Ingrid Klingmann

Aim: To better understand the motivations and needs of healthy volunteers in clinical trials. Methods: The European Federation for Exploratory Medicines Development (EUFEMED) devised a Survey of 58 questions on motivations of volunteers to participate, as well as on needs at the level of convenience, risk/benefit, social interaction, partnership and altruism. The Survey was shared with European Clinical Research Units (CRUs) who agreed to conduct the Survey in volunteers taking part in their phase 1 trials. Results: The Survey generated responses from 4349 healthy volunteers. In 54% (95% CI: 52,55) of cases contributing to new treatments was the primary motivation to participate, vs . monetary compensation in 41% (95% CI: 39,42) of responders. Volunteer requirements during overnight stays defined as important were well‐functioning showers (89%, 95% CI: 87,90), ability to spend some time outside (78%, 95% CI: 76,80), the meal quality (76%, 95% CI 73,78), access to high‐speed internet (73%, 95% CI: 71,75), a place to read/work alone (69%, 95% CI: 66,71) and a good night rest (69%, 95% CI: 67,71). The opportunity to socialize with staff was important for 85% (95% CI: 83,87), a unit with a cozy interior for 70% (95% CI 67,72) and socializing with other participants for 63% (95% CI 61,66) of responders. Conclusion: Healthy volunteers in clinical trials have specific needs during their stay in the Clinical Research Unit. Volunteer recruitment, compliance and retainment, as well as an ethical and a subject‐centric approach to trial design and conduct can benefit from understanding these needs.

Background/Aims: This preference study aimed to identify the maximum number of mini-tablets of two different sizes that children and adolescents would be willing to take, and parents, nurses, and pediatricians would be willing to administer to children and adolescents. Methods: A total of 336 participants (24 per cohort) were stratified into 14 cohorts: Acutely and chronically sick children/adolescents aged 6–<12 years (y) and 12–<18 y, parents of acutely and chronically sick children/adolescents aged 0–<2 y, 2–<6 y, 6–<12 y, and 12–<18 y, nurses, and pediatricians. After participants were shown seven different numbers of 2 and 3 mm mini-tablets, they were asked to assess the maximum number acceptable for short-, middle-, and long-term treatment using cohort-specific questionnaires. Results: Within all groups and treatment durations, the specified maximum accepted number of 2 mm mini-tablets was higher than the number of 3 mm mini-tablets. The maximum number of mini-tablets acceptable to the participants increased with increasing age of the children and ranged from 40–500 (30–400) for the 2 mm (3 mm) mini-tablets. With increasing duration of treatment, a lower maximum number of mini-tablets was considered tolerable. Chronically sick children were willing to take higher numbers of mini-tablets than acutely sick children. The maximum accepted numbers of mini-tablets specified by pediatric patients, parents, and healthcare professionals were similar for each age group; however, pediatricians consistently specified slightly higher numbers of mini-tablets than parents and nurses. Conclusions: The study demonstrated that even a high number of mini-tablets would be well-accepted by children during middle- or long-term treatment.

Pharmaceutical Medicine (PM) was defined by its founding pharmaceutical physicians as a “medical/scientific discipline concerned with the discovery, development, evaluation, registration, monitoring, and medical aspects of the commercialization of medicines, for the benefit and the health of the community.” Conceived as a medical specialty, the discipline encompassed several health-related professions and occupations, such as medicine, pharmacy, clinical pharmacology, drug safety and pharmacovigilance, pharmaceutical sciences, biology, health economics and others. Historically, non-medically qualified medicines development scientists from health-related disciplines have gradually grown into the medical roles within pharmaceutical organizations, regulatory agencies, and contract research organizations and today physicians and non-physicians lead drug development groups. Medicines Development Sciences (MDS) has been accepted as an alternative name. The practice of the disciplines involved in PM/MDS has evolved from an occupation to be accepted as a distinct profession, by meeting well established criteria. Despite thousands of health professionals participating today in medicines development, their awareness of the existence of this discipline, and its evolution from occupation to profession is low. The lack of professional identity and a clear career path have been identified as key factors limiting the advancement of this profession. This position paper aims to consolidate PM/MDS as an advanced profession in health sciences and propose a career path that is envisioned and championed by educational standards setting organizations like the International Federation of Association of Pharmaceutical Physicians and Pharmaceutical Medicine (IFAPP), PharmaTrain, and Global Medicines Development Professionals (GMDP) Academy with education and training as pillars for its achievement.

Since the acceptability of a medicine can significantly impact therapeutic outcomes, this study aimed to determine and compare the preferences of children, parents, and healthcare professionals for the most commonly used pediatric oral medicine formulations (syrup, mini-tablets, oblong tablets, round tablets) addressing all pediatric age groups, 0–<18 years (y). This survey study employed sex-, age-, and participant group-adapted questionnaires for eight cohorts of participants, i.e., children 6–<12 y, adolescents 12–<18 y, parents of children in four age groups (0–<2 y, 2–<6 y, 6–<12 y, and 12–<18 y), nurses, and pediatricians. Descriptive statistics were used for data analysis. In the age groups 0–<2 y and 2–<6 y, mini-tablets were preferred over syrup by all participants. In the age group 6–12 y, solid dosage forms were also preferred over syrup by all participants. In the age group 12–<18 y, healthcare professionals preferred solid dosage forms over syrup. Parents preferred higher amounts of mini-tablets and syrup compared to round and oblong tablets, while adolescents’ preferences did not differentiate between these formulations. Based on the study results and in contrast to current practice, it is suggested to consider solid dosage forms for future age-appropriate medicinal products already for younger age groups.

The importance of engaging patients, the public and/or communities in the design and delivery of health and social care research is recognised [1]. Not engaging with the public raises the risk that...

Plain language resources (PLR) are lay summaries of clinical trial results or plain language summaries of publications, in digital/visual/language formats. They aim to provide accurate information in jargon-free, and easy-to-understand language that can meet the health information needs of the general public, especially patients and caregivers. These are typically developed by the study sponsors or investigators, or by national public health bodies, research hospitals, patient organizations, and non-profit organizations. While the usefulness of PLR seems unequivocal, they have never been analyzed from the perspective of ethics. In this commentary, we do so and reflect on whether PLR are categorically advantageous or if they solve certain issues but raise new problems at the same time. Ethical concerns that PLR can potentially address include but are not limited to individual and community level health literacy, patient empowerment and autonomy. We also highlight the ethical issues that PLR may potentially exacerbate, such as fair balanced presentation and interpretation of medical knowledge, positive publication bias, and equitable access to information. PLR are important resources for patients, with promising implications for individual as well as community health. However, they require appropriate oversight and standards to optimize their potential value. Hence, we also highlight recommendations and best practices from our reading of the literature, that aim to minimize these biases.

Angiotensin-converting enzyme inhibitors (ACEI), such as enalapril, are a cornerstone of treatment for pediatric heart failure which is still used off-label. Using a novel age-appropriate formulation of enalapril orodispersible minitablets (ODMTs), phase II/III open-label, multicenter pharmacokinetic (PK) bridging studies were performed in pediatric patients with heart failure due to dilated cardiomyopathy (DCM) and congenital heart disease (CHD) in five participating European countries. Children were treated for 8 weeks with ODMTs according to an age-appropriate dosing schedule. The primary objective was to describe PK parameters (area under the curve (AUC), maximal concentration (Cmax), time to reach maximal concentration (t-max)) of enalapril and its active metabolite enalaprilat. Of 102 patients, 89 patients (n = 26, DCM; n = 63 CHD) were included in the primary PK endpoint analysis. Rate and extent of enalapril and its active metabolite enalaprilat were described and etiology and age could be identified as potential PK modifying factors. The dosing schedule appeared to be tolerated well and did not result in any significant drug-related serious adverse events. The PK analysis and the lack of severe safety events supports the applied age-appropriate dosing schedule for the enalapril ODMTs.

Introduction: A medicine’s acceptability is likely to have significant impact on pediatric adherence. The importance is underlined in EMA and FDA guidance on this topic where investigation of acceptability is stated as a regulatory expectation. Demonstrating acceptability can be challenging given there is no globally recognized definition and no standardized testing methodology or assessment criteria. Palatability and swallowability are generally recognized as important elements of acceptability, and this work proposes a definition of acceptability using these elements to give a composite endpoint for acceptability for pediatric subjects across all age ranges. Methods: This composite acceptability endpoint is based on validated assessment methods for swallowability and palatability in children of different age groups using different galenic placebo formulations, in line with criteria proposed by EMA for assessing acceptability in children from newborn to 18 years of age. Data from two studies investigating mini-tablets, oblong tablets, orodispersible films, and syrup were analyzed to establish the validity, expediency, and applicability of the suggested composite acceptability assessment tool. Results: The new composite endpoint is an efficient and suitable way to distinguish preferences of oral formulations: Mini-tablets and oblong tablets had significantly better acceptability than syrups and orodispersible films. Conclusion: Since the suggested acceptability criteria takes both swallowability and palatability into account as composite endpoint, it is highly sensitive to detect acceptability differences between oral formulations. It is a well-defined valid approach, which meets regulatory requirements in an appropriate and comprehensive manner and may in future serve as a pragmatic, standardized method to assess and compare acceptability of pediatric formulations with active substances.