2002年至2024年期间FDA批准的儿科肝功能障碍剂量
Deandra A Cassel1, Gilbert J Burckart1, Martina D Sahre1
1Office of Clinical Pharmacology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA.
由于挑战,儿童药物开发很少评估肝功能障碍 (HI) 剂量. 这项研究发现儿科HI剂量建议存在显著差距,现有指导方针的支持证据有限.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 儿科药物开发 儿科药物开发
- 肝病学 肝病学是一种肝病学.
背景情况:
- 药物的安全性和有效性受到肝功能的显著影响,特别是在儿科患者中.
- 在儿科药物开发中评估肝功能障碍 (HI) 是具有挑战性的,因为患者人群较小,疾病特征不同.
- 缺乏标准化标志物来评估儿童的HI严重程度,阻碍了药物开发.
研究的目的:
- 在美国FDA处方信息 (PI) 和关键儿科药物数据库 (Lexicomp,Micromedex) 中分析成人和儿科HI剂量建议.
- 确定支持儿童群体HI剂量建议的临床证据.
- 为了突出小儿HI剂量指南中现有的差距.
主要方法:
- 在PI的剂量和管理部分中提到的61种儿科和"肝"药物的系统审查.
- 对儿科特异性HI剂量建议和引用的证据基础的评估.
- 对FDAPI,Lexicomp和Micromedex的建议进行比较.
主要成果:
- 在61种审查的药物中,只有8种提供了针对儿科的HI剂量建议,主要是基于成人Child-Pugh分类.
- 支持这些建议的证据主要来自成人药理动力学研究;只有一种药物有轻度HI的儿科患者的数据.
- 莱克西康普和Micromedex反映了PI建议,但没有引用额外的支持性证据.
结论:
- 对于患有肝功能障碍的儿科患者,基于证据的剂量建议存在很大的差距.
- 目前的建议主要依赖于成年人的数据,对儿科特有的临床评估有限.
- 在未来,建模和模拟方法可能对解决儿科HI药物剂量的知识差距至关重要.
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