Drug efficacy pediatric patients

Children Not recommended for patients younger than 12 years of age. Safety and efficacy are not established for amoxapine in children younger than 16 years of age or trazodone or clomipramine in children younger than 10 years of age. The safety and efficacy of imipramine as temporary adjunctive therapy for nocturnal enuresis in pediatric patients younger than 6 years of age have not been established. The safety of the drug for long-term, chronic use as adjunctive therapy for nocturnal enuresis in pediatric patients 6 years of age and older has not been established. Safety and efficacy are not established in the pediatric age group for trimipramine, nortriptyline, protriptyline, and desipramine. 

In October 2005, Osiris received approval from the US Food and Drug Administration (FDA) to conduct a non-randomized, open-label, phase II clinical trial in adult and pediatric patients with treatment-refractory severe GVHD [628422]. By November 2005 the trial had begun, enrolling 30 patients and setting a planned completion date of January 2007. At the same time, a second phase II, double-blind, randomized, placebo-controlled clinical trial, expected to enroll 75 patients to assess the safety and efficacy of OTI-010 in acute gastrointestinal GVHD, was initiated by Osiris, with an expected completion date of April 2008 [www.clinicaltrials.gov], [632720]. 

Besides the pharmacokinetic differences previously identified between pediatric and older patients, factors related to drug efficacy and toxicity also should be considered in planning pediatric pharmacotherapy. Unique pathophysiologic changes occur in pediatric patients with some disease states. 

The differences in efficacy, toxicity, and protein binding of drugs in pediatric versus adult patients raise an important question about the acceptable therapeutic range in children. Therapeutic ranges for drugs are first established in adults and often are appfied directly to pediatric patients, but specific studies should be conducted in pediatric patients to define optimal therapeutic ranges of drugs. 

Many drugs can now be delivered rectally instead of by parenteral injection (intravenous route) or oral administration. Generally, the rectal delivery route is particularly suitable for pediatric and elderly patients who experience difficulty ingesting medication or who are unconscious. However, rectal bioavailabilities tend to be lower than the corresponding values of oral administration. The nature of the drug formulation has been shown to be an essential determinant of the rectal absorption profiles. The development of novel absorption enhancers with potential efficacy without mucosal irritation (low toxicity) is very important. The delivery of peptide and protein drugs by the rectal route is currently being explored and seems to be feasible. 

New England Journal of Medicine has pointed out, publication of an article on the unapproved use of a drug in a peer-reviewed journal is no guarantee of safety or efficacy.However, in some clinical situations, such as pediatrics, unlabeled uses may be rational and represent the most appropriate treatment for optimal patient care. 

In other cases, a new dosage formulation is required to satisfy a new market segment. Oral solutions and chewable tablets are beneficial for a pediatric population. A slow-release preparation (such as percutaneous patches) may be preferred in elderly patients taking multiple drugs if it allows once-daily (or less frequent) dosing. Trials demonstrating safety and efficacy of new formulations are often conducted in Phase IV and typically act as the supporting information for an sNDA. 

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