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Nonclinical Safety Evaluation of Pediatric Drug Products

FinalCenter for Drug Evaluation and Research02/15/2006
Risk ManagementNonclinical Safety EvaluationToxicokineticsNonclinical developmental toxicity studies

Description

The Food and Drug Administration (FDA) is announcing the availability of a guidance for industry entitled “Nonclinical Safety Evaluation of Pediatric Drug Products.” This document provides guidance on the role and timing of animal studies in the nonclinical safety evaluation of therapeutics intended for the treatment of pediatric patients. The guidance discusses some conditions under which juvenile animals can be meaningful predictors of toxicity in pediatric patients and makes recommendations on nonclinical testing.

Key Topics

Terms and concepts identified from this document

Scope & Applicability

Product Classes

5
Pediatric Drug Products

The primary subject of the nonclinical safety evaluation guidance; Nonclinical Safety Evaluation of Pediatric Drug Products; Nonclinical safety evaluation of these products

Intranasal and Oral Inhaled Corticosteroids

Class Labeling for Intranasal and Oral Inhaled Corticosteroids Containing Drug Products

Inhaled corticosteroids

found to decrease growth velocity in children

Fluoroquinolones

associated with chondrotoxicity in immature animals

New molecular entity

Typically, at least two adequate and well-controlled trials are needed to support approval of a new molecular entity.

Stakeholders

4
Sponsors

Assist sponsors in the nonclinical evaluation

Sponsor

Entity responsible for submitting applications under section 524B

Neonates

Youngest pediatric group requiring cautious bridging

Infants

Population group through 12 months of age; Population group for specific labeling rules (through 12 months).

Regulatory Context

Regulatory Activities

3
Pediatric Clinical Trials

Clinical testing phase where certain safety effects cannot be ethically assessed; supported by data generated from juvenile animal studies

Best Pharmaceuticals for Children Act

Legislation made permanent under FDASIA

Postmarketing Commitments

PMCs agreed upon in writing; Studies or clinical trials agreed upon in writing by FDA and the applicant

Document Types

3
Physician's Desk Reference

Source cited for lack of pediatric safety and efficacy information in drug listings

Class Labeling

Class Labeling for Intranasal and Oral Inhaled Corticosteroids

Product Label

Required documentation for review including mechanism of action statements

Attributes

5
Pharmacokinetics

PK data used to evaluate drug pharmacology.

Cardiac Output (CO)

Hemodynamic parameter

Dose-Response Relationship

Accurate dose-response information is important for maximizing desirable effects.

Pharmacodynamics

PD data used to evaluate drug pharmacology.

Half-life

Property used to determine maintenance dose intervals and safety monitoring

Technical Details

Substances

10
Acetaminophen

Known or potential interferent for blood glucose measurement.; Listed as an example interferent in the recommended summary table format.

Vigabatrin

Low-Dose Vigabatrin (gamma-vinyl GABA)-Induced Damage

Fluoxetine

Rats Treated with Fluoxetine During Early Juvenile Life

Benzyl Alcohol

Fatal Benzyl Alcohol Poisoning in Neonatal Intensive Care Units

CYP3A4

metabolizing enzyme with lower expression in neonates compared to adults

CYP2D6

enzyme generally considered not inducible by drugs; Specific enzyme used for extrapolation of DDI results.; Cytochrome P450 enzyme

Glutamate receptors

Nervous system developmental event

Inactive Ingredients

Requests related to inactive ingredients in generic drugs

Valproic acid

Positive control example in Reference Compound List; CAS No.: 99-66-1 (sodium valproate: 1069-66-5)

Chloramphenicol

Drug substance mentioned in veterinary context; Drug substance subject to specific regulatory policy; CPG 654.300 regarding chloramphenicol

Testing Methods

5
Juvenile Animal Studies

Nonclinical studies to support pediatric age groups.

Toxicity Testing

Methods used to evaluate the safety of nanomaterials

Electrophysiology (ECG)

Cardiac parameter maturation

Neurobehavioral Testing

measurement of organ weights, gross and microscopic examinations, and neurobehavioral testing

Histopathologic Examinations

histopathologic examinations and effects on specific growth parameters

Processes

7
Postnatal Development

tissues that undergo significant postnatal development in pediatric patients

Glucuronidation

Metabolic process of lamotrigine induced by CHCs

Juvenile animal studies

Used to identify specific age groups or unsafe parameters of exposure

Nonclinical Safety Evaluation

Required before initiating long-term clinical studies

Reproductive Toxicity Assessments

Assessments that may not adequately identify postnatal developmental toxicities

Segment III reproductive toxicity studies

can be modified to include juvenile animals

Organogenesis

Developmental stage evaluated in combined FEED/EFD studies; Critical period for dosing in developmental toxicity

Clinical Concepts

10
Pediatric Patients

Target population for efficacy extrapolation

Pediatric Populations

clinical studies planned in pediatric populations

Growth Suppression

Potential for Growth Suppression in Children

Nephrogenesis

Renal system anatomical development

Alveoli Formation

Pulmonary system developmental event

Puberty

physical indicators of onset of puberty like vaginal opening; period of intense endocrine activity with structural and functional maturation; Developmental milestone in humans and animals

Chronic drug exposure

Associated with adverse effects in nonclinical studies

Adverse effects

Reported outcomes following the use of a drug or drug class.; provide information to predict potential adverse effects in the target species

Postnatal Developmental Toxicities

Toxicities that juvenile animal studies may assist in identifying

Adverse Events

Reporting adverse events when engaging with patients.; changes may be related to benefits, tolerability, and/or unintended effects

Identified Hazards

Hazards

5
Irreversible Serious Adverse Effects

Safety effects of particular concern that cannot be safely assessed in clinical trials

Unsafe parameters of exposure

Identified through juvenile animal studies

Developmental Toxicity

Adverse effects such as dysmorphogenesis or fetal mortality

Neurotoxicity

Reason for limiting Class 2 solvents

Chondrotoxicity

risk identified in immature animals with fluoroquinolones

Standards & References

Specifications

1
NOAEL

No observed adverse effect level used to calculate ADI and margin of safety.

ICH References (4)

ICH M3

Nonclinical Safety Studies for the Conduct of Human Clinical Trials

ICH E11

Clinical Investigation of Medicinal Products in the Pediatric Population.

ICH S5A

Detection of Toxicity to Reproduction for Medicinal Products

ICH S3A

Guidance for industry on Toxicokinetics and systemic exposure in toxicity studies.

Related MFDS Guidelines

Korean regulatory guidelines covering similar topics

See Also (8)