Applying the EU Regulatory Framework to Determine the Benefit-Risk Profile of Psychedelics

Marketing authorization applications for psychedelics must align with the regulatory requirements and evidentiary standards required for the approval of all medicinal products in the European Union. While medicine regulators recognize the therapeutic potential of psychedelics, their characteristics present methodological challenges that complicate the design and interpretation of pivotal trials intended to assess their benefit-risk profile. This Viewpoint presents the European Medicines Agency's perspective on the main knowledge gaps that must be addressed to ensure robust evidence generation for regulatory decision-making, as discussed at a multistakeholder workshop convened by the Agency in April 2024. Central among these are issues related to functional unblinding and expectancy and nocebo effects. Furthermore, characteristics of the trial population must be rigorously aligned with those defined in the therapeutic indication to ensure findings are relevant and generalizable. Development programmes should also support the characterization of the dose-response relationship, both in terms of pharmacological effects and the association between the subjective experience and therapeutic response. Moreover, the decision to incorporate either psychological support or psychotherapy in the therapeutic framework has methodological implications for the trial's design and protocol, as well as the conditions for use, all of which require careful consideration. Additionally, characterization of the safety profile of psychedelics necessitates a multifaceted approach, including adequately powered clinical trials, the use of appropriate controls, the development of robust risk mitigation strategies, the establishment of continuous safety monitoring protocols, and the systematic consideration of ethical implications.