Klinické skúškya výskum v oblasti nervovosvalovýchochorení
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1 Klinické skúškya výskum v oblasti nervovosvalovýchochorení PharmDr. Tatiana Foltánová, PhD. UK v Bratislave, Farmaceutická fakulta Katedra farmakológie a toxikológie
2 Nervovosvalové choroby genetického pôvodu Príčiny: 234 génov Expertízne centrá: 98 Diagnostické testy: 2560 Pacientske organizácie: 75 Výskumné projekty: 321 Klinické štúdie: 76
3 Vývoj lieku 800 miliónov dolárov rokov
4 Nová molekula 1. modifikácia známej chemickej štruktúry 2. hľadanie medzi látkami rastlinného pôvodu (Epigallocatechin- Gallate zelený čaj 3. testovanie známych liečiv v nových indikáciach(gentamicín) 4. cielená syntéza liečiv na základe vzťahu štruktúra účinok liekový design 5. génová terapia (GSK ) testovanie želaného účinku na bunkách, tkanivách, celom organizme...
5 Predklinické testovanie Je látka bezpečná? akútna toxicita subakútna a chronická toxicita účinok na reprodukciu, teratogenita kancerogenita mutagenita toxikologické testy Mdx myši GRMD pes aplikácia výsledkov zo zvierat na ľudí správny výber experimentálneho zvieraťa
6 Klinické testovanie Fáza I zdraví dobrovoľníci Jednorázové alebo krátkodobé podanie Stanovenie dávkovacej schémy Fáza II 1x liečivo podané cieľovej populácii Fáza III účinnosť, bezpečnosť Porovnanie s doposiaľ najlepšou existujúcou liečbou Fáza IV postregistračná Sledovnie účinnosti a bezpečnosti liečiva v širokej skupine pacientov Počet jedincov Celá populácia
7 Klinický výskum v oblasti muskulárnej dystrofie Antioxidant indebenon Prebiehajúce MÚ: znižovanie štúdie škodlivých voľných radikálov A Phase II Open-Label Extension Study to Obtain Long-Term Safety, Tolerability and Efficacy Data of Idebenone in the Treatment of Duchenne Muscular Dystrophy - Extension to Study SNT-II-001 (DELPHI Extension). BELGIUM VLAAMS BRABANT LEUVEN DELOS : A Phase III Double-Blind, Randomised, Placebo-Controlled Study of the Efficacy, Safety and Tolerability of Idebenone in Year Old Patients with Duchenne Muscular Dystrophy FRANCE ILE-DE-FRANCE PARIS GERMANY Nordrhein-Westfalen ESSEN An open-label phase III study to evaluate the long-term safety of Ataluren (PTC124) in patients with nonsense mutation Dystrophinopathy- DE GERMANY Nordrhein-Westfalen ESSEN
8 Prírodná terapia Prebiehajúce štúdie SUNIMUD: SUNIMUD: Multicentre, Multicentre, randomized, randomized, placebo placebo controlled, controlled, double double blind blind phase phase II/III study II/III to study investigate to investigate safety and safety tolerance and of tolerance Sunphenon of Sunphenon Epigallocatechin-Gallate(EGCg) Epigallocatechin-Gallate in patients (EGCg) with Duchenne in patients Muscular with Duchenne Dystrophy Muscular Dystrophy GERMANY Berlin BERLIN GERMANY Berlin BERLIN
9 Duchenova muskulárna dystrofia 1987 príčina známa = mutácia génu pre dystrofín najväčší gén v ľudskom organizme!!!? Veľkosť Vlastnosti Prítomnosť vo všetkých svaloch
10 Ciele génovej terapie Obnova Oprava Náhrada
11 PRO051/GSK = antisense oligonukleotid (AON) krátky úsek DNA MÚ: exon skipping therapy Prebiehajúce štúdie Štúdie, ktoré zaraďujú pacientov preskočenie chybného úseku génu AUSTRALIA An open-label New phase South III extension Wales WESTMEAD study to evaluate the long-term safety, tolerability and efficacy of GSK in subjects with DuchenneMuscular Randomized, BELGIUM OOST-VLAANDEREN double-blind, placebo-controlled GENT clinical study to assess the efficacy Dystrophy and safety of GSK in ambulant subjects with Duchenne muscular CZECH REPUBLIC - DE dystrophy Capital City Prague, DENMARK Jylland GERMANY FRANCE RHONE-ALPES Berlin NOT YET IDENTIFIED FR NETHERLANDS GERMANY Berlin Zuid-Holland NOT YET IDENTIFIED LEIDEN DE SPAIN ITALY LAZIO MadridROMA NOT YET IDENTIFIED E NETHERLANDS Gelderland NIJMEGEN NETHERLANDS Zuid-Holland LEIDEN POLAND Kraków NOT YET IDENTIFIED PL SPAIN Madrid NOT YET IDENTIFIED -ES TURKEY ANKARA UNITED KINGDOM Tyne & Wear NEWCASTLE UPON TYNE
12 PTC 124/Ataluren = antisense oligonukleotid(aon) krátky úsek DNA MÚ: exon skipping therapy I: DMD, BMD Prebiehajúce štúdie A Phase 2b Extension Study of Ataluren(PTC124) in Subjects With Nonsense- Mutation-Mediated Duchenne and Becker Muscular Dystrophy. BELGIUM VLAAMS BRABANT LEUVEN An open-label phase III study to evaluate the long-term safety of Ataluren (PTC124) in patients with nonsense mutation Dystrophinopathy- DE GERMANY Nordrhein-Westfalen ESSEN SPAIN Cataluña ESPLUGUES DE LLOBREGAT An Open-Label Study for Previously Treated Ataluren(PTC124) Patients With Nonsense Mutation Dystrophinopathy(Phase III) ES SPAIN Cataluña ESPLUGUES DE LLOBREGAT
13 Bunková terapia Kmeňové bunky Prebiehajúce štúdie Study of autologous cellular therapy tolerance and feasibility in facioscapulohumeral muscular dystrophy (Phase I-II) FRANCE PROVENCE-ALPES-COTE D'AZUR NICE
14 Ovplyvnenie KVS komplikácií Four Effects Weeks of Cardioprotective Withdrawal of Non-Invasive Therapy, Carvedilol Ventilation(NIV) vs Ramipril, in in Patients Patients With Myotonic Affected by Dystrophy: Duchenne Cardiovascular, and Becker Muscular Metabolic Dystrophy. and Daytime Clinical Vigilance Significance Induced and Prognostic Changes Value of Cardiac Magnetic Resonance Study FRANCE ITALY LAZIO RHONE-ALPES ROMA GRENOBLE MD-NET Projekt P3: PreventiveTreatmentofleftventriculardysfunctionin Duchenne A Phase II Muscular Randomised, Dystrophy Double-Blind, Placebo Controlled, Cross-Over GERMANY Study to Investigate Bayern ERLANGEN the Efficacy of Mexiletine in Patients with Non- Dystrophic Myotonia UNITED KINGDOM Greater London LONDON Assessment of the effect of perindopril orodispersibletablet at the dose of mg/kg/day on muscular and myocardicfunctions in the early stage of DuchenneMuscular A double-blind randomisedmulti-centre, Dystrophy: a two-year, placebo-controlled double-blind, randomised, trial of placebo-controlled combined ACE-inhibitor studyand beta-blocker therapy in preventing the FRANCE development ILE-DE-FRANCE of cardiomyopathy PARIS in genetically characterisedmales with DMD without echo-detectable left ventricular dysfunction (Phase III) UNITED KINGDOM Tyne & Wear NEWCASTLE UPON TYNE
15 Skvalitnenie liečby Nemucough: Evaluation of a Mechanical Insufflation-Exsufflation Device During Acute Respiratory Failure in Patients With NeuromuscularDisorders: a Prospective, Randomized, Controlled, Multicenter Study (Phase III) FRANCE ILE-DE-FRANCE PARIS Double-blind randomized phase III trial to find optimum steroid regimen for Duchenne Muscular Dystrophy DE GERMANY Berlin NOT YET IDENTIFIED DE Finding the Optimum Regimen for Duchenne Muscular Dystrophy (FOR-DMD) ITALY CAMPANIA NAPOLI
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17 Kreatín Prirodzene sa vyskytujúca AK v kostrových svaloch Zdroj energie pre svalovú prácu V: červené mäso ryby organizmus si ho vie syntetizovať aj sám (z arginínu, metionínu, glycínu)!!! Zdravé obličky
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