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Shi J, Chen X, Hu H, Ung COL. The evolving regulatory system of advanced therapy medicinal products in China: a documentary analysis using the World Health Organization Global Benchmarking Tool standards. Cytotherapy 2024; 26:954-966. [PMID: 38739075 DOI: 10.1016/j.jcyt.2024.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
Advanced therapy medicinal products (ATMPs) are rapidly evolving to offer new treatment options. The scientific, technical, and clinical complexities subject drug regulatory authorizes to regulatory challenges. To advance the regulatory capacity for ATMPs, the National Medical Products Administration in China made changes to the drug regulatory system and developed regulatory science with the goal of addressing patient needs and encouraging innovation. This study aimed to systematically identify the regulatory evidence on ATMPs in China under the guidance of an overarching framework from the World Health Organization Global Benchmarking Tool. It was found that China's administrative authorities at all levels have issued a number of policy documents to promote the development of ATMPs, covering biopharmaceutical products research and development (n = 14), biopharmaceutical industry development (n = 9), high-quality development of medical institutions (n = 1), specific development plans/projects (n = 6) and specific regional development (n = 4). The legal and regulatory framework of ATMPs in China has been established and is subject to continuous adjustment in various aspects including regulations (n = 3), departmental rules or administrative normative documents (n = 22), and technical guidance (n = 15). As the regulatory reform continues, the drug review processes have been revised, and various technical standards have been launched, which aim to establish a regulatory approach that oversees the full life-cycle development of ATMPs in the country. The limited number of investigational new drug applications and approved ATMPs suggests a lag remains between the translation of advanced therapeutic technologies into clinically available medical products. To accelerate the translational research of ATMP in countries such as China, developing and adopting real-world evidence generated from clinical use in designated healthcare facilities to support scientific decision-making in ATMP regulation is warranted. The enhancement of regulatory capacity building and multi-stakeholder collaborations should also be encouraged to facilitate the timely evaluation of promising ATMPs to meet more patient needs.
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Affiliation(s)
- Junnan Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Xianwen Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China; Centre for Pharmaceutical Regulatory Sciences, University of Macau, Taipa, Macao SAR, China; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China; Centre for Pharmaceutical Regulatory Sciences, University of Macau, Taipa, Macao SAR, China; Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.
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Dayer VW, Drummond MF, Dabbous O, Toumi M, Neumann P, Tunis S, Teich N, Saleh S, Persson U, von der Schulenburg JMG, Malone DC, Salimullah T, Sullivan SD. Real-world evidence for coverage determination of treatments for rare diseases. Orphanet J Rare Dis 2024; 19:47. [PMID: 38326894 PMCID: PMC10848432 DOI: 10.1186/s13023-024-03041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
Health technology assessment (HTA) decisions for pharmaceuticals are complex and evolving. New rare disease treatments are often approved more quickly through accelerated approval schemes, creating more uncertainties about clinical evidence and budget impact at the time of market entry. The use of real-world evidence (RWE), including early coverage with evidence development, has been suggested as a means to support HTA decisions for rare disease treatments. However, the collection and use of RWE poses substantial challenges. These challenges are compounded when considered in the context of treatments for rare diseases. In this paper, we describe the methodological challenges to developing and using prospective and retrospective RWE for HTA decisions, for rare diseases in particular. We focus attention on key elements of study design and analyses, including patient selection and recruitment, appropriate adjustment for confounding and other sources of bias, outcome selection, and data quality monitoring. We conclude by offering suggestions to help address some of the most vexing challenges. The role of RWE in coverage and pricing determination will grow. It is, therefore, necessary for researchers, manufacturers, HTA agencies, and payers to ensure that rigorous and appropriate scientific principles are followed when using RWE as part of decision-making.
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Affiliation(s)
- Victoria W Dayer
- CHOICE Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | | | - Omar Dabbous
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
| | - Mondher Toumi
- Faculty of Medicine, Public Health Department, Aix-Marseille University, Marseille, France
| | | | | | | | - Shadi Saleh
- American University of Beirut, Beirut, Lebanon
| | - Ulf Persson
- The Swedish Institute for Health Economics, Lund, Sweden
| | | | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | | | - Sean D Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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Siderius L, Perera SD, Gelander L, Jankauskaite L, Katz M, Valiulis A, Hadjipanayis A, Reali L, Grossman Z. Digital child health: opportunities and obstacles. A joint statement of European Academy of Paediatrics and European Confederation of Primary Care Paediatricians. Front Pediatr 2023; 11:1264829. [PMID: 38188915 PMCID: PMC10766845 DOI: 10.3389/fped.2023.1264829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
The advancement of technology and the increasing digitisation of healthcare systems have opened new opportunities to transform the delivery of child health services. The importance of interoperable electronic health data in enhancing healthcare systems and improving child health care is evident. Interoperability ensures seamless data exchange and communication among healthcare entities, providers, institutions, household and systems. Using standardised data formats, coding systems, and terminologies is crucial in achieving interoperability and overcoming the barriers of different systems, formats, and locations. Paediatricians and other child health stakeholders can effectively address data structure, coding, and terminology inconsistencies by promoting interoperability and improving data quality and accuracy of children and youth, according to guidelines of the World Health Organisation. Thus, ensure comprehensive health assessments and screenings for children, including timely follow-up and communication of results. And implement effective vaccination schedules and strategies, ensuring timely administration of vaccines and prompt response to any concerns or adverse events. Developmental milestones can be continuously monitored. This can improve care coordination, enhance decision-making, and optimise health outcomes for children. In conclusion, using interoperable electronic child health data holds great promise in advancing international child healthcare systems and enhancing the child's care and well-being. By promoting standardised data exchange, interoperability enables timely health assessments, accurate vaccination schedules, continuous monitoring of developmental milestones, coordination of care, and collaboration among child healthcare professionals and the individual or their caregiver. Embracing interoperability is essential for creating a person-centric and data-driven healthcare ecosystem where the potential of digitalisation and innovation can be fully realized.
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Affiliation(s)
- Liesbeth Siderius
- Rare Care World Foundation, Loosdrecht, Netherlands
- Youth Health Care, Almere, Netherlands
| | | | - Lars Gelander
- Centre of Child Health Services, Regionhälsan, Region Västra Götaland, Borås, Sweden
| | - Lina Jankauskaite
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Coordinating Center for Rare and Undiagnosed Diseases, Lithuanian University of Health Sciences Hospital Kauno Klinikos, Kaunas, Lithuania
| | - Manuel Katz
- Patient Safety Department, Meuhedet Health Services, Tel Aviv, Israel
- Goshen Foundation, Jerusalem, Israel
| | - Arunas Valiulis
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
- European Academy of Paediatrics, Brussels, Belgium
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, Brussels, Belgium
- Medical School, European University Cyprus, Nicosia, Cyprus
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
| | - Laura Reali
- Primary Care Pediatrician, Italian National Health System (INHS), ASL Rm1, Rome, Italy
| | - Zachi Grossman
- European Academy of Paediatrics, Brussels, Belgium
- Department of Pediatrics, Adelson School of Medicine, Ariel University Pediatrics, Ariel, Israel
- Department of Pediatrics, Maccabi Health Care Services Pediatrics, Tel Aviv, Israel
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Cho J, Lee J, Kim J, Lee H, Kim MJ, Lee YJ, Yum MS, Byun JH, Lee CG, Lee YM, Lee J, Chae JH. Nusinersen demonstrates effectiveness in treating spinal muscular atrophy: findings from a three-year nationwide study in Korea. Front Neurol 2023; 14:1294028. [PMID: 38192577 PMCID: PMC10773909 DOI: 10.3389/fneur.2023.1294028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Nusinersen is the first drug approved for spinal muscular atrophy (SMA) treatment. In this study, we aimed to evaluate the long-term safety and efficacy of nusinersen, assess the therapeutic effects based on the treatment initiation timing and baseline motor function, and explore the perception of functional improvement from either parents or patients, utilizing 3-year nationwide follow-up data in South Korea. Methods We enrolled patients with SMA who were treated with nusinersen under the National Health Insurance coverage, with complete motor score records available and a minimum treatment duration of 6 months. To evaluate the motor function of patients, the Hammersmith Infant Neurological Examination-2 (HINE-2) was used for type 1 and the Expanded Hammersmith Functional Motor Scale (HFMSE) was used for types 2 and 3 patients. A significant improvement was defined as a HINE-2 score gain ≥5 for patients with type 1 and an HFMSE score ≥ 3 for patients with types 2 and 3 SMA. Effects of treatment timing were assessed. Patients with type 2 were further categorized based on baseline motor scores for outcome analysis. We also analyzed a second dataset from five tertiary hospitals with the information on parents/patients-reported impressions of improvement. Results The study comprised 137 patients, with 21, 103, and 13 patients representing type 1, 2, and 3 SMA, respectively. At the 3-year follow-up, the analysis encompassed 7 patients with type 1, 12 patients with type 2, and none with type 3. Nearly half of all enrolled patients across SMA types (42.8, 59.2 and 46.2%, respectively) reached the 2-year follow-up for analysis. Patients with type 1 SMA exhibited gradual motor function improvement over 1-, 2-, and 3-year follow-ups (16, 9, and 7 patients, respectively). Patients with type 2 SMA demonstrated improvement over 1-, 2-, and 3-year follow-ups (96, 61 and 12 patients, respectively). Early treatment from symptom onset resulted in better outcomes for patients with type 1 and 2 SMA. In the second dataset, 90.7% of 108 patients reported subjective improvement at the 1-year follow-up. Conclusion Nusinersen treatment for types 1-3 SMA is safe and effective in long-term follow-up. Early treatment initiation was a significant factor affecting long-term motor outcome.
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Affiliation(s)
- Jaeso Cho
- Department of Genomic Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
| | - Jiwon Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihye Kim
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Hyunjoo Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Jee Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook, Republic of Korea
| | - Mi-Sun Yum
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji-Hye Byun
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Chong Guk Lee
- Health Insurance Review & Assessment Service (HIRA), HIRA Research Institute, Wonju, Republic of Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Genomic Medicine, Seoul National University Children’s Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Dreyer NA, Mack CD. Tactical Considerations for Designing Real-World Studies: Fit-for-Purpose Designs That Bridge Research and Practice. Pragmat Obs Res 2023; 14:101-110. [PMID: 37786592 PMCID: PMC10541678 DOI: 10.2147/por.s396024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Real-world evidence (RWE) is being used to provide information on diverse groups of patients who may be highly impacted by disease but are not typically studied in traditional randomized clinical trials (RCT) and to obtain insights from everyday care settings and real-world adherence to inform clinical practice. RWE is derived from so-called real-world data (RWD), ie, information generated by clinicians in the course of everyday patient care, and is sometimes coupled with systematic input from patients in the form of patient-reported outcomes or from wearable biosensors. Studies using RWD are conducted to evaluate how well medical interventions, services, and diagnostics perform under conditions of real-world use, and may include long-term follow-up. Here, we describe the main types of studies used to generate RWE and offer pointers for clinicians interested in study design and execution. Our tactical guidance addresses (1) opportunistic study designs, (2) considerations about representativeness of study participants, (3) expectations for transparency about data provenance, handling and quality assessments, and (4) considerations for strengthening studies using record linkage and/or randomization in pragmatic clinical trials. We also discuss likely sources of bias and suggest mitigation strategies. We see a future where clinical records - patient-generated data and other RWD - are brought together and harnessed by robust study design with efficient data capture and strong data curation. Traditional RCT will remain the mainstay of drug development, but RWE will play a growing role in clinical, regulatory, and payer decision-making. The most meaningful RWE will come from collaboration with astute clinicians with deep practice experience and questioning minds working closely with patients and researchers experienced in the development of RWE.
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Yao Y, Yang F. Overcoming personal information protection challenges involving real-world data to support public health efforts in China. Front Public Health 2023; 11:1265050. [PMID: 37808971 PMCID: PMC10559907 DOI: 10.3389/fpubh.2023.1265050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
In the information age, real-world data-based evidence can help extrapolate and supplement data from randomized controlled trials, which can benefit clinical trials and drug development and improve public health decision-making. However, the legitimate use of real-world data in China is limited due to concerns over patient confidentiality. The use of personal information is a core element of data governance in public health. In China's public health data governance, practical problems exist, such as balancing personal information protection and public value conflict. In 2021, China adopted the Personal Information Protection Law (PIPL) to provide a consistent legal framework for protecting personal information, including sensitive medical health data. Despite the PIPL offering critical legal safeguards for processing health data, further clarification is needed regarding specific issues, including the meaning of "separate consent," cross-border data transfer requirements, and exceptions for scientific research. A shift in the law and regulatory framework is necessary to advance public health research further and realize the potential benefits of combining real-world evidence and digital health while respecting privacy in the technological and demographic change era.
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Affiliation(s)
| | - Fei Yang
- School of Law, China Jiliang University, Hangzhou, China
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7
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Spithoff S, Grundy Q. Commercializing Personal Health Information: A Critical Qualitative Content Analysis of Documents Describing Proprietary Primary Care Databases in Canada. Int J Health Policy Manag 2023; 12:6938. [PMID: 37579404 PMCID: PMC10461871 DOI: 10.34172/ijhpm.2023.6938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/03/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Commercial data brokers have amassed large collections of primary care patient data in proprietary databases. Our study objective was to critically analyze how entities involved in the collection and use of these records construct the value of these proprietary databases. We also discuss the implications of the collection and use of these databases. METHODS We conducted a critical qualitative content analysis using publicly available documents describing the creation and use of proprietary databases containing Canadian primary care patient data. We identified relevant commercial data brokers, as well as entities involved in collecting data or in using data from these databases. We sampled documents associated with these entities that described any aspect of the collection, processing, and use of the proprietary databases. We extracted data from each document using a structured data tool. We conducted an interpretive thematic content analysis by inductively coding documents and the extracted data. RESULTS We analyzed 25 documents produced between 2013 and 2021. These documents were largely directed at the pharmaceutical industry, as well as shareholders, academics, and governments. The documents constructed the value of the proprietary databases by describing extensive, intimate, detailed patient-level data holdings. They provided examples of how the databases could be used by pharmaceutical companies for regulatory approval, marketing and understanding physician behaviour. The documents constructed the value of these data more broadly by claiming to improve health for patients, while also addressing risks to privacy. Some documents referred to the trade-offs between patient privacy and data utility, which suggests these considerations may be in tension. CONCLUSION Documents in our analysis positioned the proprietary databases as socially legitimate and valuable, particularly to pharmaceutical companies. The databases, however, may pose risks to patient privacy and contribute to problematic drug promotion. Solutions include expanding public data repositories with appropriate governance and external regulatory oversight.
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Affiliation(s)
- Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women’s College Hospital, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Quinn Grundy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Althunian TA, Alrasheed MM, Alnofal FA, Tafish RT, Mira MA, Alroba RA, Kirdas MW, Alshammari TM. Recording type 2 diabetes mellitus in a standardised central Saudi database: a retrospective validation study. BMJ Open 2023; 13:e065468. [PMID: 36944455 PMCID: PMC10032409 DOI: 10.1136/bmjopen-2022-065468] [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] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES This study was conducted to assess the validity of recording (and the original diagnostic practice) of type 2 diabetes mellitus at a hospital whose records were integrated to a centralised database (the standardised common data model (CDM) of the Saudi National Pharmacoepidemiologic Database (NPED)). DESIGN A retrospective single-centre validation study. SETTINGS Data of the study participants were extracted from the CDM of the NPED (only records of one tertiary care hospital were integrated at the time of the study) between 1 January 2013 and 1 July 2018. PARTICIPANTS A random sample of patients with type 2 diabetes mellitus (≥18 years old and with a code of type 2 diabetes mellitus) matched with a control group (patients without diabetes) based on age and sex. OUTCOME MEASURES The standardised coding of type 2 diabetes in the CDM was validated by comparing the presence of diabetes in the CDM versus the original electronic records at the hospital, the recording in paper-based medical records, and the physician re-assessment of diabetes in the included cases and controls, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were estimated for each pairwise comparison using RStudio V.1.4.1103. RESULTS A total of 437 random sample of patients with type 2 diabetes mellitus was identified and matched with 437 controls. Only 190 of 437 (43.0%) had paper-based medical records. All estimates were above 90% except for sensitivity and specificity of CDM versus paper-based records (54%; 95% CI 47% to 61% and 68%; 95% CI 62% to 73%, respectively). CONCLUSIONS This study provided an assessment to the extent of which only type 2 diabetes mellitus code can be used to identify patients with this disease at a Saudi centralised database. A future multi-centre study would help adding more emphasis to the study findings.
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Affiliation(s)
- Turki Abdulaziz Althunian
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Meshael M Alrasheed
- Executive Department for Research and Studies, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Fatemah A Alnofal
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Rawan T Tafish
- Orthopedic and Spinal Surgery, Kingdom Hospital & Consulting Clinics, Riyadh, Saudi Arabia
| | - Mahmood A Mira
- Orthopedic and Spinal Surgery, Kingdom Hospital & Consulting Clinics, Riyadh, Saudi Arabia
| | - Raseel A Alroba
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Mohammed W Kirdas
- Orthopedic and Spinal Surgery, Kingdom Hospital & Consulting Clinics, Riyadh, Saudi Arabia
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Pechmann A, Behrens M, Dörnbrack K, Tassoni A, Stein S, Vogt S, Zöller D, Bernert G, Hagenacker T, Schara-Schmidt U, Schwersenz I, Walter MC, Baumann M, Baumgartner M, Deschauer M, Eisenkölbl A, Flotats-Bastardas M, Hahn A, Horber V, Husain RA, Illsinger S, Johannsen J, Köhler C, Kölbel H, Müller M, von Moers A, Schlachter K, Schreiber G, Schwartz O, Smitka M, Steiner E, Stögmann E, Trollmann R, Vill K, Weiß C, Wiegand G, Ziegler A, Lochmüller H, Kirschner J. Effect of nusinersen on motor, respiratory and bulbar function in early-onset spinal muscular atrophy. Brain 2023; 146:668-677. [PMID: 35857854 DOI: 10.1093/brain/awac252] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/22/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
5q-associated spinal muscular atrophy is a rare neuromuscular disorder with the leading symptom of a proximal muscle weakness. Three different drugs have been approved by the European Medicines Agency and Food and Drug Administration for the treatment of spinal muscular atrophy patients, however, long-term experience is still scarce. In contrast to clinical trial data with restricted patient populations and short observation periods, we report here real-world evidence on a broad spectrum of patients with early-onset spinal muscular atrophy treated with nusinersen focusing on effects regarding motor milestones, and respiratory and bulbar insufficiency during the first years of treatment. Within the SMArtCARE registry, all patients under treatment with nusinersen who never had the ability to sit independently before the start of treatment were identified for data analysis. The primary outcome of this analysis was the change in motor function evaluated with the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders and motor milestones considering World Health Organization criteria. Further, we evaluated data on the need for ventilator support and tube feeding, and mortality. In total, 143 patients with early-onset spinal muscular atrophy were included in the data analysis with a follow-up period of up to 38 months. We observed major improvements in motor function evaluated with the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders. Improvements were greater in children >2 years of age at start of treatment than in older children. 24.5% of children gained the ability to sit independently. Major improvements were observed during the first 14 months of treatment. The need for intermittent ventilator support and tube feeding increased despite treatment with nusinersen. Our findings confirm the increasing real-world evidence that treatment with nusinersen has a dramatic influence on disease progression and survival in patients with early-onset spinal muscular atrophy. Major improvements in motor function are seen in children younger than 2 years at the start of treatment. Bulbar and respiratory function needs to be closely monitored, as these functions do not improve equivalent to motor function.
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Affiliation(s)
- Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Max Behrens
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, D-70196 Freiburg, Germany
| | - Katharina Dörnbrack
- Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Adrian Tassoni
- Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Sabine Stein
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Sibylle Vogt
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Daniela Zöller
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, D-70196 Freiburg, Germany
| | - Günther Bernert
- Clinic Favoriten, Department of Pediatrics, A-1100 Vienna, Austria
| | - Tim Hagenacker
- Department of Neurology, and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, Hufelands.tr 55, 45147 Essen, Germany
| | - Ulrike Schara-Schmidt
- Department of Neuropediatrics and Neuromuscular Centre for children and Adolescents, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Inge Schwersenz
- Deutsche Gesellschaft für Muskelkranke, D-79112 Freiburg, Germany
| | - Maggie C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, D-80336 Munich, Germany
| | - Matthias Baumann
- Department of Pediatrics I, Division of Pediatric Neurology, Medical University of Innsbruck, A-6020 Innsbruck, Austria
| | - Manuela Baumgartner
- Ordensklinikum Linz, Barmherzige Schwestern, Department of Pediatrics and Adolescent medicine, A-4020 Linz, Austria
| | - Marcus Deschauer
- Department of Neurology, Technical University of Munich, School of Medicine, D-81675 Munich, Germany
| | - Astrid Eisenkölbl
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, 4020 Linz, Austria
| | | | - Andreas Hahn
- Department of Child Neurology, Justus-Liebig University, D-35392 Giessen, Germany
| | - Veronka Horber
- Department of Paediatric Neurology, University Children's Hospital, D-72076 Tübingen, Germany
| | - Ralf A Husain
- Department of Neuropediatrics, Jena University Hospital, D-07747 Jena, Germany
| | - Sabine Illsinger
- Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases, Hannover Medical School, D-30625 Hannover, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Cornelia Köhler
- Ruhr-Universität Bochum, St. Josef-Hospital, Universitätsklinik für Kinder- und Jugendmedizin, Abteilung für Neuropädiatrie und Sozialpädiatrie, D-44791 Bochum, Germany
| | - Heike Kölbel
- Department of Neuropediatrics and Neuromuscular Centre for children and Adolescents, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Monika Müller
- Department of Neuropediatrics, University Children's Hospital Würzburg, D-97080 Würzburg, Germany
| | - Arpad von Moers
- Department of Pediatrics und Neuropediatrics, DRK Kliniken Berlin, D-14050 Berlin, Germany
| | - Kurt Schlachter
- Department of Pediatrics, State Hospital of Bregenz (LKH Bregenz), A-6900 Bregenz, Austria
| | - Gudrun Schreiber
- Department of Pediatric Neurology, Klinikum Kassel, D-34125 Kassel, Germany
| | - Oliver Schwartz
- Department of Pediatric Neurology, Münster University Hospital, D-48149 Münster, Germany
| | - Martin Smitka
- Abteilung Neuropaediatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, D-01307 Dresden, Germany
| | - Elisabeth Steiner
- Department of Pediatrics, Klinikum Wels-Grieskirchen, A-4600 Wels, Austria
| | - Eva Stögmann
- Department of Pediatrics, LK-Banden-Mödling, A-2340 Mödling, Austria
| | - Regina Trollmann
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander-University of Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-University, D-80337 Munich, Germany
| | - Claudia Weiß
- Department of Pediatric Neurology and Center for Chronically Sick Children, Charité-University Medicine Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Gert Wiegand
- Neuropediatrics Section of the Department of Pediatrics, Asklepios Clinic Hamburg Nord-Heidberg, D-22417 Hamburg, Germany
| | - Andreas Ziegler
- Department of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, D-69120 Heidelberg, Germany
| | - Hanns Lochmüller
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada.,Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany.,Department of Neuropediatrics, University Hospital Bonn, Faculty of Medicine, D-53127 Bonn, Germany
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10
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Horgan D, Hamdi Y, Lal JA, Nyawira T, Meyer S, Kondji D, Francisco NM, De Guzman R, Paul A, Nallamalla KR, Park WY, Triapthi V, Tripathi R, Johns A, Singh MP, Phipps ME, Dube F, Abu Rasheed HM, Kozaric M, Pinto JA, Stefani SD, Aponte Rueda ME, Alarcon RF, Barrera-Saldana HA. Empowering quality data - the gordian knot of bringing real innovation into healthcare system. Diagnosis (Berl) 2022; 10:140-157. [PMID: 36548810 DOI: 10.1515/dx-2022-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The introduction of Personalised Medicine (PM) into healthcare systems could benefit from a clearer understanding of the distinct national and regional frameworks around the world. Recent engagement by international regulators on maximising the use of real-world evidence (RWE) has highlighted the scope for improving the exploitation of the treasure-trove of health data that is currently largely neglected in many countries. The European Alliance for Personalised Medicine (EAPM) led an international study aimed at identifying the current status of conditions. METHODS A literature review examined how far such frameworks exist, with a view to identifying conducive factors - and crucial gaps. This extensive review of key factors across 22 countries and 5 regions revealed a wide variety of attitudes, approaches, provisions and conditions, and permitted the construction of a comprehensive overview of the current status of PM. Based on seven key pillars identified from the literature review and expert panels, the data was quantified, and on the basis of further analysis, an index was developed to allow comparison country by country and region by region. RESULTS The results show that United States of America is leading according to overall outcome whereas Kenya scored the least in the overall outcome. CONCLUSIONS Still, common approaches exist that could help accelerate take-up of opportunities even in the less prosperous parts of the world.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering Sam Higginbottom University of Agriculture, Technology and Sciences Prayagraj, India
| | - Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Jonathan A Lal
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering Sam Higginbottom University of Agriculture, Technology and Sciences Prayagraj, India
- Department of Genetics and Cell Biology, GROW School of Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Institute for Public Health Genomics, Maastricht University, Maastricht, Netherlands
| | - Teresia Nyawira
- National Commission for Science, Technology and Innovation in Kenya (NACOSTI), Nairobi Kenya, Kenya
| | | | - Dominique Kondji
- Health & Development Communication, Building Capacity for Better Health in Africa Building Capacities for Better Health in AFRICA, Yaounde, Cameroun
| | - Ngiambudulu M Francisco
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde (National Institute for Health Research), Luanda, Angola
| | - Roselle De Guzman
- Oncology and Pain Management Section, Manila Central University-Filemon D. Tanchoco Medical Foundation Hospital, Caloocan City, Philippines
| | - Anupriya Paul
- Department of Mathematics and Statistics, Faculty of Science, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj, India
| | | | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Vijay Triapthi
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering Sam Higginbottom University of Agriculture, Technology and Sciences Prayagraj, India
| | - Ravikant Tripathi
- Department Health Govt of India, Ministry of labor, New Delhi, India
| | - Amber Johns
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Cancer Division, Sydney, Australia
| | - Mohan P Singh
- Center of Biotechnology, University of Allahabad, Allahabad, India
| | - Maude E Phipps
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - France Dube
- Astra Zeneca, Concord Pike, Wilmington, DE, USA
| | | | - Marta Kozaric
- European Alliance for Personalised Medicine, Brussels, Belgium
| | - Joseph A Pinto
- Center for Basic and Translational Research, Auna Ideas, Lima, Peru
| | | | | | - Ricardo Fujita Alarcon
- Centro de Genética y Biología Molecular, Universidad de San Martín de Porres, Lima, Perú
| | - Hugo A Barrera-Saldana
- Innbiogem SC/Vitagenesis SA at National Laboratory for Services of Research, Development, and Innovation for the Pharma and Biotech Industries (LANSEIDI) of CONACyT Vitaxentrum Group, Monterrey, Mexico
- Schools of Medicine and Biology, Autonomous University of Nuevo Leon, Monterrey, Mexico
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11
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Baron R, Mick G, Serpell M. The relevance of real-world data for the evaluation of neuropathic pain treatments. Pain Manag 2022; 12:845-857. [DOI: 10.2217/pmt-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treatment of neuropathic pain (NP) is challenging. Interest in real-world evidence (RWE) for benefit-risk assessments of NP treatments increases given the paucity of drugs showing efficacy in randomized controlled trials and restricted labels of available medicines. To provide further context, a literature review regarding regulatory use of RWE and a clinical trial registry search for randomized controlled trials over the last 10 years was carried out. Taken together, and especially for available NP treatments, there is increasing support to consider RWE when evaluating their benefit-risk profile. Examples are provided in which RWE could be used effectively for updating the product label and informing treatment recommendations. Collected and analyzed according to state-of-the-art standards, RWE can inform treatment recommendations and product label decisions.
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Affiliation(s)
- Ralf Baron
- Division of Neurological Pain Research & Therapy, Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Gérard Mick
- Pain Center, Voiron Hospital, CHU Grenoble Alpes, Grenoble, France
- Health, System, Process (P2S) Research Unit 4129, University of Lyon, Claude Bernard Lyon I, Lyon, France
| | - Mick Serpell
- Department of Anaesthesia, University of Glasgow, Glasgow, Scotland
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12
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Nowak MM, Niemczyk M, Florczyk M, Kurzyna M, Pączek L. Effect of Statins on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies. J Clin Med 2022; 11:jcm11195643. [PMID: 36233511 PMCID: PMC9572734 DOI: 10.3390/jcm11195643] [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: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Statins are lipid-lowering medications used for the prevention of cardiovascular disease (CVD), but the pleiotropic effects of statins might be beneficial in other chronic diseases. This meta-analysis investigated the association between statin use and mortality in different chronic conditions. Eligible studies were real-world studies that compared all-cause mortality over at least 12 months between propensity score-matched statin users and non-users. Overall, 54 studies were included: 21 in CVD, 6 in chronic kidney disease, 6 in chronic inflammatory diseases, 3 in cancer, and 18 in other diseases. The risk of all-cause mortality was significantly reduced in statin users (hazard ratio: 0.72, 95% confidence interval: 0.66−0.76). The reduction in mortality risk was similar in CVD studies (0.73, 0.66−0.76) and non-CVD studies (0.70, 0.67−0.79). There were no significant differences in the risk reduction between cohorts with different diseases (p = 0.179). The greatest mortality reduction was seen in studies from Asia (0.61, 0.61−0.73) and the lowest in studies from North America (0.78, 0.73−0.83) and Australia (0.78, 0.62−0.97). There was a significant heterogeneity (I2 = 95%, tau2 = 0.029, p < 0.01). In conclusion, statin use was associated with a significantly reduced risk of all-cause mortality in real-world cohorts with CVD and non-CVD.
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Affiliation(s)
- Marcin M. Nowak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
- Correspondence:
| | - Mariusz Niemczyk
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Leszek Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
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13
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European Health Data Space—An Opportunity Now to Grasp the Future of Data-Driven Healthcare. Healthcare (Basel) 2022; 10:healthcare10091629. [PMID: 36141241 PMCID: PMC9498352 DOI: 10.3390/healthcare10091629] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The May 2022 proposal from the European commission for a ‘European health data space’ envisages advantages for health from exploiting the growing mass of health data in Europe. However, key stakeholders have identified aspects that demand clarification to ensure success. Data will need to be freed from traditional silos to flow more easily and to cross artificial borders. Wide engagement will be necessary among healthcare professionals, researchers, and the patients and citizens that stand to gain the most but whose trust must be won if they are to allow use or transfer of their data. This paper aims to alert the wider scientific community to the impact the ongoing discussions among lawmakers will have. Based on the literature and the consensus findings of an expert multistakeholder panel organised by the European Alliance for Personalised Medicine (EAPM) in June 2022, it highlights the key issues at the intersection of science and policy, and the potential implications for health research for years, perhaps decades, to come.
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14
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Maison P, Zureik M, Hivert V, Kjaer J, Hossein Khonsari R, Trifirõ G, Ratignier-Carbonneil C. Real-world evidence (RWE): A challenge for regulatory agencies discussion of the RWE conference with the network of the european medicine agencies, patients, and experts. Front Pharmacol 2022; 13:969091. [PMID: 35959441 PMCID: PMC9360563 DOI: 10.3389/fphar.2022.969091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick Maison
- ANSM, Paris, France
- Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- *Correspondence: Patrick Maison,
| | | | | | - Jesper Kjaer
- Data Analytics Centre, Danish Medicines Agency, Copenhagen, Denmark
| | | | - Gianluca Trifirõ
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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15
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Wellnhofer E. Real-World and Regulatory Perspectives of Artificial Intelligence in Cardiovascular Imaging. Front Cardiovasc Med 2022; 9:890809. [PMID: 35935648 PMCID: PMC9354141 DOI: 10.3389/fcvm.2022.890809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Recent progress in digital health data recording, advances in computing power, and methodological approaches that extract information from data as artificial intelligence are expected to have a disruptive impact on technology in medicine. One of the potential benefits is the ability to extract new and essential insights from the vast amount of data generated during health care delivery every day. Cardiovascular imaging is boosted by new intelligent automatic methods to manage, process, segment, and analyze petabytes of image data exceeding historical manual capacities. Algorithms that learn from data raise new challenges for regulatory bodies. Partially autonomous behavior and adaptive modifications and a lack of transparency in deriving evidence from complex data pose considerable problems. Controlling new technologies requires new controlling techniques and ongoing regulatory research. All stakeholders must participate in the quest to find a fair balance between innovation and regulation. The regulatory approach to artificial intelligence must be risk-based and resilient. A focus on unknown emerging risks demands continuous surveillance and clinical evaluation during the total product life cycle. Since learning algorithms are data-driven, high-quality data is fundamental for good machine learning practice. Mining, processing, validation, governance, and data control must account for bias, error, inappropriate use, drifts, and shifts, particularly in real-world data. Regulators worldwide are tackling twenty-first century challenges raised by “learning” medical devices. Ethical concerns and regulatory approaches are presented. The paper concludes with a discussion on the future of responsible artificial intelligence.
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16
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Jandhyala R. The effect of adding real-world evidence to regulatory submissions on the breadth of population indicated for rare disease medicine treatment by the European Medicines Agency. J Pharm Policy Pract 2022; 15:36. [PMID: 35509059 PMCID: PMC9069778 DOI: 10.1186/s40545-022-00433-z] [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: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite calls for the use of additional real-world evidence (RWE) during drug development, rates of inclusion at the regulatory stage remain low. The medicine adoption model suggests that providing additional RWE to regulators would result in a wider indicated population than providing randomised-controlled trial evidence (RCTE) alone. Here, we tested this hypothesis. METHODS All engagements concerning the 88 orphan drugs approved between 2009 and 2019 on the European Medicines Agency Orphan Register were reviewed between September and December 2019. Engagements were grouped as containing either randomised-controlled trial evidence (RCTE) or RCTE with real-world evidence (RWE). The data on indicatable population (the therapeutic indication requested by an engagement) and indicated population (the therapeutic indication ultimately granted) as well as the median number of criteria limiting the indicated population in each study type (RCTE/RWE) was extracted. A chi-square test assessed the association between the indicated population (as a proportion of the indicatable population) and type of evidence (RCTE with or without RWE) and a Wilcoxon rank sum test assessed the difference between the median number of limiting criteria between RCTE and RWE studies. Prediction modelling extrapolated the results of a power analysis to a level expected to deliver significance and the time this would take. RESULTS The review identified 103 engagements, of which three were excluded (one contained only RWE; two contained only systematic literature reviews), leaving 100 engagements for 87 orphan medicines in the final analysis. Only 13% of engagements contained RWE. Although the difference was statistically insignificant, 76.92% of engagements containing RCTE and RWE resulted in a broader indicated population as compared to only 56.32% of those that contained RCTE alone. The median number of limiting criteria from RCTE (37 (28, 43)) and RWE (5 (2, 9)) studies varied significantly (p = 0.005). Modelling suggested that the analysis would achieve sufficient power by 2033-37 at the current RWE adoption rate. CONCLUSION The proportion of the disease population studied in RWE was greater than that in RCTE. The analysis testing the relationship between additional RWE and broader indicated population would achieve adequate power between 2032 and 2037 at the current RWE adoption rate.
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Affiliation(s)
- Ravi Jandhyala
- Medialis Ltd, 13 Horse Fair, Banbury, OX16 0AH, UK. .,Centre for Pharmaceutical Medicine Research, King's College University, London, UK.
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17
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Zhao D, Yao C. Pragmatic Clinical Studies: An Emerging Clinical Research Discipline for Improving Evidence-Based Practice of Cardiovascular Diseases in Asia. Korean Circ J 2022; 52:401-413. [PMID: 35656900 PMCID: PMC9160648 DOI: 10.4070/kcj.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Abstract
Pragmatic clinical studies, as an emerging clinical research discipline, include a wide range of studies that are largely embedded with routine clinical practice aiming to evaluate comparative effectiveness and safety of different clinical intervention strategies. In this review, we described the evolution of the conceptual framework of pragmatic clinical studies, shared perspectives on the importance of pragmatic clinical studies for cardiovascular diseases as a complement to conventional randomized controlled trials, as well as highlighted the specific importance of pragmatic clinical research in improving evidence-based practice for cardiovascular disease managements in Asia. Pragmatic clinical studies, an emerging clinical research discipline, include a wide range of studies that are largely embedded with routine clinical practice and aim to evaluate the comparative effectiveness and safety of different clinical intervention strategies. Increased availability and quality of electronic medical/health records drives the development of pragmatic clinical studies. In this review, we describe evolution of the conceptual framework of pragmatic clinical studies and share perspectives on the importance of pragmatic clinical studies in evidence-based practice for cardiovascular diseases, as a complement to conventional randomized controlled trials. We also highlight specific needs of pragmatic clinical studies in improving evidence-based practice for cardiovascular disease in Asian countries. The main challenges of pragmatic clinical studies are discussed briefly in this review.
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Affiliation(s)
- Dong Zhao
- Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, Beijing, China
| | - Chen Yao
- Peking University Clinical Research Institute. Peking University First Hospital, Beijing, China
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18
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Advancing the Regulation of Traditional and Complementary Medicine Products: A Comparison of Five Regulatory Systems on Traditional Medicines with a Long History of Use. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5833945. [PMID: 34745290 PMCID: PMC8566035 DOI: 10.1155/2021/5833945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
Background An appropriate regulatory system to ensure and promote the quality, safety, and efficacy of the products of traditional medicine (TM) and complementary medicine (CM) is critical to not only public health but also economic growth. The regulatory approach and evaluation standards for TM/CM products featured with a long history of use are yet to be developed. This study aims to investigate and compare the existing regulatory approaches for TM/CM products with a long history of use. Method A mixed approach of documentary analysis involving official and legal documents from official websites, as well as a scoping review of scholarly work in scientific databases about regulatory systems of TM/CM products in China, Hong Kong, Taiwan, Japan, and Korea, was employed in this study and used for comparison. Results For registration purposes, all five regulatory systems recognized the history of use as part of the totality of evidence when evaluating the safety and efficacy of TM/CM products with a long history of use. Generally, the list of classic formulas is predefined and bound to the formulas recommended in the prescribed list of ancient medical textbooks. Expedited pathways are usually in place and scientific data of nonclinical and clinical studies may be exempted. At the same time, additional restrictions with the scope of products constitute a comprehensive approach in the regulation. Quality assurance and postmarketing safety surveillance were found to be the major focus across the regulatory schemes investigated in this study. Conclusion The regulatory systems investigated in this study allow less stringent registration requirements for TM/CM products featured with a long history of use, assuming safety and efficacy to be plausible based on historic use. Considering the safety and efficacy of these products, regulatory standards should emphasize the technical requirements for quality control and postmarket surveillance.
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