Pediatric Trials Network

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The Pediatric Trials Network (PTN) is a consortium of clinical research sites located around the United States that are cooperating in the design and conduct of clinical trials to improve health care for young patients. The network is sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).[1]

The work of the PTN addresses a critical lack of information regarding the impact of therapeutic agents on infants and children. Developing organs and changes in metabolism throughout infancy and childhood affect how drugs are processed by immature or maturing bodies;[2] thus, age-dependent adjustments in doses are required to ensure that such therapies are used safely and effectively. Unfortunately, only a small percentage of drugs and devices approved by the Food and Drug Administration (FDA) have actually been studied in children and are labeled for pediatric use. Pediatricians, consequently, are often forced to prescribe medical therapies "off-label," or according to their best guess based on adult studies.[3][4]

To fill this knowledge gap, the PTN is studying the formulation, dosing, efficacy, and safety of drugs, as well as the development of medical devices, used in pediatric patients. In keeping with the goals of the Best Pharmaceuticals for Children Act (BPCA),[5] data collected from PTN trials are helping regulators to revise FDA labels for safer and more effective use in infants and children.

A map of sites currently participating in PTN trials may be viewed on the network's website [1].

Background[edit]

Pediatric clinical research faces unique challenges: low study consent rates among parents of sick children, limited blood volume available for the conduct of pharmacokinetic studies, and a relative lack of pediatric analytical expertise in pharmacokinetics and pharmacodynamics, to name a few.[6] Because of such obstacles, before 1998, pharmaceutical companies were not required by the government to test their drugs in infants and children, even if the drugs were commonly given to those populations.

The Food and Drug Administration Modernization Act (1997) and BPCA (2002, amended in 2007 and renewed in 2012) offer financial incentives in the form of patent extensions for companies that voluntarily test their drugs in pediatric patients.[5][7] BPCA also provides a mechanism by which off-patent therapeutics might be studied through a collaboration between the FDA and National Institutes of Health. The NICHD is responsible for funding these studies from its annual budget.

Since the BPCA was first enacted, the NICHD has awarded numerous projects to organizations and institutions for the purpose of gathering information to improve pediatric drug labeling. One of these projects is the PTN, which is creating a scientific, technical, and administrative infrastructure that, in strategic partnership with the NICHD, is studying critical drugs and diagnostic devices in children to improve labeling for pediatric use.

Current Projects[edit]

The PTN is conducting a number of pediatric trials spanning several therapeutic areas, including cardiovascular diseases, cancer, infectious diseases, gastroenterology, respiratory diseases, neonatology, and medical devices. Below is a summary of PTN projects as of October 2013.

Trial ClinicalTrials.gov Identifier Molecule(s) of Interest Summary
Safety and pharmacokinetics of multiple-dose metronidazole in premature infants [2] Clinical trial number NCT01222585 at ClinicalTrials.gov Metronidazole Studied the safety and pharmacokinetics of intravenous metronidazole in premature infants with suspected serious infection; study completed, dosing recommendations published[8]
Taking the guesswork out of pediatric weight estimation (TAPE) [3] Clinical trial number NCT01507090 at ClinicalTrials.gov N/A Evaluated the predictive performance and equivalence of the Mercy Method™ weight estimation method in children.[9]
An open-label study to describe the pharmacokinetics of acyclovir in premature infants [4] Clinical trial number NCT00942084 at ClinicalTrials.gov Acyclovir Evaluating the safety and pharmacokinetics of intravenous acyclovir in premature infants with suspected systemic infection; analysis in progress, results expected in 2013[needs update]
Hydroxyurea in pediatric patients with sickle cell anemia [5] Clinical trial number NCT01506544 at ClinicalTrials.gov Hydroxyurea Examining the pharmacokinetics of hydroxyurea in children with sickle cell anemia; enrollment ongoing
Pharmacokinetics of understudied drugs administered to children per standard of care (POPS) [6] Clinical trial number NCT01431326 at ClinicalTrials.gov Amiodarone, Ampicillin, Bumetanide, Clindamycin, Clonidine, Doxycycline, Epinephrine, Fentanyl, Fluconazole, Furosemide, Granisetron, Griseofulvin, Hydrochlorothiazide, Hydroxocobalamin, Ketamine, Meropenem, Methadone, Metoclopramide, Ondansetron, Pravastatin, Simvastatin, Trimethoprim-sulfamethoxazole Characterizing the pharmacokinetics of understudied drugs that are administered to children regularly by their treating physicians; enrollment ongoing
Safety and pharmacokinetics of lisinopril in pediatric kidney transplant recipients [7] Clinical trial number NCT01491919 at ClinicalTrials.gov Lisinopril Examining the pharmacokinetics of lisinopril in pediatric kidney transplant recipients; enrollment completed, results expected in 2013[needs update]
Midazolam for treatment of status epilepticus [8] N/A Midazolam Providing supplemental data to support the change of the current midazolam prescription labeling to include the treatment of seizures; analysis in progress
The ampicillin in infants study [9] N/A Ampicillin Evaluating the pharmacokinetics and safety of ampicillin for the treatment of sepsis and/or meningitis in infants at various ages and birth weights; analysis in progress
Studying obesity and drug dosing in children [10] N/A N/A Developing a drug database for clinicians and researchers that will provide dosing guidelines for obese children; in progress
Pharmacokinetics of anti-staphylococcal antibiotics in infants [11] Clinical trial number NCT01728363 at ClinicalTrials.gov Clindamycin, Rifampin, Ticarcillin-clavulanate Studying the pharmacokinetics and safety of 3 anti-staphylococcal antibiotics in term and premature infants; enrollment ongoing
Pharmacokinetics of sildenafil in premature infants [12] Clinical trial number NCT01670136 at ClinicalTrials.gov Sildenafil Evaluating the pharmacokinetics and safety of sildenafil for the treatment of bronchopulmonary dysplasia in premature infants; enrollment ongoing
Safety and pharmacokinetics of multiple-dose intravenous and oral clindamycin in obese children [13] Clinical trial number NCT01744730 at ClinicalTrials.gov Clindamycin Determining the pharmacokinetics of intravenous and oral clindamycin in overweight and obese children and adolescents with Staphylococcus aureus infections; enrollment ongoing
Safety of fluconazole prophylaxis in infants [14] N/A Fluconazole Examining the safety of fluconazole prophylaxis in premature infants with candidemia; data collection underway
Efficacy of antiviral suppression therapy after neonatal HSV infection of the central nervous system [15] N/A Acyclovir Will assess the safety of high-dose acyclovir in infants with herpes simplex virus via retrospective database and chart reviews and secondary data analysis
The effect of obesity on the pharmacokinetics of pantoprazole in children and adolescents [16] N/A Pantoprazole Will assess the pharmacokinetics of pantoprazole in obese children and adolescents; protocol in development
Safety of drugs used in hospitalized infants [17] N/A N/A Will characterize the safety of drugs used in hospitalized infants using data collected on infants discharged from NICUs managed by the Pediatrix Medical Group; protocol in development
Antibiotic safety in infants with complicated intra-abdominal infections (SCAMP) [18] Clinical trial number NCT01994993 at ClinicalTrials.gov Ampicillin, Clindamycin, Metronidazole, Piperacillin-tazobactam Will evaluate the safety of drug regimens consisting of ampicillin, metronidazole, clindamycin, and piperacillin-tazobactam in infants with complicated intra-abdominal infections
Extremely low birth weight infants exposed to furosemide or bumetanide in the neonatal intensive care unit [19] N/A Bumetanide, Furosemide Will estimate incidence of adverse events in infants exposed to furosemide or bumetanide during hospitalization in the NICU; the safety profile of the drugs of interest will be evaluated
Pharmacokinetics of multiple-dose methadone in children [20] Clinical trial number NCT01945736 at ClinicalTrials.gov Methadone Will determine the pharmacokinetics of enteral methadone in children treated for opiate withdrawal

Published Results[edit]

PTN Core Leadership[edit]

  • PTN Program Management and Clinical Operations Core; Mentorship Core: Daniel K. Benjamin Jr., Duke Clinical Research Institute [21], Durham, NC
  • Clinical Pharmacology Core: Gregory L. Kearns, Children's Mercy Hospital [22], Kansas City, MO
  • Pharmacometrics Core: Edmund Capparelli, University of California–San Diego [23], San Diego, CA
  • Safety and Ethics Core: Ross McKinney, Duke University Medical Center [24], Durham, NC
  • Devices Core: Andre Muelenaer, Virginia Tech Carilion School of Medicine [25], Roanoke, VA

PTN Administrative Core Committee[edit]

  • Jeffrey Barrett, Children's Hospital of Philadelphia [26], Philadelphia, PA
  • Michael Cohen-Wolkowiez, Duke Clinical Research Institute [27], Durham, NC
  • Matthew Laughon, University of North Carolina at Chapel Hill [28], Chapel Hill, NC
  • T. Michael O'Shea, Wake Forest Baptist Medical Center [29], Winston-Salem, NC
  • Ian M. Paul, Penn State College of Medicine [30], Hershey, PA
  • P. Brian Smith, Duke Clinical Research Institute [31], Durham, NC
  • John van den Anker, George Washington University School of Medicine and Health [32], Washington, DC
  • Kelly Wade, Children's Hospital of Philadelphia [33], Philadelphia, PA
  • The Eunice Kennedy Shriver National Institute of Child Health and Human Development [34]: David Siegel, Perdita Taylor-Zapata, Anne Zajicek
  • The EMMES Corporation (data coordinating center) [35]: Ravinder Anand, Traci Clemons

References[edit]

  1. ^ Eunice Kennedy Shriver National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/Pages/index.aspx. Accessed September 4, 2013.
  2. ^ Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE (September 2003). "Developmental pharmacology--drug disposition, action, and therapy in infants and children". The New England Journal of Medicine. 349 (12): 1157–67. doi:10.1056/NEJMra035092. PMID 13679531. 
  3. ^ Shah SS, Hall M, Goodman DM, et al. (March 2007). "Off-label drug use in hospitalized children". Archives of Pediatrics & Adolescent Medicine. 161 (3): 282–90. doi:10.1001/archpedi.161.3.282. PMID 17339510. 
  4. ^ Bazzano AT, Mangione-Smith R, Schonlau M, Suttorp MJ, Brook RH (2009). "Off-label prescribing to children in the United States outpatient setting". Academic Pediatrics. 9 (2): 81–8. doi:10.1016/j.acap.2008.11.010. PMID 19329098. 
  5. ^ a b Best Pharmaceuticals for Children Act website. Available at: http://bpca.nichd.nih.gov/. Accessed September 4, 2013.
  6. ^ Laughon MM, Benjamin DK, Capparelli EV, et al. (September 2011). "Innovative clinical trial design for pediatric therapeutics". Expert Review of Clinical Pharmacology. 4 (5): 643–52. doi:10.1586/ecp.11.43. PMC 3184526Freely accessible. PMID 21980319. 
  7. ^ Food and Drug Administration Modernization Act. Available at: http://www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/SignificantAmendmentstotheFDCAct/FDAMA/FullTextofFDAMAlaw/default.htm. Accessed September 19, 2013.
  8. ^ Cohen-Wolkowiez M, Sampson M, Bloom BT, et al. (September 2013). "Determining population and developmental pharmacokinetics of metronidazole using plasma and dried blood spot samples from premature infants". The Pediatric Infectious Disease Journal. 32 (9): 956–61. doi:10.1097/INF.0b013e3182947cf8. PMC 3769518Freely accessible. PMID 23587979. 
  9. ^ Abdel-Rahman SM, Paul IM, James LP, Lewandowski A (October 2013). "Evaluation of the Mercy TAPE: performance against the standard for pediatric weight estimation". Annals of Emergency Medicine. 62 (4): 332–339.e6. doi:10.1016/j.annemergmed.2013.02.021. PMC 4039210Freely accessible. PMID 23602655. 

External links[edit]

Pediatric Trials Network website. Available at: https://www.pediatrictrials.org/. Accessed September 4, 2013.