ABSTRACT
BACKGROUND: Obtaining assent from children participating in clinical trials acknowledges autonomy and developmental ability to contribute to the consent process. This critical step in pediatric drug development remains poorly understood, with significant room for improving the clarity, efficiency, and implementation of the assent process. Beyond ethical necessity of informing children about their treatment, the assent process provides the advantages of including children in discussions about their diagnosis and treatment-allowing greater understanding of interventions included in the study. A formalized assent process acknowledges the child as a volunteer and provides a forum for questions and feedback. Legal, cultural, and social differences have historically prevented the development of clear, concise, and accessible materials to ensure children understand the clinical trial design. Published guidelines on obtaining pediatric assent are vague, with many decisions left to local institutional review boards and ethics committees, underscoring the need for collaboratively designed standards. To address this need, 2 surveys were conducted to quantify perspectives on assent in pediatric clinical trials. METHODS: Two digital surveys were circulated in the United States and internationally (October 2014 to January 2015). The first survey targeted children, parents, and/or caregivers. The second polled clinical trial professionals on their organizations' experience and policies regarding pediatric assent. RESULTS: Forty-five respondents completed the child and parent/caregiver survey; 57 respondents completed the industry survey. Respondents from both surveys detailed experiences with clinical trials and the impediments to securing assent, offering potential solutions to attaining assent in pediatric patients. CONCLUSIONS: An important opportunity exists for standardized practices and tools to ensure pediatric patients make well-informed decisions regarding their participation in clinical trials, using materials appropriate to their level of understanding. These tools would establish a baseline standard for the assent process and be made available to researchers, improving their ability to secure assent from young patients.
Subject(s)
Clinical Trials as Topic , Informed Consent , Adolescent , Caregivers , Child , Child Health , Drug Industry , Female , Humans , Male , Parents , Surveys and QuestionnairesABSTRACT
The palatability of oral drugs influences patient adherence to prescribed regimens, especially for children. Various factors influence palatability, including smell, taste, texture, and dose volume. Evaluation of these factors plays an important role in pediatric drug development and is a target for regulatory scrutiny. The Global Alliance for Pediatric Therapeutics, a public-private consortium under the guidance of the Institute for Pediatric Innovation, convened the Alliance Palatability Working Group to discuss the issues related to the assessment of palatability in the development of pediatric oral dosage forms. An extensive scientific literature search was conducted, in addition to a multicompany industry survey and a series of workshops with the Alliance Palatability Working Group. Based on the results, 3 best practice recommendations emerged regarding the assessment of palatability for oral dosage forms in pediatric drug development. These best practice recommendations offer researchers guidance for the preclinical and clinical assessment of palatability of oral dosage forms and serve to operationalize the assessment process within the overall drug development program.
ABSTRACT
BACKGROUND: Palatability and swallowability of oral dosage forms are important considerations in the development of medications for pediatric populations. As a result of recent legislation, the number of pharmaceutical products being developed with formulations for children is increasing. However, there are limited recommendations and published literature regarding appropriate palatability and swallowability assessment scales in pediatric patients. OBJECTIVE: This systematic literature review aimed to identify and evaluate tools currently utilized to assess palatability and swallowability in clinical trials for pediatric oral dosage forms and identify any potential relationships between palatability and treatment adherence. Literature databases were searched for clinical trials that evaluated palatability of oral dosage forms targeted for pediatric patients. The searches were limited to papers in the English language from January 2008 to March 2013. RESULTS: A total of 137 citations were identified, with 27 articles included in the final full-text analysis. CONCLUSIONS: Various limitations to this systematic review exist, primarily focused on the unavailability of published, early phase development data related to palatability. However, based on results of this review, palatability is often assessed in clinical trials of pediatric dosage forms through the utilization of 2 unvalidated, yet widely accepted, visual scales. There is no standard statistical methodology for analyzing the results of these scales or the cross-comparison of results across studies. Limited evidence regarding a correlation between palatability and treatment adherence in pediatric patients was identified.
ABSTRACT
An industry-based survey was conducted by the Global Alliance for Pediatric Therapeutics in February 2013 to determine and evaluate the current industry practices in the assessment of palatability and swallowability during the development of pediatric oral solid dosage forms, including the design and statistical analysis of such studies. In addition, the survey was designed to identify areas where regulatory guidance is most needed. The survey was distributed to 6 research-based pharmaceutical companies and to members of the American Academy of Pediatrics' Provisional Section on Advances in Therapeutics and Technology. In general, while all responding companies have experience developing pediatric medicines, there was no consistent approach among respondents to the assessment of organoleptic properties of solid dosage forms, including excipients. In the direct assessment of palatability in pediatric patients in clinical trials, the survey identified that a variety of methods is used across companies, including visual analogue scales, simple and complex hedonic scales, and simplistic Likert-type scales. No assessment method identified was acknowledged as validated or with any statistical correlates, with many respondents stating that scales used in the pharmaceutical industry are adapted from the significant work conducted in the food service industry. Based on findings from the industry survey, the authors believe that there is an opportunity for consensus of the assessment of palatability and swallowability in the development of pediatric oral solid dosage forms.
