Pharmacy — market authorisation

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Obtaining a licence

Before a product can be marketed in the UK a product license must be issued by the Licensing Authority. A licence will only be granted by the Medicines and Healthcare Products Regulatory Agency (MHRA) after the applicant has been able to demonstrate that the medicine meets the its criteria of safety, quality and efficacy. These are sometimes referred to as the ‘three hurdles’.

  • Safety evaluation begins with the examination of toxicological data in a number of areas. These include short, medium and long-term studies in animals of mutagenicity, oncogenesis and teratogenicity.

    The UK government plans to establish a national centre, which will coordinate work into the replacement, reduction and refinement of the use of animals in medical research. Announcing the centre, science and innovation minister, Lord Sainsbury said:

    ‘While I believe that animals still need to be used in research and testing, I also believe strongly that a major opportunity now exists to make progress in replacing, refining and reducing the use of animals and improving their welfare.’

    Home Office minister, Caroline Flint, endorsed these sentiments:

    ‘The UK has one of the most rigorous licensing systems for animal experimentation in the world… But it is vital we maintain the good progress that has already been made.’

    Funding for the so-called ‘three Rs’ is set to double from £330,000 to £660,000 with further increases expected in the future. The move received a warm welcome from many parts of the industry. The ABPI’s science and technology director, Dr Philip Wright, said:

    ‘We are confident that this will add further impetus to the many initiatives under way that aim to replace the number of animals used in medicines research with other methods, reduce those that still have to be used and further refine procedures to ensure even higher welfare standards.’

  • Quality evaluation, in relation to pharmacy and chemistry, begins by a definition of the chemical structure and then a description of the method of production defining the synthetic route used. A description of the physico-chemical properties is required as well as details of product formulation, impurities, sterility and shelf life.
  • Efficacy evaluation adequate to satisfy the MHRA requires at least two controlled studies. These need to be sufficient to reveal with the necessary statistical power the efficacy of the medicine in comparison with a placebo, or even better, with other marketed products in the same class (although the latter is not a specific requirement). The question of balance between safety and efficacy is decided at this stage by the MHRA. Usually, data on at least 3,000 patients will be necessary to satisfy the MHRA requirement for safety data.

    It is worth pointing out that in post-NICE world, no other new technologies go through this intensive evaluation process. Efficacy is taken as a given in the requirements for the further demonstration of clinical and cost-effectiveness — the so-called ‘fourth hurdle’.

Paediatric medicines

A new initiative to encourage the development of more medicines designed specifically for use in children has been announced by the health minister, Lord Warner. Most medicines are obviously designed for and tested on adults but are widely prescribed for children. The evidence shows that children and adults respond very differently to medicines and that a treatment effective in adults may not be as suitable for children. New European legislation in this area will come through in 2006 and these new plans are part of a shorter term strategy to encourage companies to get cracking now. They will also make sure prescribers have better information about the effect of medicines on children. The details of this new paediatric strategy are available at the Medicines and Healthcare products Regulatory Agency (MHRA). The full document talks about the ‘reluctance’ of companies to develop paediatric medicines because of ‘ethical concerns about, and the practical difficulties of, conducting trials in children, together with commercial considerations’.