Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-20T00:48:50.524Z Has data issue: false hasContentIssue false

Paediatric cardiovascular clinical trials: an analysis of ClinicalTrials.gov and the Food and Drug Administration Pediatric Drug Labeling Database*

Published online by Cambridge University Press:  17 September 2015

Kevin D. Hill*
Affiliation:
Duke University Medical Center, Durham, North Carolina, United States of America Duke Clinical Research Institute, Durham, North Carolina, United States of America
Heather T. Henderson
Affiliation:
Duke University Medical Center, Durham, North Carolina, United States of America
Christoph P. Hornik
Affiliation:
Duke University Medical Center, Durham, North Carolina, United States of America Duke Clinical Research Institute, Durham, North Carolina, United States of America
Jennifer S. Li
Affiliation:
Duke University Medical Center, Durham, North Carolina, United States of America Duke Clinical Research Institute, Durham, North Carolina, United States of America
*
Correspondence to: K. D. Hill, MD MSCI, DUMC, Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, NC 27105, United States of America. Tel: +919 668 8305; Fax: +919 681 8927; E-mail: kevin.hill@duke.edu

Abstract

Recent regulatory initiatives in the United States of America and Europe have transformed the paediatric clinical trials landscape by significantly increasing capital investment and paediatric trial volume. The purpose of this manuscript was to review the impact of these initiatives on the paediatric cardiovascular trials landscape when compared with other paediatric sub-specialties. We also evaluate factors that may have contributed to the success or failure of recent major paediatric cardiovascular trials so as to inform the optimal design and conduct of future trials in the field.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at Johns Hopkins All Children’s Heart Institute, International Pediatric Heart Failure Summit, Saint Petersburg, Florida, United States of America, 4–5 February, 2015.

References

1. Wilson, JT. An update on the therapeutic orphan. Pediatrics 1999; 104 (3 Pt 2): 585590.CrossRefGoogle ScholarPubMed
2. Shah, SS, Hall, M, Goodman, DM, et al. Off-label drug use in hospitalized children. Arch Pediatr Adolesc Med 2007; 161: 282290.CrossRefGoogle ScholarPubMed
3. Sutherell, JS, Hirsch, R, Beekman, RH 3rd. Pediatric interventional cardiology in the United States is dependent on the off-label use of medical devices. Congenit Heart Dis 2010; 5: 27.CrossRefGoogle ScholarPubMed
4. Breslow, LH. The Best Pharmaceuticals for Children Act of 2002: the rise of the voluntary incentive structure and congressional refusal to require pediatric testing. Harvard J Legis 2003; 40: 133193.Google ScholarPubMed
5. Field, M, Boat, TF (eds). Safe and Effective Medicines for Children. Pediatric Studies Conducted Under the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act, 1st edn. The National Academies Press, Washington, DC, 2012.Google Scholar
6. Ward, RM, Kauffman, R. Future of pediatric therapeutics: reauthorization of BPCA and PREA. Clin Pharmacol Ther 2007; 81: 477479.CrossRefGoogle ScholarPubMed
7. Food and Drug Administration. Status Report to Congress on the Pediatric Exclusivity Provision, 2001. Retrieved December 30, 2014, from http://www.fda.gov/downloads/drugs/developmentapprovalprocess/developmentresources/ucm049915.pdf Google Scholar
8. United States Food and Drug Administration. Full Text of Best Pharmaceuticals for Children Act, 2002. Retrieved December 30, 2014, from http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/ucm148011.htm Google Scholar
9. United States Food and Drug Administration. Full Text of Food and Drug Administration Amendments Act of 2007, 2007. Retrieved December 30, 2014, from http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/FoodandDrugAdministrationAmendmentsActof2007/FullTextofFDAAALaw/default.htm Google Scholar
10. Berrington de Gonzalez, A, Mahesh, M, Kim, KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009; 169: 20712077.CrossRefGoogle ScholarPubMed
11. Hill, KD, Smith, PB, Cohen-Wolkowiez, M, Benjamin, DK, Li, JS. Pediatric exclusivity and other contemporary regulatory changes: impact on pediatric drug study, labeling and safety. Clin Invest 2013; 3: 227239.CrossRefGoogle Scholar
12. United States Food and Drug Administration. List of dugs granted pediatric exclusivity. Retrieved December 24, 2013, from http://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/UCM223058.pdf Google Scholar
13. United States Food and Drug Administration. Breakdown of Food and Drug Administration Amendments Act (FDAAA) Completed Pediatric Studies. Retrieved 30 December, 2014, from http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/ucm190622.htm Google Scholar
14. European Medicines Agency. Five-year Report to the European Commission: General report on the experience acquired as a result of the application of the Paediatric Regulation. Retrieved 27 December, 2014, from http://ec.europa.eu/health/files/paediatrics/2012-09_pediatric_report-annex1-2_en.pdf Google Scholar
15. Li, JS, Eisenstein, EL, Grabowski, HG, et al. Economic return of clinical trials performed under the pediatric exclusivity program. JAMA 2007; 297 (5): 480488.CrossRefGoogle ScholarPubMed
16. Pasquali, SK, Lam, WK, Chiswell, K, Kemper, AR, Li, JS. Status of the pediatric clinical trials enterprise: an analysis of the US ClinicalTrials.gov registry. Pediatrics 2012; 130 (5): e12691277.CrossRefGoogle ScholarPubMed
17. Hill, KD, Chiswell, K, Califf, RM, Pearson, G, Li, JS. Characteristics of pediatric cardiovascular clinical trials registered on ClinicalTrials.gov. American heart journal 2014; 167 (6): 921929 e922.CrossRefGoogle ScholarPubMed
18. Food and Drug Administration. Status Report to Congress on the Pediatric Exclusivity Provision, 2001. http://www.fda.gov/downloads/drugs/developmentapprovalprocess/developmentresources/ucm049915.pdf Google Scholar
19. Aisenberg, AC. Problems in Hodgkin’s disease management. Blood 1999; 93 (3): 761779.CrossRefGoogle ScholarPubMed
20. United States Food and Drug Administration. Full text of Food and Drug Administration Modernization Act. Retrieved December 24, 2014, from http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/FDAMA/FullTextofFDAMAlaw/default.htm Google Scholar
21. De Angelis, C, Drazen, JM, Frizelle, FA, et al. Clinical trial registration: a statement from the International Committee of Medical Journal Editors. N Engl J Med. 2004; 351 (12): 12501251.CrossRefGoogle ScholarPubMed
22. United States Food and Drug Administration. New Pediatric Drug Labeling Information Database. Retrieved December 30, 2014, from http://www.accessdata.fda.gov/scripts/sda/sdNavigation.cfm?sd=labelingdatabase Google Scholar
23. Califf, RM, Zarin, DA, Kramer, JM, Sherman, RE, Aberle, LH, Tasneem, A. Characteristics of clinical trials registered in ClinicalTrials.gov, 2007–2010. JAMA. 2012, 307 (17) 1838–1847.Google Scholar
24. Saul, JP, Ross, B, Schaffer, MS, et al. Pharmacokinetics and pharmacodynamics of sotalol in a pediatric population with supraventricular and ventricular tachyarrhythmia. Clin Pharmacol Ther. 2001; 69 (3): 145157.CrossRefGoogle Scholar
25. Saul, JP, Schaffer, MS, Karpawich, PP, et al. Single-dose pharmacokinetics of sotalol in a pediatric population with supraventricular and/or ventricular tachyarrhythmia. Journal of clinical pharmacology 2001; 41 (1): 3543.CrossRefGoogle ScholarPubMed
26. Benjamin, DK Jr., Smith, PB, Jadhav, P, et al. Pediatric antihypertensive trial failures: analysis of end points and dose range. Hypertension 2008; 51 (4): 834840.CrossRefGoogle ScholarPubMed
27. Shaddy, RE, Boucek, MM, Hsu, DT, et al. Carvedilol for children and adolescents with heart failure: a randomized controlled trial. JAMA 2007; 298 (10): 11711179.CrossRefGoogle ScholarPubMed
28. United States Food and Drug Administration. Medical, Statistical, and Clinical Pharmacology Reviews of Pediatric Studies Conducted under Section 505A and 505B of the Federal Food, Drug, and Cosmetic Act, as amended by the FDA Amendments Act of 2012 (FDASIA). Retrieved Apil 14, 2015, from http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/ucm316937.htm.Google Scholar
29. Barst, RJ, Ivy, DD, Gaitan, G, et al. A randomized, double-blind, placebo-controlled, dose-ranging study of oral sildenafil citrate in treatment-naive children with pulmonary arterial hypertension. Circulation 2012; 125 (2): 324334.CrossRefGoogle ScholarPubMed
30. Barst, RJ, Beghetti, M, Pulido, T, et al. STARTS-2: long-term survival with oral sildenafil monotherapy in treatment-naive pediatric pulmonary arterial hypertension. Circulation 2014; 129 (19): 19141923.CrossRefGoogle ScholarPubMed
31. European Medicines Agency. Assessment Report for Revatio. Retrieved December 26, 2014, from http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Assessment_Report_-_Variation/human/000638/WC500107804.pdf Google Scholar
32. United States Food and Drug Administration. Drug Safety Communication. Retrieved April 14, 2015, from http://www.fda.gov/Drugs/DrugSafety/ucm390876.htm Google Scholar
33. Wessel, DL, Berger, F, Li, JS, et al. Clopidogrel in infants with systemic-to-pulmonary-artery shunts. N Engl J Med. 2013; 368 (25): 23772384.CrossRefGoogle ScholarPubMed
34. Felker, GM, Maisel, AS. A global rank end point for clinical trials in acute heart failure. Circulation. Heart failure 2010; 3 (5): 643646.CrossRefGoogle ScholarPubMed