Advancing research and development of anti-infectives for children with a focus on antiretroviral therapy: A clinical development perspective.

Autor: Buchanan AM; ViiV Healthcare, Durham, NC, USA., Bekker A; Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa., Chandasana H; GSK, Collegeville, PA, USA., DeMasi R; ViiV Healthcare, Durham, NC, USA., Lulic Z; GSK, Brentford, Middlesex, UK., Ernest T; GSK, Ware, Hertfordshire, UK., Brothers C; ViiV Healthcare, Durham, NC, USA., Min S; ViiV Healthcare, Durham, NC, USA., Ruel T; Division of Pediatric Infectious Diseases and Global Health, Department of Pediatrics, University of California, San Francisco, CA, USA., Tan LK; ViiV Healthcare, Brentford, Middlesex, UK. Electronic address: lionel.x.tan@viivhealthcare.com.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2024 Oct; Vol. 64 (4), pp. 107306. Date of Electronic Publication: 2024 Aug 13.
DOI: 10.1016/j.ijantimicag.2024.107306
Abstrakt: The HIV treatment landscape for adults has progressed dramatically in recent decades; however, paediatric populations continue to experience delayed and limited access to effective and safe antiretroviral therapy options. Despite current incentive programmes, formulation research and development and approved drug dosing for children have been limited, particularly for neonates (aged <4 wk). Regulatory approval of drug formulations and dosing in children may lag behind adult approvals by years. Formulation and trial design adjustments complicate paediatric drug development, all of which are vital to accommodate for physiological differences, organ maturation, and rapid weight gain, which are most significant in the youngest children. To facilitate more rapid anti-infective drug development for paediatric populations, regulatory agencies provide guidelines that include extrapolating efficacy and safety data from relevant populations; using pharmacokinetic (PK) bridging and modelling to reduce sample sizes and limit the number of PK studies needed before efficacy analyses; and enrolling age- or weight-based cohorts in parallel rather than sequentially for clinical trials. Ensuring access to approved drugs poses an additional challenge, as uncertainty in demand leads to manufacturing and supply complexity with potentially higher costs that can be a barrier to uptake. Here we summarise challenges in drug development for children living with HIV, which are not unique to antiretrovirals. We aim to propose strategies for how model-based approaches and global partnerships can overcome some of these barriers to accelerate paediatric drug development, with particular reference to HIV, and how lessons learnt from HIV could be extended to other anti-infectives.
Competing Interests: Declaration of competing interests AMB, HC, RD, ZL, TE, CB, SM, and LKT are employees of ViiV Healthcare or GSK and own stock in GSK. AB serves on advisory boards pertaining to long-acting cabotegravir for post-natal prophylaxis and dolutegravir product rollout for ViiV Healthcare. TR has no conflicts to disclose.
(Copyright © 2024 ViiV Healthcare. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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