title: Likelihood approach for evaluating bioequivalence of highly variable drugs.
abstract: Bioequivalence (BE) is required for approving a generic drug. The two one-sided tests procedure (TOST, or the 90% confidence interval approach) has been used as the mainstream methodology to test average BE (ABE) on pharmacokinetic parameters such as the area under the blood concentration-time curve and the peak concentration. However, for highly variable drugs (%CV > 30%), it is difficult to demonstrate ABE in a standard cross-over study with the typical number of subjects using the TOST because of lack of power. Recently, the US Food and Drug Administration and the European Medicines Agency recommended similar but not identical reference-scaled average BE (RSABE) approaches to address this issue. Although the power is improved, the new approaches may not guarantee a high level of confidence for the true difference between two drugs at the ABE boundaries. It is also difficult for these approaches to address the issues of population BE (PBE) and individual BE (IBE). We advocate the use of a likelihood approach for representing and interpreting BE data as evidence. Using example data from a full replicate 2 × 4 cross-over study, we demonstrate how to present evidence using the profile likelihoods for the mean difference and standard deviation ratios of the two drugs for the pharmacokinetic parameters. With this approach, we present evidence for PBE and IBE as well as ABE within a unified framework. Our simulations show that the operating characteristics of the proposed likelihood approach are comparable with the RSABE approaches when the same criteria are applied.
authors.affiliation: Vanderbilt Center for Quantitative Sciences, Vanderbilt University, Nashville, TN, USA.
authors.forename: Liping
authors.initials: L
authors.lastname: Du
authors.forename: Leena
authors.initials: L
authors.lastname: Choi
mesh_terms: D018592:Cross-Over Studies; D004353:Drug Evaluation, Preclinical / Q000379:methods / Q000592:standards*; D016568:Drugs, Generic / Q000008:administration & dosage / Q000493:pharmacokinetics*; D006801:Humans; D016013:Likelihood Functions; D004364:Pharmaceutical Preparations / Q000008:administration & dosage / Q000378:metabolism*; D013810:Therapeutic Equivalency; D014481:United States; D014486:United States Food and Drug Administration / Q000592:standards*
chemical_list: D016568:Drugs, Generic; D004364:Pharmaceutical Preparations
keywords: bioequivalence; highly variable drugs; likelihood paradigm; profile likelihood