20. dr. shanthi pal - world health organization
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“WHO Medicines Safety Programme: Pharmacovigilance and risk minimization programs for biological products” Illustrates the WHO work program on pharmacovigilance, with a focus on both small molecule chemically-synthesized medicines and biotherapeuticsTRANSCRIPT
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WHO Medicines Safety Programme: Pharmacovigilance and risk minimization programs
for biological products
Dr Shanthi PalMedicines Safety Programme Manager
Essential Medicines and Health Products, [email protected]
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Birth of modern pharmacovigilanceThalidomide – Phocomelia 1961
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16th World Health Assembly 1963
Assembly Resolution 16.36 - Clinical and Pharmacological Evaluation of Drugs
INVITES Member States to arrange for a systematic collection of information on serious adverse drug reactions observed during the development of a drug and, in particular, after its release for general use.
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WHO Programme for International Drug Monitoring
WHO-HQGeneva
WHO-HQGeneva
UMCWHO-CC Uppsala
UMCWHO-CC Uppsala
National Centres
UMC-A WHO-CC
Accra
UMC-A WHO-CC
AccraWHO-CC
RabatWHO-CC
Rabat
WHO-CCOsloATC DDD
WHO-CCOsloATC DDD
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Pharmacovigilance in WHO
1. Exchange of Information2. Policies, guidelines, normative activities3. Country support4. Collaborations5. Resource mobilisation
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Advisory Committee on Safety of Medicinal Products (ACSoMP)
The Advisory Committee on Safety of Medicinal Products shall provide advice on pharmacovigilance policy and issues related to the safety and effectiveness of medicinal products
to the relevant Assistant Director-General in WHO and through him / her
to the Collaborating Centres for the Medicines Safety Programme, and
to the Member States of WHO
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What defines it
The WHO PV strategy
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Understanding what's available and what's needed in countries
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Challenges to Pharmacovigilance
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Type of assistance needed
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WHO International Drug Monitoring ProgrammeSituation 1990
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WHO International Drug Monitoring ProgrammeSituation 2012
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WHO strategy
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Concept of genericsPatent expiry of medicines enables
GenericsCost savings because no need to invest in
further human trials for safety and efficacyCan use data from investigations with
innovator productsMore patients receive treatmentFurther investment in new medicines
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Global Fund HIV/AIDS CoverageAfter 9 Rounds of proposals
0 5,0002,500
Kilometers ´
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Traditional chemical medicinesrelatively smallStable moleculesNo need to repeat large-scale human trials
Safety monitoring is needed neverthelessUsed in 'other' environments & populations:
LMIC Comorbidities, nutritional effects, genetic
differencesLong-term effects
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Pharmacovigilance in Global Fund grants
A 2010 analysis of Grant applications in the Global Fund A 2010 analysis of Grant applications in the Global Fund database (R4 to R9) database (R4 to R9) Is PV mentioned?Does it set out to establish min PV requirements?
431 individual Global Fund Proposals31% had “acceptable reference to PV''Interviews: even if mentioned, PV not implemented in
practice
(Ref: Unpublished data, Pal, Xueref et al; 2010)
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Joint WHO/Global Fund pharmacovigilance strategy
Establish basic functions and minimum requirements of national pharmacovigilance system
Minimum PV requirements
pharmacovigilance toolkit to support training and development
www.PVToolkit.org
Strong wording in Round 10 requesting countries to include PV
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BiotherapeuticsGenerally large, complex moleculesproduced from living cells using
biotechnologycan pose rare but serious risks of unwanted
immune responsesRequire extensive testing and risk
management planning
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Similar biotherapeutic products (SBPs)Copies or 'generic' versions of biotherapeutic
products (SBP)Are not exact copies of innovator products
Due to manufacturing processUnlike other generics, can't rely on data for /
from innovator productsNeed sufficient proof of similarity to
innovator product (both preclinical laboratory testing and clinical trials
Risk management plans are also essential
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Guidance from WHODeveloped in 2009Published in 2010Based on EMA guidelines of 2006
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Pharmacovigilance of SBPsManufacturer required to submit
Safety specification and PV plan at the time of submission for approval
Safety specification should describe important identified or potential safety risks for RBP, the substance class and / or any that are specifc for the SBP
Risk minimization activities may be needed : education material for patients / HCP etc
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Post approval activities for SBPsDue to potential of SBPs to provoke immune reactions
manufacturers to undertake post marketing surveillance to the same standards as RBP MAH
Pharmacovigilance plan should includeSafety monitoring as required of corresponding RBPSafety monitoring for additional risks identified
SBP manufacturers required to have PV systems in place at approvalQualified PV personnelmeans to report to NRAs where the reactions occur
in place
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Traceability of Adverse eventsAEs may be product specificCritical information to assign AEs with
specific BPsADR report for any BP to include
INNProprietary or brand nameManufacturer's nameLot numberCountry of origin
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Number of reports/million inhabitants/yearReporting last 5 years
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Reports on Monoclonal antibodies (MABs) in WHO database (out of 8 million Individual Case Safety Reports, ICSRs)
TotalICSR 356787ICSRs with INN, trade names, indications
285327
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Reports by country (top 10)
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Top 5 ADRs with MAB in WHO databaseMedDRA_PT_name Number_of_ReportsFatigue 18208Drug ineffective 15879Headache 13543Dyspnoea 13100Pyrexia 13031
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CountryMAB
reportsUkraine 1Latvia 9Estonia 21Russian Federation 23Lithuania 55Serbia 73Slovenia 187
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SBPs provideAn opportunity to engage in PPP for PV in LMICMAH of generic and innovator biotherapeutics are
obliged to invest in PVGenerics are often used in LMICThrough PV of SBPs, possible to create PV systems
in LMICThat will be used also for other medicines (not only
SBP)Governments and Pvt industry should work out a
modelData on products (MAH & Regulator)PV System and PV capacity in country
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www.who.int/medicines/areas/quality_safety/safety_efficacy/en
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But we do need to build structures and best practices because…
Dying from a disease is sometimes unavoidable. But dying from an adverse drug event is unacceptable
Dr Vladimir Lepakhin, ex Assistant Director General, World Health Organization