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Drug regulation encompasses the management of drug usage by evaluating its safety and efficacy through assessments conducted by regulatory authorities. Regrettably, the history of drug regulation is marred by several catastrophic events. One such incident is the Elixir Sulfanilamide tragedy, in which the toxic compound diethyl glycol was included in a sweet-tasting medication, leading to numerous fatalities. This event prompted the enactment of the Food, Drug, and Cosmetic Act in 1938. Under...
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Clinical development focuses on how the drug will interact with the human body and encompasses four key phases of clinical trials, each serving a specific purpose in assessing the safety and effectiveness of new drugs. These phases overlap and build upon one another. Phase I involves a small group of healthy volunteers (typically 20-80 individuals) or, in cases where significant toxicity is expected, patients with the targeted disease, such as cancer or AIDS. The volunteers are tested for...
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Preclinical development consists of a series of tests that ensure the safety and efficacy of a new therapeutic compound before it is tested in humans. There are four main phases to this process. First, safety pharmacology tests are conducted to ensure the drug does not produce any acutely harmful effects. These tests examine parameters such as bronchoconstriction, cardiac dysrhythmias, blood pressure changes, and ataxia. Next, preliminary toxicological testing is performed to determine the...
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Drug Control Governance: Regulatory Bodies and Their Impact01:03

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Drug control governance involves the oversight and regulation of pharmaceuticals to ensure their safety and efficacy while preventing illegal drug use and trafficking. Regulatory bodies, including the US Food and Drug Administration (FDA) and the European Union's European Medicines Agency (EMA), play a central role in this process. These agencies evaluate the safety and efficacy of drugs before they can be marketed. They fund clinical trials and assess the benefits and risks associated with...
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Pharmacovigilance01:19

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Post-marketing surveillance is a critical component of pharmaceutical regulation, often uncovering unanticipated adverse drug reactions (ADRs) once a drug is widely used over an extended period.
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
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Drug Administration and Therapy Phases: Overview01:26

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Drugs, the chemical agents used in diagnosing, treating, or preventing diseases, undergo a four-phase process of development: pharmaceutic, pharmacokinetics, pharmacodynamics, and therapeutic.
The pharmaceutical phase focuses on leveraging the physicochemical properties of the drug to design and manufacture an effective product. Variants include orally administered tablets or capsules, topical creams or ointments, and parenteral-delivery solutions or emulsions.
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HTA Barriers for Conditional Approval Drugs.

Mackenzie Mills1

  • 1Medical Technology Research Group, Department of Health Policy and LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. M.J.Mills@lse.ac.uk.

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Summary

Conditional approval pathways for drugs may lead to increased health technology assessment (HTA) rejection and delays. These conditionally approved drugs face greater scrutiny and barriers during the HTA process.

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Area of Science:

  • Pharmacoeconomics
  • Health Technology Assessment
  • Drug Approval Processes

Background:

  • Conditional approval pathways expedite marketing authorization for drugs addressing unmet needs in severe conditions.
  • This process relies on preliminary clinical evidence, introducing higher clinical uncertainty.
  • This uncertainty poses challenges for health technology assessment (HTA) evaluations.

Approach:

  • A mixed-methods approach was employed, including a meta-analysis of HTA outcomes.
  • The study analyzed 80 drug-indication pairs across France, England, Scotland, and Canada.
  • Logistic regressions and survival analysis assessed HTA outcomes and approval delays.

Key Points:

  • Conditionally approved drugs often lack phase III trials, clinical endpoints, and active comparators.
  • HTA agencies raise more clinical and economic evidence uncertainties for these drugs.
  • Conditionally approved drugs have a marginally lower probability of HTA approval.

Conclusions:

  • Conditionally approved drugs face significant barriers within the health technology assessment (HTA) process.
  • These drugs experience moderate delays, averaging six months, in HTA approval.
  • The findings suggest a need to re-evaluate conditional approval pathways and HTA integration.