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Assessing Similarity to Existing Drugs to Decide Whether to Continue Drug Development.

ABSTRACT: Developing a drug requires large investments, over many years, with dramatic increases in development costs at later stages. Thus, one wants to make a No Go decision on a compound early, unless evidence continues to suggest that the project will ultimately be successful, so that resources can be focused on the most promising compounds to benefit patients. Instead of predicting the probability of success of a Phase III study, our approach to this decision uses the Phase II study results to assess similarity of the novel compound to existing drugs that are classified by different decision categories, such as a clear Go decision (e.g., a clearly effective drug), a (unfortunately common) Not Sure decision (e.g., a potentially useful but not outstanding drug), and a clear No Go decision (e.g., a clearly not effective drug). We describe how this modeling can be done using both individual and binary endpoints and how results can be combined for several different endpoints. Potential extensions of the method are also discussed.

SUBMITTER: Ma GJ

PROVIDER: S-EPMC3564656 | biostudies-literature | 2012 Jan

REPOSITORIES: biostudies-literature

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Assessing Similarity to Existing Drugs to Decide Whether to Continue Drug Development.

Ma Guoguang Julie GJ Chi Eric E Ibrahim Joseph G JG Parker Robert A RA

Statistics in biopharmaceutical research 20120101 3

Developing a drug requires large investments, over many years, with dramatic increases in development costs at later stages. Thus, one wants to make a No Go decision on a compound early, unless evidence continues to suggest that the project will ultimately be successful, so that resources can be focused on the most promising compounds to benefit patients. Instead of predicting the probability of success of a Phase III study, our approach to this decision uses the Phase II study results to assess ...[more]

PMID: 23393611

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Project description:BackgroundBronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis.Aim of the studyTo unravel main reasons of pediatricians in prescribing drugs to infants with bronchiolitis, and to possibly correlate therapeutic choices to the severity of clinical presentation. Also possible influence of socially deprived condition on therapeutic choices is analyzed.MethodsPatients admitted to Pediatric Division of 2 main Hospitals of Naples because of bronchiolitis in winter season 2008-2009 were prospectively analyzed. An RDAI (Respiratory Distress Assessment Instrument) score was assessed at different times from admission. Enrollment criteria were: age 1-12 months; 1st lower respiratory infection with cough and rhinitis with/without fever, wheezing, crackles, tachypnea, use of accessory muscles, and/or nasal flaring, low oxygen saturation, cyanosis. Social deprivation status was assessed by evaluating school graduation level of the origin area of the patients. A specific questionnaire was submitted to clinicians to unravel reasons of their therapeutic behavior.ResultsEighty-four children were enrolled in the study. Mean age was 3.5 months. Forty-four per cent of patients presented with increased respiratory rate, 70.2% with chest retractions, and 7.1% with low SaO2. Mean starting RDAI score was 8. Lung consolidation was found in 3.5% on chest roentgenogram. Data analysis also unraveled that 64.2% matched clinical admission criteria. Social deprivation status analysis revealed that 72.6% of patients were from areas "at social risk". Evaluation of length of stay vs. social deprivation status evidenced no difference between "at social risk" and "not at social risk" patients. Following therapeutic interventions were prescribed: nasal suction (64.2%), oxygen administration (7.1%), antibiotics (50%), corticosteroids (85.7%), bronchodilators (91.6%). Statistically significant association was not found for any used drug with neither RDAI score nor social deprivation status. The reasons of hospital pediatricians to prescribe drugs were mainly the perception of clinical severity of the disease, the clinical findings at chest examination, and the detection of some improvement after drug administration.ConclusionsWe strongly confirm the large use of drugs in bronchiolitis management by hospital pediatricians. Main reason of this wrong practice appears to be the fact that pediatricians recognize bronchiolitis as a severe condition, with consequent anxiety in curing so acutely ill children without drugs, and that sometimes they feel forced to prescribe drugs because of personal reassurance or parental pressure. We also found that social "at risk" condition represents a main reason for hospitalization, not correlated to clinical severity of the disease neither to drug prescription. Eventually, we suggest a "step-by-step" strategy to rich a more evidence based approach to bronchiolitis therapy, by adopting specific and shared resident guidelines.

Dataset Information

Assessing Similarity to Existing Drugs to Decide Whether to Continue Drug Development.

Publications

Assessing Similarity to Existing Drugs to Decide Whether to Continue Drug Development.

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