Children are often given the same medication as adults, but in much lower doses. However, most medicines are not manufactured with this in mind. But now, thanks to 3D printing technology, it is possible to produce medication custom-made for each patient, to a very precise degree. TNO is working to that end in partnership with Erasmus MC and would like to invite the pharmaceutical industry to join them in their quest for innovation.
Children are often given medication that has been developed with adults in mind. Or, more specifically, for relatively healthy men weighing seventy kilos. Children, whether they are babies or teenagers, weigh a lot less, of course. The amount of medication they need is therefore much less too. But how can you be sure of giving the correct dose to a child? ‘The more weight a child puts on, the greater the doses they might require,’ says Liesbeth Ruijgrok, pharmacist at the Erasmus MC Sophia Children’s Hospital pharmacy. ‘The problem is that most medicines are not manufactured with this in mind. For example, it’s a daily feature of my work that I have to deal with tablets containing half a gram (500 milligrams) of an active ingredient, of which I need only 20 milligrams. So how do I split a tablet into 25 pieces, each exactly the same size? And what do we do once a young patient has left hospital but has to keep taking their medication?’
‘The more weight a child puts on, the greater the doses they might require’
One solution to the non-availability of medication in low doses is 3D printing technology. ‘TNO has been working on printing different materials for 25 years, including foodstuffs. The challenges that this brings are very similar to those in the pharmaceutical industry,’ explains Daniel van der Linden, who works at TNO as a business developer in this field. ‘The benefit of 3D printing is that you can print a very precisely customised dose of medication for any child. Also, we will soon be able to combine two to three different types of medication in the same pill.’ Ruijgrok explains why this is so important: ‘If a child has to take only one tablet a day, rather than three, there is a much greater chance of them actually taking all the medication they need.’
‘Pharmacists are being invited to share their ideas on how 3D printing can contribute towards future healthcare’
Labour intensive and costly
For the purpose of modifying existing medications, it is not immediately obvious why the pharmaceutical industry should be involved. After all, pharmacists are themselves authorised to modify medication for children. However, this is labour intensive and costly, and not every pharmacist has the necessary resources. In addition, not every type of medication lends itself to this type of modification. To facilitate greater customisation and to be sure in the process that modified medications meet all the relevant quality requirements, pharmacists do actually have a considerable role. ‘Firstly, 3D printing of medication is a technology that pharmacists can use to innovate in order to ultimately develop better medication at an affordable cost, which hopefully will help keep healthcare itself affordable,’ says Van der Linden. It is for this reason that he is inviting pharmacists to share their ideas on how 3D printing can contribute towards future healthcare for patients.
‘We will soon be able to combine two or three customised doses of medication in one pill’
A thousand and one questions
Additionally, it is important that new printed pills of this kind meet all legal and regulatory requirements. ‘How do you prove that you are printing 16 milligrams and not 17.3 milligrams?’ asks Ruijgrok. ‘In other words, how can you be sure that exactly the right amount of every ingredient is present in your printed tablet?’ That, she believes, is just one of the thousand and one questions that the development of the new product will raise; there will be a role for pharmacists here too. ‘We will first have to answer all these questions. Ultimately, we – TNO, Erasmus MC, and pharmacists – will have to convince the authorities that medication can be made safely in this way.’
Acceleration of process is crucial
An ever-greater understanding of disease processes has made possible the development of medications that are customised for specific patients or groups of patients, and which are therefore much more effective. However, the costs, time needed, and risks associated with the development of these ‘medications of the future’ are a significant cause of concern. New working partnerships and technological developments in accelerating the processes are crucial – and possible – for the purpose of reducing these costs and stimulating the development of these medications, so that every patient will get precisely the amount of medication that is suited to them.