Paediatric Drug Development from a Labeling Perspective A detailed view on the European Summary of Product Characteristics with an exemplary comparison to the US Prescribing Information Wissenschaftliche Prüfungsarbeit zur Erlangung des Titels „Master of Drug Regulatory Affairs“ der Mathematisch-Naturwissenschaftlichen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn vorgelegt von Dr. Niklas Jänich aus Koblenz Bonn 2016 Abstract 2 Betreuer und 1. Referent: Dr. Birka Lehmann Zweiter Referent: Prof. Dr. Barbara Sickmüller Abstract 3 Abstract Triggered by legislative initiatives in the European Union and the United States in the last decade, pharmaceutical companies had to increase their efforts to investigate medicinal products also in the paediatric population. Therefore today’s drug development processes are accompanied with the assessment of possibilities for a therapeutic use in the paediatric population. This Master thesis aims to systematically investigate how the considerations related to paediatric development are translated into European prescribing information documents, i.e. Summary of Product Characteristics (SmPC), and what information is finally communicated to health care professionals via this medium. In order to achieve this, qualitative and quantitative criteria were established to associate information from SmPC documents with aspects relevant for the paediatric population. These criteria were then applied to a robust sample of SmPCs to yield over 600 datasets that were the basis for further analyses. The results of these analyses revealed a very clear picture on what information is communicated to health care professionals via the SmPCs. Information related to the paediatric population was gained for instance regarding the availability of information, different types of information or age ranges. Furthermore, an exemplary comparison to US prescribing information documents was performed. Table of Contents 4 Table of Contents Abstract ............................................................................................................. 3 Table of Contents .............................................................................................. 4 List of Figures ................................................................................................... 6 List of Tables ..................................................................................................... 7 Abbreviations .................................................................................................... 8 1 Introduction and Goal ............................................................................. 9 2 Paediatric legislation and relevant regulatory guidance in the European Union .................................................................................... 11 2.1 Paediatric Regulation1 ............................................................................. 11 2.2 Guideline on Summary of Product Characteristics2 ................................ 12 3 Assessment of Product Information Documents ............................... 16 3.1 5-year report to the European Commission on the experience acquired as a result of the application of the Paediatric Regulation ........ 17 3.2 Sample Determination ............................................................................. 19 3.2.1 Field “Authorisation Status” ..................................................................... 21 3.2.2 Fields “Is Generic” and “Biosimilar” ......................................................... 21 3.2.3 Field “Start of Procedure Date” ............................................................... 22 3.2.4 Field “Multiple Application” ...................................................................... 22 3.2.5 Field “Paediatric indication” ..................................................................... 23 3.2.6 Sample .................................................................................................... 23 3.3 Criteria for SmPC assessment ................................................................ 24 3.3.1 Availability of information with relation to the use in the paediatric population ............................................................................................... 24 3.3.1.1 Scenario 1 .......................................................................................... 25 3.3.1.2 Scenario 2 .......................................................................................... 26 3.3.1.3 Scenario 3 .......................................................................................... 26 3.3.1.4 Scenario 4 .......................................................................................... 26 3.3.2 Types of information on paediatric patients in the SmPC........................ 27 3.3.3 Attribution of age ranges to different pieces of information ..................... 27 3.3.4 Other criteria relevant for the SmPC assessment ................................... 28 3.3.5 Application of the criteria on SmPC documents ...................................... 28 3.4 Results and Discussion of the SmPC assessment ................................. 29 3.4.1 Medicinal products with no paediatric indication ..................................... 29 3.4.1.1 Therapeutic areas .............................................................................. 32 Table of Contents 5 3.4.1.2 Authorisation Date .............................................................................. 36 3.4.1.3 Scenario 2a – No data........................................................................ 37 3.4.1.4 Scenario 2b – Limited data ................................................................. 40 3.4.1.5 Scenario 3a – Should not be used / Scenario 3b – Contraindicated .. 44 3.4.1.6 Scenario 4 – Not relevant ................................................................... 46 3.4.2 Medicinal products with paediatric indication .......................................... 46 3.4.2.1 Availability of information with relation to the use in the paediatric population ............................................................................................... 46 3.4.2.2 Types of information on paediatric patients in the SmPC ................... 50 3.4.2.3 Attribution of age ranges .................................................................... 52 3.4.2.4 Therapeutic areas .............................................................................. 53 3.4.3 Dosage forms/strengths, Multiple indications and Age Ranges for Waivers/Deferrals ................................................................................... 54 3.4.3.1 Dosage forms/strengths ..................................................................... 54 3.4.3.2 Multiple indications ............................................................................. 55 3.4.3.3 Age Ranges for Waivers/Deferrals ..................................................... 55 3.5 Comparison of defined criteria between datasets for orphan medicinal products from the EU SmPC assessment and the corresponding US PI documents .......................................................................................... 56 3.5.1 Sample .................................................................................................... 56 3.5.2 Comparison ............................................................................................. 57 4 Conclusion and Outlook ....................................................................... 59 Annex I: Sample of Medicinal Products ........................................................ 61 Annex II: Detailed results of the EU SmPC assessment .............................. 74 Annex III: Results from the comparison of EU SmPCs and US PIs ............ 99 References ..................................................................................................... 102 List of Figures 6 List of Figures Figure 1: Sample determination ........................................................................ 21 Figure 2: Process for application of the criteria on SmPC documents .............. 28 Figure 3: Scenarios associated with medicinal products with no paediatric indication ................................................................................................ 30 Figure 4: Frequency of different combinations of multiple scenarios per medicinal product ................................................................................... 31 Figure 5: Proportion of scenarios in relation to the year of authorisation .......... 37 Figure 6: Distribution of waivers and deferrals in scenario 2a – no data ........... 39 Figure 7: Types of information provided on the paediatric population for scenario 2b – limited data ....................................................................... 41 Figure 8: Distribution of waivers and deferrals in scenario 2b – limited data ..... 42 Figure 9: Histogram with age distribution related to information from clinical efficacy/safety and pharmacokinetic studies ........................................... 44 Figure 10: Histogram with age distribution for restrictions of use ...................... 45 Figure 11: Scenarios associated to section 4.1 of the SmPC for medicinal products with paediatric indication .......................................................... 48 Figure 12: Scenarios associated to section 4.2 of the SmPC for medicinal products with paediatric indication .........................................................