Introduction
A thorough discussion of the known effects of the investigational product(s) in humans should be provided, including information on pharmacokinetics, metabolism, pharmacodynamics, dose response, safety, efficacy and other pharmacological activities. Where possible, a summary of each completed clinical trial and ongoing trials where interim results are available that may inform the safety evaluation should be provided. Information should also be provided regarding results of any use of the investigational product(s) other than from clinical trials, such as from experience during marketing.
(a) Pharmacokinetics and product metabolism in humans
A summary of information on the pharmacokinetics of the investigational product(s) should be presented, including the following, if available:
• Pharmacokinetics (including metabolism, as appropriate, and absorption, plasma protein binding, distribution and elimination)
• Bioavailability of the investigational product (absolute, where possible, and/or relative) using a reference dosage form
• Population subgroups (e.g., sex, age and impaired organ function)
• Interactions (e.g., product-product interactions and effects of food)
• Other pharmacokinetic data (e.g., results of population studies performed within clinical trial(s))
(b) Safety and efficacy
A summary of information should be provided about the investigational product’s/products’ (including metabolites, where appropriate) safety,
pharmacodynamics, efficacy and dose response that was obtained from preceding trials in humans (healthy volunteers and/or patients). The implications of this information should be discussed. In cases where a number of clinical trials have been completed, the use of summaries of safety and efficacy across multiple trials by indications in subgroups may provide a clear presentation of the data. Tabular summaries of adverse drug reactions, including information on their frequency and natures for all the clinical trials (including those for all the studied indications) would be useful. Important differences in adverse drug reaction patterns/incidences across indications or subgroups should be discussed.
The IB should provide a description of the possible risks and adverse drug reactions to be anticipated on the basis of prior experiences with the product under investigation and with related products. A description should also be provided of the precautions or special monitoring to be done as part of the investigational use of the product(s).
(c) Marketing experience
The IB should identify countries where the investigational product has been marketed or approved. Any significant information arising from the marketed use should be summarised (e.g., formulations, dosages, routes of administration, adverse drug reactions). The IB should also identify all the countries where the investigational product did not receive approval/registration for marketing or was withdrawn from marketing/registration.