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Autoren:
Verlag:
Editio Cantor Weitere Titel dieses Verlages anzeigen
Geleitwort von Prof. Dr. med. Thomas D. Bethke | 10 | |
Vorwort der Herausgeber und Dank an die Co-Autoren | 12 | |
Hinweis: Dokumente zum kostenlosen Download | 14 | |
1 Einführung in die Thematik | ||
1.1 | Phasen der Arzneimittelentwicklung | 15 |
1.1.1 | Substanzfindung und-Optimierung | 16 |
1.1.2 | Präklinische Entwicklung | 16 |
1.1.3 | Toxikologie | 17 |
1.1.4 | Mutagenität | 19 |
1.1.5 | Reproduktionstoxikologie / Teratogenität | 20 |
1.1.6 | Kanzerogenität | 20 |
1.1.7 | Festlegung der Dosis zur Erstanwendung | 20 |
1.1.8 | Weitere präklinische Untersuchungen | 21 |
1.2 | Klinische Entwicklung | 22 |
1.2.1 | Phase 1 | 22 |
1.2.2 | Phase II | 26 |
1.2.3 | Phase III | 27 |
1.2.4 | Alternative Entwicklungskonzepte | 27 |
1.2.5 | Zulassung | 29 |
1.3 | Studien nach der Zulassung | 30 |
1.3.1 | Phase IV | 30 |
1.3.2 | Nicht-interventionelle Prüfung | 30 |
1.3.3 | Nicht-kommerzielle klinische Prüfungen | 31 |
1.3.4 Therapieoptimierungs-Studien (TOS), | ||
Investigator InitiatedTrials (IIT) | 32 | |
1.3.5 | Therapieversuch | 32 |
1.4 | Durchführung klinischer Studien | 33 |
1.5 | Pharmakovigilanz | 34 |
1.5.1 | Pharmakovigilanz-Systeme | 35 |
1.5.2 | Pharmakovigilanz in der EU | 36 |
1.5.3 | WHO Programme for International Drug Monitoring | 36 |
1.5.4 | Maßnahmen zur Risikoabwehr | 36 |
1.6 | Good Clinical Practice | 6 |
Inhalt | ||
2 Klinische Prüfung: Angewandte Good Clinical Practice | ||
2.1 | Vorbereitung der klinischen Prüfung | 38 |
2.1.1 | Kontaktaufnahme / Site Selection Visit | 38 |
2.1.2 | Vertragliche Regelungen | 40 |
2.1.3 | Studienteam | 41 |
2.1.4 | Studienunterlagen | 49 |
2.1.5 | Studienmedikation - Prüfpräparat | 57 |
2.1.6 | Weitere Studienmaterialien | 61 |
2.1.7 | Investigator Site File | 61 |
2.1.8 | Ethik-Votum | 62 |
2.1.9 | Meldung bei der Landesbehörde nach § 67 AMG | 63 |
2.1.10 | Rekrutierung und Werbung | 63 |
2.1.11 | Ablaufplanung | 64 |
2.2 | Durchführung der klinischen Prüfung | 66 |
2.2.1 | Aufklärung und Einwilligung | 66 |
2.2.2 | Aufklärung über die Probandenversicherung | 68 |
2.2.3 | Aufklärung über den Datenschutz | 69 |
2.2.4 | Datenschutz und Verschwiegenheit | 70 |
2.2.5 | Screening | 71 |
2.2.6 | Behandlung und Betreuung | 72 |
2.2.7 | Labor | 72 |
2.2.8 | Verabreichung der Prüfmedikation | 76 |
2.2.9 | Unerwünschte Ereignisse - Adverse Events | 77 |
2.2.10 | Vorbereitung von Monitoring, Audit und Inspektion | 83 |
2.2.11 | Studienabbruch | 83 |
2.2.12 | Maßnahmen am Ende der klinischen Prüfung | 84 |
2.2.13 | Close-out | 85 |
2.2.14 | Archivierung | 85 |
2.3 | Sponsor | 87 |
2.3.1 | Prüfpräparate | 89 |
2.3.2 | Auswahl des Prüfers / der Prüfzentren | 90 |
2.3.3 | Versicherung | 91 |
2.3.4 | Anzeigen und Genehmigungen | 92 |
2.3.5 | Dokumentation- und Meldepflichten des Sponsors | 94 |
2.3.6 | Monitoring | 95 |
2.3.7 | Problemfelder | 99 |
2.4 | Dokumentation | 101 |
2.4.1 | Trial Master File | 101 |
2.4.2 | Archivierung | 102 |
Inhalt | ||
2. | Qualitätsmanagement | 103 |
2.5.1 | Auditoren | 105 |
2.5.2 | Audits | 106 |
2.6 | Aufklärung bei klinischen Prüfungen (Michael Kölch) | 107 |
2.6.1 | Aufklärung und Informed Consent | 107 |
2.6.2 | Aufklärung von Minderjährigen und ihren Eltern | 109 |
2.6.3 | Regelungen | 110 |
2.6.4 | Assent | 111 |
2.6.5 | Generelles zur Aufklärung Minderjähriger | 112 |
2.6.6 | Inhalt der Aufklärung bei Minderjährigen | 112 |
2.6.7 | Art der Aufklärung bei Minderjährigen | 114 |
2.6.8 | Überprüfung des Verständnisses | 114 |
2.6.9 | Strukturierung der Aufklärung bei Minderjährigen | 115 |
2.6.10 | Dokumentation der Aufklärung | 115 |
2.6.11 | Literatur | 120 |
2.7 | Netzwerke für Studienpraxen | 120 |
2.7.1 | Background | 120 |
2.7.2 | Grundlagen bei der Etablierung | 121 |
2.7.3 | Rechtsformen | 122 |
2.7.4 | Voraussetzungen bei den Studienpraxen | 130 |
2.7.5 | Vorteile für Praxis und Patienten | 132 |
2.7.6 | Aufgaben des Sponsors | 132 |
2.7.7 | Rolle einer Site Management Organisation | 133 |
2.7.8 | Weiterführende Literatur | 133 |
3 Behörden und Ethik-Kommissionen | ||
3.1 | Bundesoberbehörden (BOB) | 134 |
3.2 | Zuständige Behörden (Aufsichtsbehörden) | 134 |
3.3 | Ethik-Kommissionen | 135 |
3.4 | Genehmigungsverfahren / Anzeigepflichten | 135 |
3.4.1 Grundzüge des Bewertungsverfahrens durch | ||
eine Ethik-Kommission | 137 | |
3.4.2 | Grundzüge des Genehmigungsverfahrens durch eine BOB | 138 |
3.4.3 | Nachrangige Genehmigungen | 139 |
3.4.4 | Anzeigepflicht bei der zuständigen Aufsichtsbehörde | 139 |
Inhalt | ||
3.5 | Inspektionen | 141 |
3.5.1 | Inspektionen durch Länderbehörden | 141 |
3.5.2 | Inspektionen durch eine BOB | 142 |
3.5.3 | Inspektionen der US Food and Drug Administration (FDA) | 143 |
3.6 Freiwilliges Harnionisierungsverfahren für klinische | ||
Prüfungen in Europa (VHP) | 146 | |
3.6.1 | Ablauf des VHP | 146 |
4 Kinderarzneimittel | ||
4.1 | Regulatorisches Umfeld in der EU | 149 |
4.2 | Pädiatrieausschuss | 150 |
4.3 | Pädiatrisches Prüfkonzept | 151 |
4.4 | Änderung eines pädiatrischen Prüfkonzepts | 152 |
4.5 | Zurückstellungen | 152 |
4.6 | Freistellungen | 153 |
4.7 | Klinische Prüfungen in der Pädiatrie | 153 |
4.7.1 | Studienplanung | 154 |
4.7.2 | Ethik-Kommission | 155 |
4.7.3 | Aufklärung und Einwilligung | 155 |
4.8 | Zulassungsverfahren und Bonusse | 156 |
4.9 | Pharmakovigilanz | 158 |
4.10 | Verbundene Rechtsakte | 159 |
4.11 Kommission des BfArM für Arzneimittel für Kinder | ||
und Jugendliche | 159 | |
5 Grundzüge der biometrischen Statistik | ||
5.1 | Deskriptive Statistik | 162 |
5.1.1 | Population, Stichprobe | 162 |
5.1.2 | Arithmetisches Mittel | 163 |
5.1.3 | Median | 164 |
5.1.4 | Spannweite (Range) | 166 |
5.1.5 | Streumaße | 166 |
5.1.6 | Standardabweichung | 166 |
5.1.7 | Varianz | 168 |
5.1.8 | Standardfehler | 18 |
Inhalt | ||
5.1.9 | Perzentile / Quartile | 168 |
5.2 | Analytische Statistik | 170 |
5.2.1 | Grundverständnis der konfirmatorischen Statistik | 171 |
5.2.2 | Hypothesen und statistische Testverfahren | 173 |
5.2.3 | Varianzanalyse - ANOVA | 176 |
5.3 | Grundlagen der Fallzahlschätzung | 176 |
5.4 | Studiendesign | 178 |
5.4.1 | Interindividuelle Vergleiche | 178 |
5.4.2 | Intraindividuelle Vergleiche | 178 |
5.4.3 | Sonderformen von Gruppenvergleichen | 179 |
5.4.4 | Verblindung | 181 |
5.5 | Randomisierung | 182 |
5.5.1 | Einleitung | 182 |
5.5.2 | Blockrandomisierung | 183 |
5.5.3 | Stratifizierte Randomisierung | 184 |
5.5.4 | Einhaltung des Randomisierungsschemas | 185 |
5.6 | Statistische Verzerrung (Bias) | 185 |
6 Klinische Prüfungen in Österreich | ||
6.1 | Bundesamt für Sicherheit im Gesundheitswesen (BASG) | 188 |
6.2 | Österreichische Arzneimittelagentur (AGES PharmMed) | 189 |
6.3 | Arzneimittelbeirat | 190 |
6.4 Gesetzliche Grundlagen für die Durchführung | ||
klinischer Prüfungen | 191 | |
7 Klinische Prüfungen in der Schweiz | ||
7.1 | Schweizerisches Heilmittelinstitut (Swissmedic) | 192 |
7.2 | Klinische Prüfungen | 192 |
7.3 | Heilmittelgesetz | 192 |
7.4 | Verordnung über klinische Versuche mit Heilmitteln | 193 |
7.5 | Internationale Richtlinien | 193 |
7.6 | Notifikationsdossier für klinische Versuche | 193 |
Inhalt | ||
7.7 | Zusammenfassung | 196 |
7.7.1 | Grundlagen | 196 |
7.7.2 | Verfahren | 196 |
Anhang | ||
I. Ausgewählte Abkürzungen | 198 | |
II. Nützliche Links | 207 | |
Behörden | 207 | |
Verbände und Gesellschaften | 207 | |
Medizinische Suchmaschinen und Suchmaschinen-Pools | 209 | |
Literatur | 209 | |
III. Weiterführendes Schrifttum | 210 | |
IV. Nationale und internationale Regelwerke | 211 | |
National | 211 | |
Ethik-Kommissionen | 213 | |
International (Europa) | 213 | |
International | 215 | |
ICH | 215 | |
FDA | 215 | |
V. Multiple Choice Fragen zum Inhalt des Buches | 216 | |
Kapitel 1 | 216 | |
Kapitel 2 | 218 | |
Kapitel 3 | 222 | |
Kapitel 4 | 223 | |
Kapitel 5 | 225 | |
Lösungen | 227 | |
VI. Muster-SOPs und Checklisten | 228 | |
Vorwort | 234 | |
SOP 00: Master-SOP | 235 | |
SOP 01 : Planung und Organisation einer klinischen Prüfung | 239 | |
SOP 02: Studienteam - Verantwortungsbereiche | 246 | |
SOP 03: Studienordner | 250 | |
SOP 04: Prüferverträge | 254 | |
SOP 05: Prüferinformation / Investigator Brochure | 256 | |
SOP 06: Prüfplan | 258 | |
SOP 07: Änderungen des Prüfplans | 267 | |
Inhalt | ||
SOP 08: Prüfbogen / Case Report Form | 270 | |
SOP 09: Schätzung der zur Verfügung stehenden Patienten | 274 | |
SOP 10: Antragstellung, Genehmigungsverfahren - Bundesoberbehörde | ||
und Ethik-Kommission | 278 | |
SOP 11: Versicherungsschutz | 292 | |
SOP 12: Audit und Inspektion | 294 | |
SOP 13: Labor | 297 | |
SOP 14: Rekrutierung | 300 | |
SOP 15: Aufklärung und Einwilligung | 302 | |
SOP 16: Studienmedikation | 306 | |
SOP 17: Unerwünschte Ereignisse | 309 | |
SOP 18: Abschlussbericht einer klinischen Prüfung | 316 | |
SOP 19: Data/Work Sheets | 321 | |
SOP 20: Archivierung | 323 | |
Stichwortverzeichnis | 326 | |
Inhalt | ||
A
Abschlussbericht 33; 88; 95; 102;
196;282
Muster-SOP 316-320
Abteilung zur
Qualitätssicherung 105
ADME - Adsorption, Distribution,
Metabolism, Excretion 21; 23;
217
ADR - Adverse Drug Reaction (s. auch Arzneimittelneben- wirkung) 34; 78-79; 82
AE - Adverse Event
(s. auch UE) 34; 55; 77-82; 265
Muster-SOP 309-315
Aktennotiz 65; 83
Alternativ-Hypothese 173-175
Amendment 52; 63; 191; 241; 259
Muster-SOP 267-269
Ames-Test 19-20; 216 12. AMG-Novelle 35; 37; 110;
159-160
AMWHV - Arzneimittel- und Wirkstoffherstellungs- verordnung 89; 211
Analytische Statistik 162; 170-176
Anonymisierung 70
ANOVA - Analysis of Variance 176-177
Anzeige(n) 35; 63; 84; 92-94; 140;
212
Anzeigepfiichte(n) 44; 88; 135-141
Arbeitsbögen 55
Archiv 87; 323-324
Archivierung 85-87; 102; 105
Muster-SOP 23-325
Arithmetisches Mittel 163-164
Arzneimittelbeirat 190
Arzneimittelentwicklung 15-22; 25;
27-28; 153; 190; 214-215; 313
Arzneimittelnebenwirkung (s. auch ADR) 27; 34; 147
Arzt-Haftpflichtversicherung 92
Assent 67; 111-112; 114-115
Attrition bias 186; 226
AUC - Area Under The Curve 24
Audit 83; 106-107; 141; 223
Muster-SOP 294-296
Auditor 105
Aufklärung 43; 48-49; 66-70; 99;
107-120; 143; 155-156; 220;
224-225; 301
Muster-SOP 302-305
Auftragsforschungsinstitute
(s. auch CRO) 33-34; 38; 88;
142-143
AVB - Allgemeine Versicherungs- bedingungen 66; 91; 293
AWB - Anwendungsbeobachtung 30-31; 77; 86; 212; 218
B
Balancierte Randomisierung 183
BASG - Bundesamt für Sicherheit
im Gesundheitswesen 188-189;
191 3. Bekanntmachung zur klinischen Prüfung vonArzneimitteln am Menschen 93; 212
Berichtsbogen (s. auch CRF
bzw. eCRF) 53-55; 98; 251; 268
Beteiligte Ethik-Kommission 137
Betroffene Person
Aufklärung 42-43; 48-49; 65; 96;
99; 107-108; 135; 143
Datenschutz 44; 69; 70; 82; 143;
213;313
Stichwortverzeichnis