Korean clinical trials: its current status, future prospects, and enabling environment

No abstract available.

Serum calcium and phosphorus levels in patients undergoing maintenance hemodialysis: A multicentre study in Korea

BACKGROUND: In many countries, nephrologists follow clinical practice guidelines for mineral bone disorders to control secondary hyperparathyroidism (SHPT) associated with abnormal serum calcium (Ca) and phosphorus (P) levels in patients undergoing maintenance hemodialysis (MHD). The Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines have long been used in Korea, and this study was undertaken to investigate the current status of serum Ca and P control in MHD patients. METHODS: Data were collected from a total of 1,018 patients undergoing MHD without intercurrent illness, in 17 hemodialysis centers throughout the country. Serum levels of Ca, P, and intact parathyroid hormone (iPTH) were measured over 1 year, and the average values were retrospectively analyzed. RESULTS: Serum levels of Ca, P, and the CaxP product were 9.1+/-0.7mg/dL, 5.3+/-1.4mg/dL, and 48.0+/-13.6mg2/dL2, respectively. However, the percentages of patients with Ca, P, and Ca x P product levels within the KDOQI guideline ranges were 58.7%, 51.0%, and 70.7%, respectively. Of the 1,018 patients, 270 (26.5%) had iPTH >300pg/mL (uncontrolled SHPT), whereas 435 patients (42.7%) showed iPTH <150pg/mL. Patients with uncontrolled SHPT had significantly higher values of serum Ca, P, and CaxP product than those with iPTH < or =300pg/mL. CONCLUSION: Despite the current clinical practice guidelines, SHPT seems to be inadequately controlled in many MHD patients. Uncontrolled SHPT was associated with higher levels of serum Ca, P, and Ca x P product, suggestive of the importance of SHPT management.

New drug development and clinical trial

Drug development is a lengthy, expensive, and complex process, and clinical development is the longest and the most expensive stage of drug development. To obtain market authorization of a new drug, applicants must prove the effectiveness and the safety of a drug through clinical trials. Korea has the same requirements for new drug approval as in developed countries and bridging data are required for approval of a new drug that was developed in another country. Clinical evaluation in humans consists of 3 phases, from phase 1 to phase 3, and the failure rates remain high while the clinical trial cost increases rapidly. Not only pharmaceutical sponsors but also patients and physicians want new, innovative medicines faster, simultaneously with improved productivity of drug development. With strong competition and market forces, the pressure to accelerate drug development and to predict the efficacy and safety profile of a drug candidate at an earlier stage is increasing. To improve the productivity of new drug development, modern principles of pharmaceutical sciences, clinical pharmacology, and information technology are being researched and employed by both health authorities and sponsors. Many global pharmaceutical companies are also pursuing geographical expansion strategies to enroll subjects faster among more diverse ethnic groups. To deliver innovative medicines to patients in a faster and more cost-effective ways, close and continuous collaboration among sponsors, academia, and health authorities is essential.