WITHDRAWN-a resource for withdrawn and discontinued drugs

Post-marketing drug withdrawals can be associated with various events, ranging from safety issues such as reported deaths or severe side-effects, to a multitude of non-safety problems including lack of efficacy, manufacturing, regulatory or business issues. During the last century, the majority of drugs voluntarily withdrawn from the market or prohibited by regulatory agencies was reported to be related to adverse drug reactions. Understanding the underlying mechanisms of toxicity is of utmost importance for current and future drug discovery. Here, we present WITHDRAWN, a resource for withdrawn and discontinued drugs publicly accessible at http://cheminfo.charite.de/withdrawn. Today, the database comprises 578 withdrawn or discontinued drugs, their structures, important physico-chemical properties, protein targets and relevant signaling pathways. A special focus of the database lies on the drugs withdrawn due to adverse reactions and toxic effects. For approximately one half of the drugs in the database, safety issues were identified as the main reason for withdrawal. Withdrawal reasons were extracted from the literature and manually classified into toxicity types representing adverse effects on different organs. A special feature of the database is the presence of multiple search options which will allow systematic analyses of withdrawn drugs and their mechanisms of toxicity

SuperDRUG2: a one stop resource for approved/marketed drugs

Regular monitoring of drug regulatory agency web sites and similar resources for information on new drug approvals and changes to legal status of marketed drugs is impractical. It requires navigation through several resources to find complete information about a drug as none of the publicly accessible drug databases provide all features essential to complement in silico drug discovery. Here, we propose SuperDRUG2 (http://cheminfo.charite.de/superdrug2) as a comprehensive knowledge-base of approved and marketed drugs. We provide the largest collection of drugs (containing 4587 active pharmaceutical ingredients) which include small molecules, biological products and other drugs. The database is intended to serve as a one-stop resource providing data on: chemical structures, regulatory details, indications, drug targets, side-effects, physicochemical properties, pharmacokinetics and drug-drug interactions. We provide a 3D-superposition feature that facilitates estimation of the fit of a drug in the active site of a target with a known ligand bound to it. Apart from multiple other search options, we introduced pharmacokinetics simulation as a unique feature that allows users to visualise the 'plasma concentration versus time' profile for a given dose of drug with few other adjustable parameters to simulate the kinetics in a healthy individual and poor or extensive metabolisers

ProTox-II: a webserver for the prediction of toxicity of chemicals

Advancement in the field of computational research has made it possible for the in silico methods to offer significant benefits to both regulatory needs and requirements for risk assessments, and pharmaceutical industry to assess the safety profile of a chemical. Here, we present ProTox-II that incorporates molecular similarity, pharmacophores, fragment propensities and machine-learning models for the prediction of various toxicity endpoints; such as acute toxicity, hepatotoxicity, cytotoxicity, carcinogenicity, mutagenicity, immunotoxicity, adverse outcomes pathways (Tox21) and toxicity targets. The predictive models are built on data from both in vitro assays (e.g. Tox21 assays, Ames bacterial mutation assays, hepG2 cytotoxicity assays, Immunotoxicity assays) and in vivo cases (e.g. carcinogenicity, hepatotoxicity). The models have been validated on independent external sets and have shown strong performance. ProTox-II provides a freely available webserver for in silico toxicity prediction for toxicologists, regulatory agencies, computational and medicinal chemists, and all users without login at http://tox.charite.de/protox_II. The webserver takes a two-dimensional chemical structure as an input and reports the possible toxicity profile of the chemical for 33 models with confidence scores, and an overall toxicity radar chart along with three most similar compounds with known acute toxicity

Spontaneous adverse drug reaction reporting by community pharmacists: preparedness and barriers

Background: Adverse drug reactions (ADRs) are undesired, unintended responses to drugs, and are significantly underreported. Pharmacists are drug experts recognized as custodians of drug safety, who are expected to be prepared for and knowledgeable about ADR reporting. Objectives: To identify Egyptian community pharmacists’ preparedness for and perceived barriers to spontaneous ADR reporting. Methods: This cross-sectional study recruited a sample of community pharmacists across Egypt, who were invited to complete a self-administrated questionnaire during April 2020. Results: A total of 923 pharmacists across Egypt responded to the questionnaire. Most pharmacists were knowledgeable about the definition of ADRs (93.9 %) and indicated they felt reporting ADRs benefits the patients (82.2%). Despite recognizing their public health value, only a small percentage of participants conveyed familiarity with the reporting process for both paper (19.2%) and electronic (30.4%) forms, indeed 56.6% of participants did not remember what the ADR report form looked like. Moreover, 75.4% of respondents said they felt that community pharmacies are not the right place for reporting, with 49% suggesting that reporting was the responsibility of physicians. However, only 32.1% reported having insufficient time being a barrier to ADR reporting. Conclusions: Community pharmacists in Egypt are not well prepared for spontaneous ADR reporting due to a lack of knowledge about the formal process and not acknowledging their responsibility, although time was not a major barrier. Therefore, this highlights a clear opportunity for improvement likely involving targeted education

From Knowledgebases to Toxicity Prediction and Promiscuity Assessment

Polypharmacology marked a paradigm shift in drug discovery from the traditional ‘one drug, one target’ approach to a multi-target perspective, indicating that highly effective drugs favorably modulate multiple biological targets. This ability of drugs to show activity towards many targets is referred to as promiscuity, an essential phenomenon that may as well lead to undesired side-effects. While activity at therapeutic targets provides desired biological response, toxicity often results from non-specific modulation of off-targets. Safety, efficacy and pharmacokinetics have been the primary concerns behind the failure of a majority of candidate drugs. Computer-based (in silico) models that can predict the pharmacological and toxicological profiles complement the ongoing efforts to lower the high attrition rates. High-confidence bioactivity data is a prerequisite for the development of robust in silico models. Additionally, data quality has been a key concern when integrating data from publicly-accessible bioactivity databases. A majority of the bioactivity data originates from high- throughput screening campaigns and medicinal chemistry literature. However, large numbers of screening hits are considered false-positives due to a number of reasons. In stark contrast, many compounds do not demonstrate biological activity despite being tested in hundreds of assays. This thesis work employs cheminformatics approaches to contribute to the aforementioned diverse, yet highly related, aspects that are crucial in rationalizing and expediting drug discovery. Knowledgebase resources of approved and withdrawn drugs were established and enriched with information integrated from multiple databases. These resources are not only useful in small molecule discovery and optimization, but also in the elucidation of mechanisms of action and off- target effects. In silico models were developed to predict the effects of small molecules on nuclear receptor and stress response pathways and human Ether-à-go-go-Related Gene encoded potassium channel. Chemical similarity and machine-learning based methods were evaluated while highlighting the challenges involved in the development of robust models using public domain bioactivity data. Furthermore, the true promiscuity of the potentially frequent hitter compounds was identified and their mechanisms of action were explored at the molecular level by investigating target-ligand complexes. Finally, the chemical and biological spaces of the extensively tested, yet inactive, compounds were investigated to reconfirm their potential to be promising candidates.Die Polypharmakologie beschreibt einen Paradigmenwechsel von "einem Wirkstoff - ein Zielmolekül" zu "einem Wirkstoff - viele Zielmoleküle" und zeigt zugleich auf, dass hochwirksame Medikamente nur durch die Interaktion mit mehreren Zielmolekülen Ihre komplette Wirkung entfalten können. Hierbei ist die biologische Aktivität eines Medikamentes direkt mit deren Nebenwirkungen assoziiert, was durch die Interaktion mit therapeutischen bzw. Off-Targets erklärt werden kann (Promiskuität). Ein Ungleichgewicht dieser Wechselwirkungen resultiert oftmals in mangelnder Wirksamkeit, Toxizität oder einer ungünstigen Pharmakokinetik, anhand dessen man das Scheitern mehrerer potentieller Wirkstoffe in ihrer präklinischen und klinischen Entwicklungsphase aufzeigen kann. Die frühzeitige Vorhersage des pharmakologischen und toxikologischen Profils durch computergestützte Modelle (in-silico) anhand der chemischen Struktur kann helfen den Prozess der Medikamentenentwicklung zu verbessern. Eine Voraussetzung für die erfolgreiche Vorhersage stellen zuverlässige Bioaktivitätsdaten dar. Allerdings ist die Datenqualität oftmals ein zentrales Problem bei der Datenintegration. Die Ursache hierfür ist die Verwendung von verschiedenen Bioassays und „Readouts“, deren Daten zum Großteil aus primären und bestätigenden Bioassays gewonnen werden. Während ein Großteil der Treffer aus primären Assays als falsch-positiv eingestuft werden, zeigen einige Substanzen keine biologische Aktivität, obwohl sie in beiden Assay- Typen ausgiebig getestet wurden (“extensively assayed compounds”). In diese Arbeit wurden verschiedene chemoinformatische Methoden entwickelt und angewandt, um die zuvor genannten Probleme zu thematisieren sowie Lösungsansätze aufzuzeigen und im Endeffekt die Arzneimittelforschung zu beschleunigen. Hierfür wurden nicht redundante, Hand-validierte Wissensdatenbanken für zugelassene und zurückgezogene Medikamente erstellt und mit weiterführenden Informationen angereichert, um die Entdeckung und Optimierung kleiner organischer Moleküle voran zu treiben. Ein entscheidendes Tool ist hierbei die Aufklärung derer Wirkmechanismen sowie Off-Target-Interaktionen. Für die weiterführende Charakterisierung von Nebenwirkungen, wurde ein Hauptaugenmerk auf Nuklearrezeptoren, Pathways in welchen Stressrezeptoren involviert sind sowie den hERG-Kanal gelegt und mit in-silico Modellen simuliert. Die Erstellung dieser Modelle wurden Mithilfe eines integrativen Ansatzes aus “state-of-the-art” Algorithmen wie Ähnlichkeitsvergleiche und “Machine- Learning” umgesetzt. Um ein hohes Maß an Vorhersagequalität zu gewährleisten, wurde bei der Evaluierung der Datensätze explizit auf die Datenqualität und deren chemische Vielfalt geachtet. Weiterführend wurden die in-silico-Modelle dahingehend erweitert, das Substrukturfilter genauer betrachtet wurden, um richtige Wirkmechanismen von unspezifischen Bindungsverhalten (falsch- positive Substanzen) zu unterscheiden. Abschließend wurden der chemische und biologische Raum ausgiebig getesteter, jedoch inaktiver, kleiner organischer Moleküle (“extensively assayed compounds”) untersucht und mit aktuell zugelassenen Medikamenten verglichen, um ihr Potenzial als vielversprechende Kandidaten zu bestätigen

Evidence to support inclusion of pharmacogenetic biomarkers in randomised controlled trials

Pharmacogenetics and biomarkers are becoming normalised as important technologies to improve drug efficacy rates, reduce the incidence of adverse drug reactions, and make informed choices for targeted therapies. However, their wider clinical implementation has been limited by a lack of robust evidence. Suitable evidence is required before a biomarker’s clinical use, and also before its use in a clinical trial. We have undertaken a review of five pharmacogenetic biomarker-guided randomised controlled trials (RCTs) and evaluated the evidence used by these trials to justify biomarker inclusion. We assessed and quantified the evidence cited in published rationale papers, or where these were not available, obtained protocols from trial authors. Very different levels of evidence were provided by the trials. We used these observations to write recommendations for future justifications of biomarker use in RCTs and encourage regulatory authorities to write clear guidelines