| Autor: |
Katerina Shulman, Ilana Weiss, Matitiahu Berkovitch, Shai Ashkenazi, Moshe E Gatt, Osnat Luxenburg, Stephany Hiayev, Einat Shacham-Shmueli, Michal Hirsch Vexberg, Rami Hershkowitz, Einat Gorelik, Haim Mayan, Yehudit Steinmetz, Noa Berar Yanai, Orly Schlissel, Muhammad Azem, Neriya Gutgold, Milly Divinsky, Nirit Yarom, Alla Vishkautzan, Chezi Ganzel, Lidia Arcavi, Eli Marom, Biatrice Uziely, Shoshana Zevin, Hadar Meirow, Denize Ainbinder |
| Jazyk: |
angličtina |
| Rok vydání: |
2023 |
| Předmět: |
|
| Zdroj: |
BMJ Open, Vol 13, Iss 5 (2023) |
| Druh dokumentu: |
article |
| ISSN: |
2044-6055 |
| DOI: |
10.1136/bmjopen-2022-067313 |
| Popis: |
Objectives US FDA and EMA allow facilitated regulatory pathways to expedite access to new treatments. Limited supportive data may result in major postapproval variations. In Israel, partly relying on Food and Drug Administration (FDA) and European Medicines Agency (EMA), clinical data are reviewed independently by the Advisory Committee of Drug Registration (ACDR). In this study, the correlation between the number of discussions at the ACDR and major postapproval variations is examined.Design This is an observational retrospective comparative cohort study.Setting Applications with FDA and/or EMA approval at time of assessment in Israel were included. The timeframe was chosen to allow a minimum of 3 years of postmarketing approval experience for potential major label variations. Data regarding the number of discussions at ACDR were extracted from protocols. Data on postapproval major variations were extracted from the FDA and EMA websites.Results Between 2014 and 2016, 226 (176 drugs) applications, met the study criteria. 198 (87.6%) and 28 (12.4%) were approved following single and multiple discussions, respectively. A major postapproval variation was recorded in 129 (65.2%) compared with 23 (82.1%) applications approved following single and multiple discussions, respectively (p=0.002). Increased risk for major variation was found for medicines approved following multiple discussions (HR=1.98, 95% CI: 1.26 to 3.09) with a median time of 1.2 years, applications approved based on phase II trials (HR=2.58, 95% CI: 1.72 to 3.87), surrogate endpoints (HR=1.99, 95% CI: 1.44 to 2.74) and oncologic indications (HR=2.48, 95% CI: 1.78 to 3.45).Conclusions Multiple ACDR discussions associated with limited supportive data are predictive for major postapproval variations. Moreover, our findings demonstrate that approval by the FDA and/or EMA does not pave the way to automatic approval in Israel. In a substantial per cent of the cases, submission of the same clinical data resulted in different safety and efficacy considerations, requiring additional supporting data in some cases or even rejection of the application in others. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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