傳統的離線檢驗法,就像是工廠為製作流程「拍幾張紀錄照」(taking several snapshots),而 PAT 的做法,卻是幫製程「錄製一個更完整的紀錄影片」(recording a movie)。除此之外,工廠也可以藉此找到流程中的缺陷,發現不曾發現的未知數,自己幫自己 debug,優化出更完美的製作流程!
面對處處充中充滿風險和陷阱的藥物製造,美國食品藥物管理局(U.S. Food and Drug Administration, 簡稱FDA)的 PAT 指南中這麼寫道「產品品質並非檢驗出來的,應是產品本身固有的或是被設計成如此(Quality cannot be tested into products; it should be built-in or should be by design)」。
高品質絕非來自於產品的最終檢驗,而是源自於好設計,使產品在製造時便蘊含高品質。從流程直接保證藥物品質,才是積極又負責的作法,這也是 FDA 在 2002 年開始提倡的新藥品品質概念: 藥品的品質是經由設計出來的(Quality by Design,簡寫為 QbD)。
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PAT帶動監測儀器發展,拓展應用層面
隨著製藥產業率先走入 PAT 的管理框架,許多相關產業如化工、化石、半導體……等,都發展出即時監控的衍生技術與設備,像是線上近紅外光譜儀(on-line NIR)或是桌上型核磁共振儀(NMR)。
相較於過去的臨床試驗,這次新冠疫情造成的社會經濟影響與傷亡人數皆十分巨大,而疫苗研發在這段期間,也比往常來得更快。因此,有些疫苗在開始施打後,才發現其他安全性上的問題,例如 AZ 跟嬌生在上市後,才發現有些施打者出現了血栓 Thrombosis with Thrombocytopenia Syndrome(TTS)反應。
不過,未來 T 淋巴球的相關指標,可能會是免疫橋接的重要指標。目前市面上的新冠疫苗,皆是設計成對抗最原始的病毒株,而在新冠肺炎流行一年多的現在,病毒也產生了變種,這導致施打疫苗後所產生的抗體,對於變種病毒的中和效果變差。但是,T 淋巴球的功能卻沒有減弱,因此 T 淋巴球被認為在對抗變種病毒中扮演重要角色。
在衛福部公布的「COVID-19 疫苗緊急使用授權審查標準」中的「療效評估標準」提到,國產疫苗的有效性評估是使用免疫橋接來確認,將國產疫苗所產生的抗體濃度與 AZ 疫苗做比較,然此條件僅考慮中和抗體。另外,在「疫苗專家審查會議」的會議紀錄中提及,高端疫苗臨床二期試驗數據,並未包含相關 T 淋巴球及變種病毒株之相關資訊,因此疫苗有效性尚待更多驗證 [23]。
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