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Samenvatting vroege klinische ontwikkeling $4.81
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Samenvatting vroege klinische ontwikkeling

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Dit is een samenvatting over het deel van de vroege klinische ontwikkeling

Last document update: 1 week ago

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  • January 6, 2024
  • December 13, 2024
  • 5
  • 2023/2024
  • Summary
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Vroege klinische ontwikkeling (Dreesen)
Exploratieve/fase 0/microdosis/snuffel studies
• Weinig niet-klinische data nodig → starten tijdens discovery fase (preklinische fase)
• 1 of meerdere GM-kandidaten
• Kleine schaal single-cohort studies in mensen van korte duur (1 site)
• Meestal in patiënten
• Relatief goedkoop
• Flexibel design
• Subtherapeutische exposure → enkel voor vroege informatie over PK, target attainment, MoA,
biomerker en PD → sneller met CT beginnen + meer veiligheid tov normale FIH
• Geen MTD bepalen
• Dosering
o Microdosis studies
▪ Extrapolatie lineair naar therapeutische dosis → onzekerheid over niet-lineaire
kinetiek → IVIVE nodig voor correctie
• Saturatie van metabole enzymes en/of transporters bij hoge dosis
• Te weinig saturatie bij lage dosis → target-mediated drug-disposition
(TMDD)
• Kan geïdentificeerd worden in vitro en in PBPK-model verwerkt worden
▪ Basis PK en bevestiging metabolisatie
▪ 100μg approach: mag in meerdere keren + geen wash-out + single-dose
toxiciteitstudie
▪ 500μg approach: max 100 per keer + wash-out + repeated-dose toxiciteitstudie
o Subtherapeutische dosis range
▪ Hogere dosis (< helft van NOAEL) + geen washout
▪ Single-dose toxiciteitstudie in rodent en non-rodent +Ames-test
o Therapeutische dosis range
▪ Nog hoger + geen washout
▪ Langere repeated-dose in rodent en non-rodent + Ames-test + chromosomale
aberratie test
• Analyse (voldoende gevoelig)
o 14C-gelabeld GM met AMS = plasma = invasief (ook veilig voor kinderen en zwangeren)
o LC-MS/MS = plasma = invasief
o 11C of 18F-gelabeld GM met PET = real-time = niet-invasief (maar blootstelling aan straling)

Fase 1
• Veiligheid (MTD), tolerability, PK en indien mogelijk PD
1. Risk assessment obv preklinische data (PK, selectiviteit, therapeutisch venster, …) → go/no-go
2. Plan voor klinisch ontwikkeling (studies voor MA, ook post-autorisatie)
3. Voorbereiding FIH (risk analysis en management (PK (bv. nauw therapeutisch venster), selectiviteit
MoA, voorspelbaarheid effecten, … + eerste dosis, doseerschema in studie, …)) → case-by-case

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