1
|
Alipour S, Nadimi Parashkouhi S, Mojahedian M, Abbasian H. Assessing drug lag in new drug approvals by the Iran Food and Drug Administration compared to the U.S. FDA, EMA, and PMDA: A 20-year analysis (2001-2021). Medicine (Baltimore) 2024; 103:e38142. [PMID: 38905367 PMCID: PMC11191854 DOI: 10.1097/md.0000000000038142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/15/2024] [Indexed: 06/23/2024] Open
Abstract
The pharmaceutical industry is vital for healthcare advancement through innovative medications, improving lives. A substantial challenge is "Drug lag," hindering patient access and increasing disease adjusted life years burdens. We aim to examine drug lag for Iran Food and Drug Administration (IFDA) approved drugs versus US Food & Drug Administration (FDA), European Medicines Agency (EMA), and Pharmaceuticals and Medical Devices Agency (PMDA) over 2001 to 2021. We reviewed new molecular entities within this period, using descriptive statistics in Excel 2019. Drug lag is assessed from relative and absolute perspectives, considering approval gaps and annual rates. Among 710 FDA-approved drugs, 410 received EMA approval, 344 from PMDA, and 148 from IFDA. For 148 IFDA and FDA-approved drugs, the maximum drug lag was 237 months. The mean relative drug lag was 65.18 ± 61.56 months. Compared to EMA (112 drugs), the maximum lag was 257 months, with a mean relative lag of 70.29 ± 53.67 months. With PMDA (127 drugs), the maximum lag was 253 months, with a mean relative lag of 38.23 ± 60.57 months. Iran faces significant drug lag compared to developed countries' regulatory bodies, limiting patient access to innovative treatments. Addressing this issue is crucial for timely drug access, reducing disease burdens. Further research and policy interventions are needed to mitigate drug lag's impact on Iran healthcare landscape.
Collapse
Affiliation(s)
- Sama Alipour
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Sadra Nadimi Parashkouhi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadmahdi Mojahedian
- Department of Clinical Pharmacy and Pharmacoeconomics, School of Pharmacy, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Abbasian
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Tachibana Y, Narukawa M. Oncology drug lag in Japan: has it improved over the last decade? Int J Clin Oncol 2023; 28:1451-1460. [PMID: 37561368 DOI: 10.1007/s10147-023-02395-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Existing studies and statistics on the drug lag between Japan and the United States (US) for anti-cancer drugs indicate that it has decreased, whereas more drugs are left unapproved in Japan. This study aimed to quantify the impact of unapproved drugs on the drug lag. METHODS Information on 136 anti-cancer drugs approved in the US between 2011 and 2022 was collected. The approval lag, defined as the number of days from the date of approval in the US to the date of approval in Japan, was calculated for all selected drugs, and the median was calculated using the Kaplan-Meier method. The approval lag for drugs not approved in Japan was treated as censored data. Factors potentially associated with the approval lag were explored using Cox regression analysis. RESULTS The median approval lags for the first half-period (2011-2016) and the last half-period (2017-2022) were 961 days (2.6 years) and 1547 days (4.2 years), respectively (Log-rank test: p = 0.0687). The participation of Japan in the global pivotal trial was associated with a shorter approval lag, and new drug applications by non-Japanese companies that did not rank in the global sales top 20 were associated with a longer approval lag. CONCLUSIONS Drug lag has not decreased over the last decade. The percentage of pivotal trials for US approval that included Japan has increased but should be further increased in the future. Japan may require a scheme to encourage smaller non-Japanese companies to include Japan in their global clinical development plan.
Collapse
Affiliation(s)
- Yoshifumi Tachibana
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan.
- Nippon Boehringer Ingelheim Co. Ltd., Tokyo, Japan.
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-Ku, Tokyo, 108-8641, Japan
| |
Collapse
|
4
|
Noguchi E, Yaginuma H, Fujiwara Y. Challenges in Expediting the Development of Oncology Drugs. JCO Oncol Pract 2023; 19:216-217. [PMID: 36657099 DOI: 10.1200/op.22.00705] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Emi Noguchi
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | | | | |
Collapse
|
5
|
Luo X, Du X, Li Z, Qian F, Yang Y. Assessment of the Delay in Novel Anticancer Drugs between China and the United States: A Comparative Study of Drugs Approved between 2010 and 2021. Clin Pharmacol Ther 2023; 113:170-181. [PMID: 36151921 DOI: 10.1002/cpt.2755] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Abstract
Access to anticancer drugs has been a critical health issue in China for many years. We retrospectively analyzed the novel anticancer drugs approved in the United States (US) between 2010 and 2021 to assess the evolving landscape of the drug lags in China by taking Japan and the European Union (EU) as comparisons. The absolute and relative lags of drug initial approval (DIA) and indication approval were calculated between China (or Japan/European Union) and the US based on the US approval date of novel agents, the duration was divided into 2010-2015 and 2016-2021. Overall, 123 (244 indications) new molecular entities (NMEs) approved in the United States were included, of which 58 (94 indications), 72 (128 indications), and 99 (170 indications) NMEs were also approved in China, Japan, and the European Union, respectively. The absolute lags of DIA and indications for approval in China improved dramatically in 2016-2021 compared with 2010-2015. Similarly, the relative DIA and indication approval lags in China decreased significantly in 2016-2021. The median review lags for DIA of China in 2016-2021 were comparable to Japan but dramatically lower than that of the European Union. Nevertheless, China had significantly longer median submission lags for DIA (28 months) in 2016-2021 than that of Japan (6 months) and the European Union (1 month). Although the absolute and relative lags of anticancer drugs in China had been initially addressed, 53% of NMEs and 61% of indications were still not approved for cancers in China compared with the United States. Therefore, China should adopt steps to further reduce drug lags.
Collapse
Affiliation(s)
- Xingxian Luo
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.,Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China.,Tsinghua-Peking Center for Life Sciences, Beijing, China
| | - Xin Du
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.,Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| | - Zhuangqi Li
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.,Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| | - Feng Qian
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - Yue Yang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.,Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| |
Collapse
|
6
|
Shizuya T, Miyazaki S. Comparison of Addition of Indications for Antineoplastic Agents Approved in the United States and Japan from 2001 to 2020. Biol Pharm Bull 2023; 46:987-996. [PMID: 37394648 DOI: 10.1248/bpb.b23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The indications for antineoplastic agents are limited in Japan compared with those in the United States. This may be because it takes longer to add indications and the number of additions of indications is lower in Japan than in the United States. To clarify the differences in the timing and number of additions of indications for antineoplastic agents, the agents approved from 2001 to 2020 and sold as of the end of 2020 in Japan and the United States were identified and their additions of indications were compared. Of the 81 antineoplastic agents analyzed, the proportion of agents with additional indications was 71.6 and 63.0%, and the number of additions of indications (median/average per agent) was 2/3.52 and 1/2.43, for the United States and Japan, respectively. The median date of approval for addition of indications was August 10, 2017 and July 3, 2018 for the United States and Japan (p = 0.015), indicating that the indications were added earlier in the United States. The proportion of priority review and orphan drug designation for addition of indications was lower in Japan (55.6 and 34.7%) than in the United States (80.9 and 57.8%) (p < 0.001). When indications were developed with global clinical trials or designated as orphan drugs in the United States, delays in application and approval in Japan against the United States were small (p < 0.020). New indications for antineoplastic agents should be added promptly for Japanese patients because malignancy is the leading cause of death in Japan.
Collapse
Affiliation(s)
- Toshiyuki Shizuya
- Division of Social Pharmacy and Regulatory Science, Showa Pharmaceutical University
- Japan Development, MSD K.K
| | - Seiko Miyazaki
- Division of Social Pharmacy and Regulatory Science, Showa Pharmaceutical University
| |
Collapse
|
7
|
Mizuno T, Katsuya Y, Sato J, Koyama T, Shimizu T, Yamamoto N. Emerging PD-1/PD-L1 targeting immunotherapy in non-small cell lung cancer: Current status and future perspective in Japan, US, EU, and China. Front Oncol 2022; 12:925938. [PMID: 36091105 PMCID: PMC9459234 DOI: 10.3389/fonc.2022.925938] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Non-small cell lung cancer (NSCLC), one of the deadliest types of cancers worldwide, has been the target of immunotherapy due to its high immune antigenicity. With the addition of immune-checkpoint inhibitors (ICIs), including anti-PD-1/PD-L1 antibodies, as an indispensable and powerful regimen for the treatment of this lethal disease, the median survival time for patients with stage IV NSCLC is approximately 2 years. In contrast, the response rate to ICIs remains less than 50%, even if the patients are selected using biomarkers such as PD-L1. Pharmaceutical companies have begun to develop additional anti-PD-1/PD-L1 antibodies to overcome resistance and are devising further immunotherapy combinations. More than 20 anti-PD-1/PD-L1antibodies have been approved or are currently in development. Numerous combination therapies are under development, and several combination therapies have provided positive results in randomized controlled trials. This review aimed to examine the current status of approved and investigational anti-PD-1/PD-L1antibodies for NSCLC in Japan, the United States, the European Union, and China. Further, this review discusses the challenges and future perspectives for developing new ICIs in alignment with the global developments in Japan.
Collapse
Affiliation(s)
- Takaaki Mizuno
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Katsuya
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Sato
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Takafumi Koyama
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Toshio Shimizu
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
- *Correspondence: Noboru Yamamoto,
| |
Collapse
|
8
|
Watanabe T, Sugiyama T, Imai K, Higashi T. How are new drugs disseminated in Japan? Analysis using the National Database of Health Insurance Claims of Japan. Cancer Sci 2022; 113:1771-1778. [PMID: 35266252 PMCID: PMC9128186 DOI: 10.1111/cas.15322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022] Open
Abstract
Drug lag refers to the difference in the time of a new drug's approval in different countries; the dissemination of the new drug after approval within the countries is another problem. We examined the nationwide dissemination of 11 cancer drugs approved in Japan between 2011 and 2015 using the National Database of Health Insurance Claims data. We extracted data on the number of cancer drug prescriptions from 47 prefectures and associated demographic information, such as age and sex. Eight diabetes drugs were also examined for comparison. We observed a lag between the marketing approval date of the drugs and their first use. To further explore the rise and pattern of each drug’s dissemination, we analyzed the trend of the cumulative number and total of new prescriptions for each prefecture. The results showed that the first month of new cancer drug prescriptions varied across prefectures. On average, they lagged by up to 2 months in the slowest prefectures, whereas the variation was almost nonexistent for diabetes drugs. The patterns of dissemination varied more among cancer drugs across the seven Japanese geographical regions. After the initial prescription, the number of prescriptions showed a steep rise for most cancer drugs, whereas the increase was gradual for diabetes drugs. In conclusion, the dissemination of cancer drugs had a greater lag time than that of diabetes drugs. Further research is needed to explore the causative factors to ensure that all effective drugs are equally accessible for those who need them.
Collapse
Affiliation(s)
- Tomone Watanabe
- Division of Health Services Research, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Cancer Health Services Research, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kenjiro Imai
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Takahiro Higashi
- Division of Health Services Research, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Cancer Health Services Research, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|
9
|
Cho I, Han E. Drug Lag and Associated Factors for Approved Drugs in Korea Compared with the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052857. [PMID: 35270550 PMCID: PMC8910054 DOI: 10.3390/ijerph19052857] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 01/02/2023]
Abstract
(1) Background: Drug lag, the delay between the first global regulatory approval and approval by the national health authorities in other countries, impacts the accessibility of drugs. Although the Korean pharmaceutical market has grown significantly, most of its innovative drugs for public health depend on imports from foreign pharmaceutical markets. (2) Methods: We extracted data from the official websites of the Korean Ministry of Food and Drug Safety (MFDS) and the US Food and Drug Administration. Information on new molecule entity drugs, approved as imported drugs by MFDS from 2000 to 2019, was extracted. Multivariate Cox proportional hazard models on drug approval were estimated. (3) Results: In total, 424 drugs were analyzed. Orphan drugs designated by MFDS were less likely to receive approval (HR = 0.731, 95% CI: 0.572–0.934). The drugs with Korean MAHs were less likely to obtain drug approval than those with MAHs of subsidiaries of multinational pharmaceutical companies (HR = 0.524, 95% CI: 0.371–0.738). In the analyses for non-orphan drugs (n = 37), oncology drugs that need local clinical study (HR = 0.247, 95% CI: 0.093–0.657) and drugs that need more patients in a local clinical study (HR = 0.993, 95% CI: 0.988–0.999) were less likely to receive approval, with longer drug lag. The higher number of clinical studies in Korea was associated with a shorter drug lag (HR = 2.133, 95% CI: 1.196–3.805). (4) Conclusions: Our findings imply that Korean pharmaceutical companies should augment their research capabilities for new drug development. Furthermore, consideration of orphan drugs used in rare diseases is needed for drug approval to ensure the availability of these drugs in the market without approval delays.
Collapse
Affiliation(s)
- Inhye Cho
- Department of Pharmaceutical Medicine and Regulatory Sciences, Yonsei Institute of Pharmaceutical Sciences, College of Medicine and Pharmacy, Yonsei University, Seoul 03722, Korea;
| | - Euna Han
- Department of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Korea
- Correspondence:
| |
Collapse
|
10
|
Maeda H, Fukuda Y, Uchida M. Assessment of Drugs Approved by Public Knowledge-Based Applications (Kouchi-shinsei) During the Last Two Decades in Japan. Clin Pharmacol Ther 2021; 110:1127-1135. [PMID: 34110632 PMCID: PMC8518418 DOI: 10.1002/cpt.2332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022]
Abstract
Public knowledge‐based application (“Kouchi‐shinsei” in Japanese) is unique to Japan, implemented to eliminate the off‐label use of unapproved indications, dosages, and administrations because of drug lag. The guidance for public knowledge‐based application was issued in 1999. This study comprehensively investigated the trends of items approved by public knowledge‐based application in Japan during the last 2 decades. Prescription drugs approved from January 2000 to December 2019 were surveyed. In Japan, 1,855 drugs were approved within the target survey period. Among them, 219 (11.8%) were approved by public knowledge‐based application. Considering the changes in the number of items approved by public knowledge‐based application over the years, the number of items approved in 2000 was 7, reaching a maximum of 34 items in 2011, and decreased after that, 8 items were approved in 2019. The regulatory characteristics of drugs approved by public knowledge‐based application and those of other drugs were compared. By public knowledge‐based application, more anticancer and pediatric drugs were approved (P < 0.001), and only one drug for orphan diseases was approved (P < 0.001). In addition, the review time of public knowledge‐based applications was significantly shorter than that of normal applications regardless of time point. The approval system using public knowledge‐based application began in 2000, following issuance of the “Guidance for off‐label use of prescription drugs.” Furthermore, the approved items were mostly drugs for cancer, infectious diseases, and pediatric drugs. We anticipate the promotion of public knowledge‐based application to accommodate the approval of drugs for orphan diseases.
Collapse
Affiliation(s)
- Hideki Maeda
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityTokyoJapan
| | - Yuka Fukuda
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityTokyoJapan
| | - Marika Uchida
- Department of Regulatory ScienceFaculty of PharmacyMeiji Pharmaceutical UniversityTokyoJapan
| |
Collapse
|
11
|
Miller JE, Mello MM, Wallach JD, Gudbranson EM, Bohlig B, Ross JS, Gross CP, Bach PB. Evaluation of Drug Trials in High-, Middle-, and Low-Income Countries and Local Commercial Availability of Newly Approved Drugs. JAMA Netw Open 2021; 4:e217075. [PMID: 33950209 PMCID: PMC8100865 DOI: 10.1001/jamanetworkopen.2021.7075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Clinical research supporting US Food and Drug Administration (FDA) drug approvals is largely conducted outside the US. OBJECTIVE To characterize where drugs were tested for FDA approval and to determine how commonly and quickly these drugs received marketing approval in the countries where they were tested, both overall and by country income level and geographical region. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of trials supporting FDA approval of novel drugs in 2012 and 2014, sponsored by large drug companies, did not involve human participants. The settings were the countries hosting trials supporting US drug approval. Data sources included Drugs@FDA, ClinicalTrials.gov, PubMed, Google Scholar, EMBASE, and drug regulatory agency websites. Data analysis was completed March through September 2020. MAIN OUTCOMES AND MEASURES The primary outcomes were the proportion of drugs approved for marketing in the countries where they were tested for FDA approval within 1, 2, 3, 4, and 5 years of FDA approval and the proportion of countries contributing participants to trials supporting FDA approvals receiving market access to the drugs they helped test within 1, 2, 3, 4, and 5 years of FDA approval. RESULTS In 2012 and 2014, the FDA approved 34 novel drugs sponsored by large companies, on the basis of a total of 898 trials, 563 of which had location information available. Each drug was tested in a median (interquartile range [IQR]) of 25 (18-37) unique countries, including a median (IQR) of 20 (13-25) high-income countries, 6 (4-11) upper-middle-income countries, and 1 (0-2) low-middle-income country. One drug was approved for marketing in all testing countries within 1 year of FDA approval and 15% (5 of 34 drugs) were approved in all testing countries within 5 years of FDA approval. Of the 70 countries contributing research participants for FDA drug approvals, 7% (5 countries) received market access to drugs they helped test within 1 year of FDA approval and 31% (22 countries) did so within 5 years. Access within 1 year occurred in 13% (5 of 39) of high-income countries, 0 of 22 upper-middle-income countries (0%), and 0 of 9 lower-middle-income countries (0%), whereas at 5 years access rates were 46% (18 of 39 countries), 9% (2 of 22 countries), and 22% (2 of 9 countries), respectively. Approvals were faster in high-income countries (median [IQR], 8 [0-11] months) than in upper-middle-income countries (median [IQR], 11 [5-29] months) or lower-middle-income countries (median [IQR], 17 [11-27] months) after FDA approval. Access was lowest in African countries. CONCLUSIONS AND RELEVANCE These findings suggest that substantial gaps exist between where FDA-approved drugs are tested and where they ultimately become available to patients, raising concerns about the equitable distribution of research benefits at the population level.
Collapse
Affiliation(s)
- Jennifer E. Miller
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Program for Biomedical Ethics and Bioethics International, New Haven, Connecticut
| | - Michelle M. Mello
- Stanford Law School, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California
- Department of Health Research and Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Joshua D. Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Emily M. Gudbranson
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Blake Bohlig
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joseph S. Ross
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cary P. Gross
- Department of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Peter B. Bach
- Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
12
|
Okuma HS, Yonemori K, Narita SN, Sukigara T, Hirakawa A, Shimizu T, Shibata T, Kawai A, Yamamoto N, Nakamura K, Nishida T, Fujiwara Y. MASTER KEY Project: Powering Clinical Development for Rare Cancers Through a Platform Trial. Clin Pharmacol Ther 2020; 108:596-605. [PMID: 32112563 PMCID: PMC7484913 DOI: 10.1002/cpt.1817] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/22/2020] [Indexed: 12/28/2022]
Abstract
For rare cancers, challenges in establishing standard therapies are greater than those for major cancers, and effective methods are needed. MASTER KEY Project is a multicenter study based in Japan, with two main parts: prospective registry study and multiple clinical trials. Advanced rare cancers, cancers of unknown primary origin, and those with rare tissue subtypes of common cancers are targeted. The registry study accumulates highly reliable consecutive data that can be used for future drug development. The multiple trials are conducted simultaneously, targeting either a specific biomarker or a rare tumor type of interest. The first interim data set from the registry part presented here shows the prevalence of genetic abnormalities, response rates, survival rates, and clinical trial enrollment rates. From May 2017 to April 2019, 560 patients (mean age = 53) were enrolled in the project. Frequent cancer types included soft tissue sarcomas, neuroendocrine tumors, and central nervous system tumors. Among the 528 patients with assessable data, 69% (364/528) had next‐generation sequencing tests, with 48% (176/364) harboring an “actionable” alteration. Seventy‐one (13%) patients have been enrolled in one of the clinical trials, with an accrual rate of 3.94 patients/month. A descriptive analysis of biomarker‐directed or non‐biomarker‐directed treatment survival was performed. This project is expected to accelerate development of treatments for rare cancers and show that comprehensive platform trials are an advantageous strategy.
Collapse
Affiliation(s)
- Hitomi S Okuma
- Department of Breast and Medical Oncology, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kan Yonemori
- Department of Breast and Medical Oncology, Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
| | - Shoko N Narita
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tamie Sukigara
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Shimizu
- Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan
| | - Taro Shibata
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenichi Nakamura
- Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiro Nishida
- Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Fujiwara
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
13
|
Nakayama H, Matsumaru N, Tsukamoto K. Safety-Related Regulatory Actions and Risk Factors for Anticancer Drugs in Japan. Pharmaceut Med 2020; 33:45-52. [PMID: 31933266 DOI: 10.1007/s40290-018-0260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The approval of anticancer drugs in Japan has increased to meet high medical demand. To maximize the benefits of anticancer drugs, adverse drug reactions (ADRs) must be properly managed. However, in some cases, clinically significant safety issues are detected after launch, and safety-related regulatory actions (SRRAs) are implemented. OBJECTIVES We aimed to determine the characteristics of SRRAs for anticancer drugs approved in Japan and to identify factors related to the drug development and regulatory approval process associated with the occurrence of an SRRA. METHODS We defined an SRRA as the issuance of a 'Yellow Letter', 'Blue Letter', or an official notification by the Ministry of Health, Labor and Welfare. Anticancer drugs approved in Japan as new active ingredients from April 2004 to July 2016 were analyzed using publicly available information. The Kaplan-Meier survival curve was plotted to estimate the probability of the occurrence of an SRRA, and the Cox proportional hazards model was used to identify risk factors associated with the occurrence of an SRRA. Independent variables were selected using backward/forward stepwise selection according to Akaike's Information Criterion. RESULTS An SRRA was implemented for 38 of 63 anticancer drugs. Approximately 70% of SRRAs occurred within 2 years after approval, and the median time between approval and the occurrence of an SRRA was 1.6 years (interquartile range 0.94-2.4). No Yellow Letter was issued during the follow-up period; however, one Blue Letter was issued for 'acute lung injury and interstitial pneumonia' for sorafenib. According to official notifications, 'clinically significant adverse reactions' was the most revised section of package inserts (62%). The probability of an SRRA at the 1-, 2- and 3-year follow-up was 15.9% (95% confidence interval [CI] 6.4-24.4%), 41.3% (95% CI 27.8-52.3%), and 56.8% (95% CI 41.8-68.0%), respectively. Monoclonal antibodies were associated with a low risk of occurrence of an SRRA (hazard ratio [HR] 0.29, p = 0.019), while the large number of patients in pivotal studies (per 100 patients) was associated with a high risk of occurrence (HR 1.07, p = 0.012). CONCLUSIONS The high-risk period for the occurrence of an SRRA for anticancer drugs in Japan was within 2 years after approval. Among the factors related to the drug development and regulatory approval process, anticancer drugs in the form of non-monoclonal antibodies, and whose pivotal studies included a large number of patients, were more likely to be associated with an SRRA. Postmarketing follow-up should therefore be carefully performed, especially in the first 2 years after approval and for non-monoclonal antibody anticancer drugs. Moreover, postmarketing follow-up is crucial, even if large-scale pivotal studies for regulatory approval have already been performed.
Collapse
Affiliation(s)
- Hiroki Nakayama
- Healthcare Policy and CSR, Astellas Pharma Inc., 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Naoki Matsumaru
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4, Daigakunishi, Gifu, 501-1196, Japan
| | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4, Daigakunishi, Gifu, 501-1196, Japan
| |
Collapse
|
14
|
Son KB. Do Free Trade Agreements Matter to Drug Lag? Recent Evidence From Korea After the Korea-U.S. Free Trade Agreement. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:147-155. [PMID: 31898472 DOI: 10.1177/0020731419898335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The KORUS FTA includes various clauses on marketing approval of new medicines and their reimbursement decisions. We aim to capture the availability of new medicines, to measure drug lags for new medicines, and to demonstrate the effect of the KORUS FTA on the timely availability of new medicines in the Korean market. We selected new drug applications approved in the United States between 2007 and 2015, calculated the drug lag, which was defined as the time difference between the date of regulatory approval in the United States and in Korea, and constructed a logistic and Cox model to capture the effect of the variables of interest on the availability and drug lag of new medicines in the Korean market. The FDA in the United States approved 160 NDAs between 2007 and 2015. The KORUS FTA does not increase the availability of new medicines or shorten the drug lag of new medicines. However, the presence of the manufacturer in Korea was significantly related to the availability and drug lag in the Korean market. It is noteworthy that the presence of the manufacturer, which is a kind of by-product of free trade in pharmaceuticals, affected drug lag.
Collapse
Affiliation(s)
- Kyung-Bok Son
- College of Pharmacy, Ewha Woman's University, Seoul, South Korea
| |
Collapse
|
15
|
Nakada H, Takashima K. Where Can Patients Obtain Information on the Preapproval Access Pathway to Investigational Treatment in Japan? A Survey of Patient Advocacy Organizations' Websites. Clin Pharmacol Drug Dev 2019; 8:978-983. [PMID: 31592580 PMCID: PMC6916578 DOI: 10.1002/cpdd.745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/13/2019] [Indexed: 11/17/2022]
Abstract
Investigational treatments are those that have been approved for testing in humans but are not yet available as an approved treatment option. For many patients with a terminal illness who have no approved treatment option and are not eligible for a clinical trial, investigational treatments are the last resort. However, not much is known about the dissemination of information by patient advocacy organizations (PAOs). We evaluated the quantity and quality of information on preapproval access to investigational therapies provided by Japanese PAO websites between January 24 and March 29, 2019. A total of 49 PAOs were identified. Of these, 16 (33%) provided no relevant information. The most frequent information provided was the PAO's own clinical trial finder or list of clinical trials (n = 15, 31%); of the 10 cancer-related PAOs, 5 (50%) provided this information. Nine (18%) PAOs had developed patient registries or provided a link to relevant registries. Only 1 PAO (2%) provided a link about the Ministry of Health, Labour, and Welfare trials that described the process and regulations of clinical trials. Our results indicate that PAOs do not disseminate adequate information on preapproval pathways. We suggest that the government involve PAOs in disseminating this information to both patients and physicians.
Collapse
Affiliation(s)
- Haruka Nakada
- Division of Bioethics and Healthcare LawCenter for Public Health SciencesNational Cancer CenterChuo‐kuTokyoJapan
| | - Kyoko Takashima
- Medical Genomics CenterNational Center for Global Health and MedicineShinjuku‐kuTokyoJapan
| |
Collapse
|
16
|
Okuma HS, Fujiwara Y. Have We Found the Key to Unravel Treatment Development Lags for Rare Cancers?: MASTER KEY Project. Clin Pharmacol Ther 2019; 106:491-492. [PMID: 31121054 PMCID: PMC6766785 DOI: 10.1002/cpt.1453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Hitomi S Okuma
- Clinical Trial Management Section, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Fujiwara
- Clinical Trial Management Section, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
17
|
Lee SW, Park SH, Song I, Noh Y, Park H, Ha D, Shin JY. Notable Differences in Drug Lag Between Korea and Japan of New Drugs Between 2009 and 2017. Ther Innov Regul Sci 2019. [DOI: 10.1177/2168479019838468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sang-Won Lee
- Sungkyunkwan University, School of Pharmacy, Suwon, Korea
| | - So-Hee Park
- Sungkyunkwan University, School of Pharmacy, Suwon, Korea
| | - Inmyung Song
- Sungkyunkwan University, School of Pharmacy, Suwon, Korea
| | - Yunha Noh
- Sungkyunkwan University, School of Pharmacy, Suwon, Korea
| | - Hyekyung Park
- Sungkyunkwan University, School of Pharmacy, Suwon, Korea
| | - Dongmun Ha
- Sungkyunkwan University, School of Pharmacy, Suwon, Korea
| | - Ju-Young Shin
- Sungkyunkwan University, School of Pharmacy, Suwon, Korea
| |
Collapse
|
18
|
Sun IC. Significant differences on submission lag following regulation reform for registration of novel therapeutic drugs in Taiwan. Invest New Drugs 2019; 37:1094-1106. [PMID: 30612310 DOI: 10.1007/s10637-018-00715-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/12/2018] [Indexed: 11/24/2022]
Abstract
Drug lag, which delays patients' access to medicinal products, is typically associated with pharmaceutical regulations. To shorten drug lag, health authorities may establish new policies to liberalize the regulations, a step that is important in countries, such as Taiwan, with consumer demand for imported novel therapeutic agents. Taiwan's government enacted Articles 38-1 and 38-2 of Regulations for Registration of Medicinal Products to relax the regulatory barriers for new drug submission, thus conditionally exempting the requirement for the Certificate of Pharmaceutical Product (CPP). This study examined whether the enacted regulations reduce submission lag by analyzing the time gap of submission between Taiwan and the United States during 2014-2017. The results indicated that the enacted regulations substantially affected submission lag. Submission lag was significantly shorter for applications not requiring a CPP than those requiring one CPP, which in turn was significantly shorter than those requiring two CPPs. This conclusion can be applied to biological, chemical, non-orphan, and oncology drugs and also applications filed by subsidiary companies, but not orphan drugs and applications filed by contract agents. Among applications requiring one CPP, oncology drugs showed the shortest submission lag. Certain factors, such as clinical studies recruiting over-threshold Taiwanese participants and those performed before the submission of new drug application in the United States, may shorten submission lag. In summary, this study justifies the policy of the exemption from CPP requirements, which supports the hypothesis that relaxing regulatory barriers can reduce submission lag in Taiwan.
Collapse
Affiliation(s)
- I-Chen Sun
- Division of Pharmaceutical Science, Center for Drug Evaluation, Taipei, Taiwan, Republic of China. .,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China.
| |
Collapse
|
19
|
Delays in New Drug Applications and Associated Factors for Orphan Anticancer Drugs in Japan Compared with the USA. Pharmaceut Med 2018. [DOI: 10.1007/s40290-018-0257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Serrano P, Hartmann M, Schmitt E, Franco P, Amexis G, Gross J, Mayer-Nicolai C. Clinical Development and Initial Approval of Novel Immune Checkpoint Inhibitors in Oncology: Insights From a Global Regulatory Perspective. Clin Pharmacol Ther 2018; 105:582-597. [PMID: 29923615 DOI: 10.1002/cpt.1123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/18/2018] [Indexed: 12/28/2022]
Abstract
Immune checkpoint inhibitors (ICI) have demonstrated meaningful patterns of clinical efficacy across various cancers. During their development, novel regulatory strategies and clinical design approaches were explored. This metrics-based narrative review examines submission strategies and clinical evidence expectations of the US, European, and Japanese drug agencies, as well as their impact on approval and overall development times. Also discussed is the role of emerging clinical science and biomarker evaluation to get the first six ICI initially approved.
Collapse
Affiliation(s)
- Philippe Serrano
- R&D Regulatory Oncology, EMD Serono Research & Development Institute, Billerica, Massachusetts, USA
| | | | - Elmar Schmitt
- R&D Regulatory Oncology, Merck KGaA, Darmstadt, Germany
| | - Pedro Franco
- Global Regulatory & Scientific Policy, Merck Serono Europe Ltd, London, UK
| | | | - Jan Gross
- R&D Regulatory Oncology, Merck KGaA, Darmstadt, Germany
| | | |
Collapse
|
21
|
Yamashita K, Kaneko M, Narukawa M. A Significant Anticancer Drug Approval Lag Between Japan and the United States Still Exists for Minor Cancers. Clin Pharmacol Ther 2018; 105:153-160. [PMID: 29882302 DOI: 10.1002/cpt.1136] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/30/2018] [Indexed: 11/08/2022]
Abstract
Reports have indicated that approval lag for anticancer drugs between Japan and the United States has decreased. However, if this is also true for drugs used to treat minor cancers remains unknown. We analyzed the anticancer drugs approved in Japan from 2006 to 2016 to compare the drug approval lag based on cancer incidence (major vs. minor cancers) between Japan and the United States. The lag of anticancer drugs for minor cancers had not decreased relative to that a decade ago. Recently, development strategies resulting in longer approval lag were used by pharmaceutical companies more often for the development of drugs used to treat minor cancers than for drugs targeting major cancers, leading to significant differences in the approval lag time between drugs for major and minor cancers. Effective measures that expedite the development of drugs targeting minor cancers in Japan should, therefore, be implemented to shorten lag time.
Collapse
Affiliation(s)
- Kenji Yamashita
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan.,MSD K.K. (a subsidiary of Merck, Kenilworth, NJ, USA), Tokyo, Japan
| | - Masayuki Kaneko
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan
| |
Collapse
|
22
|
Nakayama H, Matsumaru N, Tsukamoto K. The drug lag and associated factors for orphan anticancer drugs in Japan compared to the United States. Invest New Drugs 2018; 37:1086-1093. [PMID: 29855823 DOI: 10.1007/s10637-018-0612-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/24/2018] [Indexed: 11/24/2022]
Abstract
The approval of orphan anticancer drugs in Japan has increased to meet high social demand. Drug lag, namely the approval lag of new drugs, is recognized as a social issue in Japan. We investigated the approval lag and its components, submission lag and review-time lag, between Japan and the United States (US) to reveal whether an approval lag still exists, and to identify potential factors that may contribute to reducing the approval lag. Anticancer drugs approved in Japan between April 2004 and November 2017 were investigated using publicly available information. Results showed that the median approval lag of orphan anticancer drugs in 2016-2017 was 727.0 days (interquartile range, IQR, 310.0-1054.3). The approval lag was significantly correlated with the submission lag (correlation coefficient = 1.00, P < 0.001) but not with the review-time lag (correlation coefficient = -0.16, P = 0.22). The submission lag was significantly longer for orphan anticancer drugs than non-orphan drugs (median, 712.5 days [IQR, 186.0-1448.3] vs. 387.0 days [92.8-1096.0], P = 0.023). External collaboration in drug development was associated with a longer submission lag (coefficient = 762.1, P = 0.017), while breakthrough therapy designation in the US was associated with a shorter submission lag (coefficient = -832.8, P = 0.035). In conclusion, we revealed that an approval lag for orphan anticancer drugs still existed in 2016-2017. A submission lag for orphan anticancer drugs was the main component affecting the approval lag, and was longer than that for non-orphan drugs. External collaboration in drug development may be a potential factor in reducing the submission lag for orphan anticancer drugs.
Collapse
Affiliation(s)
- Hiroki Nakayama
- Healthcare Policy & CSR, Astellas Pharma Inc., 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Naoki Matsumaru
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4, Daigakunishi, Gifu, 501-1196, Japan
| | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4, Daigakunishi, Gifu, 501-1196, Japan
| |
Collapse
|
23
|
Kikuchi C, Murakami M, Shimomura H, Shimada S, Aoyama T. Influence of Drug Lag on New Drug Label Revisions. Ther Innov Regul Sci 2018; 53:138-145. [PMID: 29714601 DOI: 10.1177/2168479018769294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Drug lag (DL) in Japan has decreased in the last few years as a result of the globalization of drug development in the past decade, and new molecule entities (NMEs) with short DL are on the rise. The purpose of this study was to investigate the influence of DL on postmarketing safety of NMEs, by comparing the length of DL and the chronological trend of package insert revisions. METHODS The number of label revisions occurring during 6 years after approval was investigated for 142 NMEs approved between 2000 and 2006. The NMEs were classified by the length of DL (2 years and 4 years), and the label revision trends by each label section and therapeutic categories were analyzed. RESULTS The cumulative number of level revisions in the "Drug Interactions" and "Clinically Significant Adverse Reactions" sections in the first year after approval in the DL <2 years group was significantly greater than in the DL ≥2 years group. In the chemotherapeutic category that showed the shortest DL, the first label revision occurred in 33.3% within the first year and in 66.7% by the second year, and label revisions were performed earlier than in any other therapeutic categories. CONCLUSIONS These results suggest that the package inserts of NMEs with a shorter DL tend to be revised earlier and more frequently, and it requires more careful monitoring of safety information after product launch.
Collapse
Affiliation(s)
- Chikara Kikuchi
- 1 Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| | - Miyako Murakami
- 1 Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| | - Hitoshi Shimomura
- 1 Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan.,2 Department of Pharmacy, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Shuji Shimada
- 1 Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| | - Takao Aoyama
- 1 Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| |
Collapse
|
24
|
Todaka K, Kishimoto J, Ikeda M, Ikeda K, Yamamoto H. Impact of Risk-Benefit Perception and Trust on Medical Technology Acceptance in Relation to Drug and Device Lag: A Tripartite Cross-Sectional Survey. Ther Innov Regul Sci 2017; 52:629-640. [PMID: 29714546 DOI: 10.1177/2168479017739267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New drug and medical device introduction in Japan usually lags behind that in the West. Many reports indicate that in Japan, the associated risks are considered greater than the benefits recognized in other countries. This study aimed to compare the relationship between risk-benefit perception and acceptance of medical technologies in 3 leading markets. METHODS A tripartite cross-sectional survey of the general public was used. In total, 3345 adults in the United Kingdom, the United States, and Japan participated, and sexes and age groups were equally represented. Questions about the perception of risk, benefit, and acceptance of medical and other scientific technologies, and trust of medical product providers or regulatory authorities were included. RESULTS Five-step Likert coding for risk/benefit/acceptance of 4 medical items (x-rays, antibiotics, vaccines, and cardiac pacemakers) and 6 general items (such as automobiles and airplanes) were collected. Relationships between benefit perception and acceptance were linear for 4 medical technologies. The relationship had a similar slope but was shifted downward in Japan compared with the UK and US ( P < .01), suggesting a lower acceptance in Japan for all benefit perceptions. The trend was the same between risk perception and acceptance, except for slopes that were negative. Correspondence analysis showed a strong correlation among acceptance of medical technologies, benefits of medical technologies, trust in doctors, and trust in the Department of Health. The UK and US attributes were clustered with positive responses such as "useful," "acceptable," and "trustworthy," whereas Japan was clustered with intermediate to negative responses such as "neither" and "untrustworthy." CONCLUSIONS Acceptance of medical technologies was low in Japan because of significant differences in trust for doctors and authorities compared with that in the UK and US. This is a possible basis for delays of 24 to 60 months for medical product approval in Japan.
Collapse
Affiliation(s)
- Koji Todaka
- 1 Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Junji Kishimoto
- 2 Department of Research and Development of Next Generation Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ikeda
- 3 Department of Medical Informatics, Kagawa University Hospital, Miki-cho, Kagawa, Japan
| | - Koji Ikeda
- 4 Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Haruko Yamamoto
- 5 Center for Advancing Clinical and Translational Sciences, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| |
Collapse
|
25
|
Shiroiwa T, Fukuda T, Ikeda S, Takura T. New decision-making processes for the pricing of health technologies in Japan: The FY 2016/2017 pilot phase for the introduction of economic evaluations. Health Policy 2017; 121:836-841. [PMID: 28687183 DOI: 10.1016/j.healthpol.2017.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
Economic evaluation is used for decision-making processes in healthcare technologies in many developed countries. In Japan, no health economic data have been requested for drugs, medical devices, and interventions till date. However, economic evaluation is gradually gaining importance, and a trial implementation of the cost-effectiveness evaluation of drugs and medical devices has begun. Discussions on economic evaluation began in May 2012 within a newly established sub-committee of the Chuikyo, referred to as the "Special Committee on Cost Effectiveness." After four years of discussions, this committee determined that during the trial implementation, the results of the cost-effectiveness evaluation would be used for the re-pricing of drugs and medical devices at the end of fiscal year (FY) 2017. Chuikyo selected 13 products (7 drugs and 6 medical devices) as targets for this evaluation. These products will be evaluated until the end of FY 2017 based on the following process: manufacturers will submit the data of economic evaluation; the National Institute of Public Health will coordinate the review process; academic groups will perform the actual review of the submitted data, and the expert committee will appraise these data. This represents the first step to introducing cost-effectiveness analysis in the Japanese healthcare system. We believe that these efforts will contribute to the efficiency and sustainability of the Japanese healthcare system.
Collapse
Affiliation(s)
- Takeru Shiroiwa
- Department of Health and Welfare Service, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 3510197, Japan.
| | - Takashi Fukuda
- Department of Health and Welfare Service, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 3510197, Japan
| | - Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita, Chiba 286-8686, Japan
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan
| |
Collapse
|
26
|
Kogure S, Koyama N, Hidaka S. Utilization of the Bridging Strategy for the Development of New Drugs in Oncology to Avoid Drug Lag. J Clin Pharmacol 2017. [DOI: 10.1002/jcph.951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Seiji Kogure
- Department of Pharmaceutical Regulatory Science; School of Pharmacy; Nihon University; Chiba Japan
- Oncology Clinical Development Department; Daiichi Sankyo Co. Ltd.; Tokyo Japan
| | - Nobuyuki Koyama
- Clinical Data and Biostatistics Department; Daiichi Sankyo Co. Ltd.; Tokyo Japan
| | - Shinji Hidaka
- Department of Pharmaceutical Regulatory Science; School of Pharmacy; Nihon University; Chiba Japan
| |
Collapse
|
27
|
Venkatakrishnan K, Burgess C, Gupta N, Suri A, Takubo T, Zhou X, DeMuria D, Lehnert M, Takeyama K, Singhvi S, Milton A. Toward Optimum Benefit-Risk and Reduced Access Lag For Cancer Drugs in Asia: A Global Development Framework Guided by Clinical Pharmacology Principles. Clin Transl Sci 2016; 9:9-22. [PMID: 26836226 PMCID: PMC5351319 DOI: 10.1111/cts.12386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/22/2015] [Accepted: 01/05/2016] [Indexed: 12/13/2022] Open
Affiliation(s)
- K Venkatakrishnan
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - C Burgess
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - N Gupta
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - A Suri
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - T Takubo
- Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - X Zhou
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - D DeMuria
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - M Lehnert
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - K Takeyama
- Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - S Singhvi
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| | - A Milton
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts, USA
| |
Collapse
|
28
|
Nakajima K, Dagher R, Strawn L, Urushidani J, Kurokawa T, Chiba K. The Relationship Between Development Start Lag and Approval Lag in Oncology Drug Development in Japan. Ther Innov Regul Sci 2015; 49:911-919. [PMID: 30222391 DOI: 10.1177/2168479015579518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The delay of initiation of clinical development is considered a causes of delay of approval of drugs (drug lag) in Japan. METHODS For oncology drugs newly approved between 2000 and 2012 in Japan, a possible impact of delay of initiation of clinical development (development start lag [DSL]) on delay of approval (approval lag [AL]) was investigated, focusing on the delay from the US timelines. The equation defining the relationship between the DSL and AL of 33 oncology drugs was calculated by using simulation models, then the Pearson coefficient of correlation between parameters was calculated. RESULTS From the analysis of all drugs investigated, a positive relationship between the DSL and AL was suggested. However, the relationship seemed to have 2 phases, including a flat phase, followed by a linearly increased phase with a breakpoint at 2340 DSL days (approximately 6.4 DSL years). CONCLUSIONS Shortening the DSL is important for reducing large AL, but it is not necessary to eliminate the DSL completely for the purpose of minimizing the AL.
Collapse
Affiliation(s)
- Keitaro Nakajima
- 1 Department of Drug Development & Regulatory Science, Keio University of Pharmacy, Tokyo, Japan.,2 Regulatory Affairs Division, Development Japan, Pfizer Japan Inc, Tokyo, Japan
| | - Ramzi Dagher
- 3 Worldwide Safety and Regulatory, Pfizer Inc, Groton, CT, USA
| | - Laurie Strawn
- 4 Worldwide Safety and Regulatory, Pfizer Inc, San Diego, CA, USA
| | - Jun Urushidani
- 1 Department of Drug Development & Regulatory Science, Keio University of Pharmacy, Tokyo, Japan
| | - Tatsuo Kurokawa
- 1 Department of Drug Development & Regulatory Science, Keio University of Pharmacy, Tokyo, Japan
| | - Koji Chiba
- 1 Department of Drug Development & Regulatory Science, Keio University of Pharmacy, Tokyo, Japan.,5 Laboratory of Clinical Pharmacology, Yokohama University of Pharmacy, Yokohama, Japan
| |
Collapse
|
29
|
Mizugaki H, Yamamoto N, Fujiwara Y, Nokihara H, Yamada Y, Tamura T. Current Status of Single-Agent Phase I Trials in Japan: Toward Globalization. J Clin Oncol 2015; 33:2051-61. [PMID: 25918301 DOI: 10.1200/jco.2014.58.4953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In Japan, phase I trials, except first-in-human trials, are usually initiated from approximately 50% of the maximum-tolerated dose (MTD) or maximum administered dose (MAD) determined during the initial phase I trials in North America and Europe (the West). However, the key findings of phase I trials in Japan and the West, such as dose-limiting toxicity (DLT) profiles and MTD or MAD levels, have not been compared. PATIENTS AND METHODS We retrospectively analyzed data for patients enrolled onto single-agent phase I trials at the National Cancer Center Hospital between 1995 and 2012. DLT profiles, MTDs, and MADs of single-agent phase I trials in Japan were compared with those from trials in the West that were obtained from the literature. RESULTS A total of 777 patients were enrolled onto 54 single-agent phase I trials, including five first-in-human trials. DLTs were observed in 11.1% of the patients. Importantly, 66.4% of the DLTs were observed within a dose range (80% to 120%) similar to those reported for the trials in the West. The majority of MTDs or MADs could be considered similar between patients, and 80.3% of the drugs had similar MTDs or MADs in the West. CONCLUSION The toxicity profiles of single-agent phase I agents determined from trials conducted in Japan were comparable to those obtained from trials in the West. We believe that phase I trials in Japan could be conducted over timelines similar to those in the West, allowing for global or parallel phase I clinical trials.
Collapse
|
30
|
Maeda H, Kurokawa T. Recent trends for drug lag in clinical development of oncology drugs in Japan: does the oncology drug lag still exist in Japan? Int J Clin Oncol 2015; 20:1072-80. [PMID: 25837976 DOI: 10.1007/s10147-015-0825-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study exhaustively and historically investigated the status of drug lag for oncology drugs approved in Japan. METHODS We comprehensively investigated oncology drugs approved in Japan between April 2001 and July 2014, using publicly available information. We also examined changes in the status of drug lag between Japan and the United States, as well as factors influencing drug lag. RESULTS This study included 120 applications for approval of oncology drugs in Japan. The median difference over a 13-year period in the approval date between the United States and Japan was 875 days (29.2 months). This figure peaked in 2002, and showed a tendency to decline gradually each year thereafter. In 2014, the median approval lag was 281 days (9.4 months). Multiple regression analysis identified the following potential factors that reduce drug lag: "Japan's participation in global clinical trials"; "bridging strategies"; "designation of priority review in Japan"; and "molecularly targeted drugs". CONCLUSIONS From 2001 to 2014, molecularly targeted drugs emerged as the predominant oncology drug, and the method of development has changed from full development in Japan or bridging strategy to global simultaneous development by Japan's taking part in global clinical trials. In line with these changes, the drug lag between the United States and Japan has significantly reduced to less than 1 year.
Collapse
Affiliation(s)
- Hideki Maeda
- Division of Drug Development and Regulatory Science, Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30, Shibakoen, Minato-ku, Tokyo, 105-8512, Japan. .,Oncology, Clinical Development Department, Global Development, Astellas Pharma Inc., 2-5-1, Nihonbashi-honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Tatsuo Kurokawa
- Division of Drug Development and Regulatory Science, Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30, Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| |
Collapse
|
31
|
Tanimoto T. A perspective on the benefit-risk assessment for new and emerging pharmaceuticals in Japan. Drug Des Devel Ther 2015; 9:1877-88. [PMID: 25848223 PMCID: PMC4386774 DOI: 10.2147/dddt.s62636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The universal health care system in Japan is facing a historical turning point as a result of the increasing fiscal burden, rapidly aging society, and a decreasing population. To understand the challenges and opportunities in the Japanese pharmaceutical market, which occupies one tenth of the global share, this review highlights several issues related to the benefit-risk assessment that is unique to the modern Japanese society: 1) regulatory system for new drug development; 2) health hazards related to pharmaceuticals ("Yakugai" in Japanese); 3) drug lag; 4) problems and controversies in the vaccination policy; and 5) clinical study misconduct. The regulatory process places a significant importance on Japanese data collection regardless of data accumulation from other countries. Because Yakugai has repeatedly caused tragedies and social disputes historically, the regulatory judgments generally tend to be more prudential when safety concerns are raised for new and emerging pharmaceuticals. Such a regulatory system has caused more than several years of approval delays compared to delays in other countries. The problem of drug lag still lingers on despite several regulatory system revisions, while the solution is incompatible with the elimination of Yakugai because the lag potentially reduces the risk of unpredictable adverse events. The Japanese vaccination policy has also received a lot of criticism, and needs improvements so that the decision-making process can be more transparent and scientifically based. Additionally, repeated clinical study misconduct damaged the reputation of Japanese clinical studies with unnecessary defrayment in health insurance; therefore, the medical community must change its inappropriate relationship with the industry. The problems surrounding pharmaceuticals are related to centralized, strict drug pricing control under the universal health coverage. Although the current government attempts to facilitate innovative research and development of novel therapeutics in Japan, further reforms should be explored for patients who need new and emerging pharmaceuticals.
Collapse
Affiliation(s)
- Tetsuya Tanimoto
- Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| |
Collapse
|
32
|
Fujiwara Y, Yonemori K, Shibata T, Okita N, Ushirozawa N. Japanese universal health care faces a crisis in cancer treatment. Lancet Oncol 2015; 16:251-2. [DOI: 10.1016/s1470-2045(15)70007-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
33
|
Maeda H, Kurokawa T. Regulatory review time for approval of oncology drugs in Japan between 2001 and 2014. Considerations of changes, factors that affect review time, and difference with the United States. J Clin Pharmacol 2015; 55:481-9. [PMID: 25560978 DOI: 10.1002/jcph.458] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/31/2014] [Indexed: 11/11/2022]
Abstract
In this study, we comprehensively and historically studied the review time of oncology drugs approved by the regulatory authorities in Japan with publicly available information. A total of 120 applications of oncology drugs were approved in Japan between April 2001 and July 2014. The review time peaked with 732.0 days (24.4 months) in 2005, and showed a tendency to decline gradually each year thereafter. After 2012, a significant reduction of the review time was seen in comparison to the median of 13-year median time. In addition, we compared the review time with that in the United States. The median review time lag with the United States was significantly peaked in 2005. After 2005, the review time lag with the FDA has decreased, but lag did not significantly reduce by 2014. We also examined factors influencing the review time in Japan with multiple regression analysis. It was found that the factors related to a use of overseas data and expedited program for accelerating the reviews influenced the direction of shortening the review time. We consider that regulatory authorities in Japan need to keep making efforts to reduce the review time further and eliminate the review time lag with the United States.
Collapse
Affiliation(s)
- Hideki Maeda
- Division of Drug Development and Regulatory Science, Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30, Shibakoen, Minato-ku, Tokyo, Japan; Oncology, Clinical Development Department, Global Development, Astellas Pharma Inc., 2-5-1, Nihonbashi-Honcho, Chuo-ku, Tokyo, Japan
| | | |
Collapse
|
34
|
Maeda H, Kurokawa T. Acceptance of surrogate end points in clinical trials supporting approval of drugs for cancer treatment by the Japanese regulatory agency. Ann Oncol 2015; 26:211-216. [PMID: 25361994 DOI: 10.1093/annonc/mdu500] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study investigated the historic use of different end points to support approval of drugs for cancer treatment in Japan. PATIENTS AND METHODS Anticancer drugs approved between April 2001 and April 2014 were comprehensively investigated using publicly available information. RESULTS Before the revision of the guideline for oncology drugs in April 2006 in Japan, >80% of end points supporting approval were response rate and overall survival (OS) was not frequent. After the revision of the guideline in Japan, using OS in pivotal clinical trials applied for approval increased to more than approximately one-third of oncology drugs, although trials with an end point of response rate decreased. Regarding drugs for major cancers including non-small-cell lung cancer, gastric cancer, colorectal cancer, and breast cancer, survival was used as an end point in 44.0%, whereas surrogate end points were used in 56.0%. Exploration of potential factors for using surrogate end points other than survival carried out through determinations of odds ratios and 95% confidence intervals identified 'orphan drug designation in Japan' and 'accelerated approval by the U.S. Food and Drug Administration' as significant factors. CONCLUSIONS The revised guideline for oncology drugs in Japan requires the results of phase 3 studies with survival as an end point at the time of new drug application at least for major cancers. The regulatory agency in Japan also accepts surrogate end points as end points supporting approval besides survival; however, the number of surrogate end points has decreased after the revision of the guideline. We consider that accepting surrogate end points in the Japanese regulatory systems is important to approve oncology drugs quickly in Japan.
Collapse
Affiliation(s)
- H Maeda
- Graduate School of Pharmaceutical Sciences, Keio University, Tokyo; Astellas Pharma, Inc., Tokyo, Japan.
| | - T Kurokawa
- Graduate School of Pharmaceutical Sciences, Keio University, Tokyo
| |
Collapse
|
35
|
Ohwaki K, Nakabayashi T. Relationship between drug lag and factors associated with clinical trials in Japan. J Clin Pharm Ther 2014; 39:649-52. [PMID: 25200123 DOI: 10.1111/jcpt.12202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug lag is a major public concern in Japan. During the development of new drugs, some factors related to clinical trials in the marketing application package, such as trial design and the number of trials, can affect drug approval. The aim of this study was to determine whether those clinical trial factors were associated with drug lag in Japan. METHODS We investigated new drug applications for new molecular entities that were approved in Japan between April 2009 and March 2012. We collected information on clinical trials in the marketing application package from review reports. RESULTS AND DISCUSSION We constructed a multiple regression model to predict drug lag using the review period, use of foreign clinical trial data, the number of confirmatory trials, the design of the pivotal trial, failures of confirmatory trials and the death rate (n = 59). No use of foreign trial data was significantly associated with a longer drug lag (84% increase; 95% confidence interval [CI], 1·03-3·29). Compared to the open-label, one-armed design, drugs that underwent pivotal trials of placebo-controlled superiority, active-controlled superiority and active-controlled non-inferiority designs had a significantly shorter drug lag (74% decrease, 95% CI: 0·08-0·83; 74% decrease, 95% CI: 0·07-0·99; and 85% decrease, 95% CI: 0·04-0·58, respectively). WHAT IS NEW AND CONCLUSION Our findings suggest that new drug application packages that do not use data from foreign clinical trials and that involve pivotal trials of open-label, one-armed design contribute to drug lag in Japan. To reduce this lag, improved strategies for the development of new drugs should be identified.
Collapse
Affiliation(s)
- K Ohwaki
- Health Management Center, JCHO Tokyo Shinjuku Medical Center, Shinjuku-ku, Tokyo, Japan; Office of New Drug III, Pharmaceuticals and Medical Devices Agency, Chiyoda-ku, Tokyo, Japan
| | | |
Collapse
|
36
|
Significant Differences in Drug Lag in Clinical Development Among Various Strategies Used for Regulatory Submissions in Japan. Clin Pharmacol Ther 2013; 95:533-41. [DOI: 10.1038/clpt.2013.223] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/30/2013] [Indexed: 11/08/2022]
|
37
|
Hartmann M, Mayer-Nicolai C, Pfaff O. Approval probabilities and regulatory review patterns for anticancer drugs in the European Union. Crit Rev Oncol Hematol 2013; 87:112-21. [PMID: 23433721 DOI: 10.1016/j.critrevonc.2013.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/21/2012] [Accepted: 01/16/2013] [Indexed: 11/25/2022] Open
Abstract
AIM This article reviews outcomes of marketing authorization applications for anticancer drugs in the EU and outlines factors and hurdles of impact. METHODS Procedures for initial approval of anticancer and non-cancer drugs were analyzed and compared to anticancer drug approvals in the USA and Japan for the same period. RESULTS From 2006 to 2011, the regulatory review of 46 marketing authorization applications resulted in 29 new cancer drug approvals. The overall approval probability (63%) lagged behind the probability for non-cancer drugs (73%). Longer median active review times in line with additional clock-stop and EU Commission decision-making times as well as submission delays contribute to the 7.2 months median time-to-market delay [95% CI 4.7-15.0 months] compared to the USA; Japanese patients had to wait an additional 25.1 months [95% CI 6.2-34.1 months]. CONCLUSION Marketing authorization applications for anticancer drugs in the EU are associated with modest approval success. Patients in the USA get access to new products earlier, fostered by the more frequent use of expedited review procedures. So far, both procedures were used in the EU for applications claiming a major public health interest, characterized by pivotal clinical trial hazard ratios below 0.70.
Collapse
Affiliation(s)
- Markus Hartmann
- European Consulting & Contracting in Oncology, St. Annastrasse 3, D-54295 Trier, Germany
| | | | | |
Collapse
|
38
|
Kataria BC, Mehta DS, Chhaiya SB. Drug lag for cardiovascular drug approvals in India compared with the US and EU approvals. Indian Heart J 2012; 65:24-9. [PMID: 23438609 DOI: 10.1016/j.ihj.2012.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/26/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Age-standardized burden of cardiovascular diseases is substantially higher in low and middle-income countries than in high-income countries. However, Indian patients are not getting access to the new cardiovascular drugs at the same time as patients in the developed nations. The objective of this study was to assess the drug lag for new cardiovascular drugs in India compared with that in the United States (US) or European Union (EU). METHODS The information regarding approval of new cardiovascular drugs in the United States, European Union and India between 1999 and 2011 were obtained primarily from the online databases of regulatory agencies. The approval lag was obtained for all new cardiovascular drugs approved in each region, and the median approval lag was calculated for each region. RESULTS Of the 75 new cardiovascular drugs, 61 (81.33%) were approved in the United States, 65 (86.66%) in the European Union and 56 (74.66%) in India. The US was the first to approve 35 (56.45%) out of the 75 new cardiovascular drugs, the EU was the first to approve 24 (38.71%) and India was the first to approve 3 (4.84%). The median approval lag for India (44.14 months) was substantially higher as compared to the United States (0 month) and European Union (2.99 months). CONCLUSION This study confirms that there is a substantial drug lag in approval of new cardiovascular drugs in India compared with the United States and European Union. The impact of drug lag on health outcomes remains to be established.
Collapse
Affiliation(s)
- Bhaven C Kataria
- Department of Pharmacology, C.U. Shah Medical College, Surendranagar, Gujarat, India.
| | | | | |
Collapse
|
39
|
Nakajima K, Chiba K, Tsubamoto H, Walsh J, Strawn L, Suwa T. Potential factors correlating to the PMDA’s decision to waive Japanese Phase 2 and 3 studies for oncology drugs New Drug Application in Japan. Invest New Drugs 2012; 31:1051-5. [DOI: 10.1007/s10637-012-9911-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/03/2012] [Indexed: 11/28/2022]
|
40
|
Kawabata-Shoda E, Masuda S, Kimura H. Anticancer drug development from traditional cytotoxic to targeted therapies: evidence of shorter drug research and development time, and shorter drug lag in Japan. J Clin Pharm Ther 2012; 37:547-52. [PMID: 22428857 DOI: 10.1111/j.1365-2710.2012.01332.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Concern about the drug lag, the delay in marketing approval between one country and another, for anticancer drugs has increased in Japan. Although a number of studies have investigated the drug lag, none has investigated it in relation to the transition of anticancer therapy from traditional cytotoxic drugs to molecularly targeted agents. Our aim was to investigate current trend in oncology drug lag between the US and Japan and identify oncology drugs approved in only one of the two countries. METHODS Publicly and commercially available data sources were used to identify drugs approved in the US and Japan as of 31 December 2010 and the data used to calculate the drug lag for individual drugs. RESULTS AND DISCUSSION Fifty-one drugs were approved in both the US and Japan, whereas 34 and 19 drugs were approved only in the US or Japan, respectively. Of the 19 drugs approved only in Japan, 12 had not been subject to development for a cancer indication in the US, and all were approved before 1996 in Japan. Of the 34 drugs approved only in the US, 20 had not been subject to development in Japan, and none was in the top 25 by annual US anticancer drug-class sales. For drugs approved in both countries, the mean approval lag of the molecularly targeted drugs (MTDs) was significantly shorter than that of the non-molecularly targeted drugs (non-MTDs) (3·3 vs. 5·4 years). Further, mean R&D time of the MTDs was significantly shorter than that of non-MTDs (10·0 vs. 13·7 years). The price of MTDs had increased on average by 6·6% annually in the US, whereas it had decreased on average by 4·3% biyearly in Japan. WHAT IS NEW AND CONCLUSION The emergence of new molecularly targeted agents has contributed to reducing the approval lag, most likely due to improvements in R&D strategy.
Collapse
Affiliation(s)
- E Kawabata-Shoda
- Pharmaco-Business Innovation Laboratory, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | | | | |
Collapse
|