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European Pharmaceutical Contractor

Safety First

Boaz Mendzelevski, a Cardiac Safety Consultant, examines drug-induced repolarisation abnormalities and proarrhythmia with regard to improving cardiovascular safety in drug development

Cardiac safety is a relatively new field in drug development clinical research. It first emerged as a regulatory focus after the high-profile withdrawals of drugs such as terfenadine and cisapride in the 1990s, and became synonymous with drug-induced QT prolongation and its associated cardiac arrhythmia – torsades de pointes (TdP). Recent regulatory guidance, most notably ICH-E14, brought cardiac safety into the forefront of regulatory medicine. Since 2000, cardiac safety became the primary reason for drug withdrawals and non-approval of new drugs. Early detection of potential QT prolongation and TdP liability is now an essential component of the drug development paradigm.

Most recently, the scope of cardiac safety drug development has expanded and now covers three major areas of potential drug-induced cardiac toxicity: cardiac repolarisation, or drug-induced QT prolongation leading to cardiac arrhythmia; vascular thrombosis leading to myocardial ischemia and infarction; and direct myocardial toxicity leading to loss of cardiac tissue and heart failure. This article will provide an up-to-date overview of the evolving field of drug cardiac safety and the science behind drug-induced cardiotoxicity, current regulatory requirements and drug development strategies to improve management of drug cardiac safety and bring safer medicines to market.


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Boaz Mendzelevski, MD, is a Cardiac Safety Consultant based in London. He received his degree in Medicine and board certification in Internal Medicine from the Ben-Gurion University Medical School and Hospital in Beer-Sheva; and his board certification in Cardiology from the Shaare Zedek Medical Centre and Hebrew University in Jerusalem, Israel. He completed further postgraduate training in Invasive Cardiology and Clinical Electrophysiology at the National Heart and Lung and Royal Brompton Hospital in London. Boaz is a pioneer in establishing the role of safety cardiology in pharmaceutical drug research and has been involved in all stages of drug development clinical trials since 1995. He was the founder of the Quintiles Transnational ECG laboratories in London and Mumbai, India, and more recently initiated and served as the Lead for the European Cardiac Safety Services division of Covance Inc.
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Boaz Mendzelevski
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Industry Events

4th Annual Patient Recruitment and Retention in Clinical Trials

13-15 October 2008, Amsterdam

Patient recruitment is now consuming thirty percent of clinical trial time - more time than any other clinical trial activity - and almost half of all trial delays result from patient recruitment problems. As the recruiting culture becomes more sophisticated and the forces affecting patient enrollment grow more numerous and complex, pharmaceutical companies are striving to discover new strategies to facilitate enrollment in clinical trials. With increasing industry pressure to develop, test and market greater numbers of new drugs faster, pharmaceutical companies need to perform clinical trials as quickly as possible. Inefficient patient recruitment processes is a formidable barrier to pharmaceutical companies' success in launching new products. Improving the patient recruitment process is imperative to avoid wasted investments and eliminate costly delays in bringing new drugs to market -- today and even more so in the not-so-distant future. Improved patient recruitment presents one of the largest opportunities for pharmaceutical companies to eliminate delays in clinical trials, thereby making it possible to reduce time to market.  With patent time limits and large overheads meaning that any delays in the development timeline can be disastrous, a good understanding of how to successfully recruit patients for trials is vital for any company looking to succeed.
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