A Comparative Review on the Regulatory Framework of Pediatric Drugs in the US and EU: Challenges and Recommendations

  • V. Sri Sowmya Sri Vasavi Institute of Pharmaceutical Sciences
  • Y.B Manjulatha
  • J. N. B Indusekhar
  • V. Bhaskar Raju

Abstract

Children and adults have different pharmacokinetic and pharmacodynamic profiles, so it is necrssary to confirm the drug's effects in pediatrics. Drugs utilised in paediatric research They are frequently referred to as "therapeutic orphans" since they are challenging to develop and lack adequate data. Therefore, it becomes necessary to study the optimal dosages and formulations in various age groups of children. The significance of pediatric rules emerged from the fact that the physiological conditions of adults and children are different, and the same dosing regimen cannot be recommended for both. The child protection in research was recommended at the Belmont report (1979) first time. The necessity for written informed consent of the subject from a legally authorized representative of a child was described in the Declaration of Helsinki (1964). The scarcity of available patient populations, practical complexities of research, and minimal financial returns have hampered pharmaceutical investment in the clinical studies for children. More recently, pediatric policy in the US and Europe have instituted a system of obligations and incentives to stimulate investment in the pediatric drugs development. These initiatives, in conjunction with a more sophisticated process of drug discovery and development, resulting in significant advancements in the labelling of drugs for pediatric use. The present study reviews the regulation of pediatric drugs in the USA, EU and recent updates concerned to their regulations. It discusses the pediatric clinical study plans, Incentives, Timelines, challenges and possible recommendations. The challenges include ethical issues, clinical trial designs, type of formulation preparation, dosing, bioavailability and drug response measuring techniques.

Keywords: BPCA, PREA, Pediatric study plan, Pediatric investigation plan, Pediatric clinical trials

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References

1. Turner MA, Catapano M, Hirschfeld S, Giaquinto C. Paediatric drug development: The Impact of Evolving Regulations. Advanced Drug Delivery Reviews. 2014;73:2–13. doi:10.1016/j.addr.2014.02.003
2. Ajay S, Vikaas B, Manjusha C. A comprehensive study on regulation on clinical trials of Pediatrics in US, EU and India [Internet]. Akinik Publications; 2016 [cited 2023 Nov 26]. Available from:
https://www.thepharmajournal.com/archives/?year=2016&vol=5&issue=10&ArticleId=877
3. Shikha S, Divya S, Nishi S. Role of regulatory bodies in pediatric products and pediatric drug exclusivity with special reference to US, Europe and Japan. Int J Adv Res (Indore). 2015;3(3):1104-1111. Available from:
https://www.journalijar.com/uploads/93_IJAR-5340.pdf .
4. Office of New Drugs Module [Internet]. FDA [cited 2023 Nov 26]. Available from:
https://www.accessdata.fda.gov/scripts/cderworld/index.cfm?action=newdrugs%3Amain
5. Office of Pediatric Therapeutics [Internet]. [cited 2023 Nov 26]. Available from:
https://www.fda.gov/about-fda/office-clinical-policy-and-programs/office-pediatric-therapeutics
6. Baum VC, Bax R, Heon D, Yang Z, Sakiyama M. Pediatric drug regulation: International perspectives. Pediatric Anesthesia. 2019;29(6):572–82. doi:10.1111/pan.13638
7. Penkov D, Tomasi P, Eichler I, Murphy D, Yao LP, Temeck J. Pediatric medicine development: An overview and comparison of regulatory processes in the European Union and United States. Therapeutic Innovation & Regulatory Science. 2017;51(3):360–71.
doi:10.1177/2168479017696265
8. The Federal Register [Internet]. Federalregister; 2019 [cited 2023 Nov 26]. Available from:
https://www.federalregister.gov/documents/2019/04/23/2019-08167/best-pharmaceuticals-for-children-act-bpca-priority-list-of-needs-in-pediatric-therapeutics
9. Best Pharmaceuticals for Children Act - BPCA [Internet]. U.S. Department of Health and Human Services [cited 2023 Nov 26]. Available from:
https://www.nichd.nih.gov/research/supported/bpca
10. Schwarz S. Make off-patent drugs available to children: Regulatory approaches in Europe and the US [Internet]. [cited 2023 Nov 26]. Available from:
https://www.dgra.de/media/pdf/studium/masterthesis/master_schwarz_s.pdf
11. US Food & Drug Administration. Lynne, Y. Pediatric Drug Development Regulatory Considerations [Internet]. [cited 2023 Nov 26]. Available from:
https://www.fda.gov/media/100571/download
12. Gadge PM, Kenjale PP, Pokharkar VB, Gaikwad VL. Global Pediatric Regulations: An overview. Therapeutic Innovation & amp; Regulatory Science. 2019; 216847901986409. doi:10.1177/2168479019864090
13. Pediatric Drug Research: Studies Conducted under Best Pharmaceuticals for Children Act. 2007 [Internet]. [cited 2023 Dec 3]. Available from:
https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-07- 557/html/GAOREPORTS-GAO-07-557.htm .
14. Khurana M. Pediatric Drug Regulation. 2018; [Internet]. US FDA;2018 [cited 2023 Dec 3]. Available from:
https://cersi.umd.edu/sites/cersi.umd.edu/files/Khurana_Pediatric%20Drug%20Regulation.pdf.
15. Field MJ, Boat TF. Safe and effective medicines for children pediatric studies conducted under the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act. Washington: National Academies Press; 2012.
16. Center for Drug Evaluation and Research. Best Pharmaceuticals for Children Act (BPCA) [Internet]. FDA; [cited 2023 Dec 3]. Available from:
https://www.fda.gov/drugs/development-resources/best-pharmaceuticals-children-act-bpca.
17. Susan T. FDA’s Authority to Ensure That Drugs Prescribed to Children Are Safe and Effective [Internet]. FAS; 2012 [cited 2023 Dec 3]. Available from:
https://fas.org/sgp/crs/misc/RL33986.pdf
18. Center for Drug Evaluation and Research. Qualifying for pediatric exclusivity under Section 505A of the federal [Internet]. FDA; 2022 Mar 01 [cited 2023 Dec 3]. Available from:
https://www.fda.gov/drugs/development-resources/qualifying-pediatric-exclusivity-under-section-505a-federal-food-drug-and-cosmetic-act-frequently
19. Pediatric Exclusivity Granted List June 2021 [Internet]. FDA; 2023 May [cited 2023 Dec 3]. Available from:
https://www.fda.gov/media/132652/download .
20. Center for Drug Evaluation and Research. How to comply with the Pediatric Research Equity Act [Internet]. FDA; 2005 Sept [cited 2023 Dec 3]. Available from: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/how-comply-pediatric-research-equity-act
21. US Food & Drug Administration. New Pediatric Labeling Information Database. [Internet]. FDA; 2023 Dec [cited 2023 Dec 15]. Available from:
https://www.accessdata.fda.gov/scripts/sda/sdnavigation.cfm?sd=labelingdatabase
22. US Food & Drug Administration. FDA OVERVIEW OF THE PEDIATRIC LEGISLATION [Internet]. FDA;2019 Nov 21 [cited 2023 Dec 3]. Available from:
https://www.fda.gov/media/132890/download .
23. Guideline on good pharmacovigilance practices (GVP) Product- or Population-Specific Considerations IV: Paediatric population. [Internet]. EMA; 2018 [cited 2023 Dec 3]. Available from:
https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-good- pharmacovigilance-practices-gvp-product-population-specific-considerations-iv_en- 0.pdf .
24. Guideline on pharmaceutical development of medicines for paediatric use. [Internet]. EMA; 2013 [cited 2023 Dec 3] Available from:
https://www.ema.europa.eu/en/documents/scientific- guideline/guideline-pharmaceutical-development-medicines-paediatric-use_en.pdf .
25. Paediatric Committee (PDCO) - European Medicines Agency. [Internet]. EMA [cited 2023 Dec 3]. Available from: https://www.ema.europa.eu/en/committees/paediatric-committeepdco#:~:text=The%20Paediatric%20Committee%20(PDCO)%20is,expertise%20and%20defining%20paediatric%20needs
26. Paediatric investigation plans - European Medicines Agency. [Internet]. EMA [cited 2023 Dec 3]. Available from:
https://www.ema.europa.eu/en/human-regulatory/research- development/paediatric-medicines/paediatric-investigation-plans
27. Tomasi P. Key concepts of the paediatric regulation and latest developments [Internet]. EMA [cited 2023 Dec 3]. EMA. Available from:
https://www.ema.europa.eu/en/documents/presentation/presentation-key-concepts- paediatric-regulation-latest-developments-paolo-tomasi_en.pdf .
28. Paediatric medicine: Paediatric Investigation Plan. [Internet]. EMA [cited 2023 Dec 3]. Available from:
https://toolbox.eupati.eu/resources/paediatric-medicine-paediatric-investigation- plan/ .
29. Faulkner B, Delgado-Charro MB. Cardiovascular Paediatric Medicines Development: Have Paediatric Investigation Plans Lost Heart? Pharmaceutics. 2020;12(12):1176. doi:10.3390/pharmaceutics12121176
30. Paediatric-use marketing authorisation [Internet]. Wikipedia [cited 2023 Dec 3]. Available from:
https://en.wikipedia.org/wiki/Paediatric-use_marketing_authorisation
31. Paediatric-use marketing authorisations - European Medicines Agency [Internet]. [cited 2023 Dec 3].Available from:
https://www.ema.europa.eu/en/human- regulatory/marketing-authorisation/paediatric-medicines/paediatric-use-marketing- authorisations#:~:text=The%20PUMA%20was%20introduced%20by,developed%20fo r%20use%20in%20children.
32. Buccolam - European Medicines Agency [Internet]. EMA; 2011 Sept 19 [cited 2023 Dec 3]. Available from:
https://www.ema.europa.eu/en/medicines/human/EPAR/buccolam#authorisation- details-section .
33. Hemangiol - European Medicines Agency [Internet]. EMA; 2014 May 19 [cited 2023 Dec 3]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/hemangiol .
34. Sialanar - European Medicines Agency [Internet]. EMA; 2016 Sept 29 [cited 2023 Dec 3]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/sialanar
35. Alkindi - European Medicines Agency [Internet]. EMA; 2018 Mar 01 [cited 2023 Dec 3]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/alkindi
36. Kigabeq - European Medicines Agency [Internet]. EMA; 2023 Jul 07 [cited 202 3 Dec 3]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/kigabeq
37. Slenyto - European Medicines Agency [Internet]. EMA; 2011 Sept 19 [cited 2023 Dec 3]. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/slenyto
38. Medicines for children - Public Health - European Commission. [Internet]. EMA; 2020 [cited 2023 Dec 3]. Available from:
https://ec.europa.eu/health/human-use/paediatric-medicines_en
39. Chiaruttini G, Felisi M, Bonifazi D. Challenges in paediatric clinical trials: How to make it feasible. The Management of Clinical Trials;2018.
doi:10.5772/intechopen.72950
40. Overcoming the Complexities of Pediatric Clinical Trials - Kayentis [Internet]. Kayentis; 2020 Apr 02 [cited 2023 Dec 3]. Available from:
https://kayentis.com/overcoming-the-complexities-of-pediatrics-clinical-trials/
41. Hanumante NM, Ransubhe SP. Recruitment of babies in vaccine trial: A challenge. Indian J Child Health. 2019; 6(8):424-7. Available from:
https://mansapublishers.com/IJCH/article/view/1721 .
42. Effectively Addressing the Challenges of Pediatric Clinical Trials with Patient Centric Best Practices [Internet]. [cited 2023 Dec 3]. Available from:
https://www.firmaclinicalresearch.com/wpcontent/uploads/2019/11/Firma_WhitePaper
_Pediatric_update_v3.pdf .
43. 3 Steps to Effective Pediatric Recruitment and Retention [Internet]. [cited 2023 Dec 3]. Available from:
https://prahs.com/insights/3-steps-to-effective-pediatric-recruitment-and-retention .
44. Christoph H, Michael C, Jennifer C, Julia V, Lindsay S. Plan and Design with the Child in Mind: Global Pediatric Clinical Trials Network Recommendations and Insights for Sponsors of Pediatric Research [Internet]. DCRI; 2019 [cited 2023 Dec 04]. Available from:
https://dcri.org/wp-content/uploads/2019/11/GPTN-whitepaper_07nov2019.pdf
45. Fátima R. Paediatric Medicines: Formulation Considerations. Archives of Pharmacy and Pharmaceutical Sciences. 2017;1(1):024-027. Available from:
https://www.heighpubs.org/hps/apps-aid1004.php
46. Ivanovska V, Rademaker C, van Dijk L, Mantel-Teeuwisse A. Pediatric Drug Formulations: A Review of Challenges and Progress. PEDIATRICS. 2014;134(2):361-372. Available from:
https://pubmed.ncbi.nlm.nih.gov/25022739
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How to Cite
Sowmya, V. S., Y. Manjulatha, J. N. B. Indusekhar, and V. B. Raju. “A Comparative Review on the Regulatory Framework of Pediatric Drugs in the US and EU: Challenges and Recommendations”. International Journal of Drug Regulatory Affairs, Vol. 11, no. 4, Dec. 2023, pp. 74-86, doi:10.22270/ijdra.v11i4.635.