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E-grāmata: Ethical and Scientific Issues in Studying the Safety of Approved Drugs

  • Formāts: 292 pages
  • Izdošanas datums: 30-Jul-2012
  • Izdevniecība: National Academies Press
  • Valoda: eng
  • ISBN-13: 9780309218146
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  • Formāts: 292 pages
  • Izdošanas datums: 30-Jul-2012
  • Izdevniecība: National Academies Press
  • Valoda: eng
  • ISBN-13: 9780309218146

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An estimated 48 percent of the population takes at least one prescription drug in a given month. Drugs provide great benefits to society by saving or improving lives. Many drugs are also associated with side effects or adverse events, some serious and some discovered only after the drug is on the market. The discovery of new adverse events in the postmarketing setting is part of the normal natural history of approved drugs, and timely identification and warning about drug risks are central to the mission of the Food and Drug Administration (FDA). Not all risks associated with a drug are known at the time of approval, because safety data are collected from studies that involve a relatively small number of human subjects during a relatively short period.



Written in response to a request by the FDA, Ethical and Scientific Issues in Studying the Safety of Approved Drugs discusses ethical and informed consent issues in conducting studies in the postmarketing setting. It evaluates the strengths and weaknesses of various approaches to generate evidence about safety questions, and makes recommendations for appropriate followup studies and randomized clinical trials. The book provides guidance to the FDA on how it should factor in different kinds of evidence in its regulatory decisions.



Ethical and Scientific Issues in Studying the Safety of Approved Drugs will be of interest to the pharmaceutical industry, patient advocates, researchers, and consumer groups.

Table of Contents



Front Matter Abstract Summary 1 Introduction 2 Incorporating Benefit and Risk Assessment and BenefitRisk Management into Food and Drug Administration Decision-Making 3 Evidence and Decision-Making 4 Selection and Oversight of Required Postmarketing Studies 5 Synthesis Appendix A: Other Elements of the Food and Drug Administration Amendments Act Appendix B: Committee's Letter Report Appendix C: Open Session Agendas Appendix D: Decision Conferencing and Multicriteria Decision Analysis Appendix E: Benefit and Risk Assessment and Management Plan Document Template Appendix F: Committee Biosketches
Abstract 1(2)
Summary 3(26)
Charge to the Committee
4(1)
Committee's Approach to Its Charge
4(1)
Benefit--Risk Assessment and Management Throughout a Drug's Lifecycle
4(3)
Evidence and Decision-Making
7(1)
Selection and Oversight of Required Postmarketing Studies
8(3)
Responses to the Charge Questions
11(3)
Findings and Recommendations
14(15)
1 Introduction
29(32)
The Evolution of the Food and Drug Administration's Responsibilities in the Postmarketing Setting
30(16)
The Context of This Report
46(1)
Charge to the Committee
47(3)
The Committee's Approach to Its Charge
50(6)
Overview of the Report
56(1)
References
57(4)
2 Incorporating Benefit and Risk Assessment and Benefit--Risk Management into Food and Drug Administration Decision-Making
61(60)
Evaluating Benefit and Risk Over a Drug's Lifecycle
61(2)
Three-Stage Framework for Regulatory Decision-Making
63(31)
Benefit and Risk Assessment and Management Plan Document
94(4)
Special Considerations in the Decision of Whether to Require a Postmarketing Study
98(11)
Summary
109(1)
Findings and Recommendations
109(4)
References
113(8)
3 Evidence and Decision-Making
121(48)
Statistical Inference and Decision-Making
122(6)
Why Scientists Disagree
128(28)
Implications for Regulatory Decisions: The Importance of Understanding the Sources of Disagreements
156(1)
Reproducible Research, Data Sharing, and Transparency
157(1)
Findings and Recommendations
158(4)
References
162(7)
4 Selection and Oversight of Required Postmarketing Studies
169(44)
The Postmarketing Context
170(3)
Requiring Observational Studies and Randomized Controlled Trials
173(8)
Design, Analytic, and Ethical Considerations in Selecting Specific Observational and RCT Designs to Require
181(6)
The Food and Drug Administration's Ethical Obligations Regarding the Conduct and Oversight of Required Postmarketing Studies
187(14)
Summary
201(1)
Findings and Recommendations
202(5)
References
207(6)
5 Synthesis
213(14)
Responses to the Charge Questions
214(12)
References
226(1)
APPENDIXES
A Other Elements of the Food and Drug Administration Amendments Act
227(4)
B Committee's Letter Report
231(20)
C Open Session Agendas
251(4)
D Decision Conferencing and Multicriteria Decision Analysis
255(6)
E Benefit and Risk Assessment and Management Plan Document Template
261(8)
F Committee Biosketches
269