Contributors |
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xix | |
Foreword |
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xxi | |
Preface |
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xxiii | |
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1 Drug Discovery and Early Drug Development |
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3 | (24) |
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1.1 The Drug Discovery and Development Scene |
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3 | (5) |
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1.1.1 Pharmaceutical Research and Development Challenges |
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3 | (2) |
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1.1.2 Attrition During Discovery and Development |
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5 | (1) |
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1.1.3 Corporate Strategy Perspectives |
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6 | (2) |
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8 | (4) |
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1.2.1 Target Identification |
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8 | (1) |
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1.2.2 Hit-to-Lead Identification |
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9 | (1) |
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1.2.3 Lead Optimization Strategies |
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10 | (2) |
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1.3 Pre-FIH Drug Development |
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12 | (3) |
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12 | (1) |
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12 | (1) |
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1.3.3 Formulation and Drug Delivery |
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13 | (1) |
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1.3.4 Pre-FIH Drug Metabolism and Pharmacokinetics |
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14 | (1) |
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15 | (1) |
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1.5 The Regulatory Landscape |
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16 | (2) |
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1.6 Contract Research Organizations |
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18 | (4) |
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1.7 Concluding Remarks on Introductory Perspectives |
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22 | (5) |
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23 | (4) |
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PART II LEAD OPTIMIZATION STRATEGIES |
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2 ADME Strategies in Lead Optimization |
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27 | (62) |
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27 | (3) |
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30 | (6) |
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32 | (3) |
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35 | (1) |
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36 | (6) |
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2.3.1 Plasma Protein Binding |
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36 | (4) |
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40 | (1) |
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2.3.3 Tissue Distribution |
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41 | (1) |
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42 | (19) |
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2.4.1 In Vitro Metabolism Studies |
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42 | (19) |
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61 | (3) |
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64 | (4) |
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2.7 Prioritizing ADME Screens |
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68 | (1) |
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2.8 In Silico ADME Screening |
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69 | (7) |
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2.9 The Promise of Metabolomics |
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76 | (2) |
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78 | (11) |
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79 | (10) |
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3 Prediction of Pharmacokinetics and Drug Safety in Humans |
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89 | (42) |
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89 | (2) |
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3.2 Prediction of Human Pharmacokinetic Behavior |
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91 | (22) |
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3.2.1 In Vitro Models for Predicting Intestinal Absorption, Intrinsic Hepatic Clearance, and Drug Interactions |
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92 | (15) |
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3.2.2 In Vivo Models for Predicting Pharmacokinetic Behavior |
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107 | (6) |
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3.3 Prediction of Drug Safety |
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113 | (7) |
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3.3.1 In Vitro Approaches for Predicting Drug Safety |
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114 | (2) |
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3.3.2 In Vivo and Ex Vivo Methods for Predicting Drug Safety |
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116 | (3) |
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3.3.3 In Silico Methods for Predicting Drug Safety |
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119 | (1) |
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120 | (11) |
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121 | (10) |
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4 Bioanalytical Strategies |
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131 | (76) |
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131 | (2) |
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4.1.1 Bioanalysis: The Primary Basis for Pharmacokinetic and Pharmacodynamic Evaluations |
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131 | (1) |
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4.1.2 Regulatory Initiatives in Bioanalysis |
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132 | (1) |
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4.2 Basic Bioanalytical Techniques and Method Development |
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133 | (23) |
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133 | (6) |
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4.2.2 Component Separation |
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139 | (5) |
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144 | (5) |
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4.2.4 Ligand-Binding Assays |
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149 | (5) |
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4.2.5 Integration of Method Development Components: Example with LC-MS/MS |
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154 | (2) |
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4.3 Bioanalytical Method Validation |
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156 | (12) |
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4.3.1 Introduction to Validation |
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156 | (1) |
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4.3.2 The Primary Metrics: Acceptance Criteria |
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157 | (8) |
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4.3.3 Additional Validation Criteria |
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165 | (3) |
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4.4 Special Issues with Ligand-Binding Assays |
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168 | (1) |
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168 | (1) |
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168 | (1) |
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168 | (1) |
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4.4.4 Quantification Issues |
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169 | (1) |
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4.5 Partial and Cross-Validations |
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169 | (1) |
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4.6 Application of Validated Methods to Sample Analyses: Some Perspectives |
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170 | (18) |
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171 | (1) |
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172 | (1) |
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4.6.3 Quality Control Samples |
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172 | (1) |
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172 | (1) |
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4.6.5 Acceptance Criteria |
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173 | (1) |
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4.6.6 Repeat Analyses of Incurred Samples |
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174 | (2) |
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4.6.7 Sample Stability and Incurred Samples |
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176 | (1) |
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4.6.8 Scientific Versus Production Issues |
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177 | (1) |
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178 | (1) |
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179 | (9) |
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4.7 Risk-Based Paradigms: Discovery and Development Support |
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188 | (6) |
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4.7.1 Logistics and Discovery |
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189 | (3) |
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4.7.2 Early Involvement of Consultants and CROs |
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192 | (1) |
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4.7.3 Metabolites: Bioanalytical Issues Pre-FIH |
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193 | (1) |
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194 | (1) |
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4.8 The Road to "First in Human" |
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194 | (2) |
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4.8.1 Clinical Collaboration Prior to Initiation of the FIH Trial |
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195 | (1) |
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4.9 International Perspectives |
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196 | (2) |
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196 | (1) |
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197 | (1) |
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197 | (1) |
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198 | (9) |
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199 | (8) |
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PART III BRIDGING FROM DISCOVERY TO DEVELOPMENT |
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5 Chemistry, Manufacturing, and Controls: The Drug Substance and Formulated Drug Product |
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207 | (42) |
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207 | (1) |
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5.2 Pre-NCE Activities and CMC Development |
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208 | (8) |
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5.2.1 Rationale for CMC Involvement in Discovery |
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208 | (1) |
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5.2.2 Pharmaceutical Properties |
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209 | (3) |
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5.2.3 CMC Interactions with Discovery at NCE Selection |
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212 | (2) |
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214 | (2) |
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5.3 CMC Considerations at the NCE Stage |
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216 | (6) |
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5.3.1 Solid-State Compounds |
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216 | (1) |
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5.3.2 Selection of Development Form (Crystalline State) |
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217 | (3) |
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5.3.3 Characterization of Drug Substance (Preformulation) |
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220 | (2) |
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5.4 NCE-to-GLP Transition (Bridging from Discovery to Pre-FIH Development) |
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222 | (7) |
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5.4.1 Drug Synthesis and Formulation for Toxicity Studies: Meeting the Delivery Objectives |
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222 | (2) |
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5.4.2 Bridging to Formulations for FIH Studies |
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224 | (5) |
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5.5 CMCs to Meet Clinical Trial Material Requirements |
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229 | (7) |
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5.5.1 Drug Substance Comparability with Material Used in Pre-FIH GLP Studies |
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229 | (1) |
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5.5.2 Good Manufacturing Practices |
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230 | (1) |
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5.5.3 Analytical Development for Assay of Drug Substance and Drug Product |
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230 | (5) |
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5.5.4 Placebos and Blinding |
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235 | (1) |
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5.6 CMC Strategic Considerations |
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236 | (2) |
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5.6.1 Interactions Across Disciplines |
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236 | (1) |
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5.6.2 Outsourcing (and Insourcing) CMC Work |
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237 | (1) |
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238 | (6) |
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238 | (3) |
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5.7.2 Doxorubicin Peptide Conjugate |
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241 | (3) |
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5.8 Evolution of Drug Development: Implications for CMCs in the Future |
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244 | (5) |
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245 | (2) |
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247 | (2) |
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6 Nonclinical Safety Pharmacology Studies Recommended for Support of First-in-Human Clinical Trials |
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249 | (34) |
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6.1 Introduction and Overview |
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249 | (3) |
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6.2 Timing of Safety Pharmacology Studies |
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252 | (2) |
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6.3 CNS Safety Pharmacology |
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254 | (1) |
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6.4 Cardiovascular Safety Pharmacology |
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254 | (13) |
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254 | (13) |
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6.4.2 Additional Information on QT-Interval Prolongation or Delayed Ventricular Repolarization |
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267 | (1) |
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6.5 Respiratory System Safety Pharmacology |
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267 | (7) |
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6.6 Renal/Urinary Safety Pharmacology |
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274 | (1) |
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6.7 Gastrointestinal System Safety Pharmacology |
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274 | (1) |
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6.8 Autonomic Nervous System Safety Pharmacology |
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275 | (1) |
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276 | (1) |
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6.10 Discussion and Conclusions |
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277 | (6) |
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279 | (4) |
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PART IV PRE-IND DRUG DEVELOPMENT |
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7 Toxicology Program to Support Initiation of a Clinical Phase I Program for a New Medicine |
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283 | (26) |
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283 | (1) |
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7.2 Toxicology Support of Discovery |
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284 | (1) |
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7.3 Goals of the Pre-FIH Toxicology Program |
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285 | (1) |
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7.4 Importance of a Clinical Review of the Nonclinical Pharmacology Data |
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286 | (1) |
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7.5 Take the Time to Plan Appropriately |
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286 | (1) |
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7.6 The Active Pharmaceutical Ingredient |
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286 | (2) |
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7.6.1 Availability Issues |
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286 | (1) |
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7.6.2 Impurity Considerations |
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287 | (1) |
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7.6.3 Inactive Ingredients |
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288 | (1) |
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7.7 Timely Conduct of In Vitro Assays |
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288 | (2) |
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7.7.1 Comparative In Vitro Metabolism |
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288 | (1) |
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289 | (1) |
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7.8 Development of Validated Bioanalytical and Analytical Assays |
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290 | (1) |
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7.8.1 Validated Bioanalytical Assay for Determining Plasma Concentrations of the NCE |
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290 | (1) |
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7.8.2 Validated Analytical Assays for Dosing Solutions or Suspensions |
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290 | (1) |
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7.8.3 Validated Assays for Dosing Solution Stability |
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291 | (1) |
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7.9 Planning for the Conduct of Toxicity Studies |
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291 | (2) |
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7.9.1 Timing of the IND/CTA |
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291 | (1) |
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7.9.2 The Danger of Shortcuts |
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292 | (1) |
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7.9.3 Pilot In Vivo Studies for Dose Selection and Bleeding Time Determinations |
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292 | (1) |
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7.10 GLP Toxicology Program |
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293 | (11) |
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7.10.1 Toxicology Requirements for Initiating an FIH Trial |
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294 | (1) |
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7.10.2 Toxicology Protocols |
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295 | (7) |
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302 | (1) |
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7.10.4 Microscopic Examination of Tissues |
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303 | (1) |
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7.10.5 Considerations of the NOAEL and MTD in Protocol Design |
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303 | (1) |
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304 | (1) |
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305 | (4) |
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306 | (3) |
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8 Toxicokinetics in Support of Drug Development |
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309 | (52) |
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309 | (1) |
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8.2 Historical Perspectives |
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310 | (1) |
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8.3 Regulatory Considerations |
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311 | (1) |
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8.4 Factors to Consider in the Design of Toxicokinetic Studies |
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312 | (20) |
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8.4.1 Drug Supply Requirements |
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312 | (1) |
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313 | (1) |
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8.4.3 API Properties: Salt/Crystal Form, Particle Size, and Impurities |
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314 | (1) |
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8.4.4 Dose-Related Exposure |
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314 | (1) |
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8.4.5 Changes in Pharmacokinetics Following Multiple Dosing |
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315 | (1) |
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8.4.6 Selection of Dosing Vehicles |
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316 | (1) |
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8.4.7 Bioanalytical Method |
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316 | (1) |
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8.4.8 Evaluation of Metabolites |
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317 | (4) |
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8.4.9 Evaluation of Enantiomers |
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321 | (1) |
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8.4.10 Matrix Considerations |
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321 | (1) |
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322 | (1) |
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322 | (1) |
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323 | (1) |
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324 | (1) |
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8.4.15 Blood Sampling Variables |
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324 | (5) |
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329 | (2) |
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8.4.17 Considerations with Biopharmaceutics |
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331 | (1) |
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8.4.18 Practical Considerations in Planning a Toxicokinetic Program |
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332 | (1) |
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8.5 Toxicokinetic Parameter Estimates and Calculations |
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332 | (7) |
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8.5.1 Data Analysis (Noncompartmental Versus Compartmental) |
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332 | (1) |
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8.5.2 Noncompartmental Kinetic Parameters |
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333 | (5) |
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8.5.3 Statistics and Outliers |
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338 | (1) |
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8.5.4 Physiologically Based Toxicokinetic Modeling |
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338 | (1) |
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8.6 Interpretation of Toxicokinetic Data |
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339 | (6) |
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8.6.1 Review of In-life Results |
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339 | (1) |
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8.6.2 Protocol Deviations |
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339 | (1) |
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8.6.3 Confirmation of Exposure and Evaluation of Dose Proportionality |
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339 | (2) |
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8.6.4 Exposure after Single and Multiple Dosing: Accumulation Perspectives |
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341 | (2) |
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343 | (1) |
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8.6.6 Relationship to Toxicology Findings |
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344 | (1) |
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8.6.7 Midstudy Changes in Dosing Duration or Dose Level |
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345 | (1) |
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8.7 Role of Toxicokinetics in Different Types of Toxicity Studies |
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345 | (5) |
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346 | (1) |
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8.7.2 Dose-Range-Finding and Tolerability Studies |
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346 | (1) |
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8.7.3 Subchronic Studies (Two Weeks to Three Months) |
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347 | (1) |
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8.7.4 Chronic Studies (Six to 12 Months) |
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347 | (1) |
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8.7.5 Safety Pharmacology and Specialty Studies |
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347 | (1) |
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348 | (1) |
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8.7.7 Reproductive Toxicology |
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348 | (1) |
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8.7.8 Carcinogenicity Studies |
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349 | (1) |
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8.7.9 Bridging Toxicity Studies |
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350 | (1) |
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8.8 Role of Toxicokinetics in Integrated Safety Assessment |
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350 | (5) |
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8.8.1 Safety Margins: Role in Setting Clinical Doses for FIH Studies |
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350 | (2) |
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8.8.2 Role of Protein Binding and Blood Partitioning |
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352 | (1) |
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8.8.3 Toxicokinetics: Caution about Safety Margins |
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353 | (1) |
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8.8.4 Safety Margins for Different Toxicity Profiles |
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354 | (1) |
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355 | (6) |
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355 | (6) |
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9 Good Laboratory Practice |
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361 | (62) |
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361 | (2) |
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363 | (3) |
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366 | (21) |
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9.3.1 Subpart A: General Provisions |
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367 | (2) |
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9.3.2 Subpart B: Organization and Personnel |
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369 | (7) |
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9.3.3 Subpart C: Facilities |
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376 | (1) |
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9.3.4 Subpart D: Equipment |
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376 | (1) |
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9.3.5 Subpart E: Testing Facilities Operation |
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377 | (1) |
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9.3.6 Subpart F: Test and Control Articles |
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378 | (1) |
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9.3.7 Subpart G: Protocol for and Conduct of a Nonclinical Laboratory Study |
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379 | (5) |
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9.3.8 Subpart J: Reports and Records |
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384 | (3) |
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9.3.9 Disqualification of Testing Facilities |
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387 | (1) |
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9.4 GLPs in the Bioanalytical Laboratory |
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387 | (6) |
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9.4.1 Organization and Personnel |
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389 | (1) |
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9.4.2 Equipment and Testing Facilities Operation |
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389 | (2) |
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9.4.3 Some Challenges in the Bioanalytical Laboratory |
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391 | (2) |
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9.5 Moving Into the Future: A Closing Overview |
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393 | (2) |
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395 | (28) |
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Appendix 9.1 Preambles---Perspectives on GLP Requirements |
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395 | (1) |
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Appendix 9.2 International Regulations |
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396 | (2) |
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Appendix 9.3 Paraphrased FDA GLP Definitions |
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398 | (1) |
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Appendix 9.4 FDA Inspections |
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399 | (2) |
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Appendix 9.5 Critical Phase Inspections---What, Why, How, and When? |
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401 | (1) |
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402 | (1) |
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Appendix 9.7 21 CFR Part 11 |
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402 | (6) |
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Appendix 9.8 SOP Generation and Review |
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408 | (3) |
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Appendix 9.9 Study Director's Responsibilities |
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411 | (2) |
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Appendix 9.10 Regulatory Requirements for the Study Protocol |
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413 | (3) |
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416 | (7) |
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PART V PLANNING THE FIRST-IN-HUMAN STUDY AND REGULATORY SUBMISSION |
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10 Estimation of Human Starting Dose for Phase I Clinical Programs |
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423 | (42) |
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423 | (1) |
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10.2 Characteristics of Well-Behaved Therapeutic Candidates |
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424 | (2) |
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10.3 Regulatory Guidances for FIH-Enabling Nonclinical Safety Assessment: General Principles |
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426 | (1) |
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10.4 Nonclinical Pharmacokinetics and Pharmacodynamics for Human Dose Projection |
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427 | (1) |
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10.5 Establishing the First-in-Human Dose |
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427 | (12) |
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10.5.1 Phase I Clinical Trial Support: Use of the NOAEL-Based Approach |
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428 | (4) |
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10.5.2 Estimating a Human Dose |
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432 | (7) |
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10.6 Phase I Clinical Trial Support: Use of the MABEL or Pharmacologically Active Dose |
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439 | (6) |
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10.6.1 Predicting the MABEL and PAD in Humans |
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441 | (4) |
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10.7 Support of Exploratory Clinical Studies |
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445 | (1) |
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10.8 Considerations in the Design of Phase I Trials |
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446 | (2) |
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10.8.1 Toxicological Considerations |
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446 | (1) |
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10.8.2 Differences Between Animals and Humans That May Modify Exposure or Response |
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447 | (1) |
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10.8.3 Healthy Human Subjects or Patients |
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448 | (1) |
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10.9 Interdisciplinary Partnerships |
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448 | (2) |
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10.9.1 Chemistry, Manufacturing, and Control |
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448 | (1) |
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10.9.2 Regulatory Affairs |
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449 | (1) |
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449 | (1) |
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10.10 Beyond the FTH Dose |
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450 | (1) |
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10.11 Concluding Perspective |
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450 | (1) |
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451 | (14) |
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459 | (6) |
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465 | (24) |
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465 | (2) |
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11.2 Regulatory Background |
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467 | (7) |
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11.2.1 FDA Single-Dose Toxicity Guidance |
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467 | (1) |
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11.2.2 European Position Paper on Microdose Clinical Trials |
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467 | (1) |
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11.2.3 FDA Critical Path Initiative |
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468 | (1) |
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11.2.4 FDA Guidance on Exploratory IND Studies |
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469 | (3) |
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11.2.5 Belgium National Guidance on Exploratory Trials |
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472 | (1) |
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11.2.6 The ExpIND (or ExpCTA) Submission |
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473 | (1) |
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11.3 Experience and Various Perspectives on ExpINDs or ExpCTAs |
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474 | (6) |
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475 | (4) |
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11.3.2 Pharmacological Dose and MOA Studies |
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479 | (1) |
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11.4 Some Reactions and Perspectives on the ExpIND/ExpCTA Initiative |
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480 | (4) |
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11.4.1 What an ExpIND/ExpCTA Can Do |
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481 | (1) |
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11.4.2 What an ExpIND/ExpCTA Cannot Do |
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481 | (1) |
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11.4.3 Some Potential Drawbacks or Challenges in the Conduct of an ExpIND/ExpCTA Program |
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482 | (2) |
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11.5 What Is an Ideal Candidate for an ExpIND/ExpCTA? |
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484 | (1) |
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484 | (5) |
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486 | (3) |
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12 Unique Considerations for Biopharmaceutics |
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489 | (24) |
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12.1 Introduction and Background |
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489 | (1) |
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12.2 Selection of the Molecule: Contrasts to Small-Molecule Considerations |
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490 | (3) |
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12.2.1 Utility of Animal Efficacy Models |
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491 | (1) |
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12.2.2 In Vitro Activity Profiling, Sequence Homology, and the Use of Homologous Molecules for Nonclinical Efficacy and Safety Assessments |
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491 | (1) |
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12.2.3 In Vivo Profiling of Biopharmaceutical Activity |
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492 | (1) |
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12.3 Production and Process Considerations in Pre-FIH Development |
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493 | (2) |
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12.4 Bioanalytical Assay Considerations |
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495 | (1) |
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12.5 Objectives and Implementation of Pre-FIH Safety Assessment Programs |
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496 | (11) |
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496 | (1) |
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12.5.2 Considerations and Typical Program Designs for Nonclinical Safety Assessment of Biopharmaceutics |
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497 | (10) |
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12.6 Post-IND Considerations: Support of Phases II and III and Registration |
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507 | (1) |
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12.6.1 Changes in Production and Process, and Impact on Completed Studies |
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507 | (1) |
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12.7 The TeGenero Incident and Implications for Biopharmaceutic Nonclinical Safety Evaluation Programs |
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508 | (1) |
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509 | (4) |
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510 | (3) |
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13 Project Management and International Regulatory Requirements and Strategies for First-in-Human Trials |
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513 | (30) |
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13.1 Introduction: Initiate Product Development with the End in Mind |
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513 | (3) |
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13.2 Importance of Project Management |
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516 | (2) |
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13.3 FDA Input Early and Often |
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518 | (1) |
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13.4 IND Submission in the United States |
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519 | (2) |
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13.5 Global Clinical Trials |
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521 | (2) |
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13.6 Clinical Trial Applications |
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523 | (16) |
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523 | (3) |
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526 | (2) |
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528 | (2) |
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530 | (4) |
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534 | (1) |
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535 | (2) |
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537 | (2) |
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539 | (4) |
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539 | (4) |
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14 First-in-Human Regulatory Submissions |
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543 | (52) |
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543 | (1) |
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14.2 Submission Strategies |
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544 | (5) |
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14.2.1 Regulatory Environment |
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545 | (1) |
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14.2.2 Clinical Considerations |
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546 | (3) |
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14.3 First-in-Human Dossiers |
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549 | (10) |
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549 | (1) |
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14.3.2 General Considerations for Dossier Preparations |
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549 | (4) |
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14.3.3 Coordination of the Disciplines |
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553 | (4) |
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14.3.4 Document Preparation |
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557 | (2) |
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14.4 United States: Investigational New Drug Application |
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559 | (24) |
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14.4.1 Regulatory Perspective |
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559 | (6) |
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14.4.2 Chemistry, Manufacturing, and Controls |
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565 | (9) |
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14.4.3 Nonclinical Sections |
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574 | (6) |
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14.4.4 Clinical Components |
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580 | (3) |
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14.5 European Union: Clinical Trial Application |
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583 | (5) |
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14.5.1 Regulatory Perspective |
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583 | (3) |
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586 | (1) |
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14.5.3 Nonclinical Sections |
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587 | (1) |
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14.6 Japan: Clinical Trial Protocol Notification |
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588 | (1) |
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14.6.1 Regulatory Perspective |
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588 | (1) |
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588 | (1) |
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14.6.3 Nonclinical Sections |
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588 | (1) |
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589 | (1) |
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589 | (2) |
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14.9 Final Considerations |
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591 | (4) |
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591 | (1) |
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14.9.2 Preparation for Regulatory Queries |
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592 | (3) |
Appendix 1 Abbreviations and Acronyms |
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595 | (6) |
Appendix 2 Definitions and Glossary of Terms |
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601 | (6) |
Appendix 3 Some Relevant Government and Regulatory Documents |
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607 | (6) |
Appendix 4 Some Relevant Resources with Web Sites |
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613 | (4) |
Index |
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617 | |