan/amlodipine besylate, Vernakalant hydrochloride, Visilizumab, Voreloxin, Vorinostat.