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Design of Bioequivalence Studies. Alfredo García – Arieta, PhD. WHO Workshop on Assessment of Bioequivalence Data, 31 August – 3 September, 2010, Addis Ababa. Design to achieve the objective.

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Design of Bioequivalence Studies

Alfredo García – Arieta, PhD

WHO Workshop on Assessment of Bioequivalence Data, 31 August – 3 September, 2010, Addis Ababa

design to achieve the objective
Design to achieve the objective
  • BE studies are design to compare the in vivo performance of multisource product with that of comparator
  • Two purposes:
    • Provide in vivo measure of pharmaceutical quality
    • Surrogate of clinical proof of equivalence
  • It is necessary:
    • Two minimize variability (within and between subjects)
    • Eliminate bias (unequal carry-over effect in 2x2 designs)
conventional design 2x2
Conventional Design: 2x2

Randomization to sequences of treatment

>5 half-lives

  • A two-period, two sequence, single dose, cross-over, randomized design in healthy volunteers
wash out to avoid carry over
Wash-out to avoid carry-over

Period 1

Wash out

Period 2

  • Blood samples are collected and assayed
    • Before and several times after drug administration. No need after 72 h
  • Prior to period 2, pre-dose levels must be <5% of Cmax of 2nd period
  • Wash out period must take into account the slow metabolizers
  • Minimum wash out: 7 days (1 week)
alternative designs multiple dose
Alternative designs: Multiple dose

Conc.

Wash-out (>3-5t1/2)

P2 build i-up P1

Period 2

Period 1

Time

A

B

  • Very potent or toxic drugs:
    • Patients (stable) if a single dose study cannot be conducted in healthy volunteers due to tolerability reasons
    • Multiple dose study in patients is acceptable, when a single dose study is not feasible in patients
      • Multiple dose if patients cannot have passive wash-out. Usual dosing.
      • Appropriate dosing and sampling to document attainment of steady state
      • Single dose if a wash-out period is possible
alternative designs multiple dose1
Alternative designs: Multiple dose
  • In the rare situation where problems of sensitivity of the analytical method preclude sufficiently precise plasma concentration measurements after single dose administration and where the concentrations at steady state are sufficiently high to be reliably measured, a multiple dose study may be acceptable as an alternative to the single dose study
  • However, given that a multiple dose study is less sensitive in detecting differences in Cmax, this will only be acceptable if the applicant adequately can justify that the sensitivity of the analytical method cannot be improved and that it is not possible to reliably measure the parent compound after single dose administration taking into account also the option of using a supra-therapeutic dose in the BE study (no solubility or tolerability limitations)
alternative designs multiple dose2
Alternative designs: Multiple dose
  • In the past a multiple dose study was required in EU for drugs that exhibit non-linear kinetics at steady state (e.g. saturable metabolism, active secretion)
    • No longer required in EU
    • Included in WHO guideline
  • Extended release dosage-formswith a tendency to accumulation
    • In addition to single dose studies
      • Fasted state
      • Fed state
drugs with long elimination t 1 2 parallel
Drugs with long elimination t1/2: Parallel
  • Normally wash-out period should not exceed 3-4 weeks
  • If a larger wash-out period is necessary a parallel design may be more appropriate
  • Variability will be larger, needs higher sample size
    • Parallel design: Total variability (intra+inter)
    • Cross-over: Intra-subject variability
  • Sampling: Up to 72 h

Group 1: Treatment A

Randomization to treatments

Group 2: Treatment B

replicate design
Replicate design
  • In case of highly variable drugs (CV>30%)
    • Two distinguish intra-subject variability from other sources of variability: random error, analytical method, …
    • More information:
      • Intra-subject variability of Test product / Multisource (generic)
      • Intra-subject variability of Reference / Comparator
      • Subject by formulation interaction
    • If scaling / widening limits based on variability
    • Fewer subjects
    • More administrations
    • Similar number of profiles
pk parameters to characterize
PK parameters to characterize
  • AUC0-t or AUC0-inf: extent of systemic exposure / absorption
  • Cmax: peak exposure
    • Depends on rate and extent of absorption
  • Tmax: Time of peak exposure
    • Depends on rate of absorption and rate of elimination
    • Relevant only in drugs with clinically relevant onset of action (e.g. analgesics)

Cmax

AUC

Tmax

time

sampling times
Sampling times
  • Blood samples with frequency sufficient frequency for assessing Cmax, AUC and other parameters
  • Sampling points should include:
    • a pre-dose sample,
    • at least 1–2 points before Cmax,
    • 2 points around Cmax and
    • 3–4 points during the elimination phase.
    • Consequently at least seven sampling points will be necessary for estimation of the required pharmacokinetic parameters.
sampling times1
Sampling times
  • For most medicines the number of samples necessary will be higher to compensate for between-subject differences in absorption and elimination rate and thus enable accurate determination of the maximum concentration of the API in the blood (Cmax) and terminal elimination rate constant in all subjects
  • Generally, sampling should continue for long enough to ensure that 80% of the AUC (0→ infinity) can be accrued, but it is not necessary to sample for more than 72 hours
  • The exact duration of sample collection depends on the nature of the API and the input function from the administered dosage form
immediate release fasting or fed conditions
Immediate release: Fasting or fed conditions
  • Fasted-state studies are generally preferred
    • Labelling only on an empty stomach, or
    • Labelling irrespective of food intake
  • Fed state:
    • When the product is known to cause gastrointestinal disturbances in the fasted state, or
    • If labelling restricts administration in the fed state
  • Composition of meal may depend on local diet and customs
fasting conditions
Fasting conditions
  • Overnight fast of at least 10 hours
  • Participants are allowed free access to water
  • No water is allowed during the hour prior to drug admin.
  • The dose should be taken with a standard volume of water
    • Usually 150–250 ml.
  • 2 h after drug admin. water is again permitted ad libitum.
  • A standard meal is usually provided 4 hours after drug ad.
additional requirements in eu
Additional requirements in EU
  • EMA (2010):
  • For products with specific formulation characteristics
    • microemulsions,
    • solid dispersions, …
  • BE studies performed under both fasted and fed conditions are required
  • Unless the product must be taken only in the fasted state or only in the fed state
additional requirements in us fda
Additional requirements in US-FDA
  • In addition to a BE study under fasting conditions
  • BE study under fed conditions for all orally administered immediate-release drug products
  • Except:
    • When both test product and comparator are rapidly dissolving, have similar dissolution profiles, and contain a BCS Class I drug substance,
    • When the label states that the product should be taken only on an empty stomach, or
    • When the label does not make any statements about the effect of food on absorption or administration.
fasting fed conditions
Fasting & fed conditions
  • In cases where information is required in both the fed and fasted states, it is acceptable to conduct
    • either two separate two-way cross-over studies or
    • a four-way cross-over study
fed conditions meal composition
Fed conditions: meal composition
  • In studies performed under fed conditions, the composition of the meal is recommended to be according to the SPC of the originator product
  • The composition of the meal may depend on local diet and customs
  • If no specific recommendation is given in the originator SPC, the meal should be a high-fat (approximately 50 percent of total caloric content of the meal) and high-calorie (approximately 800 to 1000 Kcal) meal
meal composition in fed conditions
Meal composition in Fed conditions
  • This test meal should derive approximately 150, 250, and 500-600 Kcal from protein, carbohydrate, and fat, respectively
  • The composition of the meal should be described with regard to protein, carbohydrate and fat content (specified in grams, calories and relative caloric content (%)).
considerations for modified release products
Considerations for Modified Release Products
  • Types:
    • Prolonged release: sustained-, controlled-, extended-release
    • Delayed release: gastro-resistant
  • Several studies are required:
    • Single-dose fasted-state cross-over with highest strength
    • Single-dose fed-state cross-over with highest strength
      • High-fat meal (time according to SPC or 30 min before drug intake)
    • Multiple-dose fasted state for prolonged release product with a tendency to accumulate (not in FDA)
    • In vitro dissolution studies on alcohol effect (10, 20, 40%)
modified release products
Modified Release Products
  • Types:
    • Single-unit formulations
    • Multiple-unit formulations
  • Proportional formulations
    • Multiple-unit formulations: testing highest strength is enough
      • The other proportional strengths are waived based on dissolution
    • Single-unit formulations:
      • US-FDA: BE with the highest strength is enough (and some EU for Enteric)
        • Dissolution at least three media (e.g., pH 1.2, 4.5 and 6.8)
      • EU: All strengths have to be tested in the fasted-state single-dose study
        • Highest strength in fed-state single-dose or fasted-state multiple-dose