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Hayashi H, Nogita T, Maeda H. A Qualitative Interview Study on Expanded Access Clinical Trials for Compassionate Use in Japan. Patient Prefer Adherence 2024; 18:1471-1479. [PMID: 39011090 PMCID: PMC11249069 DOI: 10.2147/ppa.s468663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024] Open
Abstract
Purpose An expanded access clinical trials (EACTs) provides exceptional patient access to investigational new drugs for life-threatening diseases for which no effective treatment exists. Based on public information, we have studied EACTs since 2016, when the EACT system was launched in Japan. In this study, we investigated the reality of EACTs by interviewing pharmaceutical companies and clarifying how they view them. Patients and Methods We conducted semi-structured interviews with 10 pharmaceutical companies developing new drugs. This study aims to clarify the status of EACTs, so we selected pharmaceutical companies that develop innovative drugs for which they may perform EACTs (however, experience in conducting EACTs was optional). Results All those surveyed were aware of EACTs. Twelve access clinical trials were conducted, and the EACT implementation rate for pivotal clinical trials was 2.5%. The most common reason for implementing an EACT was "requests from physicians and medical institutions" (nine companies, 90.0%), and the most common reason for not implementing an EACT was "the applicability of the system" (five companies). Improvements to EACTs were identified by eight companies (80.0%); financial assistance by six companies (60.0%); reducing the scope of data to be collected and simplifying the procedure by six companies (60.0%). Seven companies (70.0%) responded that a Single Patient Investigational New Drug Application should be conducted, suggesting that the system should be revised. Conclusion An interview survey of ten pharmaceutical companies developing new drugs in Japan regarding expanded access clinical trials indicated that there were issues with the system. Many wished to improve the system by establishing a single patient access system, supporting resources, and simplifying procedures. Based on our interviews with 10 Japanese pharmaceutical companies, it was found that the system needed to be improved by introducing a single patient access system, providing supporting resources, and simplifying procedures. In Japan, about eight years have passed since EACT was established, and it appears a revision of the EACT legislation is due.
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Affiliation(s)
- Haruto Hayashi
- Department of Regulatory Science, Faculty of Pharmacy, Meiji Pharmaceutical University, Tokyo, Japan
| | - Takehide Nogita
- Department of Regulatory Science, Graduate School of Pharmaceutical Science, Meiji Pharmaceutical University, Tokyo, Japan
- CMIC Co Ltd., Tokyo, Japan
| | - Hideki Maeda
- Department of Regulatory Science, Faculty of Pharmacy, Meiji Pharmaceutical University, Tokyo, Japan
- Department of Regulatory Science, Graduate School of Pharmaceutical Science, Meiji Pharmaceutical University, Tokyo, Japan
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Maeda H, Hara A, Ofuchi M, Shingai R, Misumi T, Murai Y. Trends in oncology drug lags in Japan from 2001 to 2020: A cross-sectional study. Clin Transl Sci 2023; 16:2665-2674. [PMID: 37815272 PMCID: PMC10719463 DOI: 10.1111/cts.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023] Open
Abstract
Anticancer drugs are essential in the treatment of serious diseases, but their applications are limited by drug lags. This study investigated the characteristics of anticancer drugs approved in Japan over the past 20 years and compared the drug lag trends between Japan and the US. We assessed the changes in drug lag between Japan and the US and the factors affecting the drug lags using publicly available data for anticancer drugs approved in Japan from January 2001 to December 2020. A total of 299 anticancer drugs were approved in Japan in the last 20 years. The approval lag median between the US and Japan was 498 days (16.6 months), peaking in 2002, and decreasing annually thereafter. The minimum approval lag was 173.5 days (5.7 months) in 2018. Multivariate regression analysis revealed that "global simultaneous strategy," "catch-up strategy," and "immunotherapy" are major factors shortening the drug lag. In the past decade, 226 anticancer drugs were approved in Japan. The drug lag for anticancer drugs between Japan and the US peaked in 2002, after which it declined sharply to less than a year. However, the lag was shortest in 2018.
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Affiliation(s)
- Hideki Maeda
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityKiyoseJapan
| | - Asuka Hara
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityKiyoseJapan
| | - Momoka Ofuchi
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityKiyoseJapan
| | - Riko Shingai
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityKiyoseJapan
| | - Toshihiro Misumi
- Department of Data ScienceNational Cancer Center Hospital EastKashiwaJapan
| | - Yuna Murai
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityKiyoseJapan
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Okabe A, Hayashi H, Maeda H. Correlation of Anticancer Drug Prices with Outcomes of Overall Survival and Progression-Free Survival in Clinical Trials in Japan. Curr Oncol 2023; 30:1776-1783. [PMID: 36826098 PMCID: PMC9955512 DOI: 10.3390/curroncol30020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Drug pricing methods vary extensively across countries. Japan calculates drug prices using cost accounting and based on the efficacy of similar drugs. This study investigated the relationship between drug prices and their clinical efficacy and usefulness using public information on anticancer drugs reimbursed by the National Health Insurance price listing between January 2009 and March 2020. We investigated drug characteristics, prices, and clinical benefits based on overall survival (OS) and progression-free survival (PFS). Eighty anticancer drugs were approved in Japan during the study period. The largest number (28 drugs, 35.0%) was approved based on PFS, 18 (22.5%) were approved based on OS, and 13 (16.3%) based on the response rate. The mean (±SD) drug price was JPY 88,416.2 (±148,974.7), while the median drug price (with quartiles) was JPY 21,694 (JPY 4855.0-JPY 93,396.8). Drug prices were significantly higher for PFS than for OS, while cost index-the drug price to extend PFS or OS by one day-did not differ significantly between PFS and OS. The relationship between the 46 drugs approved based on OS or PFS and their prices was examined. A correlation was found between drug prices and their clinical usefulness in terms of OS but not PFS.
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Nakao M, Nakamura Y, Shimokawa M, Maeda H. Postmarketing all-case surveillance trends and contribution to safety measures of drugs approved in Japan: a cross-sectional survey in 1999-2019. Int J Clin Pharm 2023; 45:108-116. [PMID: 36323961 PMCID: PMC9938803 DOI: 10.1007/s11096-022-01461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/21/2022] [Indexed: 02/21/2023]
Abstract
BACKGROUND Postmarketing all-case surveillance (PACS) is a safety monitoring activity predominantly conducted for drugs with few domestic clinical trials, orphan drugs, or anticancer drugs that potentially cause serious adverse events. AIM This study comprehensively analyzed drugs in Japan requiring PACS as an approval condition and those implementing PACS-results-based safety measures. METHOD We included drugs approved in Japan between 1999 and 2019. RESULTS During the 20-year survey, 1871 drugs were approved in Japan, including 277 (14.8%) requiring PACS as an approval prerequisite. The drug number requiring PACS for approval and its ratio to the total approved-drug number is increasing annually. In 2018, the number and percentage of PACS-requiring drugs reached a 37-drug maximum (32.5%). Additionally, among the 277 PACS-requiring drugs, upon examining the results of 87 drugs for which reexamination results had already been obtained, all 87 drugs (31.4%) were found to be in Category 1 which means there is no need to revise drug-approval conditions, indicating that their usefulness is consistent with approval. Furthermore, measures such as revising the package insert and providing information to medical institutions were adopted for 53 drugs, 14 of which had PACS-results-based safety measures. CONCLUSION PACS implementation for drug approval will potentially continue increasing. Normally, PACS is not conducted overseas, as it is a safety-monitoring activity exclusive to Japan, and the burden on institutions, such as medical sites and pharmaceutical companies, is heavy. Thus, ensuring a balance between the obtained effect and this burden is imperative.
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Affiliation(s)
- Minami Nakao
- Department of Regulatory Science, Faculty of Pharmacy, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose-City, Tokyo, 204-5255, Japan
| | - Yuri Nakamura
- Department of Regulatory Science, Faculty of Pharmacy, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose-City, Tokyo, 204-5255, Japan
| | - Masafumi Shimokawa
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Yamaguchi, Japan
| | - Hideki Maeda
- Department of Regulatory Science, Faculty of Pharmacy, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose-City, Tokyo, 204-5255, Japan.
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Maeda H, Ng DB. Regulatory Approval With Real-World Data From Regulatory Science Perspective in Japan. Front Med (Lausanne) 2022; 9:864960. [PMID: 35492312 PMCID: PMC9051225 DOI: 10.3389/fmed.2022.864960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Recently, there has been a growing trend in clinical development to utilize real-world data (RWD) to improve the efficiency of drug/medical device development. Especially, the use of RWD to generate real-world evidence (RWE) in regulatory approval is currently undergoing a period of great change with an increasing degree of active discussion. In Japan, RWE has been used in the control arms of clinical trials, observational studies, post-marketing surveillance, and public knowledge-based applications for regulatory approval. However, the exclusive use of RWE applications has still not been applied. In this paper, we summarize the history and the current situation of RWE and focus on the utilization for the purpose of regulatory approval. In addition, we will discuss the issues and perspectives for registry research in the utilization for regulatory approval in Japan.
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Affiliation(s)
- Hideki Maeda
- Department of Regulatory Science, Faculty of Pharmaceutical Sciences, Meiji Pharmaceutical University, Kiyose, Japan
- *Correspondence: Hideki Maeda
| | - Daniel Bin Ng
- Department of Medical Affairs, Astellas Pharma, Singapore, Singapore
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, United States
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Wu WW, Ji X, Wang H, Chen F, Ding Q, Zhang GD, Li M, Wang SS, Ni MM, Liu QQ, Xu J, Wang Q. Pediatric Clinical Trials in Mainland China Over the Past Decade (From 2009 to 2020). Front Med (Lausanne) 2021; 8:745676. [PMID: 34671625 PMCID: PMC8520938 DOI: 10.3389/fmed.2021.745676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/08/2021] [Indexed: 12/05/2022] Open
Abstract
In mainland China, there remains a shortage of pediatric drugs. The Chinese government has recently launched policies and incentives to encourage pediatric drug development and clinical trials. However, data on the characteristics or development trends of these trials are limited. In this review, we extracted source data from the Chinese Clinical Trials Registry and Information Transparency Platform and systematically reviewed the pediatric clinical trials conducted in mainland China from 2009 to 2020, a comprehensive process evaluation of the pediatric drug clinical trials development in the past decade, providing data support to policy makers and industry stakeholders. We included 487 pediatric clinical trials. Over the past decade, the number of pediatric trials has increased, especially since 2016. The most common therapeutic areas were infectious diseases (n = 108, 22.2%), agents for preventive purpose (n = 99, 20.3%), and neurological and psychiatric diseases (n = 71, 14.6%). The number of clinical trials involving epilepsy (39, 10.1%), asthma (33, 8.5%), and influenza (24, 6.2%) were the highest. The distribution of leading institutions is unbalanced in mainland China, with most units in East China (34.0%) and few in Southwest China (6.9%). China has made progress in improving the research and development environment of pediatric drugs and increasing pediatric trials. However, a wide gap in pediatric drug development and clinical trials quality exists between China and the developed countries. The pharmaceutical industry in China has faced grim setbacks, including study duplication, lack of innovation, poor research design, and unbalanced resource allocation. Thus, we suggest that the Chinese government should adjust their policies to improve innovation and clinical design capacity, and optimize resource allocation between regions.
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Affiliation(s)
- Wen-Wen Wu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Ji
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Wang
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Feng Chen
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Ding
- Clinical Research Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Guan-Dong Zhang
- Office of Clinical Trial Institution, Shanxi Children's Hospital, Taiyuan, China
| | - Man Li
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shan-Shan Wang
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Ming Ni
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qing-Qing Liu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Xu
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wang
- Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
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