Regulatory Considerations in the Development of Therapies for Diabetic Nephropathy and Related Conditions

  • G. Alexander Fleming

Abstract

The importance of regulation in the drug development process is well appreciated, but the principles and practices of the major regulatory agencies overseeing therapeutic development are much less understood even by well-informed academicians. This chapter is intended to provide a better understanding of the regulatory framework and processes that are pertinent to therapeutic development in general and the advancement of therapies for diabetic nephropathy and related conditions in particular. While this attempt reflects the perspective and focus of a former evaluator in the United States Food and Drug Administration (FDA), the important roles of other national and supranational authorities cannot be over-stated for what has become a shared, global enterprise.

Keywords

Diabetic Nephropathy Surrogate Outcome Aldose Reductase Inhibitor Therapeutic Development Advanced Glycation Endproducts 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    See: A. S. C. Ross, The Assize of Bread, Economic History Review, Second Series, vol. 9, 332–342, 1956.CrossRefGoogle Scholar
  2. 2.
    R. Temple. Development of Drug Law, Regulations, and Guidance in the United States. In Principles of Pharmacology, Basic Concepts and Clinical Applications, Revised Reprint. Pp 1643–1664. Editor Paul L. Munson with Co-editors Robert A. Mueller and George R. Bresse. Chapman and Hall, New York, 1994Google Scholar
  3. 3.
    R. E. McFadyen, Thalidomide in America: A Brush with Tragedy. Clio Medica: 11, no. 2, 79–93, 1976.PubMedGoogle Scholar
  4. 4.
    United States Food, Drug, and Cosmetic Act: Section 505(d).Google Scholar
  5. 5.
    Guidance for Industry Providing Clinical Evidence of Effectiveness for Human Drugs and Biological Products Additional copies are available from: the Drug Information Branch (HFD-210), Center for Drug Evaluation and Research (CDER), 5600 Fishers Lane, Rockville, MD 20857.Google Scholar
  6. 6.
    Prescription Drug Users Fee Act of 1992; United States Public Law Number 102-57, 106 Stat. 4491, October 29, 1992.Google Scholar
  7. 7.
    R. Sheila, S. Kaitin, K. Kaitin, the Prescription Drug User Fee Act of 1992: A 5-year experiment for industry and the FDA, Pharmacoeconomics 121: 126, 1996.Google Scholar
  8. 8.
    Food And Drug Administration Moderization Act Of 1997; United States Public Law Number 105-15, 111 Stat. 2296, Page 2295 October 1, 1997.Google Scholar
  9. 9.
    R. Temple, Development of Drug law, Regulations, and Guidance in the United States.Google Scholar
  10. 10.
    B. Barton, and G.A. Fleming, Good Clinical Practice: Any Changes Expected in the USA? Drug Information Journal, 28: 1115–1117, 1994CrossRefGoogle Scholar
  11. 11.
    J. Showalter, International Conference on Harmonization. The Journal of Biology & Business 1(2): 90–93.Google Scholar
  12. 12.
    G.A. Fleming, Beyond Drug Evaluation: The Science of Drug Evaluation, Molecular Medicine 2:5, 1996.Google Scholar
  13. 13.
    S.J. Pocock. Clinical trials: a Practical Approach. John Wiley, New York, 1983.Google Scholar
  14. 14.
    L.M. Friedman, C.D. Furberg, D.L. DeMets. Fundamentals of Clincial Trials. Second Edition. PSG, Boston, 1985.Google Scholar
  15. 15.
    R. Temple. A regulatory authority’s opinion about surrogate endpoints. In Nimmo WS, Tucker GT, eds. Clinical Measurement in Drug Evaluation. Vol. 3, p. 21. Chichester: John Wiley and Sons, Ltd, 1995.Google Scholar
  16. 16.
    R. Temple. Difficulties in evaluating positive control trials. Proceedings of the American Statistical Association, Biopharmaceutical Section, 1983.Google Scholar
  17. 17.
    The Cardiac Arrhythmia Suppression Trial Investigators. Effect of the anti-arrhythmic moricizine on survival after myocardial infarction. New England Journal of Medicine. 327: 227–233, 1992.CrossRefGoogle Scholar
  18. 18.
    L. B. Sheiner. Learning versus confirming in clinical drug development. J Clin Pharm Ther, 61(3):275–291, 1997CrossRefGoogle Scholar
  19. 19.
    G.A. Fleming. American Heart Journal 138: S338–S345, 1999PubMedGoogle Scholar
  20. 20.
    G.A. Fleming, S. Jhee, R. Coniff, H. Riordan, M. Murphy, N. Kurtz, N. Cutler. In Optimizing Therapeutic Development in Diabetes. Greenwich Medica Media, London, pp. 47–60, 1999.Google Scholar
  21. 21.
    The Sorbinil Retinopathy Trial Research Group: A randomized trial of sorbinil, an aldose reductase inhibitor in diabetic retinopathy, Arch Ophthalmol 108:1234–1244, 1990.CrossRefGoogle Scholar
  22. 22.
    M. Foppiano, G. Lombardo, Worldwide pharmacovigilance systems and tolrestat withdrawal. Lancet 1997; 349: 399–400.PubMedCrossRefGoogle Scholar
  23. 23.
    E.J. Lewis, L.G. Hunsicker, R.P. Bain, & R.D. Rohde, for the Collaborative Study Group. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. New England Journal of Medicine, 329(20): 1456–1462, 1993.PubMedCrossRefGoogle Scholar
  24. 24.
    Heart Outcomes Prevention Evaluation (HOPE) Study Investigator. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy Lancet 355, 253–259, 2000.CrossRefGoogle Scholar
  25. 25.
    G.A. Fleming, S. Jhee, R. Coniff, H. Riordan, M. Murphy, N. Kurtz, N. Cutler. In Optimizing Therapeutic Development in Diabetes. Greenwich Medica Media, London, pp. ix–x, 1999.Google Scholar
  26. 26.
    T. Soulis-Liparota, M. Cooper, D. Papazoglou, B. Clarke, G. Jerums. Retardation by aminouanidine of development of albuminuria, mesangial expansion, and tissue fluorescense in streptozotocin-induced diabetic rat. Diabetes 40(10): 1328–1334.Google Scholar
  27. 27.
    C.W. Yang, C.C. Yu, Y.C. Ko, C.C. Huang. Aminoguanidine reduces glomerular inducible nitric oxide synthase (iNOS) and transforming growth factor-beta 1 (TGF_beta 1) mRNA expression and diminshes glomerulosclerosis in NZB/W F1 mice. Clin Exp Immunol 1998; 113(2): 258–264.PubMedCrossRefGoogle Scholar
  28. 28.
    H.P. Hammes, M. Brownlee, D. Edelstein, M. Saleck, S. Martin, K. Federlin. Aminoguanidine inhibits the development of accelerated diabetic retinopathy in the spontaneous hypertensive rat. Diabetologia 1994; 37(1):32–35.PubMedCrossRefGoogle Scholar
  29. 29.
    H.P. Hammes, D. Strodter, A. Weiss, R.G. Bretzel, K. Federlin, M. Brownlee. Secondary intervention with aminoguanidine retards the progression of diabetic retinopathy in the rat model. Diabetologia 1995; 38(6): 656–660.PubMedCrossRefGoogle Scholar
  30. 30.
    D. Edelstein, M. Brownlee,. Aminoguanidine ameliorates albuminuria in diabetic hypertensive rats. Diabetologia 1992; 35(1): 96–97.PubMedCrossRefGoogle Scholar
  31. 31.
    E.A. Friedman, D.A. Distant, J.F. Fleishhacker, T.A. Boyd, K. Cartwright. Aminoguanidine prolongs survival in azotemic-induced diabetic rats. AM J Kidney Dis 1997; 30(2): 253–259.PubMedCrossRefGoogle Scholar
  32. 32.
    S. Panagiotopoulos, R.C. O’Brien, R. Bucala, M.E. Cooper, G. Jerums.. Aminoguanidine has an anti-atherogenic effect in the cholesterol-fed rabbit. Atherosclerosis 1998; 136(1): 125–131.PubMedCrossRefGoogle Scholar
  33. 33.
    G.A. Zimmerman, M. Meistrell 3rd, O. Bloom, K.M. Cockroft, M. Bianchi, D. Risucci, J. Broome, P. Farmer, A. Cerami, H. Vlassara, et al. Neurotoxicity of advanced glycation endproducts during focal stroke and neuroprotective effects of aminoguanidine. Proc Natl Acad Sci USA 1994; 92(9): 3744–3748.CrossRefGoogle Scholar
  34. 34.
    Makita Z, Vlassara H, Rayfield E, Cartwright K, Friedman E, Rodby R, Cerami A, Bucala R, Hemoglobin-AGE: a circulating marker of advanced glycosylation. Science 1992: 258(5082): 651–653.PubMedCrossRefGoogle Scholar
  35. 35.
    G. Appel, K. Bolton, B. Freedman, J-P. Wuerth, K. Cartwright. Pimagedine (PG) Lowers Total Urinary Protein (TUP) and Slows Progression of Overt Diabetic Nephropathy in Patients with Type 1 Diabetes Mellitus. Abstract: American Society of Nephropathy Annual Meeting [A0786] 1999.Google Scholar
  36. 36.
    Script No.2320. Side Effects with Alteon’s pimagedine. March 25, 1998, p. 24.Google Scholar
  37. 37.
    F. Whittier, B. Spinowitz, J-P. Wuerth, K. Cartwright. Pimagedine safety profile in patients with type I diabetes mellitus. Abstract: American Society of Nephropathy Annual Meeting [A0941] 1999.Google Scholar
  38. 38.
    M.E. Thomas, N.J. Brunskill, K.P. Harris, E Bailey, J.H. Pringle, P.N. Furness, J. Walls Proteinuria induces tubular cell turnover: A potential mechanism for tubular atrophy. Kidney International: 55(3):890–898. 1999.PubMedCrossRefGoogle Scholar
  39. 39.
    The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia. Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy Lancet 349: 1857–1863, 1997.CrossRefGoogle Scholar
  40. 40.
    P.L. Kimmel, G.J. Mishkin, W.O. Umana. Captopril and renal survival in patients with human immunodeficiency virus nephropathy. American Journal Of Kidney Diseases 28: 202–208, 1996.PubMedCrossRefGoogle Scholar
  41. 41.
    S. Wakai, K. Nitta, K. Honda, S. Horita, H Kobayashi, K. Uchida, W. Yumura, H. Nihei. Relationship between glomerular epithelial cell injury and proteinuria in IgA nephropathy. Nippon Jinzo Gakkai Shi 40(5):315–321, 1998.PubMedGoogle Scholar
  42. 42.
    F. Locatelli, D. Marcelli, M. Comelli, D. Alberti, G. Graziani, G. Buccianti, B. Redaelli, A. Giangrande. Proteinuria and blood pressure as causal components of progression to end-stage renal failure. Northern Italian Cooperative Study Group. Nephrology Dialysis Transplant, 11(3):461–467, 1996.CrossRefGoogle Scholar
  43. 43.
    G. Remuzzi. Renoprotective Effect of ACE Inhibitors: Dissecting the Molecular Clues and Expanding the Blood Pressure Goal. American Journal of Kidney Diseases 34: 951–954. 1999PubMedCrossRefGoogle Scholar
  44. 44.
    K. Sharma, B.O. Eltayeb, T.A. McGowan, et al. Captopril induced reduction of serum levels of transforming growth factor-ß1 correlates with long-term renoprotection in insulin-dependent diabetic patients. American Jounal of Kidney Disease 34:818–823, 1999CrossRefGoogle Scholar
  45. 45.
    T.M. Osicka, Y. Yu, S Panagiotopoulos, et al. Prevention of albuminuria by aminoguanidine or ramipril in streptozoticin-induced diabetic rats is associated with the normalization of glomerular protein kinase C. Diabetes 49: 87–93, 2000.PubMedCrossRefGoogle Scholar
  46. 46.
    W.F. Keane, G. Eknoyan. Proteinuria, Albuminuria, Risk, Assessment, Detection, Elimination (PARADE): A Position Paper of the National Kidney Foundation American Journal of Kidney Disease 33:1004–1010, 1999.CrossRefGoogle Scholar
  47. 47.
    Califano J. Order of the Secretary, U.S. Department of Health, Education and Welfare, Suspending Approval. Re: New Drug Applications for Phenformin: NDA 11-624, NDA 12-752, NDA 17-127; 17 July, 1977. Phenformin: removal from general market. FDA Drug Bulletin 7(3): 14–16, 1997.Google Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • G. Alexander Fleming
    • 1
  1. 1.Regulatory AffairsWorldwide Clinical TrialsUSA

Personalised recommendations