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Is there a role for the No Observed Adverse Effect Level in safety pharmacology?

Mow, Tomas and Andersen, Nidette and Dragsted, Nils and Lassen, Anders B. and Laursen, Morten and Bass, Alan and Valentin, Jean-Pierre and Markgraf, Carrie and Authier, Simon and Baird, Ted and Bhatt, Siddhartha and Traebert, Martin and Leishman, Derek J and Jones, David and Curtis, Michael J (2020) Is there a role for the No Observed Adverse Effect Level in safety pharmacology? Journal of pharmacological and toxicological methods. ISSN 10568719

Abstract

In nonclinical toxicology the highest dose or exposure without test article-related adverse effects, known as the No Observed Adverse Effect Level (NOAEL), is a variable that may be determined. In safety pharmacology the vast majority of the endpoints measured are quantitative numeric functional endpoints such as changes in heart rate, blood pressure or respiratory frequency, endpoints that are usually not assessed using a defined framework of adversity. Therefore, we asked the question: is there a role for the NOAEL in safety pharmacology? To populate our consideration, we conducted a survey via the Safety Pharmacology Society. We found that within safety pharmacology there is no formal definition of adversity and no guidance on defining NOAEL. We also found, perhaps unsurprisingly, there is no agreed rubric for using a NOAEL in safety pharmacology and we learned that the NOAEL is not a requirement in order to progress a new investigational drug through the regulatory process. Thus, a summary label such as NOAEL lacks nuance and disregards context in relation to the nature and the severity of the safety pharmacology findings. Consequently, defining ‘adversity’ and determining a NOAEL in safety pharmacology studies are not recommended since the range of functional endpoints investigated do not conform to a binary ‘toxic/non-toxic’ rubric. Focusing on describing test article-related effects on safety pharmacology endpoints, using reasoned arguments as part of an integrated risk assessment, will ensure that the clinical pharmacologists and regulatory bodies see a clear description of relevant findings at each dose or exposure level. This will inform a narrative about the potential risks of the test article and support a recommendation for optimal dose setting and optimal monitoring of vital signs in clinical trials

Item Type: Article
Date Deposited: 17 Sep 2020 00:45
Last Modified: 17 Sep 2020 00:45
URI: https://oak.novartis.com/id/eprint/42604

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