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Perehudoff K, Durán C, Demchenko I, Mazzanti V, Parwani P, Suleman F, de Ruijter A. Impact of the European Union on access to medicines in low- and middle-income countries: A scoping review. THE LANCET REGIONAL HEALTH. EUROPE 2021; 9:100219. [PMID: 34693391 PMCID: PMC8513155 DOI: 10.1016/j.lanepe.2021.100219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This Scoping Review synthesises evidence of the impacts of European Union (EU) law, regulation, and policy on access to medicines in in non-EU low- and middle-income countries (LMICs), and the mechanisms and nature of those impacts. We searched eight scholarly databases and grey literature published between 1995-2021 in four languages. The EU exerts global influence on pharmaceuticals in LMICs in three ways: explicit agreements between EU-LMICs (ex. accession, trade, and economic agreements); LMICs' reliance on EU internal regulation, standards, or methods (ex. market authorisation); 'soft' forms of EU influence (ex. research funding, capacity building). This study illustrates that EU policy makers adopt measures with the potential to influence medicines in LMICs despite limited evidence of their positive and/or negative impact(s). The EU's fragmented internal and external actions in fields related to pharmaceuticals reveal the need for principles for global equitable access to medicines to guide EU policy.
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Affiliation(s)
- Katrina Perehudoff
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, University of Toronto, Canada
- Medicines Law & Policy, Amsterdam, the Netherlands
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Carlos Durán
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, Netherlands
| | - Ivan Demchenko
- Department of Forensic Medicine and Medical Law, Bogomolets National Medical University, st. Mechnikova, 5, Kyiv, 01133, Ukraine
| | - Valentina Mazzanti
- Department of Public Health & Primary Care, Ghent University, Ghent, Belgium
| | - Pramiti Parwani
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, University of KwaZulu-Natal, Campus Westville, Durban, 4041, South Africa
| | - Anniek de Ruijter
- Law Centre for Health & Life, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, 1105 BP Amsterdam, Netherlands
- Amsterdam Centre for European Law and Governance, Amsterdam Law School, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, Netherlands
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Durán CE, Cañás M, Urtasun M, Elseviers M, Vander Stichele R, Christiaens T. Potential negative impact of reputed regulators' decisions on the approval status of new cancer drugs in Latin American countries: A descriptive analysis. PLoS One 2021; 16:e0254585. [PMID: 34255795 PMCID: PMC8277058 DOI: 10.1371/journal.pone.0254585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many new cancer drugs are being approved by reputed regulatory authorities without evidence of overall survival benefit, quality of life improvement, and often based on clinical trials at high risk of bias. In recent years, most Latin American (LA) countries have reformed their marketing authorization (MA) rules to directly accept or abbreviate the approval process in case of earlier authorization by the European Medicines Agency (EMA) and the US Food and Drug Administration, mainly. This study assessed the potential impact of decisions taken by EMA regarding the approval of new cancer drugs based on no evidence of overall survival or in potentially biased clinical trials in LA countries. DESIGN Descriptive analysis. SETTING Publicly accessible marketing authorization databases from LA regulators, European Public Assessment Report by EMA, and previous studies accessing EMA approvals of new cancer drugs 2009-2016. MAIN OUTCOME AND MEASURES Number of new cancer drugs approved by LA countries without evidence of overall survival (2009-2013), and without at least one clinical trial scored at low risk of bias, or with no trial supporting the marketing authorization at all (2014-2016). RESULTS Argentina, Brazil, Chile, Colombia, Ecuador, Panama and Peru have publicly accessible and trustful MA databases and were included. Of the 17 cancer drugs approved by EMA (2009-2013) without evidence of OS benefit after a postmarketing median time of 5.4 years, 6 LA regulators approved more than 70% of them. Of the 13 drugs approved by EMA (2014-2016), either without supporting trial or with no trial at low risk of bias, Brazil approved 11, Chile 10, Peru 10, Argentina 10, Colombia 9, Ecuador 9, and Panama 8. CONCLUSIONS LA countries keep approving new cancer drugs often based on poorly performed clinical trials measuring surrogate endpoints. EMA and other reputed regulators must be aware that their regulatory decisions might directly influence decisions regarding MA, health budgets and patient's care elsewhere.
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Affiliation(s)
- Carlos E. Durán
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Martín Cañás
- Federación Médica de la Provincia de Buenos Aires, La Plata, Argentina
- Instituto de Ciencias de la Salud, Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Martín Urtasun
- Federación Médica de la Provincia de Buenos Aires, La Plata, Argentina
- Instituto de Ciencias de la Salud, Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Monique Elseviers
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Robert Vander Stichele
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Thierry Christiaens
- Clinical Pharmacology Research Group, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
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Durán CE, Cañás M, Urtasun MA, Elseviers M, Andia T, Vander Stichele R, Christiaens T. Regulatory reliance to approve new medicinal products in Latin American and Caribbean countries. Rev Panam Salud Publica 2021; 45:e10. [PMID: 33859678 PMCID: PMC8040933 DOI: 10.26633/rpsp.2021.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Objective. To describe the current status of regulatory reliance in Latin America and the Caribbean (LAC) by assessing the countries’ regulatory frameworks to approve new medicines, and to ascertain, for each country, which foreign regulators are considered as trusted regulatory authorities to rely on. Methods. Websites from LAC regulators were searched to identify the official regulations to approve new drugs. Data collection was carried out in December 2019 and completed in June 2020 for the Caribbean countries. Two independent teams collected information regarding direct recognition or abbreviated processes to approve new drugs and the reference (trusted) regulators defined as such by the corresponding national legislation. Results. Regulatory documents regarding marketing authorization were found in 20 LAC regulators’ websites, covering 34 countries. Seven countries do not accept reliance on foreign regulators. Thirteen regulatory authorities (Argentina, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Mexico, Panama, Paraguay, Peru, Uruguay, and the unique Caribbean Regulatory System for 15 Caribbean States) explicitly accept relying on marketing authorizations issued by the European Medicines Agency, United States Food and Drug Administration, and Health Canada. Ten countries rely also on marketing authorizations from Australia, Japan, and Switzerland. Argentina, Brazil, Chile, and Mexico are reference authorities for eight LAC regulators. Conclusions. Regulatory reliance has become a common practice in the LAC region. Thirteen out of 20 regulators directly recognize or abbreviate the marketing authorization process in case of earlier approval by a regulator from another jurisdiction. The regulators most relied upon are the European Medicines Agency, United States Food and Drug Administration, and Health Canada.
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Affiliation(s)
- Carlos E Durán
- Ghent University Ghent Belgium Ghent University, Ghent, Belgium
| | - Martín Cañás
- Federación Médica de la Provincia de Buenos Aires (FEMEBA) La Plata Argentina Federación Médica de la Provincia de Buenos Aires (FEMEBA), La Plata, Argentina
| | - Martín A Urtasun
- Federación Médica de la Provincia de Buenos Aires (FEMEBA) La Plata Argentina Federación Médica de la Provincia de Buenos Aires (FEMEBA), La Plata, Argentina
| | | | - Tatiana Andia
- Universidad de los Andes Bogotá Colombia Universidad de los Andes, Bogotá, Colombia
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