Analysis of the Current Situation of Drug Clinical Trial Institutions in Shaanxi Province

To understand the current situation of institutional registration in Shaanxi Province after the implementation ofregistration system management in drug clinical trial institutions.Relevant information was collected on the“Announcement on the Accreditation of Drug Clinical Trial Institutions”issued by the National Medical Products Administration from 2005 to August 2022,the record management information system of drug and medical device clinical trial institutions,and the drug clinical trial registration and information publicity platform.A retrospective analysis was carried out in terms of institutional development,regional distribution,registered majors,principal investigators,and the number of drug clinical trials.After the implementation of institution registration,the number of drug clinical trial institutions in Shaanxi Province increased by 47.4%,884 principal investigators were registered,the number of registered majors expanded from 58 qualified to 117,and the professional scope increased by 50.4%.The policy of institution registration is conducive to promoting the rational use of medical resources and the development of drug clinical trial institutions and improving the healthy development of the pharmaceutical industry in Shaanxi Province.

基于Clinical Trials数据库的癌性疼痛治疗药物临床试验分析

目的了解近年来癌性疼痛(癌痛)治疗药物临床试验的趋势和特点,为癌痛治疗药物的开发和临床研究提供参考依据。方法从Clinical Trials数据库中检索1987—2022年癌痛治疗药物临床试验的相关信息,从试验类型、备案时间、申报地区、癌痛类型、癌痛治疗药物等角度进行描述性分析。结果筛选出临床试验376项,由研究者发起的试验(IIT)项目数多于注册类试验(IST),其中北美洲的总项目数、IIT和IST项目数最多;试验总项目数和IST项目数先增长后回落,IIT的试验项目数稳步增长。针对慢性癌痛、爆发性癌痛和重度癌痛的研究相对较多。研究对象以阿片类药物尤其是芬太尼的占比最高。结论癌痛治疗药物临床试验对推进癌痛治疗药物治疗发挥了重要作用,未来有待进一步加强IST在新型癌痛治疗药物的研究和开展更多IIT研究,以更好地优化癌痛治疗效果。

Anti-oxidative stress treatment and current clinical trials

Oxidative stress disturbs the balance between the production of reactive oxygen species(ROS)and the detoxification biological process.It plays an important role in the development and progression of many chronic diseases.Upon exposure to oxidative stress or the inducers of ROS,the cellular nucleus undergoes some biological processes via different signaling pathways,such as stress adaption through the forkhead box O signaling pathway,inflammatory response through the IκB kinase/nuclear factor-κB signaling pathway,hypoxic response via the hypoxia-inducible factor/prolyl hydroxylase domain proteins pathway,DNA repair or apoptosis through the p53 signaling pathway,and antioxidant response through the Kelch-like ECH-associated protein 1/nuclear factor E2-related factor 2 signaling pathway.These processes are involved in many diseases.Therefore,oxidative stress has gained more attraction as a targeting process for disease treatment.Meanwhile,anti-oxidative stress agents have been widely explored in pre-clinical trials.However,only limited clinical trials are performed to evaluate the efficacy of anti-oxidative stress agents or antioxidants in diseases.In this letter,we further discuss the current clinical trials related to anti-oxidative stress treatment in different diseases.More pre-clinical studies and clinical trials are expected to use anti-oxidative stress strategies as disease treatment or dietary supplementation to improve disease treatment outcomes.

Quality Management Model for Phase I Clinical Drug Trials:A Structural Equation Model

This study aimed to construct a quality management model for phase I clinical drug trials.A cross-sectional survey was conducted and data were collected from 604 respondents at 69 institutions in China engaged in phase I clinical drug trials.Exploratory and confirmatory factor analyses were used to develop the survey tool.Structural equation modeling was used to construct a quality management model for phase I clinical drug trials.The results showed that the final survey tool had good reliability and validity(Cronbach’sα=0.938,root mean square error of approximation=0.074,comparative fit index=0.962,and Tucker—Lewis index=0.955).The model included five dimensions:government regulation,industry management,medical institution management,research team management,and contract research organization(CRO)management.In total,22 measurement items were obtained.The structural equation model indicated government regulation,industry management,medical institution management,and CRO management significantly affected the quality of phase I clinical drug trials(β=0.195,β=0.331,β=0.279,andβ=−0.267,respectively;P<0.05).Research team management had no effect on the quality of trials(β=0.041,P=0.610).In conclusion,the model is valuable for identifying factors influencing phase I clinical drug trials and guiding quality management practices.

基于Clinicaltrials.gov平台的口腔鳞状细胞癌临床研究注册特点分析

目的:基于Clinicaltrials.gov平台分析全球口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)的临床研究注册特点,了解研究现状和发展趋势,为OSCC临床研究和诊疗提供新思路。方法:通过挖掘Clinicaltrials.gov平台建库至2023年3月24日已注册的OSCC临床试验数据,从年度趋势、地域分布、临床分期、研究类型、受试者人数、经费来源、机构数量等多方面进行统计分析,归纳其临床研究特征。结果:共纳入OSCC临床注册研究332项,注册数量最多的3个国家是美国(188项,56.63%),中国(37项,11.14%)和法国(18项,5.42%)。332项研究中干预性研究和观察性研究分别占83.43%和16.57%,277项干预性试验中药物干预204项(73.65%),其中单克隆抗体药物研究79项(28.52%),顺铂60项(21.66%)。119项平行试验中105项(88.24%)采用随机方法,44项(36.97%)为盲法。332项研究中约1/3(111项,33.43%)归属于Ⅱ期临床试验,受试者人数在50以下的占比超过一半(177项,53.31%)。结论:OSCC的临床研究存在地区不均衡性,多中心大样本随机三盲对照的高质量临床研究不足,应加强临床试验注册的培训和审查,以促进OSCC临床试验高质量的开展,推动其治疗方案的优化。

The Role of Study Nurses in Clinical Trials of IBD Drugs

Objective: To explore the establishment and roles of study nurses in IBD drug clinical trials. Methods: The management experience of this department’s study nurses in IBD drug clinical trials was retrospectively analyzed. Results: The study nurses played very important roles at all links during the preliminary preparation of IBD drug clinical trials, the whole-process management after project initiation, and the later work of project conclusion. Conclusions: As direct participants in drug clinical trials, study nurses play a very important role in ensuring standardization of the trial process, safeguarding patient’s rights and safety, and assisting investigators in carrying out study works smoothly.

Regulation of Drug Clinical Trials in China: Course and Development Trend

Objective To provide a basis for future regulation reform of drug clinical trials in China in the context of the continuous deepening of drug regulation reform. Methods Literature review and regulation study were conducted to analyze the course and development trend of drug clinical trial regulation in China. Results and Conclusion It is found that the regulation system and the standardization for clinical trials in China are gradually improving, but there is still a gap compared with developed countries. In the future, the regulation authorities still need to further improve relevant regulations, clarify regulation responsibilities, and to improve the drug clinical trial review system to ensure the quality of clinical trials and the safety and effectiveness of listed drugs.

The Expanding Roles of Hospital Pharmacists in Clinical Drug Trials in China

Objective To aim at summarizing the role of hospital pharmacists in clinical drug trials in China against the background that hospital pharmacists have already involved in team-based patient care.Methods The roles and responsibilities of Chinese hospital pharmacists were listed and categorized.Results and Conclusion There has been an upsurge in clinical drug trials in China.Hospital pharmacists play increasingly important roles in all aspects of clinical trials,such as stakeholder liaisons,protocol developers,ethics committee members,research team members,study drug managers,and subject intervention agents.Hospital pharmacists are an integral part of a clinical drug trial multidisciplinary team.Their value is reflected in several pharmacist-led or pharmacist-participating clinical trials as well as the trial project management position within hospitals.Pharmacists should be the designers,researchers,managers and supervisors of clinical drug trials.We expect that all clinical trial projects will include hospital pharmacists in their research teams soon.

Clinical Trial Phases

Developers of drugs, biologicals, and medical devices must ensure product safety, demonstrate medical benefit in people, and mass produce the product. Preclinical development starts before clinical trials and the main goals are to determine safety and effectiveness of the intervention. If preclinical studies show that the therapy is safe and effective, clinical trials are started. Clinical trial phases are steps in the research to determine if an intervention would be beneficial or detrimental to humans and include Phases 0, I, II, III, IV, and V clinical studies. Understanding the basis of clinical trial phases will help researchers plan and implement clinical study protocols and, by doing so, improve the number of therapies coming to market for patients.

Design flaws in randomized, placebo controlled, double blind clinical trials

The hypothesis in drug clinical trials is that the drug is better than a placebo in patients suffering from a disease. The unstated assumption is that the drug cures the disease or is a powerful treatment for the disease. This is an incorrect assumption. Drugs do not cure or treat diseases. The body heals itself; drugs promote this ability of the body to heal itself. Placebos are assumed to be inactive; however, placebos can also promote the ability of the body to heal itself. Placebos are actually treatments that can stimulate endogenous healing mechanisms. The possible place of placebos in health management is controversial. Clinical trial design should be altered. The hypothesis of clinical trials should be that the drug speeds up or improves the healing of the patient, putting patient healing as the first objective. Placebos should not be used as controls but could be tested as drugs in their own right. The control in clinical trials should be no treatment. Alternatively, new drugs could be compared to existing drugs in clinical trials.

Clinical Trial Participant Willingness and Influencing Factors Study of Patients with Inflammatory Bowel Disease

Objective: The study was conducted to understand the situation of patients with inflammatory bowel disease (IBD) to participant clinical trials and to analyze the factors affecting the clinical trial participation of patients with IBD. A clinical experiment guidance will be proved by this study to maximized the benefits to patients and to help the clinical trial to conduct successfully. Method: An anonymous questionnaire was designed and was administrated to the patients with IBD who were randomly delivered in the inpatient or outpatient departments. The survey result was analyzed. Result: Total 372 available questionnaires were returned. Among these patients, 26.3% patients with IBD indicated willingness to participate, 57.3% indicated a situation dependence, and 41.04% indicated unwillingness. Among the potential factors that may influence the patient’s willingness to participate the clinical, trusted physician’s recommendation, no proved drugs to use and accessing to free medication to release financial burden were statistically significant. Conclusion: The overall willingness of IBD patients to participate in drug clinical trials is not high. Among the patients who are willing to participate in clinical trials, the main reasons for their participation are that they trust doctors’ recommendation, can get free medication and examination, and can reduce the economic burden. Efficacy and safety were the main influencing factors in patients who were case-dependent and unwilling to participate in clinical trials.

Randomized,blind,parallel-controlled and multiple-centre clinical trial on the efficacy and safety of sustained-released leuprolide acetate in the treatment of endometriosis

Objective:To evaluate the efficacy and safety of leuprolide acetate in the treatment of endometriosis. Methods:The patients with endometriosis were randomly divided into leuprolide(n = 75) and control(n=74) groups.They were treated with either sustained-release injection of leuprolide acetate or Enatntone injection(control) for 3 times totally.After treatment,the ovarian mass volume was measured under B ultrasound.The changes in hormone levels of estrodial(E_2),FSH and LH,the pelvic signs,the scores of the patient's subjective symptoms during menstruation and non-menstrual days were observed. Results:The rate of changes in ovarian mass volume had no statistically significant difference between the two groups(P=0.495-0.965).The average reduction of ovarian mass volume was 47.91%in leuprolide group,and 53.51%in the control group 12 weeks after first medication.The distinct improvement rate and improvement rate of total symptom scores during menstruation and non-menstrual days had no significant difference between the two groups.The hormone levels of E_2,FSH and LH were not significantly different between the two groups.The differences in the incidence of adverse reactions were not significant between the two groups. Conclusion:Leuprolide acetate produced by Livzon China is effective and safe in the treatment of endometriosis.

Anti-obesity drugs currently used and new compounds in clinical development

Obesity is a chronic disease which requires treatment. As lifestyle interventions alone hardly ever result in long-term weight loss, pharmacotherapy is an impor-tant adjunct to lifestyle measures to improve the induc-tion and maintenance of weight loss. Owing to the lim-ited options currently available for the pharmacological treatment of obesity, it is imperative to develop new safe compounds. This study aims to review the current medications approved by European Medicines Agency and United States Food and Drug Administration （FDA） for the treatment of obesity, focusing essentially on their benefits and risks, as well as on the new drugs which are presently under clinical trials. Moreover, it lists the anti-obesity agents that have been recently withdrawn from the market. A revision of the scientifc literature was carried out, through a search on Pubmedfor papers published from January 2010 to January2013. Orlistat （Xenical？） is currently the only long-termpharmacotherapy for obesity available in the Europeanmarket, as rimonabant and sibutramine were with-drawn in 2008 and 2010, respectively, due to serious psychiatric and cardiovascular adverse effects. Lorca-serin （Belviq？） and the association of phentermine and topiramate （QsymiaTM） were recently approved by FDA. Orlistat suppresses appetite inhibiting gastrointestinal lipase, being its adverse effects mostly gastrointestinal. Lorcaserin activates 5-HT2C receptors, phentermine is a norepinephrine releasing drug, and topiramate is an anticonvulsivant drug with weight loss properties.

Psychedelic Drug Therapy for Mental Disorders?

Objective: Psychedelic drug therapy is banned in all countries of the world except Australia, where the government regulatory watchdog, the Therapeutic Goods Administration, is planning to allow approved psychiatrists, as of July 1, 2023, to prescribe psilocybin to treat depression and MDMA to treat post-traumatic stress disorder, a move precipitated by the U.S. Food and Drug Administration’s designation of these two drugs as “breakthrough therapy”. The objective of the present article is to demonstrate that the evidence on which the FDA and then the TGA relied is irretrievably flawed and should be dismissed. Method: Expert review of psychedelic therapy clinical trials and specifically of the methodology and measures used. Results: The present review demonstrates that the studies the U.S. FDA and the Australian TGA relied on to approve these two psychedelic drugs for therapy are irretrievably flawed. All future trials will follow the same procedure and are therefore bound to be flawed as well. Conclusions: Psychedelic drug studies have so far provided no trustworthy evidence of their effectiveness for treating mental disorders and are not likely to produce this evidence in the future. Psychedelic drug therapy is in any event impractical because of its specialized training requirements and very high treatment costs. It is also dangerous because false publicity about its effectiveness will almost certainly lead to unsupervised self-dosing with drugs that not only are illegal but have an unacceptably high addiction rate.

基于OBE理念的药物临床试验课程教学改革研究

首都医科大学将成果导向型教学(OBE)理念引入药物临床试验课程教学改革中。教师针对课程教学内容更新速度快、教学方式传统陈旧、考评模式较为单一等普遍存在的问题,以学生为中心组织和引导教学过程,优化教学大纲、改善教学方法、提升自身教学能力、完善学生评价体系,有效提升了教学产出和学生的创新性学习能力,可为相关课程教学改革提供借鉴。

药物临床试验培训导入临床药学教学的分析与思考

基于国家大健康产业、医药产业创新发展对临床药学和临床试验人才数量和质量的新需求,初步探讨在临床药学人才教学中导入药物临床试验相关理论、实践的必要性和方式。依据院校临床药学培养教学内容和特点,将临床试验相关理论和实践整合到临床药学培养的不同阶段开展教学,在临床药学基础理论教学中导入药物临床试验理论和案例教学,在临床药学毕业实践中进行临床试验实践教学提升能力,在临床药学研究生培养阶段进行临床试验创新培养。一方面提高临床药学专业学生实践能力,扩大临床试验人才培养路径;另一方面提升临床药学学生的创新思维和能力,满足社会大健康产业多元需求。

广东省药物临床试验机构备案情况及监管现状分析

目的:了解广东省药物临床试验机构备案形势、临床试验开展情况和临床试验机构监管现状,为监管相关工作提供参考。方法:从药物临床试验机构备案管理信息系统提取药物临床试验机构备案信息,通过电子调查问卷收集药物临床试验项目数量,梳理汇总药物临床试验机构监督检查情况,并从多个维度统计分析相关数据。结果:截至2023年12月31日,广东省共备案140家药物临床试验机构,主要为三级甲等公立医院,累计备案118个专业。备案药物临床试验机构分布于19个地级市,其中位于广州市的药物临床试验机构(占比32%)承接了广东省78%的药物临床试验。监督检查中发现一些机构在组织管理、责任意识和伦理审查方面尚存在问题,新备案机构尤为突出。结论:药物临床试验机构备案制的施行促进了广东省药物临床试验资源的释放,但凸显了技术层次不齐、专业布局不合理和区域发展不均衡等制约资源有效利用的问题。建议监管部门从加强指导服务力度方面完善监管机制,助力提升药物临床试验资源的利用效率,进而推动广东省药物临床试验机构健康发展。

含新药口服短程方案治疗利福平耐药肺结核患者的多中心随机对照临床试验

背景:耐药结核病治疗疗程长,治愈率低,不良反应发生率高,世界卫生组织推广的大部分全口服短程耐药方案因药物品种和药品耐受性的问题,无法在我国全面推广,亟须探索适合我国的、更安全有效的治疗方案和药物。方法:采用前瞻性多中心随机对照临床试验,以分子药物敏感性试验或表型药物敏感性试验确诊的利福平耐药肺结核患者为研究对象,随机分为采用世界卫生组织推荐的18个月长程治疗方案作为对照组,以及采用含贝达喹啉、康替唑胺、德拉马尼、莫西沙星或左氧氟沙星(对氟喹诺酮类药物耐药的患者改为氯法齐明)的6个月口服短程耐药方案,评估含康替唑胺的新口服6个月方案治疗利福平耐药肺结核的有效性和安全性。讨论:本研究旨在缩短利福平耐药肺结核的治疗时间,提升治愈率,优化方案的安全性,为开发利福平耐药肺结核新药和新短程治疗方案提供依据,为世界卫生组织制定耐药结核病治疗指南提供中国数据。同时,本研究包含我国Ⅰ类创新药,代表我国在医药创新领域的最新成果。但本研究并非头对头临床试验,而是将两种不同治疗方案进行比较,获得整体治疗方案的结局。未来还需要验证方案中新药的适宜剂量,以及验证更多适合中国人群的全口服短程耐药方案,为我国利福平耐药肺结核患者制定不同适宜方案提供更多选择。

陕西省药物临床试验机构伦理初始审查的现况分析

目的研究陕西省医疗机构药物临床试验伦理初始审查的流程,分析初始审查的现状,为加快药物临床试验项目在通过伦理初始审查的速度提出建议。方法根据“药物和医疗器械临床试验机构备案管理信息系统”中陕西省备案的药物临床试验机构,通过检索医院官网、微信公众号并结合电话咨询等方式整理备案机构药物临床试验项目初始审查的流程,分析各医院伦理初始审查的要求、递交文件及获取批件时限。结果陕西省备案的药物临床试验机构共44家。63.6%机构明确发布了伦理审查/申请指南,部分机构对于初始审查递交清单、简版资料及盖章要求等缺少详细的规定;31.8%机构建立了伦理审查管理系统;36.4%机构通过邮箱接收初始审查资料并进行形审;获取伦理批件平均时长5.13~6 d。结论建议进一步完善伦理审查指南,规范初始审查的流程,细化伦理初始审查文件和机构立项文件,搭建信息化管理平台,缩短药物临床试验项目初始审查的时间,提高临床试验启动的速度。

零期临床助力中国原创药研发新范式迭代

新药研发是一项耗时长且风险高的系统工程,需要投入大量资源。由于药物的安全性很难预料,药物开发失败花费的75%左右都在早期临床阶段。零期临床研究主要通过“微剂量”研究快速获得人体药代动力学及药效学等重要信息,为后期的药物临床试验节约资源,提高成功率。但在我国零期临床研究尚处于起步阶段,没有相应的法规和指导原则,缺乏合理的研究设计和专业的研究人员。本文就创新药物零期临床研究的内涵、目前存在的问题及解决策略与如何在中国有效开展零期临床等作一概述,以期为我国的原创药研发提供新范式参考。