Pharmaceutical Research Methodology and Bio-statistics: Theory and Practice

Bank

CHAPTER 1

Introduction to Research and Bio-statistics in Pharmaceuticals

Research in pharmaceuticals starts from study of etiology of a disease to the study of post marketing surveillance of a drug product in the market. When a disease is identified as an outbreak or for an existing disease, a study at the molecular level of the causative organism of the disease is conducted. In this process, the entire life cycle of the organism is established with the molecular mechanism of its growth. Such study is expected to identify all possible targets to inhibit the growth of the organism. Such targets usually include inhibition of cell wall synthesis, inhibition of enzymes that are responsible for growth of the organism etc. As a lead, scientists initiate research for possible natural herbs or new chemical entities (synthetic or molecular modeling) that can inhibit the growth of the organism. A promising natural herb is phyto-chemically/pharmacognically studied for the active constituents from different parts of the plant by collecting in various seasons, if necessary. Several times a naturally available chemical constituent, that is promising, further acts as a lead for chemical synthesis or on pure chemical synthesis basis, further new molecules are synthesized to minimize side effects and maximize beneficial effects that are established through pharmacological studies on animals. A promising molecule is established through animal studies (pre-clinical) for their pharmacological activity, safety, toxicity and proceeds further for human studies (clinical) as an investigational new drug. Once the investigational drug is through, the new chemical entity has transformed to new drug after scrutiny and approval by drug regulatory at each stage. It is necessary to understand that pre-clinical and clinical studies in most of the times overlap. During clinical studies (phases I to IV), pharmacodynamic and pharmacokinetic studies, route of administration, dosage form, strength, possible combinations are established. Contrary to innovator's drug, generic manufacturer establishes bio-equivalence studies for identical drug product or establish entire pharmacodynamic and pharmacokinetic data for a similar drug product. After the drug regulators review of the drug products for their safety, efficacy and reliability, the drug product is approved for release into the market with simultaneous monitoring of drug products for their therapeutic efficacy during long term by monitoring as pharmacovigilance or post-marketing studies.

Statistics are a compilation of a data and is generated through experimental or available retrospectively (data that is already available, but compiled for analysis). Statistics are derived from a huge population, but such compilations may not be feasible and data is collected from a sample size of a population which itself is derived from statistical calculations. Statistics play a critical role right from individual growth to the economic growth of a country. In pharmaceuticals, bio-statistics are more prominent and have to be interpreted carefully so as to ensure that there is biological significance rather than mathematical significance/insignificance.

In pharmaceuticals, at every stage statistics apply. Any research study is aimed with a statistical planning and the end results are statistically concluded. In research, a problem is identified and is solved through experiments, validated through statistics for drawing final conclusions.

Several questions lead to research activity. For an initiator, the different questions that arise are what disease condition requires new treatments? What is the causative microorganism or conditions for the disease? What are the molecular mechanisms for growth of the disease causative organism? What are the possible targets for inhibiting the growth of the micro-organism? What are the existing natural herbs, new chemical entities that have required inhibitory activity? How to identify past research conducted for a problem? How to identify the literature as review or research articles? How to compile the findings? How to draw conclusions from the findings for continuing research? How to isolate active ingredients from natural herbs? How to synthesize new chemical entities? How to design new chemical entities through molecular modeling? How to select animals and conduct pre-clinical studies? How to plan for clinical studies? What are the national/international guidelines for clinical studies? How to estimate a population of a disease in a country? How to draw a sample size from a population? What statistical methods to be used to draw conclusions for the studies? What dosage form, route of administration, strength to be planned? What kind of analytical techniques have to be established for biological fluids, for formulations? How to develop a similar, identical drug product? How to establish bio-equivalence studies for the generic drug product? How to file an IND, NDA, ANDA application for drug approval so as to market within a country?

Forth coming chapters are expected to empower the reader to acquire the various kinds of mental approaches to be followed to finally execute research activity, conduct some statistical calculations to achieve final conclusions.

CHAPTER 2

Information Sources

2.0 Introduction

Relating to health, information sources can be broadly classified into primary and secondary. Primary information is the one where a researcher has reported his laboratory work in a specified format to a journal publisher and upon acceptance being published as research article/paper in the journal. A research article usually comprises of a title, abstract, author/s name/s, place of work, keywords, introduction, past evidenced work as a basis to take up current work, methodology, materials and methods, description of the experimental work with all the established data in the laboratory, results, discussion, conclusions, acknowledgements and finally with references. Secondary information is the one obtained from books, review articles, association publications, trade publications, from pharmacopoeia, internet, conferences, media etc. In most of the cases information is available in both electronic and printable formats.

2.1 Primary Sources

Primary sources can be further considered as research articles in journals and databases. Reaching the research article of our interest and compiling from different journals is cumbersome and it is through databases one can achieve the information. Some of the globally established databases are Medline, Embase, Evidence Based Medicine database (EBM), International Pharmaceutical Abstracts (IPA), Iowa Drug Information Service (IDIS), BIOSIS, Chemical Abstracts etc.

Medline is a database developed by US Library of Medicine and it is believed that it has over 4500 medical related journals as access. The database is an indication of reported research and published in various renowned journals. Pubmed is a search engine that helps to make the search of the medline database bit faster. US Government initiative of subsidizing Pubmed/Medline has made access of information on free basis on the internet. Such engines work on key words resulting in retrieving several research articles published in various journals. For a precise and required hits of the desired work of interest several commercial service providers such as Dialog, Ovid makes the filtering process of required desired articles still easier.

Embase is a database developed by Elsevier, The Netherlands. The database covers mainly the medical information of the European Union and it has been observed in a study that when a data was retrieved on a subject of interest on both Medline and on Embase, it has been observed that about 35 percent of the data is common and the remaining are unique.

Evidence Based Medicine Database (EBM) is a database relating to evidence established randomized clinical trial study. Such databases helps to understand more prominently clinical research worked in various countries across the globe. Several times, a meta-analysis (analysis of analysis) using such database helps to resolve issues that have ambiguity with respect to conclusions. Yet another database called as Cochrane library was established by Great Britain by assigning interested scholars to compile all the reported and non-reported randomized clinical trial data. Such library has overcome the barrier of research that was not reported or published.

Iowa Drug Information Service (IDIS) is a database established by College of Pharmacy, University of Iowa, US wherein about 200 clinical journal information were provided with an access so that health professionals and public can acquire knowledge of drug, drug interactions, drug combinations etc. The information is especially useful for drug information centers.

Chemical Abstracts is a database established by American Chemical Society (ACS) as Chemical Abstract Service (CAS). The database is mainly useful to pharmaceutical professionals in knowing more about new chemical entities, drug molecules, their physicochemical parameters, synthesis, pharmacological activity, spectral analysis etc. The uniqueness of this database is that every chemical entity being assigned with a unique CAS registry number. The database can be accessed with respect to molecular formula, molecular name, subject name, patent number, CAS number etc. Online version and CD Rom version of the database is available and the commercial versions available to industry are STN, Sci-Finder and as an academic version as Sci-Finder Scholar. The unique feature with the online version of the database is that one can retrieve data based on chemical structure.

BIOSIS Previews is a Biological Abstract and Bio Research Index database, where in information relating to preclinical toxicity and carcinogenicity studies data can be retrieved.

International Pharmaceutical Abstracts (IPA) is a pharmaceutical related database where information relating to research and from associations can be retrieved. Even though several data can be retrieved from various other databases, it has its unique identity. The database is exclusive relating to pharmacy periodicals. The database is established by American Society of Health System Pharmacists (ASHP).

2.2 Secondary Sources

Literature derived from primary sources (also called as primary literature) as a compilation, commentaries or digest is called as secondary source. A review is also considered as a compilation of information from primary sources relating to a particular subject matter. A review article is written upon invitation. There are various secondary sources such as text books, trade literature, pharmacopoeias, formularies, drug compendia, internet sources, electronic mail, discussion groups, search engines like google, MSN, pharmacy websites, various libraries, government websites, electronic publications, online community pharmacies etc.

The combined book of United States Pharmacopoeia and National Formulary (commonly represented as USP/NF) does not include all the drugs approved for use in United States, rather includes drugs and excipients whose standards were established and approved by United Stated Pharmacopoeial Convention, a representation of physicians, pharmacists and other relating health care communities. USP contains monographs of drugs, other substance with therapeutic uses, for some dietary supplements from botanical sources, whereas a national formulary consists of monographs for excipients, non-therapeutic additives used in pharmaceuticals. Several other secondary sources of importance are the British Pharmacopoeia (UK), European Pharmacopoeia (Council of Europe), WHO's International Pharmacopoeia etc.

Earlier a formulary was a recipe book but now it is a list of drug products that are approved by a hospital, health plan or a government for use. A hospital formulary is established and approved by Pharmacy and Therapeutic Committee of a hospital. Likewise yet some other secondary sources are Index Nominum edited by Swiss Pharmaceutical Society, The Merck Index comprising of over 10, 000 monographs on drugs, common organic chemicals.

US Compendia is categorized into prescription, non-prescription, parenterals, catalogs, physical identification, and consumer drug information as individual books. The book usually include information relating to dosage, contraindications, adverse effects and pharmacokinetics, pictures of tablets and capsules for aiding in identification. Especially relating to consumer drug information it may be as a book, pamphlet, newspaper, magazine or internet. Martindale, the extra pharmacopoeia is yet another compendium of drugs and includes medicines covering around the world with list of proprietary products, manufacturers. The book helps in identifying foreign drug products.

The Review of Natural Product, is a monthly loose-leaf service that covers both herbal and other natural products. The monographs include overview of chemistry, pharmacology and toxicology of the product. Several other sources such as Drug Interaction Facts, Meyler's side effects of drugs, Poisindex are some sources for information relating to drug-drug interaction and procedures to treat during drug poisoning conditions.

CHAPTER 3

Literature Search

3.0 Introduction

To initiate a research activity, it is necessary to select a subject of interest and identify the current existing problems. In the quest, several problems can be identified in the society. For instance in pharmaceuticals, in therapeutics several problems like multiple drugs are administered individually on the same day or same time, regular puncturing of skin as parenterals, drug combinations not available, highly expensive drug products where competition is minimum and requires generics, several pediatric dosage forms not well accepted by children leading to reflux arc of vomiting when the drug product is orally administered, need of new route of administration, new dosage form, new combination, several individual drugs taken at the same time may be administered in combination form, identification of product patented drugs and release as generics, developing analytical methods for off-product patented drugs/combinations drugs, quest for new combination therapies, practitioners of medicine need for possible combinations, problems of drug in-compatibilities etc. For instance, Botox is widely used for cosmetic purpose, but requires several injections on the face.

Once a problem is identified, the immediate doubt that arise is that what was the research conducted already for the problem and to proceed further. In this process, several hindrances arise to make the review of the literature in the form of organized and un-organized literature search. It is believed that there exists over 40, 000 journals where in every 30 seconds a research article is in the process of consideration for publication (Mohoney, 1985).

In the past, several research activities were not organized initially and later became organized. In the current day scenario of globalization, information resources have become reachable in most of the circumstances through internet, but the information several times is not to the mindset of the researcher and leads to a compromise by the researcher. To overcome this, the researcher needs to set his mind for an organized thinking process several times making a meta-analysis.

In every country in the world, majority of the basic research is invested by the Government where as innovative research is invested by private organisations as business activity. Basic research is most widely initiated by academic institutions, government funded autonomous organisations or government organisations. For instance, Indian CSIR, DST, CCMB, NIN, Government Universities, IICT, AYUSH are granting finance for basic and innovative research activity. For instance, academic institutions in pharmaceuticals are more prone for basic research rather than process research. Handling dangerous chemicals by the students/scholars, lack of facility are some of the reasons that inhibit research.

Some of the Indian inventions that are promising or products available in the market are a breakthrough invention for oral administration of insulin, Centchroman (already available in market), several analytical methods that are available in Indian Pharmacopoeia etc. In several cases, innovative research at the academic levels is limited, for instance, several Active Pharmaceutical Ingredients (APIs) are process developed by the pharmaceutical industry and establishment of the limit tests for inorganic or organic impurities depends on the starting materials, catalyst, reagents used, bi-products formed, impurities formed, type of reactors used and problems rose by the nature and level of impurity can be known by the formulation industry who develop formulation products and hence, it is necessary that inputs for Pharmacopoeial monographs are more valuable from industry rather than the academic organisations. In the same way, a lead for a process may be from the fundamental reactions learnt at the academic levels or so. Several logics learnt from the academic organisations led to innovative products.

Hence, a solution for a problem may be simple, but several times becomes a complex process to reach the solution. In several cases, a research was initiated assuming such research was not earlier reported or patented but, at a later stage being identified as already reported. Such setbacks may be due to improper literature search.

Even though internet is a big global library, searching with keywords is still not precise or accurate. Internet source has become ambiguous in taking decisions. American Chemical Society is providing a rich source of research compilations as Chemical Abstract Services (CAS). The society is currently providing various collective volumes (5 years) to conduct a systematic research. Such collective volumes are being published from end of eighteen century. Hence, a systematic search provides a better clarity of information. The following is an attempt in making the reader to inculcate the habit of conducting systematic literature search chronologically. A systematic literature search using Chemical Abstract Service or from other sources, can be as follows:

3.1 Type of Index as Volumes

A. Dictionary of Organic Compounds:

i. Name Index: In these volumes, for a chemical name 2-Bromo-4, 6 -dinitroaniline see B-02330 and upon further referring under B-02330 it is observed 2-Bromo-4, 6 - dinitroaniline, 8CI or 2-Bromo-4, 6 -dinitrobenzenamine [1817-73-8]

C6H4BrN3O4   M 262

Yellow needles (AcOH or EtOH) Mp 153-4°, sublimes

BX 9275000

N-Me: Yell cryst (AcOH or EtOH). Mp 153° (147°), N-Ac: Cryst. (EtOH). Mp 235°

D.R.Pat., 610613 (1935); CA, 29, 5860 (Synth); Schouten, A.E., Recl. Trav. Chim.

Pays-Bas, 1937, 56, 541 (Synth)

Wasylishen, R. et. Al, Can. J. Chem, 1970, 48, 1263 (pmr)

Venturella, V.S et al. J. Chromtogr. Sci, 1973, 11, 379 (Chromatog)

ii. CAS Registry Number Index, 6th Edition Vol. 9

2143-88-6: 4-Methyl-4'-nitrobiphenyl-M-0-03105

2144-41-4: Tetrahydro-2,5-dimethyl furan; (2RS,5SR)-from, in T-0-01074

iii. Molecular Formula Index, 5th Edition

a. C14H17N3O3

N-Alanyltryptophan, A-00700

N-Tryptophylalanine, T-04526

b. C14H17N3O6

3,6-Dinitrophenantraquinone; Monoxime, in D-07580

B. Chemical Abstract Services (CAS):

i. Name Index:

Earlier chemical names are not uniform throughout the World. The chemical names provided in dictionary of organic compounds may be different from chemical names provided in chemical abstract services. Several times, there may be more than two names. Hence, it is necessary to search literature in both the names and it is common that the chemical abstract service provides an indication that if you are referring to one name, it indicates see for the other name mentioned.

For instance: When you are searching the Chemical Abstract Index guide, A-M, 1982-86, it indicates

a. Albendazole

seeCarbamic acid, [5-(propylthio)-1H-benzimidazol-2-yl]-methyl ester [54965-21-8]

b. Alcoholmetry

See Alcohols, analysis Ethanol [64-17-5], analysis

c. Alcohols, reactions,

Esterification of-see Esterification

ii. Chemical Substance Index:

In a collective volume of Chemical Substance Index, generic names (International Non-Proprietary-INN names) are observed in alphabetical order.

Under each name, the research conducted as well as abstract number is provided.

For instance:

Chemical Substance 9th collective index, A-Ames, Vol. 76-85, 1972-76 indicates

Acetic acid [64-19-7], analysis

- acetic acid derivs. and formaldehyde detn. In aq. Solns. Of, 78:52379

- acetic anhydride detn. In, 76:107685 y

- chromatog. Detn of in molasses, 77:103604u in molasses and sugar juices, 85:7569f in sugar juices and sirups, 83: 207816e

- chromatography of, 78:66658n

- detn. of 76:67959g, 78:26011q

iii. Molecular Formula Index:

As the name indicates, molecular formulas of compounds are listed in the collective of molecular formula index. It is necessary to know the chemical structure and its molecular formula prior referring for the details.

For instance:

Chemical Abstract, 5th Decennial Formula Index, C13-C19, Vol:41-50, 1947-56 indicates

a. C7H8ClN

Aniline, Chloro-N-methyl- 27:74; 32:911

Benzylamine, chloro., 26:2437; 28:4378; 29:7717; 34:997, 998

HCl, 32:4149; 39:4318; and -HCl, 21:54

2,3-Lutidine, 6-chloro-, 35:2517

b. C7H8N2

Benzaldehyde, hydrazone, 14:3647; 33:622; 39:1395

Benzamidine, 15:535; 16:3078; 24:5732; 31:5797; 36:6538; 39:P3544, 4073, 40:4367; and -HNO3 20: 2320; salts, 24:3013; 30:8156; 36:1917

Formaldehyde, phenylhydrazone, 29:6217; 39:917

iv. Patent Index:

Whether a molecule is having a patent or not is known through P indicated along with the abstract number. When the abstract is referred in the abstract index, the patent number is identified. When we proceed further with the patent number in the patent index, the list of family patents etc., can be identified.

For instance:

Chemical Abstract, Patent Index

a. Vol 94, 1981 indicates

i. 2122655 A, 78:55127n

   FR 2139303 A5

   GB 1386872 A

   JP 56/010583 B4

   US 3825342 A

ii. 2122804 A, 76:73998 k

   FI 56713 B

   FR 2093716 A5

   JP 56/003477 B4 SE 375566 B

   US 3716448 A

iii. 2123027 A, see DE 1958608A

b. WO-WO, Vol. 151, No:5, 2009 indicates

i. 2004/020555 A1 (Designated States: AU, BR, CN, IN, RU, ZA), 140:2205064

AU 2003/228122 A1(B2) (Related)

BR 2003/06210 A (Related)

BR 2003/06210 A (Related)

CN 1596293 A (1328358 C) (Related)

IN 2004DN01324 A (Related)

KR 2003/0052954 A (905581 B1) (Related)

RU 2264435 C2 (Related)

ZA 2004/03265 A (Related)

v. General Subject Index:

This is a collective volume of research published and is listed in terms of general subject. For instance: To identify plant/herbal resources that are reported for anti-fertility activity, the information cannot be available in molecular formula or chemical name index. This can be obtained from General Subject Index. Let us imagine that we are searching for anti-fertility activity of "Achyranthesaspera (Telugu regional names: antisha, uttareni).

The below mentioned table provides a systematic search of the collective volumes of chemical abstracts published by Chemical Abstract Services, American Chemical Society, USA.