1
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Polak TB, Cucchi DGJ, Schelhaas J, Ahmed SS, Khoshnaw N, van Rosmalen J, Uyl-de Groot CA. Results from Expanded Access Programs: A Review of Academic Literature. Drugs 2023:10.1007/s40265-023-01879-4. [PMID: 37199856 DOI: 10.1007/s40265-023-01879-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Although expanded access is an increasingly used pathway for patients to access investigational medicine, little is known on the magnitude and content of published scientific research collected via expanded access. METHODS We performed a review of all peer-reviewed expanded access publications between January 1, 2000 and January 1, 2022. We analyzed the publications for drugs, diseases, disease area, patient numbers, time, geographical location, subject, and research methodology (single center/multicenter, international/national, prospective/retrospective). We additionally analyzed endpoints reported in all COVID-19-related expanded access publications. RESULTS We screened 3810 articles and included 1231, describing 523 drugs for 354 diseases for 507,481 patients. The number of publications significantly increased over time ([Formula: see text]). Large geographical disparities existed as Europe and the Americas accounted for 87.4% of all publications, whereas Africa only accounted for 0.6%. Oncology and hematology accounted for 53% of all publications. Twenty-nine percent of all expanded access patients (N = 197,187) reported on in 2020 and 2021 were treated in the context of COVID-19. CONCLUSIONS By summarizing characteristics of patients, diseases, and research methods described in all scientific literature published on expanded access, we provide a unique dataset for future research. We show that published scientific research on expanded access has surged over the past decades, partly due to COVID-19. However, international collaboration and equity in geographic access remain an issue of concern. Lastly, we stress the need for harmonization of research legislation and guidance on the value of expanded access data within real-world data frameworks to improve equity in patient access and streamline future expanded access research.
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Affiliation(s)
- Tobias B Polak
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands.
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - David G J Cucchi
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Jasmin Schelhaas
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Syed S Ahmed
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Naima Khoshnaw
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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2
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Krendyukov A, Singhvi S, Green-Morrison Y, Zabransky M. Early access provision: Awareness, educational needs and opportunities to improve oncology patients' access to care. Front Oncol 2022; 12:714516. [PMID: 36387084 PMCID: PMC9643861 DOI: 10.3389/fonc.2022.714516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/03/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND An unmet medical need exists for many oncology patients who cannot be treated satisfactorily by available therapeutic options. Early access provision (EAP) is endorsed by competent authorities to improve patient access to innovative medicinal products (InMPs). This paper determined awareness and understanding among practicing physicians of integrated EAP protocols, and of the procedures involved in EAP applications for oncology trials prior to marketing authorization. METHODS An on-line, fully anonymous survey reaching out to more than 3,258 physicians (including practicing oncologists) was initiated between November 2020 - January 2021. Participants were questioned about their knowledge and understanding of EAP and the decision processes involved, level of experience, interest for further educational activities and opportunities to improve the process, both in general and specifically during the COVID-19 pandemic. The frequency of EAP protocols for oncology InMPs was identified by a search of ClinicalTrials.gov and EU Clinical Trials registers. RESULTS Survey results (75% oncologists) indicated 75% of respondents were 'very comfortable' or 'comfortable' with using EAP for their patients, but only 54.5% correctly answered the specific knowledge-based question related to the EAP definition. For 56% of respondents, experience with EAP in daily practice was very limited. Two-thirds indicated an average or lower level of understanding about the application process and regulatory requirements involved (65.2% and 66.0%, respectively). Knowledge on data collection and serious adverse event reporting under EAP was lower at 57.8% and 50.5% of respondents, respectively. Awareness of physician responsibilities was high in 59.7% of respondents, but fewer understood roles and responsibilities of manufacturing companies (31.2%). Most indicated they would consider clinical efficacy and safety data from comparative phase III randomized controlled trials as of high importance to support their decision to apply for EAP (93.4% and 86.8%, respectively). During the COVID-19 pandemic, the majority of respondents highlighted the need to improve and adapt EAP with regard to the application process and documentation (83.8%), InMP supply and logistics (88.4), and safety reporting process (78.0%). Of identified oncology trials with a ClinicalTrials.gov protocol, only 149 (0.4%) included EAP, and 23 used the data to receive a marketing authorization during the period Jan 2015 to December 2020. Of oncology trials with a EudraCT protocol, only 21 (0.23%) included EAP, of which 6 were used to receive a conditional or full marketing authorisation over the same period. CONCLUSION Use of EAP in daily practice remains limited. Challenges posed by the EAP process, together with a lack of education on this topic, might contribute to its under-utilization and influence access of oncology patients to care. Continuous educational efforts from different stakeholders are required to better inform and support practicing oncologists during the EAP application process and regulatory framework follow up. Education should also be provided on EAP roles and responsibilities, monitoring, and potential adaptations when faced with specific challenges, such as the current COVID-19 pandemic.
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Affiliation(s)
- Andriy Krendyukov
- Andriy Krendyukov VP Medical Affairs, Apogenix AG, Heidelberg, Germany
| | - Sanjay Singhvi
- Sanjay Singhvi/Yianick Green-Morrison VMLY&R Health, London, United Kingdom
| | | | - Markus Zabransky
- Markus Zabransky, Global Medical Affairs, Sandoz GmbH, Holzkirchen, Germany
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3
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Polak TB, Cucchi DGJ, van Rosmalen J, Uyl-de Groot CA, Darrow JJ. Generating Evidence from Expanded Access Use of Rare Disease Medicines: Challenges and Recommendations. Front Pharmacol 2022; 13:913567. [PMID: 35677436 PMCID: PMC9168458 DOI: 10.3389/fphar.2022.913567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/05/2022] [Indexed: 12/05/2022] Open
Abstract
Patients with rare diseases often have limited or no options for approved treatments or participation in clinical trials. In such cases, expanded access (or “compassionate use”) provides a potential means of accessing unapproved investigational medicines. It is also possible to capture and analyze clinical data from such use, but doing so is controversial. In this perspective, we offer examples of evidence derived from expanded access programs for rare diseases to illustrate its potential value to the decision-making of regulators and payers in the European Union and the United States. We discuss ethical and regulatory aspects to the use of expanded access data, with a focus on rare disease medicines. The heterogeneous approach to expanded access among countries within the European Union leaves uncertainties to what extent data can be collected and analyzed. We recommend the issuance of new guidance on data collection during expanded access, harmonization of European pathways, and an update of existing European compassionate use guidance. We hereby aim to clarify the supportive role of expanded access in evidence generation. Harmonization across Europe of expanded access regulations could reduce manufacturer burdens, improve patient access, and yield better data. These changes would better balance the need to generate quality evidence with the desire for pre-approval access to investigational medicine.
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Affiliation(s)
- Tobias B Polak
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Biostatistics, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus University Rotterdam, Rotterdam, Netherlands.,Real-World Data Department, myTomorrows, Amsterdam, Netherlands
| | - David G J Cucchi
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Hematology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jonathan J Darrow
- Department of Law and Taxation, Bentley University, Waltham, MA, United States.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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4
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Abiri OT, Bah AJ, Lahai M, Lisk DR, Komeh JP, Johnson J, Johnson WCN, Mansaray SS, Kanu JS, Russell JBW, Thomas F, Sesay MM, Conteh TA, Tejan-Kella A, Sesay M, Ghazzawi M, Thompson B, Conteh S, Deen GF. Regulating clinical trials in a resource-limited setting during the Ebola public health emergency in Sierra Leone. Trials 2022; 23:466. [PMID: 35668457 PMCID: PMC9167901 DOI: 10.1186/s13063-022-06416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
Clinical trials during public health emergencies of novel medical products such as therapeutics and vaccines in resource-limited settings are daunting due to the limited capacity for regulatory assessment. Regulating clinical trials during the Ebola outbreak in Sierra Leone required expedited evaluation to identify medical products that could be promptly introduced to combat the epidemic in the absence of approved treatment or prevention. This article explored the decisions taken by the Pharmacy Board of Sierra Leone through its Expert Committee on Medicine Safety and Clinical Trials regarding clinical trials oversight during the Ebola epidemic and the lessons learned. This independent expert committee assessed and provided scientific opinions to the Pharmacy Board of Sierra Leone to inform approval of all clinical trials within 10–15 working days. We also requested for assisted review from the African Vaccine Regulatory Forum and support from the US Food and Drug Administration through a unilateral recognition and reliance memorandum of understanding. In addition, the Agency-ensured structures and systems were in place for reporting and reviewing adverse events and serious adverse events, management of biological samples, submission and review of progress reports, and good clinical practice inspections. Unfortunately, the Ebola epidemic revealed many weaknesses in the country’s clinical trials regulatory structure and processes. Government and partners should further offer more resources to build the clinical trial structures and systems so that the Agency will be better poised to handle future public health emergencies.
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Affiliation(s)
- Onome T Abiri
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone. .,Pharmacy Board of Sierra Leone, Freetown, Sierra Leone.
| | - Abdulai J Bah
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Michael Lahai
- Pharmacy Board of Sierra Leone, Freetown, Sierra Leone.,Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Durodami R Lisk
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - James P Komeh
- Pharmacy Board of Sierra Leone, Freetown, Sierra Leone.,Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joy Johnson
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Wiltshire C N Johnson
- Pharmacy Board of Sierra Leone, Freetown, Sierra Leone.,Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sheku S Mansaray
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - James B W Russell
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Fawzi Thomas
- Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | | | | | | | - Mohamed Sesay
- Pharmacy Board of Sierra Leone, Freetown, Sierra Leone.,Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Brian Thompson
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sorie Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla Fadlu Deen
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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5
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The DRUG Access Protocol: access inequality and European harmonisation. Lancet Oncol 2022; 23:e202. [DOI: 10.1016/s1470-2045(22)00098-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
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6
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Polak TB, Cucchi DGJ, van Rosmalen J, Uyl-de Groot CA. Real-world data from expanded access programmes in health technology assessments: a review of NICE technology appraisals. BMJ Open 2022; 12:e052186. [PMID: 34992108 PMCID: PMC8739059 DOI: 10.1136/bmjopen-2021-052186] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To quantify and characterise the usage of expanded access (EA) data in National Institute for Health and Care Excellence (NICE) technology appraisals (TAs). EA offers patients who are ineligible for clinical trials or registered treatment options, access to investigational therapies. Although EA programmes are increasingly used to collect real-world data, it is unknown if and how these date are used in NICE health technology assessments. DESIGN Cross-sectional study of NICE appraisals (2010-2020). We automatically downloaded and screened all available appraisal documentation on NICE website (over 8500 documents), searching for EA-related terms. Two reviewers independently labelled the EA usage by disease area, and whether it was used to inform safety, efficacy and/or resource use. We qualitatively describe the five appraisals with the most occurrences of EA-related terms. PRIMARY OUTCOME MEASURE Number of TAs that used EA data to inform safety, efficacy and/or resource use analyses. RESULTS In 54.2% (206/380 appraisals), at least one reference to EA was made. 21.1% (80/380) of the TAs used EA data to inform safety (n=43), efficacy (n=47) and/or resource use (n=52). The number of TAs that use EA data remained stable over time, and the extent of EA data utilisation varied by disease area (p=0.001). CONCLUSION NICE uses EA data in over one in five appraisals. In synthesis with evidence from well-controlled trials, data collected from EA programmes may meaningfully inform cost-effectiveness modelling.
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Affiliation(s)
- Tobias B Polak
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- RWD Department, myTomorrows, Amsterdam, The Netherlands
| | - David GJ Cucchi
- Department of Haematology, Amsterdam UMC, Location VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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7
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Polak TB, Bunnik EM. Financial considerations in expanded access policy for gene therapies: A tough nut to crack? Mol Ther 2021; 29:1936. [PMID: 33964226 DOI: 10.1016/j.ymthe.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tobias B Polak
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; RWD Department, myTomorrows, Amsterdam, the Netherlands.
| | - Eline M Bunnik
- Department of Medical Ethics, Philosophy, and History of Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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8
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Kearns L, Chapman CR, Moch KI, Caplan AL, Watson T, McFadyen A, Furlong P, Bateman-House A. Gene therapy companies have an ethical obligation to develop expanded access policies. Mol Ther 2021; 29:1367-1369. [PMID: 33714373 DOI: 10.1016/j.ymthe.2021.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Lisa Kearns
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA.
| | | | | | - Arthur L Caplan
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Pat Furlong
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
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9
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Rizk JG, Forthal DN, Kalantar-Zadeh K, Mehra MR, Lavie CJ, Rizk Y, Pfeiffer JP, Lewin JC. Expanded Access Programs, compassionate drug use, and Emergency Use Authorizations during the COVID-19 pandemic. Drug Discov Today 2020; 26:593-603. [PMID: 33253920 PMCID: PMC7694556 DOI: 10.1016/j.drudis.2020.11.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
The US Food and Drug Administration (FDA) Expanded Access (EA) Program, which allows for compassionate uses of unapproved therapeutics and diagnostics outside of clinical trials, has gained significant traction during the Coronavirus 2019 (COVID-19) pandemic. While development of vaccines has been the major focus, uncertainties around new vaccine safety and effectiveness have spawned interest in other pharmacological options. Experimental drugs can also be approved under the FDA Emergency Use Authorization (EUA) program, designed to combat infectious disease and other threats. Here, we review the US experience in 2020 with pharmacological EA and EUA approvals during the pandemic. We also provide a description of, and clinical rationale for, each of the EA- or EUA-approved drugs (e.g. remdesivir, convalescent plasma, propofol 2%, hydroxychloroquine, ruxolitinib, bamlanivimab, baricitinib, casirivimab plus imdevimab) during the pandemic and concluding reflections on the EA program and its potential future uses.
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Affiliation(s)
- John G Rizk
- Edson College, Arizona State University, Phoenix, AZ, USA.
| | - Donald N Forthal
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, School of Medicine, Irvine, CA, USA; Department of Molecular Biology and Biochemistry, University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, School of Medicine, Irvine, CA, USA; Department of Epidemiology, University of California, Los Angeles, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Youssef Rizk
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - John C Lewin
- National Coalition on Health Care, Washington, DC, USA
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10
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Polak TB, van Rosmalen J, Uyl-De Groot CA. Response to Open Peer Commentary "Making It Count: Extracting Real World Data from Compassionate Use and Expanded Access Programs". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:W4-W5. [PMID: 33103977 DOI: 10.1080/15265161.2020.1820113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Tobias B Polak
- Erasmus Medical Center
- Erasmus University Rotterdam
- myTomorrows
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11
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Rozenberg O, Greenbaum D. Making It Count: Extracting Real World Data from Compassionate Use and Expanded Access Programs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:89-92. [PMID: 32716805 DOI: 10.1080/15265161.2020.1779857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Ori Rozenberg
- Zvi Meitar Institute for Legal Implications of Emerging Technologies, Interdisciplinary Center Herzliya
| | - Dov Greenbaum
- Zvi Meitar Institute for Legal Implications of Emerging Technologies, Interdisciplinary Center Herzliya
- Harry Radyzner Law School, Interdisciplinary Center Herzliya
- Molecular Biophysics and Biochemistry, Yale University
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12
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Polak TB, van Rosmalen J, Uyl-de Groot CA. Expanded Access as a source of real-world data: An overview of FDA and EMA approvals. Br J Clin Pharmacol 2020; 86:1819-1826. [PMID: 32200551 PMCID: PMC7444779 DOI: 10.1111/bcp.14284] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 12/24/2022] Open
Abstract
Aims To identify, characterize and compare all Food and Drug Administration (FDA) and European Medicines Agency (EMA) approvals that included real‐world data on efficacy from expanded access (EA) programmes. Methods Cross‐sectional study of FDA (1955–2018) and EMA (1995–2018) regulatory approval documentation. We automated searching for terms related to EA in 22,506 documents using machine learning techniques. We included all approvals where EA terms appeared in the regulatory documentation. Our main outcome was the inclusion of EA data as evidence of clinical efficacy. Characterization was based on approval date, disease area, orphan designation and whether the evidence was supportive or pivotal. Results EA terms appeared in 693 out of 22,506 (3.1%) documents, which referenced 187 approvals. For 39 approvals, data from EA programmes were used to inform on clinical efficacy. The yearly number of approvals with EA data increased from 1.25 for 1993–2013 to 4.6 from 2014–2018. In 13 cases, these programmes formed the main evidence for approval. Of these, patients in EA programmes formed over half (median 71%, interquartile range: 34–100) of the total patient population available for efficacy evaluation. Almost all (12/13) approvals were granted orphan designation. In 8/13, there were differences between regulators in approval status and valuation of evidence. Strikingly, 4 treatments were granted approval based solely on efficacy from EA. Conclusion Sponsors and regulators increasingly include real‐world data from EA programmes in the efficacy profile of a treatment. The indications of the approved treatments are characterized by orphan designation and high unmet medical need.
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Affiliation(s)
- Tobias B Polak
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,RWD Department, myTomorrows, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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