WCCT Experience in Ethnobridging

WCCT is uniquely situated in Southern California which is home to diverse populations such as Asian Americans, Hispanics, and African Americans.

WCCT has conducted over 80 Asian ethnobridging / Japanese bridging/ Chinese bridging trials in the last 5 years. In an interesting WCCT case study, a sponsor conducted a 120 volunteer study with 5 key endpoints: SAD, MAD, food effect, ethnobridging comparison, and monitoring of the primary pharmacodynamic endpoint (platelet aggregation). Such a study was  a pivotal part of the development plan for allowing the program  to include Japan and the rest of Asia in the global phase III program.

In one of the largest Asian bridging studies ever,  WCCT, as a single site, recruited 26 Japanese, 26 Caucasian, 26 Asian Indian, 26 Korean, 26 Chinese, 26 Filipino, and 26 Vietnamese volunteers for a rosuvastatin study. This study, along with other data generated, resulted in a label change for rosuvastatin stating that Asians, but not Asian Indians, needed to be given half the dose as compared to Caucasians.

For sponsors who are interested in increasing the value of their NCE asset, WCCT can contract and draft a complete phase I program development that incorporates bridging into their program. In terms of innovative study design,  it is not uncommon to add small cohorts of Korean or Chinese subjects in addition to Japanese subjects to an ethnobridging trial depending on the company goals for the compound.

Download our Ethnobridging Brochure Here


Integrating Asia into Global Drug Development

In traditional drug development, companies with a promising new chemical entity (NCE) would develop the drug in the US or EU markets first. Then if the drug became successful , the companies would then turn their attention to developing the NCE for the Japanese market. This approach led to a “Japan gap” with a 5 to 7 year time lag from approval of a compound in the US/EU versus approval in Japan. Because of the size of the Japanese market, billions of dollars of “lost sales” was left on the table by pharmaceutical companies.

After the issuance of the E5 guidelines, companies who have been developing compounds in the US and Europe have adopted asian bridging or ethnobridging strategies which typically involves comparing Caucasian and Japanese cohorts to show equivalence or lack of equivalence with respect to PK data. In one review (Uyama, Y et al. Clin Pharmacol Ther 2005: 78: 102-13), the PMDA (the Japanese regulatory agency) published data showing that a new drug approval (NDA) took 32 months when a Japanese bridging strategy was used versus 56 mo for NDA approval when full repeat development program with no bridging was done.

With the pressures of making the drug development process more cost effective and time efficient, most multinational pharmaceutical sponsors are developing strategies where they  are accelerating global development by planning to incorporate Asian data in their phase I program so that by the time a NCE reaches phase 3, the program is being run globally and including Asian sites. It is not uncommon for phase I study designs to integrate an Asian bridging arm into their single ascending dose (SAD) and multiple ascending dose (MAD) study designs rather than running an entirely separate bridging study.

*** For large, multinational pharmaceutical companies  they are using these integrated SAD/MAD with ethnic subarms studies as a means to initiate small dose ranging Phase II studies in Asian countries which is then used to include those Asian countries in the global phase III program.

***For smaller biotechnology companies where the goal is to bring a compound thru phase 2a proof of concept (POC) and establish safety and PK data, incorporating ethnobridging in the phase I development program is a way to increase their product’s value when out-licensing occurs. Options include 1) outlicensing the NCE for the rights to Japan and China separate from the US and European development rights., 2) extracting a better market value and milestone payments for the NCE for a global pharmaceutical company which wants to develop the compound in Asia as well as in Europe and the US.

Background on Ethnobridging, Asian Bridging & Japanese Bridging

The possibility that ethnic differences exist in different populations with regards to metabolism and distribution of drugs has been documented for years. These differences may be manifested with a difference in safety, efficacy and/or dosages, or in terms of adverse profiles in these ethnically diverse populations. Based on the premise that one should not have to repeat an entire clinical drug development program, the three regions represented by the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), published a document entitled “Ethnic Factors in the Acceptability of Foreign Clinical Data” (E-5) on 5 Feb 1998. Download Document Here.

In this document the concept of “extrinsic” and “intrinsic” ethnic  factors were discussed. Extrinsic factors are factors associated with the environment and culture in which a person resides. Examples of extrinsic factors include diet, use of tobacco and alcohol, exposure to environmental pollutants and sunshine, local normal bacterial and viral flora, etc. Intrinsic factors include genetic polymorphism, age, gender, weight, lean body mass, etc. All of these factors can have potentially profound effects on drug distribution, metabolism and elimination. This, in turn may affect the pharmacokinetics, pharmacodynamics, and therefore the safety and efficacy of drugs in different ethnic populations.

In light of these potential ethnic factors, the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuteicals for Human Use (ICH)* prepared the E5 guidance which was endorsed  by the three regulatory agencies on February 5, 1998. The guidance is intended to recommend a framework for evaluating the impact of ethnic factors on drug efficacy and safety with the goal of minimizing duplication of clinical studies and accelerating drug approval process. The goal is to be able to use bridging studies  to extrapolate foreign clinical data into a new region.

Ethnic differences have been noted in three major areas: 1) PK profiles (eg. WCCT Study) 2) pharmacodynamic endpoints, 3) different adverse event profiles (eg  sildnafil : 100 mg in Japanese causes abnormal vision in 10.8% vs 3.4% in 50 mg with no added efficacy resulting in a lower maximum dose in Japan).

*ICH consists of the regulatory and industry representatives from three regions, the US, Europe, and Japan: European Commission, Eurpoean Federation of Pharmaceutical Industries Associations, Japanese Ministry of Health and Welfare, Japanese Pharmaceutical Manufacturers Association, The Centers for Drug Evaluation and Research and Biologics Evaluation and Research, FDA, and the pharmaceutical Research and Manufacturers Associations (IFPMA).

WCCT Global Ethnobridging Video Series

Ethnobridging Episode 1

Ethnobridging Episode 2

Ethnobridging Episode 3

Ethnobridging Episode 4

Ethnobridging Episode 5

Keywords: Description:
early phase Phase 1 trials are usually the earliest trials of drugs in people. But your doctor might ask if you would like to join a phase 0 study. These studies aim to find out if a drug behaves in the way researchers expect it to from their laboratory studies.
clinical development  The main goals of pre-clinical studies are to determine the safe dose for First-in-man study and start to assess product’s safety profile. Products may include new or iterated or like-kind medical devices, drugs, gene therapy solutions,
clinical research Clinical research is a branch of healthcare science that determines the safety and effectiveness (efficacy) of medications, devices, diagnostic products and treatment regimens intended for human use. These may be used for prevention, treatment, diagnosis or for relieving symptoms of a disease. Clinical research is different from clinical practice. In clinical practice established treatments are used, while in clinical research evidence is collected to establish a treatment.
clinical pharmacology Clinical pharmacology is the science of drugs and their clinical use. It is underpinned by the basic science of pharmacology, with added focus on the application of pharmacological principles and quantitative methods in the real world. It has a broad scope, from the discovery of new target molecules, to the effects of drug usage in whole populations.
ethnobridging studies Science studies is an interdisciplinary research area that seeks to situate scientific expertise in broad social, historical, and philosophical contexts. It uses various methods to analyze the production, representation and reception of scientific knowledge and its epistemic and semiotic role.
early phase studies  The phases of clinical research are the steps in which scientists do experiments with a health intervention in an attempt to find enough evidence for a process which would be useful as a medical treatment. In the case of pharmaceutical study, the phases start with drug design and drug discovery, go on to animal testing, then start by testing in only a few human subjects and expand to test in many study participants if the trial seems safe and useful.