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Sullivan T, Zorenyi G, Feron J, Smith M, Nord M. A Structured Benefit-Risk Assessment Operating Model for Investigational Medicinal Products in the Pharmaceutical Industry. Ther Innov Regul Sci 2023; 57:849-864. [PMID: 37005972 PMCID: PMC10276786 DOI: 10.1007/s43441-023-00508-2] [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: 12/20/2022] [Accepted: 02/24/2023] [Indexed: 04/04/2023]
Abstract
Robust and transparent formal benefit-risk (BR) analyses for medicinal products represent a means to better understand the appropriate use of medicinal products, and to maximize their value to prescribers and patients. Despite regulatory and social imperatives to conduct structured BR (sBR) assessments, and the availability of a plethora of methodological tools, there exists large variability in the uptake and execution of sBR assessments among pharmaceutical companies. As such, in this paper we present an sBR assessment framework developed and implemented within a large global pharmaceutical company that aims to guide the systematic assessment of BR across the continuum of drug development activities, from first-time-in-human studies through to regulatory submission. We define and emphasize the concepts of Key Clinical Benefits and Key Safety Risks as the foundation for BR analysis. Furthermore, we define and foundationally employ the concepts of sBR and a Core Company BR position as the key elements for our BR framework. We outline 3 simple stages for how to perform the fundamentals of an sBR analysis, along with an emphasis on the weighting of Key Clinical Benefits and Key Safety Risks, and a focus on any surrounding uncertainties. Additionally, we clarify existing definitions to differentiate descriptive, semi-quantitative, and fully quantitative BR methodologies. By presenting our framework, we wish to stimulate productive conversation between industry peers and health authorities regarding best practice in the BR field. This paper may also help facilitate the pragmatic implementation of sBR methodologies for organizations without an established framework for such assessments.
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Affiliation(s)
- Tim Sullivan
- Global Patient Safety BioPharmaceuticals, Chief Medical Office, R&D, AstraZeneca, 200 Orchard Ridge Drive, Gaithersburg, MD, 20878, USA.
| | - Gyorgy Zorenyi
- Global Patient Safety Oncology, Chief Medical Office, R&D, AstraZeneca, Cambridge, UK
| | - Jane Feron
- Global Patient Safety, Epidemiology and Risk Management, Chief Medical Office, R&D, AstraZeneca, Cambridge, UK
| | - Meredith Smith
- Formerly of Global Patient Safety, Epidemiology and Risk Management, Chief Medical Office, R&D, Alexion-AstraZeneca Rare Disease, Boston, MA, USA
| | - Magnus Nord
- Global Patient Safety BioPharmaceuticals, Chief Medical Office, R&D, AstraZeneca, Gothenburg, Sweden
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Lackey L, Thompson G, Eggers S. FDA's Benefit-Risk Framework for Human Drugs and Biologics: Role in Benefit-Risk Assessment and Analysis of Use for Drug Approvals. Ther Innov Regul Sci 2020; 55:170-179. [PMID: 32779045 DOI: 10.1007/s43441-020-00203-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Structured, descriptive approaches are utilized by drug regulatory agencies to support and communicate approval decisions about human drugs and biologics. The US Food and Drug Administration (FDA) uses the Benefit-Risk Framework (BRF), which has been integrated into its drug review process. This paper reviews how FDA review teams have used the BRF to communicate approval decisions. METHODS This paper (1) uses content analysis to systematically review the decision factors communicated by FDA review teams in all BRFs associated with novel drugs approved by FDA in 2017-2018 and (2) presents a case study about how the BRF was used for three drugs approved for HIV-1 in 2018-2019. RESULTS The content analysis found most BRFs for novel drug approvals communicate what we call an "urgent" context and complicating decision factors around benefit and/or risk; the HIV-1 case study highlights the flexibility of the structured BRF tool. CONCLUSIONS FDA's BRF provides a flexible mechanism for communicating important decision factors, allowing it to support the diversity of drug approval decisions made by FDA.
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Affiliation(s)
- Leila Lackey
- Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, USA.
- , 10903 New Hampshire Ave, WO Bldg 51 Rm 1141, Silver Spring, MD, 20993, USA.
| | - Graham Thompson
- Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, USA
| | - Sara Eggers
- Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, USA
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Keyter A, Salek S, Banoo S, Walker S. Can Standardisation of the Public Assessment Report Improve Benefit-Risk Communication? Front Pharmacol 2020; 11:855. [PMID: 32625087 PMCID: PMC7313675 DOI: 10.3389/fphar.2020.00855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background National regulatory authorities (NRAs) make the decision to register a medicine based on an assessment of its benefits and risks and publicly available assessment reports are used as a tool to communicate the basis for the decision. The Universal Methodology for Benefit-Risk Assessment (UMBRA) has also been used to effectively communicate the basis of regulatory decisions. Many NRAs in emerging markets place reliance on the public assessment reports (PARs) of reference agencies to inform about their own regulatory decisions. However, PAR users often criticise the redacted nature of PARs and may be challenged in identifying key benefits and risks, value judgements, and benefit-risk (BR) trade-offs. Methods PARs for ertugliflozin l-pyroglutamic acid, erenumab, and durvalumab published by regulatory bodies in Australia, Europe, Canada, and the United States were compared with the validated UMBRA Benefit-Risk Template to evaluate the BR decision documentation. Published validation of UMBRA included report of a consortium of four regulatory authorities in Australia, Canada, Switzerland, and Singapore indicating that their clinical assessment templates were modified to align with the UMBRA approach. A focus group discussed the use of PARs as potential knowledge management tools for stakeholder understanding of regulatory decision making. The South African Health Product Regulatory Authority (SAHPRA) approach to document and communicate the BR decisions was evaluated. Results Results indicate key elements to include in the PARs including regulatory history, an effects table and a record of the strengths and uncertainties for each benefit and risk. Focus group participants agreed that a harmonised PAR template would support improved regulatory decision-making transparency. SAHPRA communication of BR decisions could be improved through the use of the UMBRA BR Template as a guidance for BR assessment and the basis of the South Africa public assessment report format. Conclusion SAHPRA's use of a structured template that supports transparent and quality decision making could have a major impact in ensuring consistency in the BR assessment of new medicines. The implementation of this effective approach for communicating BR decisions will advance agency goals of being a trusted, responsive, accountable regulatory body in which all healthcare stakeholders may rely on with confidence.
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Affiliation(s)
- Andrea Keyter
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,South African Health Products Regulatory Authority, Johannesburg, South Africa
| | - Sam Salek
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Shabir Banoo
- South African Health Products Regulatory Authority, Johannesburg, South Africa.,Right to Care and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Stuart Walker
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Centre for Innovation in Regulatory Science, London, United Kingdom
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Juhaeri J. Benefit-risk evaluation: the past, present and future. Ther Adv Drug Saf 2019; 10:2042098619871180. [PMID: 31489173 PMCID: PMC6712756 DOI: 10.1177/2042098619871180] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/27/2019] [Indexed: 12/31/2022] Open
Abstract
In the last two decades there has been a shift in the approach to evaluating the benefit-risk (BR) profiles of medicinal products from an unstructured, subjective, and inconsistent, to a more structured and objective, process. This article describes that shift from a historical perspective; the past, the present, and the future, and highlights key events that played critical roles in changing the field.
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Affiliation(s)
- Juhaeri Juhaeri
- Sanofi, Bridgewater, 55 Corporate Drive, Bridgewater, NJ 08807, USA
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Oliveira MD, Mataloto I, Kanavos P. Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:891-918. [PMID: 31006056 PMCID: PMC6652169 DOI: 10.1007/s10198-019-01052-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/14/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Multi-criteria decision analysis (MCDA) concepts, models and tools have been used increasingly in health technology assessment (HTA), with several studies pointing out practical and theoretical issues related to its use. This study provides a critical review of published studies on MCDA in the context of HTA by assessing their methodological quality and summarising methodological challenges. METHODS A systematic review was conducted to identify studies discussing, developing or reviewing the use of MCDA in HTA using aggregation approaches. Studies were classified according to publication time and type, country of study, technology type and study type. The PROACTIVE-S approach was constructed and used to analyse methodological quality. Challenges and limitations reported in eligible studies were collected and summarised; this was followed by a critical discussion on research requirements to address the identified challenges. RESULTS 129 journal articles were eligible for review, 56% of which were published in 2015-2017; 42% focused on pharmaceuticals; 36, 26 and 18% reported model applications, issues regarding MCDA implementation analyses, and proposing frameworks, respectively. Poor compliance with good methodological practice (< 25% complying studies) was found regarding behavioural analyses, discussion of model assumptions and uncertainties, modelling of value functions, and dealing with judgment inconsistencies. The five most reported challenges related to evidence and data synthesis; value system differences and participant selection issues; participant difficulties; methodological complexity and resource balance; and criteria and attributes modelling. A critical discussion on ways to address these challenges ensues. DISCUSSION Results highlight the need for advancement in robust methodologies, procedures and tools to improve methodological quality of MCDA in HTA studies. Research pathways include developing new model features, good practice guidelines, technologies to enable participation and behavioural research.
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Affiliation(s)
- Mónica D Oliveira
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal.
| | - Inês Mataloto
- CEG-IST, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group, LSE Health London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Keyter A, Salek S, Banoo S, Walker S. The South African Medicines Control Council: Comparison of Its Registration Process With Australia, Canada, Singapore, and Switzerland. Front Pharmacol 2019; 10:228. [PMID: 30923501 PMCID: PMC6426768 DOI: 10.3389/fphar.2019.00228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction: Comparisons between regulatory authorities of similar size and regulatory characteristics facilitate value-added benchmarking and provide insight into regulatory performance. Such comparisons highlight areas for improvement as authorities move toward achieving their regulatory goals and stakeholders’ demands. The aims of this study were to compare the registration process and the regulatory review model of the South African Medicines Control Council (MCC) to that of four other similar-sized regulatory authorities and to identify areas for improvement that may inform recommendations to the South African Health Products Regulatory Authority (SAHPRA) as it looks to re-engineer and enhance the registration process in South Africa. Methods: A questionnaire describing the organisational structure, the registration process, good review and decision-making practices of the MCC was completed by the author (AK) for the purpose of this study and validated by the Registrar of the MCC. Similar questionnaires were also completed and validated by Australia’s Therapeutic Goods Administration (TGA), Canada’s Health Canada, Singapore’s Health Science Authority (HSA) and Switzerland’s Swissmedic. Results: A comparison of the MCC regulatory process with the four comparative agencies indicated that they all have similar requirements and employ a full-review model although the timelines for the MCC were considerably longer. However, similar quality measures were implemented by all authorities as part of their good review practices (GRevP) including prioritising transparency, communication, continuous improvement initiatives and training. Conclusion: Comparisons made through this study provided insight into the areas of the MCC registration process that may be improved and have informed recommendations to SAHPRA including the implementation of facilitated regulatory pathways, definition of targets for key milestones in regulatory review and formal implementation and monitoring of GRevP. In order to build quality into the review process the application of a standardised template for the clinical assessment of medicines such as the Universal Methodology for Benefit-Risk Assessment (UMBRA) could be considered as well as enhancing transparency and communication through the application of an electronic management system and the development of publicly available summaries for the basis of approval.
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Affiliation(s)
- Andrea Keyter
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Department of Health, South African Health Products Regulatory Authority, Pretoria, South Africa
| | - Sam Salek
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Shabir Banoo
- Department of Health, South African Health Products Regulatory Authority, Pretoria, South Africa.,Department of Pharmacy and Pharmacology, University of the Witwatersrand, Johannesburg, South Africa
| | - Stuart Walker
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Centre for Innovation in Regulatory Science, London, United Kingdom
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Tegenge MA, Moncur MM, Sokolic R, Forshee RA, Irony T. Advancing the science of patient input throughout the regulatory decision-making process. Learn Health Syst 2017; 1:e10032. [PMID: 31245564 PMCID: PMC6508573 DOI: 10.1002/lrh2.10032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/20/2017] [Accepted: 05/13/2017] [Indexed: 11/12/2022] Open
Abstract
The US Food and Drug Administration (FDA) understands the value of patient input in the regulatory decision-making process and has worked to enhance meaningful engagement. In recent years, there has been an increased scientific demand for more systematic and quantitative approaches to incorporate patient input throughout the medical product lifecycle, including to inform regulatory benefit-risk assessments. The use of patient preference information (PPI), elicited using established scientific methods, is a promising strategy for accomplishing this. Although much of the science behind PPI is not new, its application in a regulatory setting will require adapting and advancing the science of identifying, collecting, and evaluating patient input for informing regulatory decision making. Patient input and empowerment are foundational to a learning healthcare system. A learning healthcare system paradigm can also help us better understand and continuously improve the incorporation of the patient perspective in regulatory decision making. In this article, we highlight the Food and Drug Administration's Center for Biologics Evaluation and Research experience and current initiatives on advancing the science of patient input in a regulatory setting, in particular, PPI. We provide a use case that explores how the principles and benefits of PPI applied in shared clinical decision making can be realized and leveraged to enhance regulatory evaluation of innovative therapies. To further advance the application of the science of patient input in our regulatory framework, we compiled a list of example resources that support stakeholders in designing and conducting PPI studies. More collaborative research among stakeholders is needed to establish best practice approaches, ensure scientific validity, and continuously learn and improve the systematic incorporation of scientific patient input throughout the regulatory decision-making process.
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Affiliation(s)
- Million A. Tegenge
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
| | - Megan M. Moncur
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
| | - Robert Sokolic
- Office of Tissues and Advanced TherapiesCBER, US Food and Drug AdministrationSilver SpringMaryland
| | - Richard A. Forshee
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
| | - Telba Irony
- Office of Biostatistics and EpidemiologyCenter for Biologics Evaluation and Research (CBER)US Food and Drug AdministrationSilver SpringMaryland
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Costa MJ, He W, Jemiai Y, Zhao Y, Di Casoli C. The Case for a Bayesian Approach to Benefit-Risk Assessment:: Overview and Future Directions. Ther Innov Regul Sci 2017; 51:568-574. [PMID: 30231681 DOI: 10.1177/2168479017698190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The benefit-risk assessment of a new medicinal product or intervention is one of the most complex tasks that sponsors, regulators, payers, physicians, and patients face. Therefore, communicating the trade-off of benefits and risks in a clear and transparent manner, using all available evidence, is critical to ensure that the best decisions are made. Several quantitative methods have been proposed in recent years that try to provide insight into this challenging problem. Bayesian inference, with its coherent approach for integrating different sources of information and uncertainty, along with its links to optimal decision theory, provides a natural framework to perform quantitative assessments of the benefit-risk trade-off. This paper describes the current state of the art in Bayesian methodologies for quantitative benefit-risk assessment, and how these may be leveraged throughout the life cycle of a medicinal product to support and augment clinical judgment and qualitative benefit-risk assessments. Gaps and potential new directions that extend the current approaches are also identified.
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Affiliation(s)
- Maria J Costa
- 1 Clinical Statistics, GlaxoSmithKline, Stevenage, United Kingdom
| | - Weili He
- 2 Clinical Biostatistics, Merck & Co Inc, Kenilworth, NJ, USA
| | | | - Yueqin Zhao
- 4 Division of Biometrics VII, Office of Biostatistics, OTS, CDER, FDA, Silver Spring, MD, USA
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9
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Structured Frameworks to Increase the Transparency of the Assessment of Benefits and Risks of Medicines: Current Status and Possible Future Directions. Clin Pharmacol Ther 2015; 98:522-33. [DOI: 10.1002/cpt.203] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/01/2015] [Indexed: 11/07/2022]
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10
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Spielberg SP. 2015 and Beyond. Ther Innov Regul Sci 2015; 49:8. [DOI: 10.1177/2168479014563272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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