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pt consultant to WHO | November 20071 |
Planning a BE StudyPlanning a BE StudyPlanning a BE StudyPlanning a BE Study
Training Program on Pharmaceutical Training Program on Pharmaceutical Quality, Good Manufacturing Quality, Good Manufacturing Practice and BioequivalencePractice and Bioequivalence
Jiaxing, Zhejiang, China
5 – 9 November 2007
Dr. Henrike Potthast ([email protected])
temporary advisor to WHO
pt consultant to WHO | November 20072 |
Guidance DocumentsGuidance DocumentsGuidance DocumentsGuidance Documents
WHO Working Document Multisource (Generic) Pharmaceutical Products: Guidelines on Registration Requirements to Establish Interchangeability
November 2005
EU “Note for Guidance on the Investigation of
Bioavailability and Bioequivalence”
CPMP/EWP/QWP/1401/98 and related guidances and documents (www.emea.eu.int/pdfs/human/ewp )
FDA - Guidance for Industry: “Bioavailability and Bioequivalence Studies for Orally Administered Drug Products – General Considerations” (Oct. 2000)
Canadian Guidance for Industry: “Conduct and Analysis of Bioavailability and Bioequivalence Studies – Part A: Oral Dosage Formulations used for systemic effects.” (1992)……………………….an related/others
pt consultant to WHO | November 20073 |
Some Background InformationSome Background InformationSome Background InformationSome Background Information
CTD
5.3 Clinical Study Reports
5.3.1 Biopharmaceutic Studies (bioavailability and bioequivalence; “what does the product do to the drug substance”)
5.3.2. + 5.3.3 Human Pharmacokinetic Studies
(in situ and in vivo; „what does the body do to the drug substance”)
5.3.4 Human Pharmacodynamic Studies („what does the drug substance do to the body“)
5.3.5 Efficacy and Safety Studies
pt consultant to WHO | November 20074 |
Planning a BE Study Planning a BE Study Some Background InformationSome Background Information
Planning a BE Study Planning a BE Study Some Background InformationSome Background Information
1. drugs are usually administered as dosage forms
2. the dosage form can affect drug bioavailability
3. differences in the pharmaceutical formulation can lead to different bioavailabilities
4. effects of formulation differences apply particularly to oral dosage forms and may be manifest at all stages of the absorption process
5. in vitro tests provide valuable information but are not necessarily a reliable guide to the bioavailability or therapeutic performance of the product
6. therapeutic equivalence between like formulations should not be assumed, unless therapeutic equivalence (bioequivalence) has been demonstrated in man; nor should therapeutic equivalence be assumed simply because therapeutic non-equivalence has not been reported
(nach D.N. Wade aus ‚Drug Treatment‘, Graeme S. Avery, 1980, Adis Press, Sydney))
pt consultant to WHO | November 20075 |
Planning a BE Study Planning a BE Study DefinitionsDefinitions
Planning a BE Study Planning a BE Study DefinitionsDefinitions
Bioavailability – rate and extent at which a drug substance... becomes available in the general system (product characteristic!)
Bioequivalence – equivalent bioavailability within pre-set acceptance ranges
Pharmaceutical equivalence Bioequivalence
Bioequivalence Therapeutic equivalence
pt consultant to WHO | November 20076 |
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
♦ „Two medicinal products are bioequivalent if they are pharmaceutically equivalent or pharmaceutical alternatives AND if their bioavailabilities after administration in the same molar dose are similar to such degree that their effects, with respect to both efficacy and safety, will be essentially the same.“
[section 2.4 of the EU guidance on BA and BE]
possible surrogate for full clinical/toxicological documentation
pt consultant to WHO | November 20077 |
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
♦ Bioequivalence is „…the absence of a significant difference in the rate and extent to which the active ingredient or active moiety in pharmaceutical equivalents or pharmaceutical alternatives becomes available at the site of drug action when administered at the same molar dose under similar conditions in an appropriately designed study.“
[FDA Guidance for Industry Bioavailability and Bioequivalence Studies for orally administered Drug Products-General Considerations March 2003]
pt consultant to WHO | November 20078 |
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
♦ „…Bioequivalence focuses on the equivalence of release of the active pharmaceutical ingredient from the pharmaceutical product and its subsequent absorption into the systemic circulation.“
[WHO Working Document Multisource (Generic) Pharmaceutical Products: Guidelines on Registration Requirements to Establish Interchangeability November 2005]
pt consultant to WHO | November 20079 |
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
Planning a BE StudyPlanning a BE Study DefinitionsDefinitions
♦ „….if the fraction of the dose absorbed is the same, the human body should always do the same with the absorbed compound …Even in a disease state, this argument is still a valid statement.“
[Faassen et al. Clin Pharmacokinet 43 (2004)1117]
what does the product do to the drug substance?
pt consultant to WHO | November 200710 |
Planning a BE studyPlanning a BE studyPlanning a BE studyPlanning a BE study
Bioequivalence Studies
in vivo comparison by means of volunteers serving as “in vivo dissolution model”
‘biological quality control’
comparison of product characteristics in order to ensure therapeutic equivalence
pt consultant to WHO | November 200711 |
Planning a BE StudyPlanning a BE Study Ethical ConsiderationsEthical Considerations Planning a BE StudyPlanning a BE Study Ethical ConsiderationsEthical Considerations
IEC / IRB: ICH Definition
An independent body of medical, scientific and non-scientific members
Responsibility is to ensure the protection of the rights, safety and well-being of human subjects involved in a trial
Among other things, reviewing, approving, and providing continuing review of trial protocol and amendments and of the methods and material to be used in obtaining and documenting informed consent of the trial subjects;
Independent “Risk-benefit” evalution
pt consultant to WHO | November 200712 |
Planning a BE StudyPlanning a BE Study Ethical ConsiderationsEthical ConsiderationsPlanning a BE StudyPlanning a BE Study
Ethical ConsiderationsEthical Considerations
Composition requirements ICH GCP
At least 5 members
At least one member whose primary area of interest is a non-scientific area
At least one member who is independent of the trial site
Members without conflicting interest
Only those members independent of the investigator and the sponsor should review on a trial-related matter
pt consultant to WHO | November 200713 |
Planning a BE StudyPlanning a BE Study Ethical considerationsEthical considerationsPlanning a BE StudyPlanning a BE Study
Ethical considerationsEthical considerations
e.g. additional US FDA requirement for IRB composition:
Diverse backgrounds (race, gender, cultural, qualification)
Not entirely one gender
Special expertise may be invited but without voting rights
pt consultant to WHO | November 200714 |
Planning a BE StudyPlanning a BE Study Ethical ConsiderationsEthical ConsiderationsPlanning a BE StudyPlanning a BE Study
Ethical ConsiderationsEthical Considerations
Required documents
Protocol (signed at least by the principal investigator)
Patient Information Sheet/Consent Form
Investigator´s Brochure
Subject recruitement procedures (e. g. advertisements)
pt consultant to WHO | November 200715 |
Planning a BE StudyPlanning a BE Study Ethical ConsiderationsEthical ConsiderationsPlanning a BE StudyPlanning a BE Study
Ethical ConsiderationsEthical Considerations
Approval notification to Investigator as part of study report
Timely written approval- Identification of study (title, protocol number, version, investigator, site)- Specify all items reviewed- Date & place of review- Trial/study related decisions- Reasons for modifications & disapprovals
Minimum information required by ICH-GCP:
Date of the meeting
Documents reviewed (versions & dates)
List of members
pt consultant to WHO | November 200716 |
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
pt consultant to WHO | November 200717 |
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
♦ „A document that describes the objective(s), design, methodology, statistical consideration and organisation of a trial. It usually gives the background and rationale of the trial …“
Ref.: ICH GCP Guidance
pt consultant to WHO | November 200718 |
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
General Information/Title Page
♦ Title
♦ Protocol Number
♦ Version Number/Date
♦ Sponsor Details♦ Name, Address, Telephone♦ Monitor/Medical Personnel
Responsibilities!
pt consultant to WHO | November 200719 |
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
General Information/Title Page contd.
♦ Investigator Details♦ Principal Investigator, Medical Doctor
♦ Other Laboratory/Institution Details
Responsibilities!
pt consultant to WHO | November 200720 |
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
Planning a BE StudyPlanning a BE Study Study ProtocolStudy Protocol
Protocol Development
Definition of Responsibilities
Organisation, premises, personnel & QMS
Clinical phase (timely data transfer ensured?)
Bioanalytical phase (timely data transfer ensured?)
Statistics and reporting (timely data transfer ensured?)
Archival
pt consultant to WHO | November 200721 |
Planning a BE StudyPlanning a BE Study Protocol DevelopmentProtocol DevelopmentPlanning a BE StudyPlanning a BE Study
Protocol DevelopmentProtocol Development
Drug substance / Drug products
basic knowledge about particularities e.g.
pharmacokinetics (t1/2, peak concentration, time of peak concentration, metabolism, variability?…)
practicability of roughly anticipated measurement period and/or wash-out period (crossover study possible?)
pt consultant to WHO | November 200722 |
Planning a BE StudyPlanning a BE Study Protocol DevelopmentProtocol DevelopmentPlanning a BE StudyPlanning a BE Study
Protocol DevelopmentProtocol Development
Drug substance / Drug products
basic knowledge about particularities e.g.
important side effects (acceptable for healthy volunteers, concomitant medication necessary, acceptable regarding evaluation (e.g. vomiting); acceptable for women with childbearing potential?)
pt consultant to WHO | November 200723 |
Planning a BE StudyPlanning a BE Study Protocol DevelopmentProtocol DevelopmentPlanning a BE StudyPlanning a BE Study
Protocol DevelopmentProtocol Development
Drug substance / Drug products
basic knowledge about particularities e.g.
concept of bioanalytical method available?
plasma concentrations sufficiently quantifiable (LOQ) – e.g. administration of more than one dosage form necessary/possible?
pt consultant to WHO | November 200724 |
Planning a BE StudyPlanning a BE Study Protocol DevelopmentProtocol DevelopmentPlanning a BE StudyPlanning a BE Study
Protocol DevelopmentProtocol Development
Drug Products
Availability
Certification Content In vitro dissolution
Preparation of investigative products per volunteer acc. to GMP
Protocol amendment for product details frequently necessary
(e. g. labeling)
pt consultant to WHO | November 200725 |
Planning a BE StudyPlanning a BE Study Protocol DevelopmentProtocol DevelopmentPlanning a BE StudyPlanning a BE Study
Protocol DevelopmentProtocol Development
Drug Products
batch size pilot batch? commercial batch?
not smaller than 100 000 units or 10 % of industrial batch size (whichever is higher)
pt consultant to WHO | November 200726 |
Planning a BE StudyPlanning a BE Study Protocol DevelopmentProtocol DevelopmentPlanning a BE StudyPlanning a BE Study
Protocol DevelopmentProtocol Development
Drug Products
assay
close to label claim difference regarding the content of the investigative
products (T and R) should preferably not be more
than 5 %
pt consultant to WHO | November 200727 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Selection of subjects
participation of healthy volunteers (“in vivo model”) reasonable inclusion and exclusion criteria (protocol and
CRFs) comprehensive verbal and written information and informed
consent volunteers´ insurance reimbursement
pt consultant to WHO | November 200728 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Selection of subjects
males or females or both gender? “…the sponsor may wish to include
both…”(WHO)
pt consultant to WHO | November 200729 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Selection of subjects
Safe contraception for women (cave: interferences of contraceptives with investigative drug excluded?)
Phenotyping of volunteers (cave: possible side effects with e.g. “poor metabolisers” may cause drop-outs; variability reduction/explanation; fast and slow metabolizers evenly distributed in parallel group designs)
pt consultant to WHO | November 200730 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Selection of subjects♦ description of volunteers; smoker, vegetarian, phenotyping….
♦ verifying health of volunteers ( e. g. ECG, clinical blood chemistry, blood pressure…)
♦ number of volunteers depending on variability; at least 12 (EU: healthy, 18-55y; FDA: both sexes, > 18y)
♦ randomisation
objective: minimising interindividual variability in order to detect product differences!
pt consultant to WHO | November 200731 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Number of subjects
Required sample size depends on intra-individual variability either known through reasonable literature or by means of a pilot study
“low” variability: ~ 12 – 20 volunteers“high” variability: ~ 24 – 26 (plus) volunteers
pt consultant to WHO | November 200732 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Number of subjects ctd.
Required sample size depends on the expected mean difference between the test and reference formulation
For sample size calculation see also literature data (e.g. Eur J Drug Metab Pharmacokinet 30 (2005) 41; J Biopharm Stat 13 (2003) 529; Stat Med 18 (1999) 93 …)
Consideration of possible withdrawals
pt consultant to WHO | November 200733 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Number of subjects ctd.
Required sample size depends on the desired significance and power level
For sample size calculation see literature data (e.g. Eur J Drug Metab Pharmacokinet 30 (2005) 41; J Biopharm Stat 13 (2003) 529; Stat Med 18 (1999) 93 …)
pt consultant to WHO | November 200734 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Number of subjects
“The number of subjects to be used in the study should be estimated by considering the standards that must be passed. It should be calculated by appropriate methods (…). The number of recruited subjects should always be justified with the sample size calculation provided in the study protocol. A minimum of 12 subjects is required.”
WHO – working document on multisource (generic) pharmaceutical products (QAS/04.093)
pt consultant to WHO | November 200735 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Subject withdrawals subject must adhere to study requirements…
…however … they are free to break off at any time! definition of “drop-outs” in the protocol (reason,
reimbursement policy, handling of data, follow-up…) concomitant medication reporting
pt consultant to WHO | November 200736 |
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Planning a BE StudyPlanning a BE Study Study SubjectsStudy Subjects
Subject withdrawals contd…
subject must adhere to study requirements but …
define a time frame regarding vomiting depending also on pharmacokinetics of the drug substance, e.g. volunteers must be withdrawn in case vomiting occurs within 4 h postdose
“pre-specify!!”
pt consultant to WHO | November 200737 |
Planning a BE StudyPlanning a BE Study Study DesignStudy Design
Planning a BE StudyPlanning a BE Study Study DesignStudy Design
Randomization to a Crossover-design
“latin square” / balanced / randomized
Intra-individual comparison!
Parallel group design
Replicate design
Volunteer Period 1 Period 2
1 A B
2 B A
… … …
pt consultant to WHO | November 200738 |
Planning a BE StudyPlanning a BE Study Study DesignStudy Design
Planning a BE StudyPlanning a BE Study Study DesignStudy Design
others e.g.,
Parallel group design
Replicate design
pt consultant to WHO | November 200739 |
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Procedure of drug intake
time of administration (fasted or fed state)
liquid volume
traceability of administrations
cave: e.g. granules, suspensions liquid formulations!
(require ‘method sheet’)
pt consultant to WHO | November 200740 |
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Fasted state e.g.
Confinement of subjects at least 10 h prior to drug administration
Last food intake ~10 h prior to drug intake
No food or fluids ~2 h prior to drug intake
Drug administration with ~150-200 ml (e.g.) water
Light standardized meal not before ~4 h post-dose
pt consultant to WHO | November 200741 |
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Standardized fluid and food intake (time, composition, amount)
Prohibition of alcohol Restriction of xanthins (coffee*, tea, coke, chocolate, chewing
gum, grapefruit….)
Standardized posture
Restriction of physical activities
…
*cave: withdrawal may cause headache
pt consultant to WHO | November 200742 |
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Planning a BE StudyPlanning a BE Study StandardisationStandardisation
Fed state
Define time of drug administration and food intake, (e. g. drug intake within 30 min. before, immediately before or after the standardised meal)
High fat meal may serve to investigate the „worst case“ scenario
pt consultant to WHO | November 200743 |
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
♦ Sampling
♦ number of samples ♦ sampling times (Cmax!)♦ time of sampling (extrapolated AUC max. 20 %)♦ wash-out-phase (not less than 5 half-lives)
knowledge of basic pharmacokinetics of the particulardrug substance is inevitable!
objective: characterisation of ‚drug input‘!(see e.g. sect. 3.1 of the EU guidance 1401/98)
pt consultant to WHO | November 200744 |
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
Sampling times
appr. 3 – 4 to describe drug “input” appr. 3 sampling times around peak concentration appr. 3 – 4 to describe elimination
Minimum!
pt consultant to WHO | November 200745 |
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
Number of samples
sufficient to “describe” at least 80 % of total AUC
usually ~12– 18 samples (minimum)
pt consultant to WHO | November 200746 |
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
pt consultant to WHO | November 200747 |
Planning a BE StudyPlanning a BE StudyPlanning a BE StudyPlanning a BE Study
pt consultant to WHO | November 200748 |
Planning a BE StudyPlanning a BE StudyPlanning a BE StudyPlanning a BE Study
Verapamil; BE study; Govi-Verlag 1989
pt consultant to WHO | November 200749 |
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
„…Cmax is affected by the sampling points of truncated screening protocol. As isoniazid and pyrazinamide are highly soluble and highly permeable molecules resulting in rapid absorption….Cmax should be carefully evaluated…..AUC was found to be a robust parameter unaffected by sampling points….“
[Panchagnula et al., Pharmacol Res 48 (2003) 383]
pt consultant to WHO | November 200750 |
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
Panchagnula et al., Pharmacol Res 48 (2003) 383
pt consultant to WHO | November 200751 |
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
Panchagnula et al., Pharmacol Res 48 (2003) 383
pt consultant to WHO | November 200752 |
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
Planning a BE StudyPlanning a BE Study Exceptional CasesExceptional Cases!!
„The comparative Spearman‘s correlation analysis on the pharmacokinetic parameters Cmax, AUCt and AUCinf … showed that the 11 time points, namely 0, 0.25, 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, and 8 h, were sufficient for demonstration of comparative bioavailability and bioequivalence of INH, RMP, PZA, and EMB, and that a schedule of six time points…..is not adequately reliable for determining the bioavailability and bioequivalence of anti-tuberculosis FDCs.“
[Gabriels et al., Int J Tuberc Lung Dis 11 (2007) 181]
pt consultant to WHO | November 200753 |
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
Planning a BE StudyPlanning a BE Study Study SamplesStudy Samples
Wash-out-phase
must be long enough to avoid residual concentrations
closely related to the limit of quantitation
metabolites may be considered
pt consultant to WHO | November 200754 |
Planning a BE StudyPlanning a BE Study SamplingSampling
Planning a BE StudyPlanning a BE Study SamplingSampling
Blood withdrawal equipment (consider bioanalytical method)
Preparation of plasma or serum volume cooling anticoagulant centrifugation aliquotation labeling freezing transport…
pt consultant to WHO | November 200755 |
Planning a BE StudyPlanning a BE Study Bioanalytical MethodBioanalytical MethodPlanning a BE StudyPlanning a BE Study Bioanalytical MethodBioanalytical Method
The protocol should state
the bioanalytical method/detection the limit of quantitation (1/10 of the expected peak concentration
should be measurable)
the validation concept whether metabolites are to be considered
pt consultant to WHO | November 200756 |
Planning a BE StudyPlanning a BE Study CalculationsCalculations
Planning a BE StudyPlanning a BE Study CalculationsCalculations
The protocol should state (-among others-)
the transfer of bioanalytical results for biostatistical calculations
the handling of missing data
the handling of digits
pt consultant to WHO | November 200757 |
Planning a BE StudyPlanning a BE Study CalculationsCalculations
Planning a BE StudyPlanning a BE Study CalculationsCalculations
The protocol should state (-among others-)
calculation procedure/methods
characteristics (e.g. AUC, Cmax…)
possible consideration of differences of drug content
acceptance ranges – widening acceptable?!
pt consultant to WHO | November 200758 |
Planning a BE StudyPlanning a BE Study CalculationsCalculations
Planning a BE StudyPlanning a BE Study CalculationsCalculations
single dose studies
reg. characteristics
AUC – extent of bioavailability (calculated by means of ‚trapezoidal rule‘)
AUCt – for single dose studies (t = last quantifiable concentration)
AUCinf – AUCt extrapolated to infinity (‚total exposure‘)
‚exposure‘
pt consultant to WHO | November 200759 |
Planning a BE StudyPlanning a BE Study CalculationsCalculations
Planning a BE StudyPlanning a BE Study CalculationsCalculations
single dose studies
‚rate‘ of bioavailability
Cmax – observed maximum concentration (peak exposure)
tmax – time at which maximum concentration occurs
pt consultant to WHO | November 200760 |
Planning a BE StudyPlanning a BE Study Calculations Calculations
Planning a BE StudyPlanning a BE Study Calculations Calculations
multiple dose studies
direct switching vs. wash-out
primary characteristics (e.g. AUCtau, Cmax, Cmin…)
consideration of fluctuation (e.g. Ptf…)
compare Cmin to ensure steady-state
pt consultant to WHO | November 200761 |
Planning a BE StudyPlanning a BE Study - Adverse Events - Adverse EventsPlanning a BE StudyPlanning a BE Study - Adverse Events - Adverse Events
Definitions and handling/information
Evaluation of seriousness Evaluation of relation to investigative drugs
Treatment (cave: concomitant drug intake should be tested ‘a priori’ for possible analytical interferences)
serious but not study drug related
pt consultant to WHO | November 200762 |
Planning a BE StudyPlanning a BE StudyPlanning a BE StudyPlanning a BE Study
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