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Quinn SC, Lama Y, Jamison A, Freimuth V, Shah V. Willingness of Black and White Adults to Accept Vaccines in Development: An Exploratory Study Using National Survey Data. Am J Health Promot 2020; 35:571-579. [DOI: 10.1177/0890117120979918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Explore acceptability of vaccines in development: cancer, Type II diabetes, Alzheimer’s disease, Lyme disease, Ebola, and obesity. Research questions: To what extent does acceptability vary by vaccine type? To what extent does acceptability of vaccines in development vary by race and other key demographics? To what extent are general vaccine hesitancy and key demographics associated with acceptability of vaccines in development? Design: Cross-sectional online survey administered through GfK’s KnowledgePanel in 2015. Analysis completed in 2020. Subjects: Nationally representative sample of Black and White American adults (n = 1,643). Measures: Willingness to accept a novel vaccine was measured on a 4-point Likert scale. Independent variables included demographics (e.g. age, race, gender) and measures of vaccine hesitancy, trust, and the “Three C’s” of vaccine confidence, complacency, and convenience. Analysis: Exploratory analysis including descriptive statistics and regression modeling. Results: Acceptability varied from 77% for a cancer vaccine to 55% for an obesity vaccine. White race, male gender, older age, having a chronic health condition, and higher socioeconomic status were associated with higher acceptability. Higher vaccine confidence and lower vaccine hesitancy were predictors for acceptability. Conclusion: The success of a vaccine depends on widespread public acceptance. Vaccine hesitancy may hinder acceptance of future vaccines, with significant differences by demographics. Future social science research is necessary to better understand and address vaccine hesitancy.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, MD, USA
| | - Yuki Lama
- Department of Family Science, School of Public Health, University of Maryland, MD, USA
| | - Amelia Jamison
- Center for Health Equity, School of Public Health, University of Maryland, MD, USA
| | | | - Veeraj Shah
- Department of Health Policy and Management, School of Public Health, University of Maryland, MD, USA
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Dheman N, Mahoney N, Cox EM, Farley JJ, Amini T, Lanthier ML. An Analysis of Antibacterial Drug Development Trends in the US, 1980 - 2019. Clin Infect Dis 2020; 73:e4444-e4450. [PMID: 32584952 DOI: 10.1093/cid/ciaa859] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/22/2020] [Indexed: 01/21/2023] Open
Abstract
We present a longitudinal analysis of investigational new drug applications (INDs) for new, systemic antibacterial drugs under active development between 1980 and 2019, evaluating the characteristics of these investigational drugs and the outcomes of these drug development programs. The number of INDs in active development declined by two-thirds from 39 active INDs at its peak in 1987 to a low 13 in 2001, with decreased development of new cephalosporin, quinolone, and macrolide drugs and reduced participation from large pharmaceutical firms. Antibacterial drug development activity rebounded substantially from 2002 - 2009, primarily led by small pharmaceutical company involvement. As of December 31, 2019, the number of active INDs has declined to an 11-year low, and the number of antibacterial INDs initiated with the FDA from 2010-2019 was lower than any of the previous three decades. Antibacterial drug development programs initiated in the 1980s and 1990s had high success rates, with over 40% of INDs obtaining marketing approval, in a median time of about six years from IND receipt to approval. For drug development programs initiated between 2000 and 2009, we find IND-to-approval rates reduced to 23% with median development times for approved antibacterial drugs increasing to 8.2 years. The majority of INDs in development as of December 31, 2019 come from already established drug classes, most in early stages of development, and few are sponsored by large pharmaceutical companies.
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Affiliation(s)
- Nidhi Dheman
- Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | | | - Edward M Cox
- Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - John J Farley
- Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Thushi Amini
- Office of Infectious Diseases, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Michael L Lanthier
- Economics Staff, Office of Economics and Analysis, Office of the Commissioner, Food and Drug Administration, Silver Spring, MD
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Detoc M, Launay O, Dualé C, Mutter C, Le Huec JC, Lenzi N, Lucht F, Gagneux-Brunon A, Botelho-Nevers E. Barriers and motivations for participation in preventive vaccine clinical trials: Experience of 5 clinical research sites. Vaccine 2019; 37:6633-6639. [PMID: 31543417 DOI: 10.1016/j.vaccine.2019.09.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023]
Abstract
Recruitment in preventive vaccine trials (PVT) is challenging due to common barriers to clinical research and lack of vaccine confidence. Identifying determinants of participation can help to improve recruitment. A prospective survey was conducted in 5 French clinical investigational sites. People asked to participate in a PVT were given a questionnaire whether they decided to participate or not in the trial. A total of 341 people answered the survey: 210 accepting and 131 declining to participate in a PVT. Acceptors were significantly younger (38.5 vs 54.9 years old), more likely to be involved in early phase trials, had a higher level of education (p < 0.005) and a significantly better general opinion concerning vaccines (92.3% versus 72.3%, p < 0.005) compared with those who declined. Factors associated with acceptance or refusal were evaluated in 224 people in the 4 sites where both groups were included. In a multivariate analysis, three factors: older age, having heard about PVT through multiple sources and financial incentives were significantly associated with refusal to participate in the PVT. A generally favourable opinion of vaccines was associated with acceptance. The main motivation for participation was altruism (93.2%) whereas fear of side effects was at the forefront of the barriers (36.6%). Information given by the physician was a key point for decision-making in 70.2% of those who accepted. In brief, vaccine hesitancy may decrease recruitment in PVTs; reinforcing altruism and quality of information given are key points in acceptance of participation in PVT.
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Affiliation(s)
- M Detoc
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - O Launay
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; Inserm, CIC 1417, Assistance Publique-Hôpitaux de Paris, CIC Cochin Pasteur, Hôpital Cochin Broca Hôtel-Dieu, Paris, France
| | - C Dualé
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France; Centre de Pharmacologie Clinique (INSERM CIC1405), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - C Mutter
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France; CIC Inserm 1434, CHU de Strasbourg, Strasbourg, France
| | - J-C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Unité Rachis, Université Bordeaux Deterca Lab, 15 rue Boucher, 33000 Bordeaux, France
| | - N Lenzi
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - F Lucht
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - A Gagneux-Brunon
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - E Botelho-Nevers
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.
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Hwang TJ, Franklin JM, Kesselheim AS. Effect of US Food and Drug Administration's Cardiovascular Safety Guidance on Diabetes Drug Development. Clin Pharmacol Ther 2017; 102:290-296. [PMID: 28390139 DOI: 10.1002/cpt.705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
In 2008, the US Food and Drug Administration (FDA) issued guidance on the need for cardiovascular outcome trials to assess the safety of new diabetes medications. Using two large commercial databases, we evaluated the effect of the FDA's cardiovascular safety guidance on drug development for type 2 diabetes as well as a comparison group of drugs intended to treat other alimentary and metabolic conditions. The FDA's guidance was associated with a 31% differential decrease in the rate of diabetes drugs entering phase II trials, but the remaining drugs were significantly more likely to target novel biological pathways (72% of drugs had novel mechanisms after the guidance vs. 49% before the guidance). No differential changes were observed for phase I and phase III trials. There was no measurable improvement during the study period in glycemic efficacy among investigational products entering phase III trials. This research highlights how regulatory actions can impact pharmaceutical innovation.
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Affiliation(s)
- T J Hwang
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - J M Franklin
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - A S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Hwang TJ, Lauffenburger JC, Franklin JM, Kesselheim AS. Temporal Trends and Factors Associated With Cardiovascular Drug Development, 1990 to 2012. JACC Basic Transl Sci 2016; 1:301-308. [PMID: 30167520 PMCID: PMC6113354 DOI: 10.1016/j.jacbts.2016.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease remains a leading cause of death, but stakeholders have recently raised concerns about the pace of innovation and investment in developing new therapeutics. Here, the authors characterized temporal trends in cardiovascular research and development over the past 2 decades and the likelihood of successful completion of pre-approval clinical trials. The authors also evaluated the reasons for discontinuation, novelty, and rates of trial results publication for cardiovascular therapies in late-stage development. Between 1990 and 2012, the number of new cardiovascular drugs entering clinical trials declined across all stages of development (p < 0.001 for linear trends). There was no evidence for a difference in probability of successful progression to the next stage of development between cardiovascular and noncardiovascular drugs. Small and medium-sized companies sponsored 43%, 38%, and 31% of new Phase 1, Phase 2, and Phase 3 trials, respectively. Roughly one-half of the drugs in Phase 3 trials were categorized as targeting a novel biological pathway. The number of cardiovascular trials sponsored by small and medium-sized companies and the number of novel drugs entering Phase 3 trials increased over time. Most drugs were discontinued in Phase 3 due to inadequate efficacy (44%) or safety issues (24%), but the Phase 3 trial results for only one-half of the discontinued drugs were published in peer-reviewed journals. These results shed light on important shifts in research and development activity and confirm the perceived challenges in cardiovascular translational research.
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Affiliation(s)
- Thomas J. Hwang
- Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Julie C. Lauffenburger
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica M. Franklin
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Reprint requests and correspondence: Dr. Aaron S. Kesselheim, Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, Massachusetts 02120.
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