Wednesday, August 7, 2019

What are the challenges in pediatric trials?


Conference: 2nd International Conference on Clinical Trials and Pharmacovigilance
Date: September 26 – 27, 2019
Place: Prague, Czech Republic

Pediatric patients can be divided into several age groups, including pre-term new-borns, full-term new-borns, infants and toddlers, children, and adolescents. It is known that pharmacokinetic (PK) parameters can differ greatly among these subpopulations due to the natural development and maturation of hepatic and renal systems. The issue of pharmacokinetic (PK) variability can be solved by using parameters such as gestational age and weight to predict the variability. The variability in pharmacodynamic (PD) parameters raises more questions with an inadequate understanding of the disease pathology. Population PK/PD (pop/PD) modelling and simulation approaches can be very useful in providing variability information for experimental design, data analysis, and interpretation.


Enrolment DifficultiesPediatric clinical studies rarely enrol healthy volunteers, except for certain studies with minimal or no risk. In most of the studies, Pediatric patients are recruited rather than healthy children. In this scenario, with many Pediatric diseases being rare disorders, getting enough patients enrolled to satisfy statistical requirements is a huge challenge. To make things worse, these rare Pediatric diseases usually do not share similar disease progression with the adult form. Therefore, the easy path of extrapolation from adult studies is invalid, and a full, well-controlled PK/PD study with enough patient is required.

Difficulties in Allocation to Placebo Arm: Use of a placebo control is relatively restricted in Pediatric clinical trial design, as it is often difficult to convince parents/guardians to enrol their child into a study where they may receive a non-efficacious treatment. Outside of certain special circumstances where the use of a placebo control might be justified, standard-of-care treatment is more frequently used as the control in Pediatric clinical trials. The active treatment thus needs to be proved on-inferior, equivalent, or superior to the standard-of-care treatment.

Pediatric drug development is not just drug development for small adults. Indeed, the Pediatric population presents several challenges, from physiological differences to unique study design elements, that must be carefully considered. However, along with these challenges come many opportunities to leverage available data in a way that can expedite development while still ensuring safe and effective treatments for Pediatric patients

Source: Nuventra*
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