1. Drug development for pediatric neurogenic bladder dysfunction: dosing, endpoints, and study design.
- Author
-
Momper JD, Karesh A, Green DJ, Hirsch M, Khurana M, Lee J, Kim MJ, Mulugeta Y, Sachs HC, Yao L, and Burckart GJ
- Subjects
- Adolescent, Adrenergic alpha-1 Receptor Antagonists administration & dosage, Adrenergic alpha-1 Receptor Antagonists pharmacokinetics, Adrenergic alpha-1 Receptor Antagonists therapeutic use, Area Under Curve, Benzhydryl Compounds administration & dosage, Benzhydryl Compounds pharmacokinetics, Child, Child, Preschool, Cresols administration & dosage, Cresols pharmacokinetics, Delayed-Action Preparations, Humans, Infant, Mandelic Acids administration & dosage, Mandelic Acids pharmacokinetics, Marine Toxins administration & dosage, Marine Toxins pharmacokinetics, Muscarinic Antagonists administration & dosage, Muscarinic Antagonists pharmacokinetics, Muscarinic Antagonists therapeutic use, Oxocins administration & dosage, Oxocins pharmacokinetics, Phenylpropanolamine administration & dosage, Phenylpropanolamine pharmacokinetics, Quinazolines administration & dosage, Quinazolines pharmacokinetics, Tablets, Tolterodine Tartrate, Benzhydryl Compounds therapeutic use, Cresols therapeutic use, Mandelic Acids therapeutic use, Marine Toxins therapeutic use, Oxocins therapeutic use, Phenylpropanolamine therapeutic use, Quinazolines therapeutic use, Urinary Bladder, Neurogenic drug therapy
- Abstract
Pediatric drug development is challenging when a product is studied for a pediatric disease that has a different underlying etiology and pathophysiology compared to the adult disease. Neurogenic bladder dysfunction (NBD) is such a therapeutic area with multiple unsuccessful development programs. The objective of this study was to critically evaluate clinical trial design elements that may have contributed to unsuccessful drug development programs for pediatric NBD. Trial design elements of drugs tested for pediatric NBD were identified from trials submitted to the U.S. Food and Drug Administration. Data were extracted from publically available FDA reviews and labeling and included trial design, primary endpoints, enrollment eligibilities, and pharmacokinetic data. A total of four products were identified. Although all four programs potentially provided clinically useful information, only one drug (oxybutynin) demonstrated efficacy in children with NBD. The lack of demonstrable efficacy for the remainder of the products illustrates that future trials should give careful attention to testing a range of doses, using objectively measured, clinically meaningful endpoints, and selecting clinical trial designs that are both interpretable and feasible. Compiling the drug development experience with pediatric NBD will facilitate an improved approach for future drug development for this, and perhaps other, therapeutic areas., (© 2014, The American College of Clinical Pharmacology.)
- Published
- 2014
- Full Text
- View/download PDF