1
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Simoens S, Abdallah K, Barbier L, Lacosta TB, Blonda A, Car E, Claessens Z, Desmet T, De Sutter E, Govaerts L, Janssens R, Lalova T, Moorkens E, Saesen R, Schoefs E, Vandenplas Y, Van Overbeeke E, Verbaanderd C, Huys I. How to balance valuable innovation with affordable access to medicines in Belgium? Front Pharmacol 2022; 13:960701. [PMID: 36188534 PMCID: PMC9523170 DOI: 10.3389/fphar.2022.960701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Countries are struggling to provide affordable access to medicines while supporting the market entry of innovative, expensive products. This Perspective aims to discuss challenges and avenues for balancing health care system objectives of access, affordability and innovation related to medicines in Belgium (and in other countries). Methods: This Perspective focuses on the R&D, regulatory approval and market access phases, with particular attention to oncology medicines, precision medicines, orphan medicines, advanced therapies, repurposed medicines, generics and biosimilars. The authors conducted a narrative review of the peer-reviewed literature, of the grey literature (such as policy documents and reports of consultancy agencies), and of their own research. Results: Health care stakeholders need to consider various initiatives for balancing innovation with access to medicines, which relate to clinical and non-clinical outcomes (e.g. supporting the conduct of pragmatic clinical trials, treatment optimisation and patient preference studies, optimising the use of real-world evidence in market access decision making), value assessment (e.g. increasing the transparency of the reimbursement system and criteria, tailoring the design of managed entry agreements to specific types of uncertainty), affordability (e.g. harnessing the role of generics and biosimilars in encouraging price competition, maximising opportunities for personalising and repurposing medicines) and access mechanisms (e.g. promoting collaboration and early dialogue between stakeholders including patients). Conclusion: Although there is no silver bullet that can balance valuable innovation with affordable access to medicines, (Belgian) policy and decision makers should continue to explore initiatives that exploit the potential of both the on-patent and off-patent pharmaceutical markets.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Khadidja Abdallah
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Liese Barbier
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | | | - Alessandra Blonda
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Elif Car
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Zilke Claessens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Thomas Desmet
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Evelien De Sutter
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Laurenz Govaerts
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Rosanne Janssens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Teodora Lalova
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- KU Leuven Centre for IT & IP Law (CiTiP), Leuven, Belgium
| | - Evelien Moorkens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Robbe Saesen
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Elise Schoefs
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Yannick Vandenplas
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Eline Van Overbeeke
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Ciska Verbaanderd
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- Anticancer Fund, Strombeek-Bever, Brussels, Belgium
| | - Isabelle Huys
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
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2
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Lopez-Navas L, Torrents S, Sánchez-Pernaute R, Vives J. Compliance in Non-Clinical Development of Cell-, Gene-, and Tissue-Based Medicines: Good Practice for Better Therapies. Stem Cells Transl Med 2022; 11:805-813. [PMID: 35830540 PMCID: PMC9397649 DOI: 10.1093/stcltm/szac046] [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: 03/25/2022] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
The development of cell-, gene- and tissue engineering (CGT)-based therapies must adhere to strict pharmaceutical quality management standards, as for any other biological or small-molecule drug. However, early developments often failed to fully comply with good laboratory practices (GLP) in non-clinical safety studies. Despite an upward trend of positive opinions in marketing authorization applications, evidence of adherence to the principles of GLP is not openly reported; therefore, their relative impact on the overall quality of the product development program is unknown. Herein we investigated the actual degree of GLP implementation and the underlying factors impeding full compliance in non-clinical developments of CGT-based marketed medicines in the EU and USA, including (i) the co-existence of diverse quality management systems of more strategic value for small organizations, particularly current Good Manufacturing Practices n(GMP); (ii) lack of regulatory pressure to pursue GLP certification; and (iii) the involvement of public institutions lacking a pharmaceutical mindset and resources. As a final reflection, we propose conformity to good research practice criteria not as a doctrinaire impediment to scientific work, but as a facilitator of efficient clinical translation of more effective and safer innovative therapies.
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Affiliation(s)
- Luis Lopez-Navas
- Andalusian Network for the Design and Translation of Advanced Therapies, Andalusian Health Ministry, Sevilla, Spain
| | | | - Rosario Sánchez-Pernaute
- Andalusian Network for the Design and Translation of Advanced Therapies, Andalusian Health Ministry, Sevilla, Spain
| | - Joaquim Vives
- Banc de Sang i Teixits, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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3
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Retzer A, Aiyegbusi OL, Rowe A, Newsome PN, Douglas-Pugh J, Khan S, Mittal S, Wilson R, O'Connor D, Campbell L, Mitchell SA, Calvert M. The value of patient-reported outcomes in early-phase clinical trials. Nat Med 2022; 28:18-20. [PMID: 35039659 DOI: 10.1038/s41591-021-01648-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK
| | - Anna Rowe
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Philip N Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jessica Douglas-Pugh
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sheeba Khan
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Roger Wilson
- NCRI Consumer Forum National Cancer Research Institute, London, UK
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK.
- National Institute for Health Research Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science and Innovation, Birmingham, UK.
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.
- UK SPINE, University of Birmingham, Birmingham, UK.
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4
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Iglesias-Lopez C, Agustí A, Vallano A, Obach M. Current landscape of clinical development and approval of advanced therapies. Mol Ther Methods Clin Dev 2021; 23:606-618. [PMID: 34901306 PMCID: PMC8626628 DOI: 10.1016/j.omtm.2021.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/06/2021] [Accepted: 11/07/2021] [Indexed: 01/26/2023]
Abstract
Advanced therapy medicinal products (ATMPs) are innovative therapies that mainly target orphan diseases and high unmet medical needs. The uncertainty about the product's benefit-risk balance at the time of approval, the limitations of nonclinical development, and the complex quality aspects of those highly individualized advanced therapies are playing a key role in the clinical development, approval, and post-marketing setting for these therapies. This article reviews the current landscape of clinical development of advanced therapies, its challenges, and some of the efforts several stakeholders are conducting to move forward within this field. Progressive iteration of the science, methodologically sound clinical developments, establishing new standards for ATMPs development with the aim to ensure consistency in clinical development, and the reproducibility of knowledge is required, not only to increase the evidence generation for approval but to set principles to achieve translational success in this field.
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Affiliation(s)
- Carolina Iglesias-Lopez
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonia Agustí
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Antoni Vallano
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
| | - Merce Obach
- Medicines Department, Catalan Healthcare Service, Barcelona, Spain
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5
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Cockroft A, Wilson A. Comparability: what we can learn from the review of advanced therapy medicinal products. Regen Med 2021; 16:655-667. [PMID: 34278825 DOI: 10.2217/rme-2021-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Publicly available summaries from Marketing Authorization Applications for gene and cell therapy products (advanced therapies) were evaluated to explore data expectations for product characteristics pre and post changes (comparability). Public assessment reports were used to analyze trends in information requests from regulators concerning comparability from current commercial advanced therapies. In the analysis, 12 products approved in the USA and EU were included. Inadequacies were highlighted for comparability data (six products); additional information requests (five products) and major objections were identified relating to comparability (two products, EU). Postapproval authorization obligations were imposed for six products. Comparability data are essential component for regulatory applications and public assessment reports provide a valuable source of insight into regulators' expectations.
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6
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Hidalgo-Simon A, Fibbe WE. Advanced therapies are ready to take centre stage: Academia's involvement with regulation needs to raise its game. Br J Clin Pharmacol 2021; 87:2412-2413. [PMID: 33899269 DOI: 10.1111/bcp.14863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/25/2023] Open
Affiliation(s)
- Ana Hidalgo-Simon
- Advanced Therapies Office, Human Medicines Division, European Medicines Agency (EMA), Amsterdam, The Netherlands
| | - Willem E Fibbe
- Department of Internal Medicine and Nephrology, Leiden University Medical Center, Leiden, The Netherlands
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7
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Tavridou A, Rogers D, Bonelli M, Schiel A, Hidalgo-Simon A. Towards a better use of scientific advice for developers of advanced therapies. Br J Clin Pharmacol 2020; 87:2459-2464. [PMID: 33237580 PMCID: PMC8247399 DOI: 10.1111/bcp.14672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022] Open
Abstract
Scientific advice (SA) is an important tool offered by regulators to help developers generate robust evidence on a medicine's benefits and risks. Drawing on accumulated experience and looking at the SA provided by the European Medicines Agency in 2018 to advanced therapy medicinal products originally developed by public bodies, we discuss most commonly raised issues and the complexity and timings of the questions posed. Earlier and more frequent SA could help advanced therapy medicinal product developers to pre‐empt delays at the marketing authorisation stage. Carefully addressing quality and nonclinical issues before entering the pivotal phase of development will clear the path for a smooth clinical development and successful marketing authorisation.
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Affiliation(s)
- Anna Tavridou
- Scientific Advice Office, Human Medicines Division, European Medicines Agency, Amsterdam, The Netherlands
| | - Dolca Rogers
- Pharmaceutical Quality Office, Human Medicines Division, European Medicines Agency, Amsterdam, The Netherlands
| | - Milton Bonelli
- Scientific Advice Office, Human Medicines Division, European Medicines Agency, Amsterdam, The Netherlands
| | - Anja Schiel
- Regulatory and Pharmacoeconomic Statistics, Norwegian Medicines Agency (NoMA), Norway.,Chair of Scientific Advice Working Party (SAWP), European Medicines Agency, Amsterdam, The Netherlands
| | - Ana Hidalgo-Simon
- Head of Advanced Therapies, Human Medicines Division, European Medicines Agency, Amsterdam, The Netherlands
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