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Cronin TK, Ronayne C, O'Donovan N, McGuinness E, Cooke K, Dennehy M, Dennehy C, Power DG, Cahill MR, Collins DC, Connolly RM, Bambury RM, Mykytiv V, Higgins MJ, Noonan SA, O'Reilly S. The impact of expanded access programs for systemic anticancer therapy in an Irish cancer centre. Ir J Med Sci 2024:10.1007/s11845-024-03701-w. [PMID: 38806877 DOI: 10.1007/s11845-024-03701-w] [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: 06/07/2023] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Expanded access programs (EAPs) allow cancer patients with unmet clinical need to obtain access to pre-authorisation treatments. There is no standardised process for implementing these programs nationally, and real-world data on their impact is lacking. AIMS This study aimed to evaluate the prevalence of such EAPs and their impact in a cancer centre. METHODS Data relating to adult cancer patients treated via EAPs from 2011 to 2021 in three Cork university hospitals was collated. Descriptive statistics were employed to get an overview of the impact these programs currently have on cancer care provision. RESULTS We identified 193 patients who accessed EAPs during the study period, availing of 33 separate drugs for a total of 50 different cancer indications. The prevalence of EAP usage was shown to have been trending upwards in recent years with a total of 189 programs being accessed throughout the period. Drugs provided were from a number of different anti-cancer drug classes, particularly targeted therapies (n = 18) and immune checkpoint inhibitors (n = 17). Cancers from a wide range of both solid and liquid tumour types were treated with EAP drugs, and patients treated were from across a broad spectrum of ages (26-82, SD 11.99). CONCLUSIONS EAPs have an increasing role in accessing novel cancer therapies in our community and by extension nationally. Equity of EAP access would be facilitated by a national registry of available agents which we have established. Assessment of their benefits and toxicities would be enhanced by the requirement for a real-world database as a condition of EAP approval.
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Affiliation(s)
- Timothy K Cronin
- School of Medicine and Health, University College Cork, Cork, Ireland.
| | | | - Niamh O'Donovan
- South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Eimear McGuinness
- South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Katie Cooke
- South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Maeve Dennehy
- Mercy University Hospital, Grenville Place, Cork, Ireland
| | | | - Derek G Power
- Cork University Hospital, Wilton, Cork, Ireland
- Mercy University Hospital, Grenville Place, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Mary R Cahill
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Dearbhaile C Collins
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Roisin M Connolly
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Richard M Bambury
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Vitaliy Mykytiv
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | | | - Sinéad A Noonan
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Seamus O'Reilly
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
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2
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Vermeulen SF, Polak TB, Bunnik EM. Expanded access to investigational drugs in psychiatry: A systematic review. Psychiatry Res 2023; 329:115554. [PMID: 37890403 DOI: 10.1016/j.psychres.2023.115554] [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] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Some psychiatric patients have exhausted all approved treatment options. Numerous investigational drugs are currently being developed and tested in clinical trials. However, not all patients can participate in clinical trials. Expanded access programs may provide an opportunity for patients who cannot participate in clinical trials to use investigational drugs as a therapeutic option outside of clinical trials. It is unknown to what extent expanded access occurs in psychiatry. We conducted a systematic literature search on PubMed, Embase, and PscyInfo, with additional information from ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and FDA/EMA approvals, in order to find all expanded access programs ever conducted, globally, in the field of psychiatry. This resulted in a total of fourteen expanded access programs ever conducted in psychiatry. Given the prevalence of psychiatric disorders, the activity in clinical research in psychiatry, the regulatory framework enabling expanded access, and the impact of psychiatric disorders on patients, their families, and society, we had expected a higher utilization of expanded access. We propose that the psychiatric community, with pharmaceutical industry, should consider establishing and optimizing expanded access programs.
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Affiliation(s)
- Stefan F Vermeulen
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, the Netherlands; GGz Breburg, Tilburg, the Netherlands.
| | - Tobias B Polak
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands; Real-World Data Department, myTomorrows, Amsterdam, the Netherlands
| | - Eline M Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, the Netherlands
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3
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Polak TB, Cucchi DGJ, Schelhaas J, Ahmed SS, Khoshnaw N, van Rosmalen J, Uyl-de Groot CA. Results from Expanded Access Programs: A Review of Academic Literature. Drugs 2023:10.1007/s40265-023-01879-4. [PMID: 37199856 DOI: 10.1007/s40265-023-01879-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Although expanded access is an increasingly used pathway for patients to access investigational medicine, little is known on the magnitude and content of published scientific research collected via expanded access. METHODS We performed a review of all peer-reviewed expanded access publications between January 1, 2000 and January 1, 2022. We analyzed the publications for drugs, diseases, disease area, patient numbers, time, geographical location, subject, and research methodology (single center/multicenter, international/national, prospective/retrospective). We additionally analyzed endpoints reported in all COVID-19-related expanded access publications. RESULTS We screened 3810 articles and included 1231, describing 523 drugs for 354 diseases for 507,481 patients. The number of publications significantly increased over time ([Formula: see text]). Large geographical disparities existed as Europe and the Americas accounted for 87.4% of all publications, whereas Africa only accounted for 0.6%. Oncology and hematology accounted for 53% of all publications. Twenty-nine percent of all expanded access patients (N = 197,187) reported on in 2020 and 2021 were treated in the context of COVID-19. CONCLUSIONS By summarizing characteristics of patients, diseases, and research methods described in all scientific literature published on expanded access, we provide a unique dataset for future research. We show that published scientific research on expanded access has surged over the past decades, partly due to COVID-19. However, international collaboration and equity in geographic access remain an issue of concern. Lastly, we stress the need for harmonization of research legislation and guidance on the value of expanded access data within real-world data frameworks to improve equity in patient access and streamline future expanded access research.
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Affiliation(s)
- Tobias B Polak
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands.
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - David G J Cucchi
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Jasmin Schelhaas
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Syed S Ahmed
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Naima Khoshnaw
- Real-World Data Department, myTomorrows, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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4
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Sarp S, Reichenbach R, Aliu P. An approach to data collection in compassionate use/managed access. Front Pharmacol 2022; 13:1095860. [PMID: 36605403 PMCID: PMC9810195 DOI: 10.3389/fphar.2022.1095860] [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: 11/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Compassionate Use (CU)/Managed Access programs provide access to locally unapproved medicines. As these programs become more global and involve a broader range of products, determining whether patients derive benefit from treatment could provide insights into therapeutic use in a real-word setting with diverse pools of patients. CU primary purpose is to provide treatment and it is not targeting research. However, it is increasingly considered as a source of real-world data. In the absence of a harmonized framework on CU data collection, Novartis developed a company-wide guidance to collect baseline patient data and prospective follow-up information at product resupply. Although this approach has recently been implemented and utilization of this data has been mainly internal to the company so far, the prospective collection of key efficacy parameters in patients receiving therapies via CU could potentially be used as a supportive set of information collected in a real-world setting to be submitted in addition to clinical trial data, if not as a main source of data for regulatory submission.
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5
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Polak TB, Cucchi DGJ, van Rosmalen J, Uyl-de Groot CA, Darrow JJ. Generating Evidence from Expanded Access Use of Rare Disease Medicines: Challenges and Recommendations. Front Pharmacol 2022; 13:913567. [PMID: 35677436 PMCID: PMC9168458 DOI: 10.3389/fphar.2022.913567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/05/2022] [Indexed: 12/05/2022] Open
Abstract
Patients with rare diseases often have limited or no options for approved treatments or participation in clinical trials. In such cases, expanded access (or “compassionate use”) provides a potential means of accessing unapproved investigational medicines. It is also possible to capture and analyze clinical data from such use, but doing so is controversial. In this perspective, we offer examples of evidence derived from expanded access programs for rare diseases to illustrate its potential value to the decision-making of regulators and payers in the European Union and the United States. We discuss ethical and regulatory aspects to the use of expanded access data, with a focus on rare disease medicines. The heterogeneous approach to expanded access among countries within the European Union leaves uncertainties to what extent data can be collected and analyzed. We recommend the issuance of new guidance on data collection during expanded access, harmonization of European pathways, and an update of existing European compassionate use guidance. We hereby aim to clarify the supportive role of expanded access in evidence generation. Harmonization across Europe of expanded access regulations could reduce manufacturer burdens, improve patient access, and yield better data. These changes would better balance the need to generate quality evidence with the desire for pre-approval access to investigational medicine.
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Affiliation(s)
- Tobias B Polak
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Biostatistics, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus University Rotterdam, Rotterdam, Netherlands.,Real-World Data Department, myTomorrows, Amsterdam, Netherlands
| | - David G J Cucchi
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Hematology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jonathan J Darrow
- Department of Law and Taxation, Bentley University, Waltham, MA, United States.,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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6
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Polak TB, Cucchi DGJ, van Rosmalen J, Uyl-de Groot CA. Real-world data from expanded access programmes in health technology assessments: a review of NICE technology appraisals. BMJ Open 2022; 12:e052186. [PMID: 34992108 PMCID: PMC8739059 DOI: 10.1136/bmjopen-2021-052186] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To quantify and characterise the usage of expanded access (EA) data in National Institute for Health and Care Excellence (NICE) technology appraisals (TAs). EA offers patients who are ineligible for clinical trials or registered treatment options, access to investigational therapies. Although EA programmes are increasingly used to collect real-world data, it is unknown if and how these date are used in NICE health technology assessments. DESIGN Cross-sectional study of NICE appraisals (2010-2020). We automatically downloaded and screened all available appraisal documentation on NICE website (over 8500 documents), searching for EA-related terms. Two reviewers independently labelled the EA usage by disease area, and whether it was used to inform safety, efficacy and/or resource use. We qualitatively describe the five appraisals with the most occurrences of EA-related terms. PRIMARY OUTCOME MEASURE Number of TAs that used EA data to inform safety, efficacy and/or resource use analyses. RESULTS In 54.2% (206/380 appraisals), at least one reference to EA was made. 21.1% (80/380) of the TAs used EA data to inform safety (n=43), efficacy (n=47) and/or resource use (n=52). The number of TAs that use EA data remained stable over time, and the extent of EA data utilisation varied by disease area (p=0.001). CONCLUSION NICE uses EA data in over one in five appraisals. In synthesis with evidence from well-controlled trials, data collected from EA programmes may meaningfully inform cost-effectiveness modelling.
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Affiliation(s)
- Tobias B Polak
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- RWD Department, myTomorrows, Amsterdam, The Netherlands
| | - David GJ Cucchi
- Department of Haematology, Amsterdam UMC, Location VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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7
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Borysowski J, Lewis ACF, Górski A. Conflicts of interest in oncology expanded access studies. Int J Cancer 2021; 149:1809-1816. [PMID: 34233015 DOI: 10.1002/ijc.33733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022]
Abstract
Expanded access is a treatment use of investigational drugs, biologicals or medical devices outside of clinical trials. The purpose of our study was to assess self-reported conflicts of interest (COIs) in oncology expanded access studies. One hundred fifty-eight oncology expanded access studies published from 2013 through 2020 were included. The pharmaceutical industry funded either completely or in part 94 studies (59.49%). The authors disclosed mostly financial COIs, while the number of the reported nonfinancial conflicts was relatively small (3528 and 57 COIs, respectively). The number of articles in which at least one author had a financial COI was 118 (74.68%). The most common financial COI types included advisory board membership/consulting (1471 COIs; 41.7%), followed by honoraria (570 COIs; 16.16%) and research funding (441 COIs; 12.5%). Logistic regression was performed to identify predictors of disclosing financial COIs and positive study's conclusions. On univariate analysis, financial COIs were more likely to occur in studies with at least one center located in the United States (odds ratio [OR], 5.62; 95% confidence interval [CI], 1.57-35.98; P = .02). We also found that positive conclusions about the studied treatments were less likely in studies without industry funding (OR, 0.26; CI, 0.08-0.77; P = .01). Most of the research on COIs in oncology performed to date focused on other types of studies, especially clinical trials. To our knowledge, our study is the first to evaluate COIs in oncology expanded access studies.
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Affiliation(s)
- Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland.,Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Warsaw, Poland
| | - Anna C F Lewis
- Edmond J. Safra Center for Ethics, Cambridge, Massachusetts, USA.,Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrzej Górski
- Laboratory of Bacteriophages, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
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8
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Bunnik EM, Aarts N. The Role of Physicians in Expanded Access to Investigational Drugs: A Mixed-Methods Study of Physicians' Views and Experiences in The Netherlands. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:319-334. [PMID: 33590374 PMCID: PMC8324586 DOI: 10.1007/s11673-021-10090-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/20/2021] [Indexed: 05/05/2023]
Abstract
Treating physicians have key roles to play in expanded access to investigational drugs, by identifying investigational treatment options, assessing the balance of risks and potential benefits, informing their patients, and applying to the regulatory authorities. This study is the first to explore physicians' experiences and moral views, with the aim of understanding the conditions under which doctors decide to pursue expanded access for their patients and the obstacles and facilitators they encounter in the Netherlands. In this mixed-methods study, semi-structured interviews (n = 14) and a questionnaire (n = 90) were conducted with medical specialists across the country and analysed thematically. Typically, our respondents pursue expanded access in "back against the wall" situations and broadly support its classic requirements. They indicate practical hurdles related to reimbursement, the amount of time and effort required for the application, and unfamiliarity with the regulatory process. Some physicians are morally opposed to expanded access, with an appeal to safety risks, lack of evidence, and "false hope." Some of these moral concerns and practical obstacles may be essential targets for change, if expanded access to unapproved drugs is to become available for wider groups of patients for whom standard treatment options are not-or no longer-available, on a more consistent and equal basis.
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Affiliation(s)
- Eline M Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, The Netherlands.
| | - Nikkie Aarts
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, The Netherlands
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9
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Chapman CR, Belli HM, Leach D, Shah LD, Bateman-House A. A survey of pediatric hematologists/oncologists’ perspectives on single patient Expanded Access and Right to Try. MEDICINE ACCESS @ POINT OF CARE 2021; 5:23992026211005991. [PMID: 36204503 PMCID: PMC9413614 DOI: 10.1177/23992026211005991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Physicians in the United States play an essential role guiding patients
through single patient pre-approval access (PAA) to investigational medical
products via either the Food and Drug Administration (FDA)’s Expanded Access
(EA) or the federal Right To Try (RTT) pathways. In this study, we sought to
better understand pediatric hematologist/oncologists’ attitudes about
seeking PAA, on behalf of single patients, to investigational drugs outside
of clinical trials. Methods: A cross-sectional survey was developed and sent to pediatric
hematologist/oncologists via St. Baldrick’s Foundation’s email distribution
list. Results: Of 73 respondents (10.1% of those who received the survey), 56 met
eligibility criteria and are included in the analysis. Over 80%
(n = 46) had prior experience with single patient PAA.
Respondents were most concerned about the unknown risks and benefits of
investigational drugs and financial implications of PAA for patients. One
hundred percent and 91.1% of respondents indicated a willingness to support
patients through EA and RTT pathways, respectively. When asked about their
most recent experience with PAA, 40 out of 46 indicated that they used the
FDA’s EA pathway to seek PAA and 4 out of 46 indicated that they used the
RTT pathway. Of 44 respondents who had used the EA or RTT pathway, 43
indicated that the biotechnology or pharmaceutical company they solicited
granted access to the requested product. Conclusion: Survey results support other findings suggesting a need for additional
physician support and education about PAA and that physicians may have
unequal access to information about investigational drugs and concerns about
financial implications of PAA for their patients.
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Affiliation(s)
- Carolyn Riley Chapman
- Department of Population Health, Division of Medical Ethics, New York University Grossman School of Medicine, New York, NY, USA
| | - Hayley M Belli
- Department of Population Health, Division of Biostatistics, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle Leach
- St. Baldrick’s Foundation, Monrovia, CA, USA
- National Brain Tumor Society, Newton, MA, USA
| | - Lesha D Shah
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison Bateman-House
- Department of Population Health, Division of Medical Ethics, New York University Grossman School of Medicine, New York, NY, USA
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10
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Goyal PK, Mathur R, Medhi B. Understanding the challenges and ethical aspects of compassionate use of drugs in emergency situations. Indian J Pharmacol 2020; 52:163-171. [PMID: 32873998 PMCID: PMC7446672 DOI: 10.4103/ijp.ijp_665_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
| | - Roli Mathur
- ICMR Bioethics Unit, ICMR-National Centre for Disease Informatics and Research, Bengaluru, Karnataka, India
| | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, India
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11
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Polak TB, van Rosmalen J, Uyl-de Groot CA. Expanded Access as a source of real-world data: An overview of FDA and EMA approvals. Br J Clin Pharmacol 2020; 86:1819-1826. [PMID: 32200551 PMCID: PMC7444779 DOI: 10.1111/bcp.14284] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/19/2019] [Accepted: 03/06/2020] [Indexed: 12/24/2022] Open
Abstract
Aims To identify, characterize and compare all Food and Drug Administration (FDA) and European Medicines Agency (EMA) approvals that included real‐world data on efficacy from expanded access (EA) programmes. Methods Cross‐sectional study of FDA (1955–2018) and EMA (1995–2018) regulatory approval documentation. We automated searching for terms related to EA in 22,506 documents using machine learning techniques. We included all approvals where EA terms appeared in the regulatory documentation. Our main outcome was the inclusion of EA data as evidence of clinical efficacy. Characterization was based on approval date, disease area, orphan designation and whether the evidence was supportive or pivotal. Results EA terms appeared in 693 out of 22,506 (3.1%) documents, which referenced 187 approvals. For 39 approvals, data from EA programmes were used to inform on clinical efficacy. The yearly number of approvals with EA data increased from 1.25 for 1993–2013 to 4.6 from 2014–2018. In 13 cases, these programmes formed the main evidence for approval. Of these, patients in EA programmes formed over half (median 71%, interquartile range: 34–100) of the total patient population available for efficacy evaluation. Almost all (12/13) approvals were granted orphan designation. In 8/13, there were differences between regulators in approval status and valuation of evidence. Strikingly, 4 treatments were granted approval based solely on efficacy from EA. Conclusion Sponsors and regulators increasingly include real‐world data from EA programmes in the efficacy profile of a treatment. The indications of the approved treatments are characterized by orphan designation and high unmet medical need.
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Affiliation(s)
- Tobias B Polak
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,RWD Department, myTomorrows, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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12
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Wilking N, Bucsics A, Kandolf Sekulovic L, Kobelt G, Laslop A, Makaroff L, Roediger A, Zielinski C. Achieving equal and timely access to innovative anticancer drugs in the European Union (EU): summary of a multidisciplinary CECOG-driven roundtable discussion with a focus on Eastern and South-Eastern EU countries. ESMO Open 2019; 4:e000550. [PMID: 31798977 PMCID: PMC6863652 DOI: 10.1136/esmoopen-2019-000550] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022] Open
Abstract
The Central European Cooperative Oncology Group (CECOG) and ‘ESMO Open—Cancer Horizons’ roundtable discussion brought together stakeholders from several European Union (EU) countries involved in drug development, drug authorisation and reimbursement or otherwise affected by delayed and unequal access to innovative anticancer drugs. The approval process of drugs is well established and access delays can be caused directly or indirectly by national or regional decision-making processes on reimbursement. The two key aspects for those involved in reimbursement decisions are first the level of evidence required to decide and second pricing, which can be challenging for some innovative oncology compounds, especially in Eastern and South-Eastern European countries. Other important factors include: available healthcare budget; the structure and sophistication of healthcare authorities and health technology assessment processes; societal context and political will. From the point of view of the pharmaceutical industry, better alignment between stakeholders in the process and adaptive pathway initiatives is desirable. Key aspects for patients are improved access to clinical trials, preapproval availability and reports on real-world evidence. Restricted access limits oncologists’ daily work in Eastern and South-Eastern EU countries. The roundtable discussion suggested considering the sequencing of regulatory approval and reimbursement decisions together with more flexible contracting as a possible way forward. The panel concluded that early and regular dialogue between all stakeholders including regulators, payers, patient stakeholders and industry is required to improve the situation.
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Affiliation(s)
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products, Vienna, Austria
| | | | | | - Andrea Laslop
- Scientific Office, Austrian Federal Office for Safety in Health Care, Vienna, Austria
| | - Lydia Makaroff
- Fight Bladder Cancer, Chinnor, United Kingdom and World Bladder Cancer Patient Coalition, Brussels, Belgium
| | - Alexander Roediger
- EFPIA Oncology Platform, Brussels, Belgium and Oncology Policy Europe, Middle East, Africa and Canada, MSD, Kriens, Switzerland
| | - Christoph Zielinski
- Central European Cooperative Oncology Group (CECOG) and Vienna Cancer Center, Vienna Hospital Association, Vienna, Austria
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Pace J, Ghinea N, Kerridge I, Lipworth W. An ethical framework for the creation, governance and evaluation of accelerated access programs. Health Policy 2018; 122:984-990. [DOI: 10.1016/j.healthpol.2018.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/07/2018] [Accepted: 07/14/2018] [Indexed: 12/23/2022]
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