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Information on the state of commercial stocks of the fish population of the Ivankovo reservoir from 1980 to the present is presented. According to our data, the total commercial fish stocks in the Ivankovo reservoir in comparison with the 1980s and 1990s decreased by almost 1,000 tons. Over the past 5 years, they have been in the range of 2245–2808 tons. The closure of industrial fishing in 2007 led not to an increase, but to a decrease in fish stocks, due to a decrease in the rate of their linear and weight growth, deterioration of exterior and commercial qualities. The material damage caused by the closure of industrial fishing at the Ivankovsky reservoir since 2007 has been determined. To determine the material damage caused by the closure of industrial fishing at the Ivankovsky reservoir, retail prices for 21 types of fish were determined. The resulting value for each type of fish was correlated with the volume of fish that was not caught due to the absence of fishing in the period from July 2007 to 2022. Data on catch volumes in the Ivankovo reservoir are taken from the Orders on approval of the total allowable catches and recommended catch of aquatic biological resources in 2007–2022. Over the past 15 years, the possibility of catching almost 7.4 thousand tons of fish has been lost, which in monetary terms is 1,103 million rubles.

Generally, preclinical studies of medicines conducted in accordance with national and international regulatory recommendations allow minimising the risks of detecting serious adverse events in patients at the stage of clinical trials. Nevertheless, current analytical trends motivate the development of new prognostic approaches aimed at improving the reliability and accuracy of safety assessments.The aim of this study was to develop and test methodological approaches to comprehensive preclinical assessment of the key risk factors associated with the use of medicinal products in humans and to mathematical prediction of the corresponding benefits and risks.Materials and methods: the study combined information analysis and statistics; it used consolidated preclinical data on the protective properties of fabomotizole and national and international regulatory documents describing the principles and methods of evidence-based medicine, in particular, Bayesian statistics and prognostic research methods.Results: The article presents mathematical approaches developed to confirm the statistical reliability and prognostic significance of the results of preclinical assessment of the safety of medicines, based on Bayesian statistics, in particular, the concepts of weight of evidence (WoE), information value (IV), and normalised density (ND). Depending on the volume of the evaluated data, the WoE can be used to determine the weight of evidence of single variables, as well as entire groups of variables from individual tests or whole test panels, considered in the studies of general toxic effects, reproductive toxicity, genotoxicity and other studies characterising the condition of vital organs when evaluating the safety of medicines.Conclusions: The developed methodology allows evaluating the entire volume of information obtained in preclinical studies of medicinal products. The criteria in the form of WoE and IV in preclinical safety assessment of medicines can be used to estimate the benefits and risks of using medicines, including the products developed specifically for children and pregnant women.

Introduction. The article discusses the problem of assessing the similarity of the dissolution profiles of two batches of the nebivolol. The use of a generally accepted similarity factor for assessing equivalence is unacceptable in some cases, for example, for drugs with a high variability in the values of the release of the active substance from the formulation. At the same time, at present, there are no generally accepted approaches to comparing the profiles of the dissolution kinetics of drugs, with the exception of the method for assessing the comparability of profiles based on the mathematical calculation of the similarity factor f2, which has certain criteria that limit its application.Aim. To demonstrate alternative methods for assessing the similarity between the dissolution profiles of two drugs using a practical example.Materials and methods. The results of the comparative dissolution test of two series of nebivolol at a dosage of 5 mg. Five model-independent methods for assessing the equivalence of drug dissolution were used. Statistical data processing was performed using Microsoft Excel software.Results and discussion. The paper presents a practical example of using five alternative model-independent methods for assessing the equivalence of the dissolution profile. An example is used to illustrate the proposed equivalence limits and statistical methodology. Also, various approaches to determining the boundaries of equivalence have been proposed to assess the similarity of the dissolution profiles of an active substance.Conclusion. According to the results of the comparative dissolution test of two batches of nebivolol, it was shown that the use of the similarity factor as a criterion for assessing dissolution profiles led to a false positive result. In such cases, the possibility of using alternative methods for assessing the equivalence of dissolution profiles described in the article, or other methods presented in the scientific literature, should be considered, with a justification of their acceptability in each specific case.

The criteria for diagnosis and classification of spondyloarthritides (SpAs) have undergone significant changes over the past 10 years. The emergence of new diagnostic methods and availability of new information on the prognosis of the disease outcome made it possible to distinguish a separate group of SpAs—axial SpA. Axial SpA is distinguished as a separate disease due to its high social significance, and special mechanisms of its development. The development of medicinal products for the treatment of axial SpA has some specific features, which requires preparation of specific recommendations for conducting clinical trials of such products. The aim of the study was to elaborate a methodological approach to clinical research and evaluation of efficacy and safety of medicinal products for systemic treatment of axial SpA. The study took into account the requirements/recommendations of the European Medicines Agency for planning clinical trials of medicinal products for the treatment of axial SpA, in order to streamline evaluation of national and foreign clinical trial results. The paper identifies the main stages of clinical trials, and proposes criteria for assessing product efficacy at each stage. It defines methods and tools for assessing clinical trial endpoints, which are necessary for evaluation of treatment effects. The paper describes specific aspects of clinical trial designs and their duration, and identifies the objectives of exploratory and confirmatory clinical trials. It also reviews treatment goals and treatment outcome evaluation. The study results could be used in elaboration of recommendations for clinical research of new medicinal products for axial SpA.

A bioequivalence (BE) study is one of the key stages of investigations required for the registration of oral generic drugs. The planning of this type of study is determined by many factors, including the linearity of the pharmacokinetics of the active substance. The choice of the drug dose for a BE study will depend on this property in registering several drug strengths. Regulatory requirements for planning BE studies of drugs with non-linear pharmacokinetics are considered using atazanavir and valaciclovir as examples. An analysis of protocols and reports of BE studies received by the SCEEMP according to the State Drug Registry and open published data on BE revealed differences in both the tested drug dosages and the number of tests performed. All characteristics of the given active substance, available literature data, international experience, and current regulatory requirements should be taken into account in planning and evaluating BE studies of drugs with non-linear pharmacokinetics.

The coronavirus (COVID-19) pandemic, which began in 2020, has affected all spheres of life, including clinical trial processes. Health authorities around the world issued recommendations aimed at minimising the risks of virus spreading and ensuring the safety of study participants. One of the types of clinical trials is bioequivalence studies of generic medicines. The aim of the study was to analyse current foreign approaches to planning and conduct of bioequivalence studies of medicines in the context of the COVID-19 pandemic, and to develop recommendations for planning of studies conducted in the Eurasian Economic Union and evaluation of their results. The paper discusses the main provisions of the current guidelines of the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) on the planning, conduct and evaluation of clinical trials and, in particular, bioequivalence studies of generic medicines. The paper substantiates the necessity of detailing the recommendations of the Ministry of Health of the Russian Federation, published in an open letter to all market stakeholders and regulating the conduct of clinical trials of medicines in the context of the coronavirus pandemic. The results of the analysis helped to develop recommendations aimed at ensuring the protection of clinical trial participants, as well as maintaining an acceptable level of quality and reliability of study results.

In the paper, preliminary results of hydrochemical, hydrobiological, parasitological and ichthyological investigations have been given, carried out on waters of the Lake Senezh in 2020 and compared with analogous works for 2004–2006. The ecosystem of the given water object is extremely understudied. In the size structure of fish species, caught in 2020, dynamics of a good reproduction potential could be noted. The condition factor of all fish species is very high. One can see a significant prevalence of females over males, excepting bream, in all fish groups studied. The water object investigated showed the 2,8 times MPC increase for iron in fish farming water bodies. Concentration of toxic elements in water samples and bottom sediments did not increase MPC for all other indices. The bacteriological water analysis showed insignificant increase of bacterial contamination at the area of the investigation station 6 only, what is most likely of the anthropogenic nature and is being a result of the littoral lake zone pollution. Parasitological analysis of the Senezh lake fishes indicates of o high level of their invasion. 11 parasites species were found in 3 fish species investigated, which were represented by 73% of trematodes at the metacercaria and maritas stage. The fish ergasiles problem, existed in this water body since 2005 and up to-date, continues. In zanders gills, parasitic Ergasilus sieboldin were found. The given work would be interesting for investigators who will study the Senezh lake as well as other water bodies of the Moscow area.

No new drug can be used in clinical practice without marketing authorisation. Acquisition of the necessary amount of clinical data may take several years, which is especially critical for pernicious diseases for which no alternative therapy is available. Lack of treatment options creates conditions in which early introduction of efficacious therapy into clinical practice is becoming crucial. This need resulted in the development of new regulatory approaches aimed at accelerated approval of drugs both by reducing the time frame and by fulfilling post-authorisation requirements. The aim of the study was to review regulatory approaches to the accelerated authorisation procedure based on incomplete clinical data, and analyse their potential use in the Russian Federation. The paper presents an overview of authorisation pathways based on incomplete clinical data, which are used by different regulatory authorities, as well as regulatory approaches used in the Eurasian Economic Union (EAEU) and as part of the Russian national authorisation procedure. It was demonstrated that the approaches used by the US, European, and Japanese regulatory authorities, despite some differences, share a common objective of accelerated approval of drugs that fill an unmet medical need. The EAEU also has a conditional approval procedure, but the proposed criteria do not make it possible to use this approach in a real clinical situation of an unmet medical need. A similar national procedure would make it possible to reach a compromise between the needs of the healthcare system and the sound basis for informed decisions of the regulatory authority. Accelerated introduction of novel drugs that address unmet medical needs would set the national regulation in the area of drug circulation on the right track.

Issues with planning bioequivalence studies of lopinavir/ritonavir (LPV/RTV) preparations are discussed. LPV is an antiviral (HIV) medicine and HIV protease inhibitor that was developed in a fixed-dose combination with RTV. According to existing RF legislation, results from bioequivalence studies with a reference drug must be submitted to register generics. Protocols and reports of bioequivalence studies of LPV/RTV film-coated tablet dosage forms that were submitted for review to the SCEEMP, MHRF, are analyzed. The number of administered tablets and duration of sample collection differed slightly in the study designs. The number of volunteers included in the study differed more substantially and was calculated based on the intra-subject coefficient of variation of LPV/RTV. A search of the internet for data on the variability of LPV/RTV found several results indicating that LPV/RTV was highly variable (30%). Recommendations for planning bioequivalence studies of LPV/RTV preparations are formulated based on the analysis.

Angiotensin II receptor antagonists (ARAs) are one of the most promising classes of antihypertensive drugs. They are most widely represented on the Russian market by losartan drugs which total 24 items. Therefore, it is crucial to analyse the factors that may affect the results of comparison of generic and reference losartan drugs.The aim of the study was to perform a retrospective analysis of bioequivalence studies of generic losartan drugs in order to develop approaches to expert evaluation of research protocols and reports.Materials and methods: the retrospective analysis covered the results of 27 bioequivalence studies of losartan and included the calculation of the pharmacokinetic parameters Cmax and AUC0-t, their intra-individual variability, and the weighted average of intra-individual variability. The calculations were made for the pooled population of men and women, as well as separately for each gender.Results: the data obtained indicate borderline high variability of losartan in bioequivalence studies (for Cmax in 50 % of the studies). It was demonstrated that losartan drugs may have different pharmacokinetics in men and women in terms of Cmax and AUC0-t. The retrospective analysis of the data made it possible to formulate relevant expert approaches to evaluation of protocols and reports of bioequivalence studies of losartan drugs.Conclusions: Bioequivalence of losartan should be evaluated in three- or four-period, double crossover, two-sequence replicate design studies. The study has to determine the pharmacokinetic parameters of the starting compound and its active metabolite; the period of determination of analytes should be at least 36 hours; the washout period of 7 days is sufficient; blood sampling should be more frequent during the first hour after administration for losartan and during the first 3–4 hours for the metabolite. When determining the sample size, the weighted average of the coefficient of intra-individual variability of Cmax of losartan (33 %) should be taken into account. The bioequivalence margins for Cmax can be scaled up.

The quality and effectiveness of preclinical trials of medicines depend on compliance with the Good Laboratory Practice (GLP) principles. At the same time, the data of the World Health Organisation (WHO) and the analysis of the regulatory framework suggest that the reliability and reproducibility of the results of basic biomedical research are currently a very urgent problem in medicine development. Due to the exploratory nature of studies related to confirmation of scientific hypotheses, and the variety of methodological approaches used, strict GLP criteria cannot be applied to all types of pharmacological studies. According to international acts, GLP principles have the status of requirements and regulate the quality of preclinical safety studies as represented by well-standardised «batteries of tests» used in toxicological studies and safety pharmacology studies, but they do not apply to studies of primary pharmacodynamics which determine potential therapeutic efficacy of the medicinal product. Foreign regulators recommend applying GLP principles to secondary pharmacodynamics studies as well, especially if this type of research makes an important contribution to the safety assessment of medicines. Thus, studies of pharmacological activity of medicines, which are crucial in assessing the prospects of the candidate medicine at the preclinical stage, are mostly «unregulated studies», the results of which may be incorrect. The article discusses the system of regulation of pharmacological studies, including principles of planning and implementation of these studies, as set out in recommendations on Quality Practice in Basic Biomedical Research (QPBR). The application of QPBR principles ensures reliability and reproducibility of the results of preclinical pharmacological studies and increases their scientific and practical value in the development of new medicines.

Results of a retrospective analysis of bioequivalence studies of generic angiotensin II receptor antagonists are presented. Losartan, valsartan, and telmisartan medicines can be considered highly variable with respect to the pharmacokinetic parameter for maximum blood-plasma concentration. Candesartan, irbesartan, and olmesartan medicines do not demonstrate high intra-individual variance in bioequivalence studies. Current regulatory recommendations and approaches to bioequivalence studies of highly variable medicines are discussed. Recommendations for the design and evaluation of test results of angiotensin II receptor antagonists are formulated.

US FDA requirements published in the new 2018 guidance for bioanalytical method validation and the necessity to confirm their reliability for determining analyte concentrations are reviewed. The history of regulations for bioanalytical method validation is briefly described. The key changes and additions to the FDA guidance for bioanalytical method validation that include unified requirements for chromatographic and ligand-binding method validation, instructions for biomarker validation, a separate section focused on new technologies (e.g., dry blood-spot method), and introduction of the fit-for-purpose concept are discussed. FDA and EAEU requirements for validation of chromatographic assay parameters are compared. In general, the requirements of the new FDA guidance and the EAEU agree despite several differences in the number of parameters and their acceptance criteria.

Generic drugs are widely discussed in the scientific literature. Their key advantage is high availability in the medical practice due to the possibility of a significant reduction in developer costs. In most cases the efficacy and safety of generic oral drugs are confirmed based on the acceptable results of pharmacokinetic evaluation of their bioequivalence with the reference drug. However, generic drugs are not directly compared with one another, and this calls into question the validity of the conclusion about the interchangeability of the generic drugs.The aim of this study was to evaluate the results of indirect comparison of generic drugs by the ratios of their AUC0-t and Сmax based on the information obtained in bioequivalence studies involving the reference drug.Materials and methods: the authors performed an indirect comparison of the results of bioequivalence studies of generic drugs containing one active pharmaceutical ingredient. The analysis was based on bioequivalence study reports over the last 7 years dealing with risk/benefit assessment of imatinib and tacrolimus products.Results: the results of indirect assessment of 90 % confidence intervals of the ratios of imatinib products’ geometric means show that in 46.7 % of cases the intervals fall outside the generally accepted limits (80–125 %) for at least one of the estimated parameters. As for tacrolimus products, the intervals did not go beyond the generally accepted limits (80–125 %) for the AUC0-t ratio, but a discrepancy was found in 10 % of cases for the Cmax ratio. However, when narrower limits of 90–111 % were used to assess the AUC0-t ratio, 90 % of the compared pairs did not meet the recommended standards. Conclusions: thus, conclusions on the acceptable degree of bioequivalence of two generic drugs to the reference product cannot constitute a scientifically sufficient reason for regarding these generic drugs as clinically equivalent.

There are no specific requirements and recommendations in the Russian Federation for evaluation of bioequivalence of modified-release medicinal products. Until recently, modified-release products were regulated in a similar manner as immediate-release products, which is unacceptable considering the active ingredient release profile and its pharmacokinetics. The modified release characteristics require a more complex approach to the assessment of equivalence of generic medicines as compared with the reference product. The number of parameters to be assessed and the scope of testing depend on many factors (release mechanism, specific features of the dosage form, linearity of pharmacokinetics, potential for ingredient accumulation, dependence on food intake, dose-dumping effects, and the number of dosage strengths to be registered). The aim of this paper was to develop recommendations for the national procedure of modified-release products authorisation based on the analysis of international regulatory experience in this field. The paper reviews the current European Medicines Agency (EMA) guidelines on evaluation of bioequivalence of generic modified-release dosage forms for oral use that were taken as a basis for the development of Eurasian Economic Union regulations on bioequivalence assessment. The analysis of the above-mentioned documents made it possible to develop recommendations for the national procedure of modified-release products authorisation. In the case of modified-release products for oral use it is recommended to perform bioequivalence studies by comparing the test product with the reference product. The authors developed a procedural algorithm for bioequivalence studies of modified-release medicinal products.

Neuropsychological research methods are used to evaluate cognitive functions (CF). Tests used in clinical neuropsychology, in most cases, describe one or more aspects of cognitive domains that are theoretical «constructs» in which several cognitive processes are involved. Neuropsychological tests measure CFs regardless of the medical condition of the test subject. This allows for determination of even minor changes in CFs, including in clinical trials, which is of fundamental importance in studying the efficacy and safety of a given therapy. This article deals with specific aspects of using neuropsychological and screening testing of cognitive functions in individual domains on the basis of foreign experience. It discusses the criteria for selection and application of individual tools, their features, and choice of criteria for evaluating the results of testing in clinical studies in cases of CFs deterioration in various medical conditions accompanied by cognitive impairment. When planning clinical trials, it should also be taken into account that mixed anxiety-depressive disorders are likely to cause forgetfulness, and this calls for differential diagnosis and should be registered in clinical research protocols. The use of subscales and combinations of components of different tools are encouraged based on the objectives of the clinical study, and the tools of neuropsychological research and cognitive function assessment should be validated taking into account the specificity and sensitivity of the method, using statistical analysis methods for specific purposes and tasks. Such a multifaceted approach to the study of cognitive impairments will significantly increase the level of clinical trials conducted and, consequently, will make it possible to put up for sale efficacious and safe medicines for the treatment of cognitive impairment.

Planning issues for darunavir (DRV) bioequivalence studies are considered. DRV is an antiviral (HIV) agent classified as an HIV protease inhibitor. Bioequivalence test results must be submitted for registration of generic drugs in the RF according to Federal Law 61-FZ. Bioequivalence study protocols and reports for DRV preparations that were submitted for review to the SCEEMP were analyzed. Differences in study designs including administration after fasting or meals, with or without a low dose of ritonavir, numbers of volunteers included in the study, and intra-subject variability were found. The internet was also searched for data on DRV variability. Recommendations for planning bioequivalence studies of DRV preparations were formulated based on the analysis.

Literature data and domestic and foreign methodological documentation for preclinical studies of the safety and toxicokinetics of pharmaceuticals are analyzed. According to Marketing Authorization and Assessment Rules for Medicinal Products in the EAEU, a developer must include in a General Technical Document information on toxicokinetic studies that is evaluated during a review of preclinical test results. The main approaches to expert evaluation of drug toxicokinetic studies are formulated. The main content of the expert analysis includes the methodological basis and results of the research, safety profile characteristics, extrapolation of preclinical data, risk factor characteristics, and predicted clinical patient safety profile. The inclusion of toxicokinetic studies in a program of preclinical toxicological studies is important in principle for an adequate extrapolation of experimental data and prediction of the safety of pharmaceuticals in humans. Expert analysis of toxicokinetic data allows toxicology study results, drug toxicity profile characteristics, and the risk of toxic side effects to be interpreted correctly.

The article analyses regulatory documents and requirements for statistical principles of planning and evaluation of results of bioequivalence studies. It describes current statistical approaches to bioequivalence evaluation and relevant recommendations for the planning of studies of conventional medicinal products, medicinal products with a narrow therapeutic range, and analogues of endogenous compounds. The article analyses such statistical approaches as average Bioequivalence (ABE), Average Bioequivalence with Expanding Limits (ABEL), Reference-Scaled Average Bioequivalence (RSABE). It describes specific aspects of statistical analysis of insufficiently studied medicinal products. The article also describes acceptable algorithms of planning and performing two-stage bioequivalence study designs, since such studies call for multiple testing of the bioequivalence hypothesis which leads to an increased probability of type i error (consumer risk). The article offers recommendations for the choice of statistical approaches and describes some aspects of statistical analysis methods depending on the design of the study and the type of generic medicines.

Expansion of the range of new medicines leads to a significant increase in healthcare spending and, consequently, to the appearance of more affordable generic drugs. A drug can be recognised as generic if there is sufficient evidence of equivalent structural characteristics of the active substance and therapeutic characteristics of the drug. However, for a number of substances which are multicomponent mixtures of sister compounds it is quite difficult to demonstrate absolute similarity of the chemical structure and to determine a substrate for bioavailability evaluation. Therefore, a separate group of non-biological complex drugs has been singled out. The present article summarises the requirements of the leading regulatory agencies for demonstration of equivalence between the reference product and such medicines as glatiramoids, liposome-encapsulated doxorubicin and iron-based nanosized colloidal products. It has been shown that preclinical and clinical studies are still necessary for these types of products, and the amount of testing will depend on the results of comparability assessment.

Issues pertaining to determination of the pharmacokinetic parameters of calcium preparations are examined using their comparative bioavailability as an example. Pharmacokinetic parameters of calcium such as area under the concentration—time curve (AUC) and maximum concentration (Cmax) are calculated considering the background calcium contents in volunteers. Calcium excretion with urine is assessed as clearance of creatinine, a calcium elimination factor. The dynamics of the content of parathormone (PTH), the main hormone regulating calcium homeostasis, are studied. The results can be used to plan clinical trials for assessing the pharmacokinetics of drug analogs of endogenous compounds.

Rational drug use considers the medical, biological, and pharmaceutical factors that ensure high bioavailability and efficacy. On the other hand, the interaction of a drug with in vivo systems is of interest to take into account chronopharmacology, which studies drug action as a function of human biorhythms. According to chronopathology, various pathological processes and disorders, in particular diabetes mellitus (DM), are related to biorhythm disruption. The pathogenesis of DM involves desynchronosis related to not only the disruption of endogenous insulin secretion but also the artificially induced rhythm of conventional insulin therapy. Available data on the influence of carbohydrate metabolism biorhythms on the efficacy of hypoglycemic treatment were summarized. The expediency of studying and developing schedules for administered hypoglycemic drugs was discussed.

The principles for assessing therapeutic equivalence based on bioequivalence studies as accepted in Russia are significantly different from those adopted abroad, in particular with respect to drugs with narrow therapeutic indices (NTI). Certification of these drugs based on bioequivalence studies with commonly recognized limits is unacceptable in practice because drugs in this concentration range can cause serious adverse side effects and be more dangerous than the reference drug. The situation becomes especially critical when the reference drug is replaced by a generic. This circumstance creates the need to develop stricter regulations for NTI drugs. This article analyzes possible approaches to planning bioequivalence investigations for NTI drugs as adopted by leading world regulatory institutions in order to harmonize them with bioequivalence studies of NTI drugs in the Russian Federation. General recommendations for planning bioequivalence studies of NTI drugs were formulated based on the analysis.

We compared anti-IIa activity of a heparin analogue and a reference product was carried out to confirm their biosimilarity. The experiment was based on the method of estimation of anti-IIa activity of a commercial sodium heparin preparation according to United States Pharmacopoeia. High similarity of the two medicinal heparin preparations by this parameter is shown. The method is recommended for the use in comparability studies.

We describe general principles of demonstrating biosimilarity, as well as selecting the biosimilarity margins. Any change in the structure of a biological molecule can modify its functional activity. Therefore, therapeutic equivalence between a biosimilar product and the corresponding reference product cannot be demonstrated using a single criterion. To demonstrate biosimilarity between two medicinal products, their various characteristics have to be evaluated which may, directly or indirectly, justify that clinically significant differences are absent. Insufficient understanding of 6ritical quality attributes brings a risk for the biosimilar product developer. This will either increase the number of non-clinical and clinical tests and trials needed or will result in awareness that the manufacturing process needs to be improved at the late stages of development, after investing significant resources in the development process. At the same time, the specification of the biological medicinal product cannot solely ensure safety and efficacy thereof. Properly characterized and controlled manufacturing process, which ensures consistency in its attributes not adequately controlled in specifications but influencing safety and efficacy profiles and showing their relevance in non-clinical tests and clinical trials, is an additional quality assurance factor. Justification of all development strategy details, including biosimilarity margins, has to be provided each time when the development process is initiated or when proceeding to the next steps. All problems encountered by the developer have to be resolved in close communication with the regulatory authority. In order to increase the quality of investigation and developer's adherence to good practices, clinical trial results should be published in detail.

The article gives a definition of highly variable drugs, describes currently existing regulatory guidance and approaches to the study of bioequivalence of highly variable drugs, and formulates recommendations on the design and evaluation of the results of studies of such drugs. These aspects are considered by the example of calculations based on actual data from the registration dossiers materials for rosuvastatin.

Methotrexate or leflunomide is used as a first-line synthetic disease-modifying anti-rheumatic drug in the therapy of rheumatoid arthritis (RA). In 2011, the Russian Federation registered and since it has been successfully using leflunomide**. Objective: to evaluate the efficacy and tolerability of leflunomide** used to treat RA in routine clinical practice. Subjects and methods. The investigation enrolled patients with varying duration of RA that met the 1987 classification criteria. The patients were followed up in 33 healthcare facilities of Russia from March 2013 to October 2014. A total of 235 patients were randomized; the data of 196 patients were statistically processed. The mean age of the patients was 52.4±11.8 years; the mean duration of the disease was 75.4±69.1 months. The disease activity estimated by DAS28 and CDAI were 5.5±1.2 and 35.1±14.3 scores, respectively. 105 and 57 patients had X-ray Stages II and III disease, respectively. 80.1% of the patients were positive for rheumatoid factor and anti-cyclic citrullinated peptide antibodies. According to the instruction of its use, leflunomide was administered in a dose of 100 mg/day during the first 3 days and then in that of 20 mg/day. When adverse reactions (ARs) occurred, it was recommended that the daily dose of the drug was decreased to 10 mg. The patients were examined before and 1, 3, and 6 months after treatment. The investigators measured the number of tender joints (NTJ) and that of swollen joints (NSJ), and visual analog scale (VAS) pain intensity, performed a laboratory examination involving clinical blood test, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), in patients during their visits to physicians. The disease activity was assessed with DAS28 and CDAI and ARs were recorded. Results. Six-month therapy reduced the mean NSJ from 10.9 to 7.5%, NTJ from 12.3 to 8.9, VAS pain intensity from 64.1 to 39.3 mm, on average, ESR from 37.04 to 23.6 mm/hr, and CRP from 27.8 to 12.35 mg/l. By 6 months of therapy, low and moderate RA activities estimated by DAS28 were noted in 70.9% of cases and those by CDAI in 61.2%. No serious ARs were detected during the study. Conclusion. The findings suggest that leflunomide shows a good clinical efficacy and tolerability.

By taking into account the fact that there are a few alternative biological agents for the treatment of rheumatoid arthritis (RA), the cost of an annual therapy cycle using the agents is greater than that of high-technology surgical interventions, and a pharmacoeconomic study substantiating the optimal choice of a specific drug has been conducted. The pharmacoeconomic analysis has indicated the use of the biological agents etanercept (ETC) can decrease the cost of an annual therapy cycle for each patient with RA by an average of 84,764–481,622 rubles and considerably increase the number of patients receiving the current therapy without allocating additional resources. Switching 100 patents with RA to a treatment regimen including ETC enables 14–78% of the patient with this condition to be additionally treated within the framework of the same budget. The given results with regard to the data that there are significant differences in the efficacy and safety of biological agents used to treat RA (National and EULAR guidelines for the treatment of RA, a number of meta-analyses of randomized controlled clinical trials) may conclude that the treatment regimen incorporating ETC is most preferential. The cost-effectiveness analysis based on the single meta-analysis proposed by G.J. Bergman et al., which had demonstrated differences in the efficacy of biological agents, also yielded the similar results. In this case, the administration of ETC is also more preferential because it can minimize expenditures of the health care system to achieve ACR20 and ACR50 responses. This advantage of ETC will cause the highest reduction in the number of hospital admissions, social benefits, and other expenses associated with the management of patients with RA. The authors are aware of the disadvantages of the performed trial, which cannot fully interpret uniquely the findings: the results of meta-analyses have limitations due to its low sensitivity in assessing the differences between the drugs; the virtually complete absence of published data on the direct comparison of the drugs, by employing sufficient patient samples, makes it necessary to use the data of the meta-analyses and to state that biological agents have similar efficacy and safety within the clinically permissible limit to recognize their equivalence; the trial has considered only an annual perspective to use the agents without regard for their therapy discontinuation rate and remission rate that requires that treatment should not be continued.

Objective: to analyze disease activity, functional state, quality of life (QL), and the frequency of infectious complications in methotrexate (MT) – or leflunomide (LF)-treated patients with rheumatoid arthritis (RA) who had undergone endoprosthetic replacement of the large joints of the lower limbs. Subjects and methods. One hundred and fourteen patients with RA who had undergone endoprosthetic replacement of the knee and hip joints were divided into 3 groups: 1) 36 patients who continuously received MT or LF in the perioperative period; 2) 42 patients who dis- continued MT or LF 2 and 4 weeks, respectively, prior to surgery; 3) 36 patients who took no disease-modifying anti-rheumatic drugs (DMARDs) within 12 months before surgery. Disease activity was estimated by the DAS28 index. QL was determined using the EQ-5D questionnaire and functional capacity was estimated by the HAQ index. Results and discussion. In all the groups, there was a preponderance of patients with moderate RA activity (more than 60%). In Groups 1 and 2, the mean dose of MT was about 10 mg weekly and that of LF was 20 mg daily. The use duration of glucocorticoids (GC) and their doses were comparable in all the groups. Twelve months after surgery, DAS28 significantly reduced from 4.22±1.08 to 3.58±1.07 months in Group 1 (p = 0.01); in Group 2, the decrease was insignificant: from 4.17±1.17 to 3.80±1.15 (p > 005); in Group 3, RA activity remained as before. All the groups achieved 50% functional improvement; better results were obtained in the group of patients who continued to use DMARDs in the perioperative period (∆HAQ=-0.67). The difference in the Eq-5D index corresponded to a moderate QL improvement: ∆EQ-5D = 0.28, 0.29, and 0.31 in Groups 1, 2, and 3, respectively (p < 0.05). There were no significant group differences. Deep infection in the endoprosthetic replacement area was detected in 2.8, 2.4, and 8.3% of cases, respectively (p > 005). Conclusion. Continuous use of MT and LF leads to a reduction in total disease activity and to functional improvement in patients with RA after endoprosthetic joint replacement, without increasing the frequency of infectious complications.

Lethality of pts with rheumatoid arthritis (RA) exceeds mortality values in general population. Possibility of disease modifying anti-rheumatic drugs (DMARD) influence on RA pts lethality has been widely discussed lately in scientific works. Objective. To determine possible lethality diminishment in Russian population of RA pts with one of biological drugs TNFα antagonist adalimumab. Material and methods. Model construction is based on the fact of lethality dependence on pt functional state assessed by HAQ. Model simulating progression of functional disability in pts with RA visiting medical institutions of Russia was made (RAISER study). 3 model variants for imitation of consecutive change of DMARDs including adalimumab were done. First consecution assessed DMARD change in the next chain: adalimumab-methotrexate-sulfasalazine-leflunomide-azathioprine-cyclosporine-palliative therapy. Second consecution: adalimumab administration after failure of first 3 DMARDs. Third consecution considered only change of synthetic DMARDs without adalimumab inclusion. Model imitated participation of 3000 pts in every consecution. Prognosis horizon was 12 years. Age of pts and initial HAQ distribution were get from results of epidemiological RAISER study. Calculation was done on the base of elevation of standardized lethality level (SLL) in population of RA pts in average from 135% to 300%. SLL values from 80 to 320% were used depending on functional disability degree with converting to Russian values of age-specific lethality coefficient for 1999. Results. Lethality in treatment consecutions including adalimumab was significantly lower. To the end of 12th year in group not using adalimumab, using it at once and using it after 376 DMARDs respectively 65,1%, 71,6% and 71,1% of pts were still alive. Conclusion. Significant decrease of lethality with adalimumab inclusion in consecution of DMARD change during treatment of RA pts was demonstrated with imitation modeling method.

Во всем мире продолжается разработка эффективных средств для диагностики и лечения ревматических заболеваний. В последнее десятилетие сделано большое количество открытий, созданы принципиально новые технологии, основанные на использовании достижений молекулярной биологии, которые позволяют значительно улучшить качество жизни (КЖ) больных тяжелыми воспалительными заболеваниями суставов.Все большее значение приобретает оценка экономической эффективности терапии больных ревматоидным артритом (РА). Это обусловлено быстрыми темпами роста стоимости лечения, особенно вследствие все более широкого применения новых генно-инженерных биологических препаратов, при выборе которых приходится учитывать не только их клиническую эффективность, но и стоимость, а также тенденцией к общему удорожанию медицинских услуг. Ни одно государство не располагает достаточными средствами для того, чтобы полностью покрыть потребности национального здравоохранения, а для рационального их распределения необходимо проведение тщательного экономического анализа [1].