Post-marketing authorisation safety and efficacy surveillance of advanced therapy medicinal products in Brazil, the European Union, the United States and Japan

Enhancing the clinical translation of stem cell models by focusing on standardization and international regulatory cooperation

The article by Granjeiro et al provided a thorough review of the role of stem cell models in the development of advanced therapy medicinal products. It emphasized the potential of stem cell models to refine preclinical studies and align with regulatory requirements for clinical applications. This article introduced a new perspective on enhancing the transition of stem cell research into clinical practice, focusing on the importance of international regulatory harmonization and the need for standardization in stem cell-based therapies.

Global harmonization in advanced therapeutics: balancing innovation, safety, and access

INTRODUCTION

Advanced Therapy Medicinal Products (ATMPs), which include gene therapies, somatic cell therapies, and tissue-engineered products, are a new paradigm for treating previously intractable diseases. Their regenerative and personalized approach makes them, unlike conventional treatments, require changing regulatory systems to adjust to their intricacies.

AREAS COVERED

This review gives a comprehensive critique of international regulatory programs that include the FDA's RMAT designation, EMA's PRIME program, and Japan's Sakigake program intended to bring ATMPs to patients faster while ensuring patient safety. It also considers innovation-led strategies like adaptive licensing, rolling reviews, and real-world evidence (RWE) led decision-making for pre-market authorization and post-market monitoring. In addition, it discusses problems like regulatory divergence, intricate manufacturing standards, price constraints, and the transformative role of digital technologies such as artificial intelligence and blockchain in traceability and regulatory compliance. Patient-centric models and early access schemes are also extensively debated as part and parcel of the future of regulatory science.

EXPERT OPINION/COMMENTARY

To achieve the maximum potential of ATMPs across the world, regulatory systems need to be harmonized and responsive, involving real-time data analysis, flexible approval processes, and improved stakeholder cooperation. New technologies, coupled with more patient engagement and global convergence efforts, are crucial for providing equal access to effective and safe advanced therapies.

Risk Minimisation Measures of Advanced Therapy Medicinal Products Authorised in the EU Between 2009 and 2023: A Cross-Sectional Study

INTRODUCTION

Because of the novelty of advanced therapy medicinal products (ATMPs), pro-active risk management is needed post-authorisation; for example, through implementation of additional risk minimisation measures (aRMMs).

OBJECTIVE

We described which aRMMs were introduced at marketing authorisation (MA) for ATMPs authorised in the European Union (EU), and for what safety concerns.

METHODS

We included all ATMPs ever authorised in the EU until December 31, 2023. Data on safety concerns and aRMMs was collected from the European public assessment reports (EPARs) related to initial MA for each ATMP. Safety concerns were categorised using the Medical Dictionary for Regulatory Activities (MedDRA®) or context of use, where appropriate.

RESULTS

Of the 25 included ATMPs, most (n = 23, 92.0%) were authorised with aRMMs. Of these 23 ATMPs, all (100%) had educational material for healthcare professionals. Additionally, educational material for patients/caregivers was in place for 18 (78.3%) ATMPs and a controlled distribution or controlled access programme for 16 (69.6%). Safety concerns related to 'Long term effects' (n = 23, 92.0%), 'Injury, poisoning and procedural complications' (n = 22, 88.0%), and 'Use in special populations' (e.g., use in pregnancy) (n = 20, 80.0%) were common among all 25 ATMPs. ATMPs often had aRMMs introduced that addressed safety concerns related to 'Injury, poisoning and procedural complications' (n = 19/23; 82.6%), 'General disorders and administration site conditions' (n = 8, 34.8%), and/or 'Immune system disorders' (n = 8, 34.8%).

CONCLUSION

The majority of ATMPs were authorised with aRMMs. Whilst educational materials were most prevalent, controlled distribution or controlled access programmes were also commonly introduced. For many ATMPs, aRMMs addressed risks related to 'Injury, poisoning and procedural complications'.

Advancing in Silico Clinical Trials for Regulatory Adoption and Innovation

The evolution of information and communication technologies has affected all fields of science, including health sciences. However, the rate of technological innovation adoption by the healthcare sector has been historically slow, compared to other industrial sectors. Innovation in computer modeling and simulation approaches has changed the landscape in biomedical applications and biomedicine, paving the way for their potential contribution in reducing, refining, and partially replacing animal and human clinical trials. In Silico Clinical Trials (ISCT) allow the development of virtual populations used in the safety and efficacy testing of new drugs and medical devices. This White Paper presents the current framework for ISCT, the role of in silico medicine research communities, the different perspectives (research, scientific, clinical, regulatory, standardization, data quality, legal and ethical), the barriers, challenges, and opportunities for ISCT adoption. In addition, an overview of successful ISCT projects, market-available platforms, and FDA- approved paradigms, along with their vision, mission and outcomes are presented.

Adverse event signal analysis of remimazolam using the FDA adverse event reporting system database

BACKGROUND

Remimazolam, a novel ultra-short-acting benzodiazepine, has gained popularity in various anesthetic applications due to its pharmacokinetic advantages. However, as its use increases, safety concerns also rise, necessitating thorough examination. Additionally, the limited reports on its side effects require a broader investigation to better understand the drug's safety profile.

METHODS

This observational study systematically investigated adverse drug events (ADEs) associated with remimazolam using the FAERS database from Q1 2020 to Q4 2023. The primary objective was to assess potential safety signals and provide comprehensive information for clinical and regulatory purposes.

RESULTS

A total of 67 cases and 161 ADEs were identified. The incidence of ADEs was higher in patients aged >45 years, particularly those >65 years. Intravenous general anaesthesia was the most common administration method. Notable ADE signals included serious events such as allergic reactions, respiratory and cardiac arrest, and vascular access occlusion.

CONCLUSION

Clinicians should be vigilant about potential allergic reactions to remimazolam, especially in older patients, and avoid off-label use until more data are available. Continuous monitoring of post-market surveillance data is essential for uncovering undetected ADEs and ensuring the safe use of remimazolam.

EDITORIAL COMMENT

This study analyzed adverse drug events (ADEs) associated with remimazolam using the FAERS database, identifying serious safety signals like allergic reactions, respiratory and cardiac arrests, and vascular access site occlusions, especially in older patients. The findings highlight the need for vigilant monitoring, cautious off-label use, and ongoing post-marketing surveillance.

Systematic analysis of sugammadex-related adverse drug reaction signals using FAERS database

BACKGROUND

With the clinical integration of sugammadex, a selective relaxant-binding agent, the approach to reversing neuromuscular blockade is revolutionized. Despite its efficacy, sugammadex's adverse reactions range from mild symptoms to severe cases, including anaphylaxis and coagulopathy. Assessing the nature of these reactions using the Food and Drug Administration's Adverse Event Reporting System (FAERS) database is vital for safe anesthetic practice. This study aimed to analyze and categorize the adverse drug events (ADEs) related to sugammadex reported in the FAERS database and evaluate the potential safety signals since its market entry.

MATERIALS AND METHODS

This systematic analysis study extracted and filtered FAERS data pertinent to sugammadex from its introduction in 2008 to the last quarter of 2023 and employed standardized MedDRA terminologies for ADE re-encoding. The Reporting Odds Ratio (ROR) method analyzed ADE signal strength, identifying significant cardiovascular, allergic, and neurological signals.

RESULTS

From 1505 patient reports totaling 3562 ADEs, prominent adverse reaction signals were detected for respiratory and cardiovascular systems and severe allergic and neurological effects. Specific signals, including laryngospasm, bronchospasm, and Disseminated Intravascular Coagulation (DIC), among others, were highlighted and necessitated urgent clinical attention.

CONCLUSIONS

Sugammadex is associated with a spectrum of adverse reactions, some of which demand increased clinical surveillance, particularly in older and pediatric populations. The significance of allergic reactions, airway spasms, and coagulation events indicates the need for precise risk assessment and vigilant monitoring during clinical use.

A Comprehensive Study on Adverse Reactions of Benzoyl Peroxide (BPO) in Dermatological Aesthetics Utilizing the FAERS Database

BACKGROUND

Benzoyl peroxide (BPO) is widely used in dermatological aesthetics for treating acne and other skin conditions. However, its potential adverse reactions remain a concern.

AIMS

This study aimed to investigate the application of BPO in dermatological aesthetics, analyze its associated adverse reactions, and provide insights into patient safety.

METHODS

The study analyzed adverse reaction reports related to BPO in the Food and Drug Administration's Adverse Event Reporting System database from 2004 to 2024. Demographic characteristics, types of adverse reactions, and specific issues related to the novel drug EPSOLAY (5% microencapsulated BPO) were examined.

RESULTS

The findings reveal that BPO users are predominantly female (74.18%), with a significant proportion falling within the 18-44 age group (37.45%). The most common adverse reactions involve skin and subcutaneous tissue disorders (36.34%), including skin swelling, pain, and burning sensations. Reports on EPSOLAY indicate adverse reactions such as erythema, pruritus, and skin exfoliation, but no tumor-related reports have been recorded.

CONCLUSIONS

BPO usage in dermatological aesthetics is associated with various adverse reactions, primarily affecting the skin. The introduction of EPSOLAY has not altered the adverse reaction profile significantly. However, the risk of BPO decomposing into the carcinogen benzene under certain conditions necessitates enhanced patient education, improved production processes, and continuous post-marketing surveillance to ensure drug safety.

Paradigm Shift in Eye Banking: From Tissue Retrieval to Cellular Harvesting and Bioengineering

ABSTRACT

An integrated cell, tissue, and eye bank is vital to meet the evolving needs of ocular transplant therapies. In addition to traditional corneal transplant tissues, it encompasses processing and delivery of transplant materials for newer treatments like cell-based therapies and gene-modified products, adhering to rigorous standards, optimizing tissue utilization with comprehensive services for surgeons.

Evolutionary game analysis on the regulation of medical devices used in health services delivery

Medical devices (MDs) play a critical role in healthcare delivery while also bringing potential medical risks and unintended harms to patients. Although government regulation is well recognized as a critical and essential function for ensuring the safety of MDs in many countries, the supplementary role that hospitals play is often neglected. This paper constructs a tripartite evolutionary game model involving the government, hospitals, and MDs enterprises to explore their strategic behaviors of MDs regulation in healthcare delivery. We performed theoretical analysis and numerical simulations to examine the stability of stakeholders' strategy selections. Our results reveal that: (1) Evolutionarily stable strategy (ESS) can be reached under specific revenue conditions for the government, hospitals, and MDs enterprises. (2) Penalty intensities largely affect the convergence rates of hospital strict management and enterprise quality improvement strategies. (3) Whistleblowing is an efficient factor to influence strategy selections of the hospital and MDs enterprise. Based on these findings, we propose policy recommendations to enhance MDs regulation effectiveness, including encouraging hospitals' engagement in regulation, promoting whistleblowing with more public participation, balancing penalty systems, and strengthening multi-party cooperation.

Diabetic adverse events associated with three commonly used statins: a disproportionality analysis based on the FDA adverse event reporting system database

BACKGROUND

The increasing prevalence of statin use for cardiovascular disease management has raised concerns regarding their safety profile, particularly regarding the potential risk of diabetes. Our study aims to analyze diabetic adverse event reports related to statins using a large pharmacovigilance database to provide timely insights into this significant issue.

METHODS

We analyzed data from the FDA Adverse Event Reporting System (FAERS) database from 2004 to 2023. Disproportionality analyses were performed to detect signals of diabetic adverse events associated with the three most commonly prescribed statins: atorvastatin, rosuvastatin, and simvastatin.

RESULTS

We identified 11,364 cases of statin-related diabetic adverse events across the three statins. Disproportionality analyses revealed a significant association between these statins and four specific diabetic adverse events: type 2 diabetes mellitus, impaired glucose tolerance, diabetic neuropathy, and diabetic retinal edema. Notable sex differences emerged, with females exhibiting an overall significantly higher propensity for diabetes-related adverse events.

CONCLUSIONS

Our study is timely and relevant as it addresses growing concerns about the safety of widely prescribed statins and their association with diabetes. By highlighting these critical issues, the study seeks to contribute valuable insights to practitioners, ultimately guiding better clinical practices and enhancing pharmacovigilance efforts.

Post-marketing surveillance framework of cell and gene therapy products in the European Union, the United States, Japan, South Korea and China: a comparative study

BACKGROUND

Cell and gene therapy products (CGTPs) often receive accelerated approvals, lacking comprehensive long-term safety and efficacy data, which can raise significant safety concerns. This research aims to study the post-marketing surveillance (PMS) of CGTPs in the European Union (EU), the United States (US), Japan, South Korea, and China, to offer insights for the development of a secure and standardized post-marketing regulatory framework for CGTPs.

METHODS

Related regulations and the implementation effect of PMS for approved CGTPs were studied searching PubMed, CNKI, and the official websites of the European Medicines Agency, the US Food and Drug Administration, Japan's Pharmaceuticals and Medical Device Agency, South Korea's Ministry of Food and Drug Safety, and the National Medical Products Administration of China.

RESULTS

Compared to those in China, the guidelines of PMS for CGTPs in the EU, the US, Japan, and South Korea was more comprehensive. Notably, the EU had dedicated regulations and supporting guidelines of PMS. Of the 26 CGTPs approved in the EU, 88% were under additional monitoring, 38% received conditional marketing authorization, and 12% were authorized under exceptional circumstances, with 77% designated as orphan drugs. The US had released 34 guidelines specifically for CGTPs which, forming the foundation of post-marketing risk management. Among the 27 CGTPs approved in the US, 22% were required to perform risk evaluation and mitigation strategies, 37% added black box warnings in the package inserts, 63% mandated to post-marketing requirements, and 15% subject to post-marketing commitments. In Japan, stringent supervision measures encompassing all-case surveillance (79%) and re-examination (53%) were applied to the 19 approved CGTPs, with 21% approved through conditional and time-limited approval. The PMS for CGTPs in South Korea, mainly included PSUR, re-examination, and re-evaluation. China had introduced several relevant regulations, which consisted of general statements and lacked detailed guidance.

CONCLUSIONS

This study demonstrates that the regulatory policies of PMS for CGTPs in the EU, the US, Japan, and South Korea were comprehensive. The implementation of PMS for CGTPs in the EU, the US, and Japan was well developed. This knowledge holds valuable insights for China's future learning and development in this field.

Challenges and opportunities for access to Advanced Therapy Medicinal Products in Brazil

BACKGROUND AIMS

The marketing authorization of Advanced Therapy Medicinal Products (ATMPs) in Brazil is recent. The features of these therapies impose specialized regulatory action and are consequently challenging for developers. The goal of this study was to identify the industry's experience in clinical development, marketing authorization and access to ATMPs through the Unified Health System (SUS, acronym in Portuguese), from a regulatory perspective.

METHODS

A survey containing structured questions was conducted among research participants who work at companies that commercialize ATMPs. A descriptive analysis was performed.

RESULTS

We invited 15 foreign pharmaceutical companies, of which 10 agreed to participate. Overall, participants assessed that Brazil has a well-established regulatory system, especially the sanitary registration by the National Health Surveillance Agency (Anvisa), which ensures the quality, safety, and efficacy of the products. The Agency's good interaction with the regulated sector, the harmonization of sanitary and ethical assessment systems with other countries, and the analysis time in the biosafety assessment of Genetically Modified Organisms (GMOs) stand out as positive in industry's evaluation. On the other hand, it is important to advance the pricing regulation for these products since Brazilian regulations do not establish specific criteria for ATMP. One of the biggest challenges is the difficulty for the SUS in reimbursing these very high-cost therapies, especially using current Health Technology Assessment (HTA) methods.

CONCLUSIONS

Considering the increasing number of approvals of cell and gene therapies in Brazil in the coming years, a close dialogue between the industry and the public sector is recommended to advance regulatory improvements (pricing and HTA). Additionally, the construction of policies to promote the national Health Economic-Industrial Complex, based on a mission-oriented vision that encourages innovative models of financing, especially those that consider risk-sharing and co-financing technologies, will help provide the population with universal, equitable and sustainable access to ATMP in the SUS.