Shifting the burden: restructuring the drug review process.
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Biomedical subjects
Publications and source records attributed to B Scoville.
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We performed a double-masked study in which 98 patients with ocular hypertension who had been previously treated with timolol received either timolol 0.25% or carteolol 1%, a beta-blocker with intrinsic sympathomimetic activity. The drugs were administered topically twice daily for one month after a one-week washout period. Intraocular pressure was measured at baseline and after one and four weeks of treatment. The appearance of the fundus, external eye, visual fields, tear secretion, blood pressure, and pulse were recorded. Adverse symptoms were elicited using a menu-type questionnaire and an overall judgment of therapy was recorded. Carteolol was as effective as timolol in reducing intraocular pressure. There were significantly fewer patients reporting adverse events overall (P = .019), and eye irritation specifically (P = .02), in the group treated with carteolol.
Thirty-six normal subjects received a drop in either eye of two of four ophthalmic solutions, balanced saline (S), carteolol, 1% (C1), carteolol, 2% (C2), or timolol, 0.5% (T), in a double-blind, randomized trial in a balanced incomplete block design. Subjects reported immediately, at three, and again at ten minutes after administration whether one eye felt more irritated and marked an analog scale of irritation. An observer also made ratings at three minutes based on responses to stereotyped questions. Significant differences in irritation between timolol and each of the other drugs and placebo were shown by analog scale scores immediately after instillation of the solutions. Maximum likelihood estimates were calculated based on statements of subject preference, and a significant preference was demonstrated. Observer ratings also demonstrated a treatment effect. This simple clinical assay system provides a new, valid method for estimating irritation induced by ophthalmic solutions.
In this paper we describe advances in the clinical development of antiepileptic drugs as a function of the Antiepileptic Drug Development Program of the National Institute of Neurological and Communicative Disorders and Stroke. This program encompasses both the preclinical and clinical elements of drug development through the Anticonvulsant Screening Project, the Toxicology Project, and the support of controlled clinical trials of potential new drugs that emerge from these projects and promise to be more effective and less toxic than those currently available for the treatment of epilepsy.
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The questions involved in higher unit dosage of psychotropic drugs are made concrete in writing the Dosage and Administration Section of package inserts for drugs. The author outlines a number of problems in recommending specific changes in conventional dosage regimens. He suggests that a major reason for reluctance to adopt new regimens using less frequent dosing is the relative paucity of data demonstrating that less frequent, higher dosing is as effective as conventional regimens. Intrinsic methodological and pharmacological problems make it difficult to generate such data for psychotropic drugs. Nonetheless, recommendations for less frequent, higher, psychotropic dosage regimens will become more common in package inserts.