drdds
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2007-11-03 12:42
(6011 d 07:47 ago)

Posting: # 1272
Views: 26,873
 

 blood sampling [Study Per­for­mance]

Dear all,
Can you please guide me on the following?
In the bioequivalance study, we had deviation in time point of the blood collection, how much and how long are the deviations acceptable?? If not, why? if yes, what precausions to be taken in analysis? and what should be collection time points in crossover period??
Thank you.
DDS


Edit: Category changed. [HS]
Ohlbe
★★★

France,
2007-11-04 01:29
(6010 d 19:01 ago)

@ drdds
Posting: # 1275
Views: 22,367
 

 blood sampling

Dear drdds,

No guideline that I know of.

❝ if yes, what precausions to be taken in analysis?


I would suggest to specify in your protocol when you will be using real sampling times and when you will use nominal sampling times (e.g. deviation of more than x minutes, or x minutes before a specific time point and y minutes after, or x % deviation from nominal...).

❝ and what should be collection time points in crossover period??


Stick to the nominal time point in the protocol. No adjustment based on the deviation in Period I.

Regards
Ohlbe
Helmut
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2007-11-04 02:13
(6010 d 18:17 ago)

@ drdds
Posting: # 1276
Views: 22,751
 

 blood sampling

Dear DDS!

❝ In the bioequivalance study, we had deviation in time point of the blood collection, how much and how long are the deviations acceptable??


In addition to Ohlbe’s post a quote…
G Pabst
Deviations in sampling times (Chapter 5.5)
in: W Cawello (ed), Parameters for Compartment-free Pharmacokinetics - Standardisation of Study Design, Data Analysis and Reporting
Shaker Verlag, Aachen 2003, pp 78-79

Sometimes a sample cannot be taken at the planned time after drug administration. In prin­ciple, it is always possible to use the actual time of sampling – relative to drug administration – when calculating the AUC. On the other hand, this effort frequently dose not seem to be jus­tified, since a shift of d data point in the concentration-time curve usually has only a mar­ginal effect on the area under the curve (only the partial areas surrounding the delayed sample are affected).

The sampling time points in the study protocol were selected in order to permit a description of the concentration-time profile as precisely as possible. Based on this, only those time devi­ations will be of pharmaco­kinetic relevance in which the time interval between the preceding and the affected sample or the interval between the affected and the following sample was pro­longed or shortened by, for example, more than 5%. In practice it has been proven accept­able to consider only those time deviations out of this specified range when calculating the AUC.
At later time points after drug administration the samples are commonly taken at relatively long intervals. For these samples a deviation by more than about 30 minutes should also be considered to be of possible pharmacokinetic relevance in order to allow for a conceivable circadian rhythm, even if the deviation is less than 5% of the shorter of the two surrounding time intervals. On the other hand, considering that the sampling process itself takes some time, it is not reasonable to account for any deviations of less than a minute.

This procedure for calculating pharmacokinetic parameters by ignoring any time deviations of less then 5% of the shorter of the two time intervals surrounding the sample affected has been shown by simulations to lead to estimates that differ at the most by 1.5% from the theoretical value. In unfavourable circumstances (very few samples, all deviations sys­tema­tically in one direction) the relative error may increase to 3.6%. The simulation furthermore showed that a well-chosen design (e.g. with respect to sampling times) is more important than other factors (e.g. theoretical profile, analytical accuracy).
Any sampling occuring too early is a deviation that should be reported even if pharma­co­ki­netically irrelevant, since there are only few plausible reasons why an activity should have been performed earlier than planned. When investigating the pharmacokinetics after single dosing, the predose sample, except for endogenous substances, is only used to demonstrate that there were no quantifiable concentrations preceding drug administration. This sample may therefore be taken within a reasonable time span preceding dug administration e.g. within 30 minutes; nevertheless, it will be considered during the calculations as if it has been taken simultaneously with the drug administration.


Hope that helps…

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Ohlbe
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France,
2007-11-04 14:25
(6010 d 06:05 ago)

@ Helmut
Posting: # 1278
Views: 22,482
 

 blood sampling

Dear HS,

I do agree. Corrections for time deviations in AUC calculations usually result only in negligible differences in AUC results.

But as always, I prefer to see things planned and described in advance, either in the protocol or in SOPs.

Regards
Ohlbe
Helmut
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2007-11-04 14:45
(6010 d 05:45 ago)

@ Ohlbe
Posting: # 1279
Views: 22,470
 

 blood sampling

Dear Ohlbe!

❝ Corrections for time deviations in AUC calculations usually result only in negligible differences in AUC results.


Not only in the results (as stated by G Pabst based on simulations), but even more pronounced in the context of bioequivalence. Deviations of AUCs obtained from scheduled sampling times instead of from the more correct actual ones simply mean out in the calculation of BE (point estimate, confidence interval).
A couple of years ago I evaluated quite a lot of studies in both ways to get some impressions. Results generally differed to less than 0.1% (!) in terms of BE…

❝ But as always, I prefer to see things planned and described in advance, either in the protocol or in SOPs.


Me too! I’m always suggesting to use actual sampling times, but everybody should be aware that the crucial point is not the method of calculation (actual vs planned), but the location of sampling points.
IMHO the most important region is around Cmax.

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Dr.Tarak Parikh
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India,
2007-11-06 10:59
(6008 d 09:31 ago)

@ Helmut
Posting: # 1288
Views: 22,471
 

 blood sampling

Hi, the explanation is understood,.
would like to ask only 2 things.
  1. if it is a IR product, Tmax-12min, and T1/2 - 1hr, then what?
  2. if deviation of blood collection is more than 5%, then should we continue the 2nd period?, if yes then should we collect the blood as per actual time point or schedule time?
please give your suggestion.
regards
Dr.Tarak
Helmut
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2007-11-09 18:27
(6005 d 02:02 ago)

@ Dr.Tarak Parikh
Posting: # 1293
Views: 22,770
 

 First Time Cmax

Dear Tarak!

❝ 1. if it is a IR product, Tmax-12min, and T1/2 - 1hr, then what?


Wow! Tmax 12 minutes, the perfect analgesic!
It will be quite challenging to avoid FDA's http://www.fda.gov/cder/guidance/5356fnl.pdf First Point Cmax-problem (see Section VI.D). Sample as frequently as possible…

In order to avoid bias in the calculation of AUC consider method 9 by

RD Purves
Optimum Numerical Integration Methods for Estimation of Area-Under-the-Curve (AUC) and Area-under-the-Moment-Curve (AUMC)
J Pharmacokin Biopharm 20/3, 211–26 (1992)


Unfortunately this algorithm is not implemented in standard PK software; you would have to write your own routines – which is not very complicated anyhow.

❝ 2. if deviation of blood collection is more than 5%, then should we continue the 2nd period?, if yes then should we collect the blood as per actual time point or schedule time?


Continue in any case; but be prepared to report the reason for the deviation(s) in detail.
Collection in the second period should be performed at the scheduled time; otherwise with such a short half life sampling at actual time points of period I for every subject you will end up in some kind of logistic chaos in period II.


Edit: Link corrected to latest archived copy. [Helmut]

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ratnakar1811
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India,
2009-12-10 08:05
(5243 d 12:25 ago)

@ Helmut
Posting: # 4452
Views: 21,201
 

 blood sampling

Dear HS and forum members,

❝ Me too! I’m always suggesting to use actual sampling times, but everybody should be aware that the crucial point is not the method of calculation (actual vs planned), but the location of sampling points.

❝ IMHO the most important region is around Cmax.


This topic was discussed long back, but recently i have received a letter from WHO for using actual time for PK analysis, as earlier we were considering schedule time if the deviation is <10% and for deviation >10% actual time.

Generally we have a window of 2 min for inhouse sampling and for ambulatory samples we have a window of 1 hr mentioned in the protocol, now my question is should we use actual time for all the deviation irrespective as mentioned above (i.e. even the sample is delayed by 1 min also) or for only those samples for which protocol deviation required to be filed?

Currently we have mentioned actual time to be considered for all the deviations even it is for 1 min also.

Your views will be highly aprreciated.

Regards,
Ratnakar
Pankaj Mishra
☆    

Mumbai, India,
2009-12-10 11:05
(5243 d 09:24 ago)

@ ratnakar1811
Posting: # 4456
Views: 21,177
 

 blood sampling

Dear Ratnakar,

❝ Generally we have a window of 2 min for inhouse sampling and for ambulatory samples we have a window of 1 hr mentioned in the protocol, now my question is should we use actual time for all the deviation irrespective as mentioned above (i.e. even the sample is delayed by 1 min also) or for only those samples for which protocol deviation required to be filed?


❝ Currently we have mentioned actual time to be considered for all the deviations even it is for 1 min also.


I think we should use an acceptable limit of ± 2 minutes for all the samples whether in-house or ambulatory and we can mention this in our SOP. Why 1 hr for ambulatory when that is also scheduled? I don't think any regulatory may have an objection on this approach except for those case where we have first point Cmax and half life is very low (e.g. 1 hr). In those cases we may restrict ourselves to 1 min of acceptable deviation.

Regards,
Pankaj Mishra

Pankaj Mishra
ratnakar1811
★    

India,
2009-12-10 13:46
(5243 d 06:43 ago)

@ Pankaj Mishra
Posting: # 4458
Views: 21,116
 

 blood sampling

Dear Pankaj,
Thanks for reply! what about the consideration of actual time or schedule time in PK analysis?

Best Regards,

Ratnakar
Pankaj Mishra
☆    

Mumbai, India,
2009-12-11 11:49
(5242 d 08:40 ago)

@ ratnakar1811
Posting: # 4468
Views: 21,155
 

 blood sampling

Dear Ratnakar,

❝ Thanks for reply! what about the consideration of actual time or schedule time in PK analysis?


Apologies that I missed that important point...it will always be the actual time points for PK calculation whenever the deviation is more than the acceptable limits as defined in SOP or protocol.
As I said earlier, acceptable limit can be taken as ± 2 min (usually plus but very rarely we observe negative deviation also :-) so better to keep both the limits) for all the blood samplings and we need to take scheduled sampling time points for PK calculation when the sampling is done within defined limits ( i.e. within ± 2 min). This way, we will be taking actual sampling time points only for those cases where it will be a protocol deviation (a cross-check also). I hope, I was able to answer your question :-)

Regards,
Pankaj Mishra

Pankaj Mishra
Helmut
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Vienna, Austria,
2009-12-11 15:03
(5242 d 05:27 ago)

@ Pankaj Mishra
Posting: # 4472
Views: 21,132
 

 Actual vs. scheduled time

Dear Pankaj!

❝ … it will always be the actual time points for PK calculation whenever the deviation is more than the acceptable limits as defined in SOP or protocol.

❝ […] we will be taking actual sampling time points only for those cases where it will be a protocol deviation.


Simple-minded question: What is your rationale of using
  • actual if |deviation| > limits, and
  • scheduled if otherwise?

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Helmut
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Vienna, Austria,
2009-12-10 14:13
(5243 d 06:17 ago)

@ ratnakar1811
Posting: # 4459
Views: 21,147
 

 blood sampling

Dear Ratnakar!

❝ ❝ I’m always suggesting to use actual sampling times

                                ^^^^^^^^^^^^^^^^^^^^^^^

❝ […] recently i have received a letter from WHO for using actual time for PK analysis


Not surprising; see WHO Technical Report Series, No. 937 (2006)
Annex 7:

6.10 Reporting of Results
The tabulated results should present the date of run, subject, study period, product administered (multisource or comparator) and time elapsed between drug application and blood sampling in a clear format.

Annex 9:

19.3 Actual sampling times and deviations from the pre-specified sampling times should be recorded.


❝ […] as earlier we were cinsidering schedule time if the deviation is

❝ <10% and for deviation >10% actual time.


Since you are already able to perform the calculation on actual times (according to your procedure if deviation >10%), why not to employ it in all cases?

❝ Generally we have a window of 2 min for inhouse sampling and for ambulatory samples we have a window of 1 hr mentioed in the protocol, now my question is should we use actual time for all the deviation irrespective as mentioned above (i.e. even the sample is delayed by 1 min also) or for only those samples for which protocol deviation required to be filed?


If ever possible use the actual sampling time in the calculation. Many CROs record all actual times, and define time windows in the protocol where deviations have to be commented in the CRF.

❝ Currently we have mentioned actual time to be considered for all the deviations even it is for 1 min also.


:confused: Hhm, isn’t that a contradiction?

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ratnakar1811
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India,
2009-12-11 11:16
(5242 d 09:14 ago)

@ Helmut
Posting: # 4467
Views: 21,115
 

 blood sampling

Dear HS!
thanks a lot for reply.

:confused: Hhm, isn't that a contradiction?


We have proposed this change of actual time for all the deviations, in our current SOP which is under review.

Regards,
Ratnakar
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