KHI Current Project
Drug Development in Children with Kidney Diseases
Abstract
Drug development in children with kidney diseases must consider issues unique to this vulnerable population of limited size. Legislation by the United States and the European Union mandates plans for pediatric development as part of an overall product development strategy. This highlights the need to prioritize those programs that may be deemed most necessary and impactful and to optimize designs to facilitate successful completion. This project aims to bring together relevant stakeholders for patients, healthcare providers, researchers, professional organizations, industry partners, and regulators, to develop recommendations to foster drug development for children with kidney diseases.
Deliverables
A key deliverable for this signature project is the Kidney Pediatric Accelerator Trial Clearing House (Kidney-PATCH) to optimize planning for pediatric kidney disease clinical trials.
A workgroup has been assembled to draft a manuscript, over a 12 month timeframe, which is projected to take inventory of the current challenges and propose consensus based recommendations for improvements, including but not limited to:
- Recognize the legal remit and regulatory framework for pediatric study plans in US and Europe. Outline the current avenues of collaboration and communication between the regulatory agencies in US and Europe regarding pediatric plans
- Explore avenues for harmonization of study designs (including endpoints) and timelines for pediatric plans across US and European regulatory agencies.
- Develop a mechanism to prioritize drugs and drug classes for trials in children with kidney diseases through multi-stakeholder guidance and input, considering the following prioritization factors:
- Unmet patient needs (e.g., new drug class, new mechanism of action)
- Finite research resources in terms of number of patients affected and sites, in context of numerous pediatric commitments
- Regulatory landscape for studies in children with kidney diseases
- Timelines and priority metrics
- Optimize planning of pediatric drug trials by
- Enabling feasibility assessment in terms of the available patient populations through data sharing and access to kidney diseases pediatric registries
- Consultation on design and protocols by a panel of pediatric nephrologists, trialists, patient representatives early in the design process
- Enhance the likelihood of successful trial execution through assessment of the capacity of various pediatric renal clinical trial organizations
- Identify key considerations for a balanced assessment of perceived benefits and risks (including toxicity), through a collaboration with experts (including toxicologists, clinical trialists from other pediatric disciplines that deal with toxicology risk vs. benefit, patients and caregivers). The prioritization process in Goal 3 should be informed by the patient/caregiver perspective in terms of this balance.
Timeline
Completion goal of December 2020
Children with kidney diseases are a vulnerable population in need of therapeutic innovation. The United States and the European Union have permanent legislation in place mandating plans for pediatric development as part of an overall product development strategy.(1,2) EU and FDA requirement are not necessarily aligned. The overall number of children aged 0-19 on dialysis is about 2000 in the US with an equally small number estimated in the preceding stages of kidney diseases.(3)
Only a fraction of children with kidney diseases may be eligible for a particular study and there is active competition for different trials. There are marked clinical differences across age groups and the numbers dwindle with decreasing ages. This highlights the need to prioritize those programs that may be deemed most necessary and impactful by all stakeholders to facilitate successful study completion in this population of limited size. Furthermore, study design and execution must carefully consider specific technical and scientific issues related to diseases, treatments, age and ethics unique to children with kidney diseases.(4) Safety concerns are often heightened due to greater uncertainties stemming from less directly applicable information on pharmacodynamics and toxicity for younger age groups.
This project aims to foster drug development in children with kidney diseases by commissioning a workgroup to take inventory of current challenges, share insights and lessons learnt, and develop consensus based recommendations for overcoming barriers. The workgroup membership will take advantage of the diversity of constituent members within KHI and include representatives for patients, healthcare providers, researchers, professional organizations, industry partners, and regulators.
| Role | Name | Organization | |
|---|---|---|---|
| Co-Chair | Stuart Goldstein, MD | Cincinnati Children's Hospital Medical Center | |
| Co-Chair, Board of Directors Liaison | Katrin Uhlig, MD, MS | Keryx Biopharmaceuticals, Inc. | |
| Member | Ann Danderand, MD | Otsuka America Pharmaceuticals, Inc. | |
| Member | Pamela Duquette | Johns Hopkins University, KHI Patient and Family Partnership Counicl | |
| Member | Elizabeth Fox, MD, MS | Children's Hospital of Philadelphia | |
| Member | Debbie Gipson, MD | University of Michigan | |
| Member | Egger Gunter, DVM | European Medicines Agency | |
| Member | Jan Iles, MD, MPH | Amgen, Inc. | |
| Member | Mona Khurana, MD | Division of Pediatric and Maternal Health, FDA | |
| Member | Teresa Vu Lewis, PharmD, BCPS | The University of Oklahoma Health Sciences Center, College of Pharmacy | |
| Member | Amy Mason, MD, MS | Bayer AG | |
| North American Pediatric Renal Trials and Collaborative Studies Liaison | Alicia Neu, MD | Johns Hopkins University | |
| Member | Ron Portman, MD, FAAP, FASN | Novartis Pharmaceutical Corporation | |
| Member | Marco Prunotto, PhD | Roche Pharmaceuticals | |
| Member | Jesse Roach, MD | Center for Medicare and Medicaid Services | |
| Member | Michelle Rheault, MD | University of Minnesota | |
| Member | H. William Schnaper, MD | Northwestern University | |
| Member | Sandi See Tai, MD | Pfizer, Inc. | |
| Member | Aliza Thompson, MD, MS | US Food and Drug Administration | |
| Staff Liaison | Meaghan Allain | Kidney Health Initiative |