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April 18, 2013

European Clinical Trials Report Issued by European Medicines Agency

EMA Logo.jpgThe European Medicines Agency ("EMA") has released their report giving detailed information regarding numbers of patients, sites and inspections with respect to pivotal clinical trials submitted in marketing authorization applications ("MAA") between January 2005 and December 2011.

As we noted in a previous blog there has been an increase in concern amongst regulators and the public about how well clinical trials are conducted from an ethical and scientific/organizational standpoint, and especially with regard to good clinical practice ("GCP") compliance. An applicant has to provide information in every MAA regarding the location, conduct and ethical standards applied in respect of the clinical trials conducted in third countries.

The report relates mainly to new applications (485), line extensions (95), and variations where new clinical trial information was provided (97). Generic applications are included as part of the new applications, but they generally do not add much to the number of patients, because these applications are mainly based on small bioequivalence trials, but they do provide information on the locations where these trials were conducted.

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April 10, 2013

Orphan Drug Prices Challenged in Europe - Will the U.S. Follow?

eurosdollars.jpgOn April 7, Simeon Bennett from Bloomberg reported that individual members of the European Union are attempting to control the cost of medical care by containing the reimbursement of drugs intended for smaller patient populations, generally called orphan drugs. In Europe, orphan drugs are defined as a medicine to treat no more than 5 in 10,000 inhabitants. Many of these drugs undergo a centralized approval process via the European Medicines Agency (see related blog resource page here.) In practice, however, these drugs may only reach the market when each member state decides that its national health system will reimburse for the drug. For example, 35 orphan drugs reached the market in Belgium, 44 in the Netherlands, and 28 in Sweden in 2008. 35 such drugs reached the market in France and 23 in Italy in 2007.

According to Yann Le Cam, CEO of Eurodis, a French patient advocacy group for patients with rare diseases, "The price of orphan medicinal products is under much more debate. We have seen countries which were providing good access to orphan medicinal products now questioning the continuation of reimbursement."

Some examples provided in the Bloomberg report included the Netherlands demanding price reductions for certain therapies such as Sanofi's Myozyme® (alglucosidase alfa), an enzyme replacement therapy for patients with Pompe disease, which costs 700,000 euros ($909,000). As we previously reported from MassBio's Annual Meeting, Myozyme® was the largest research and development effort in the history of Genzyme, which was later acquired by Sanofi, and the result of a concerned father of two children with Pompe's disease pushing the promising therapy along to help it reach the public. Another example mentioned in the report included Ireland recommending against the government paying for Vertex Pharmaceuticals, Inc.'s Kalydeco® (ivacaftor) for cystic fibrosis until the company significantly reduced the price for the drug product. Yet another example was the rejection by the United Kingdom ("UK") to expand use of Alexion Pharmaceuticals, Inc.'s drug Soliris® (eculizumab) for two blood disorders, despite the recommendation for this use by an advisory panel. Instead, the government referred the matter to its National Institute for Health and Care Excellence, which we recently blogged on here, as an instrument to encourage value-based medicine in the UK.

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April 5, 2013

Clinical Trials Transparency

clinical trials.jpg
For some time now, there have been strident calls for the publishing of all clinical trial data. The pressure has arisen due to revelations that companies may have hidden crucial clinical data that might have shown that the drug being tested was not as efficacious or even as safe as they appeared from quoted trial results (see, for instance, a previous blog here). The campaign group AllTrials has brought together several people and groups (including for example David Tovey, editor The Cochrane Library; Ben Goldacre (book Bad Pharma); Carl Heneghan, Centre for Evidence-Based Medicine, University of Oxford) because, as they put it:

Around half of all clinical trials have not been published; some trials have not even been registered. If action is not taken urgently, information on what was done and what was found in trials could be lost forever, leading to bad treatment decisions, missed opportunities for good medicine, and trials being repeated unnecessarily.

Key publications like the British Medical Journal and research bodies such as the Medical Research Council and the Wellcome Trust agree, the trust encouraging its grant recipients to release their trial data.

The European Medicines Agency ("EMA") has been looking at this for some time, with the same aim in mind and is trying to develop a workable policy to enable the data to be published. Indeed it is thought that in the next few weeks, major players in the United Kingdom's medical community will meet to try and take things further in a more practical manner.

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April 3, 2013

UK's NICE To Have the Crucial Role in the Value-Based Pricing of Medicines from 2014

Bristish Notes.pngThe United Kingdom's ("UK's") method of controlling the prices its Department of Health pays for innovative medicines has been, up until now, the Pharmaceutical Price Regulation Scheme ("PPRS"). The PPRS has been a voluntary scheme run over many years between the Department of Health and the branded pharmaceutical industry represented by the Association of the British Pharmaceutical Industry ("ABPI"). Its objective was to deliver the provision of safe and effective medicines at reasonable prices to the National Health Service ("NHS") while promoting innovation, the rapid uptake of new clinically and cost effective medicines, and in a sustainable manner.

Over recent years, the National Institute for Health and Care Excellence ("NICE") has been taking on a more visible and key role. Its job has been to improve outcomes for people using the NHS by producing evidence-based guidance by way of advice to healthcare professionals and to develop quality standards and measures for those providing health care services and also providing information to practitioners and managers in both health and social care.

The UK Government's response to the Health Select Committee report of 2012-2013 on NICE was to re-establish NICE as a new statutory body giving it a key position in the healthcare system. It gives NICE the role of deciding the value-based pricing of medicines. Thus, value-based pricing will replace the current PPRS, when it expires in January 2014.

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December 14, 2012

European Unified Patent Approach Approved

Thumbnail image for Thumbnail image for Thumbnail image for european commission.jpegThis Tuesday, the European Parliament approved European Union ("EU") regulations creating a European patent with unitary effect ("unitary patent") and setting forth related language translation requirements. The unitary patent, granted by the European Patent Office ("EPO"), will be offered in addition to already-existing national patents. It will be effective across the EU (except Spain and Italy) and enforceable with a single court ruling.

If ratified by at least thirteen states including France, Germany, and the United Kingdom, a Unified Patent Court ("UPC") will exercise exclusive jurisdiction over unitary patents. The UPC Agreement will come to vote in February of next year. (Notably, the Court of Justice of the EU ruled last March that a proposed unified patents court would not be compatible with EU treaties.) The unitary patent is set to take effect beginning in 2014 or when the UPC is ratified, whichever is earlier.

European Commissioner Michel Barnier declared the "long-awaited agreement" a "decisive contribution to the implementation of the economic and growth agenda." Barnier let the numbers speak for themselves: "In the United States, in 2011, 224 000 patents were granted, in China 172 000 while here in Europe only 62 000 European patents were delivered. One of the reasons for this difference is without a doubt the prohibitive cost and the complexity of obtaining patent protection throughout the single market."

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October 29, 2012

Online Pharmacies: Europe Takes Steps to Make Safer

onlinepharmacy.jpgPurchasing of pharmaceuticals through on-line pharmacies is on the rise and gives rise to many potential problems. Crucially the most important issue is whether the medicinal product is genuine, contains the correct ingredients, and is an approved product in the relevant regulatory jurisdiction. Medicines supplied via on-line links can come from anywhere in the world, and this method of distribution is more open to fraudulent activity.

In Europe, the European Parliament passed Directive 2011/62/EU, which relates to medicinal products for human use, and is in regard to the prevention of the entry into the legal supply chain of falsified medicinal products. The European Commission ("EC") has put some thought into how on-line pharmaceutical purchases can be made safe and to comply with the Directive. To that end, they have released a Concept Paper for public consultation on the introduction of a "common logo" for websites of legally-operating
on-line pharmacies/retailers.

The requirements are that the logo is recognizable throughout the EU and identifies the Member State in which the on-line pharmacy/retailer is established. There is also an obligation for each Member State to set up a dedicated website providing a national list of all legally-operating on-line pharmacies/retailers. The entries in these lists must have a hyperlink to the respective on-line pharmacies/retailer's website and a reciprocal link from the logo on the on-line pharmacies/retailer's website back to the national list. The point being that a customer can go to either the national list to find approvable pharmacies and vice versa to the on-line pharmacies/retailer's website and link back to the national list via the logo thus assuring authenticity.


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October 18, 2012

European Biosimilars to Reference Non-European Biosimilars

Thumbnail image for Thumbnail image for dna.jpgWhenever an applicant wishes to register their follow-on medicinal product, be it a generic product or a biosimilar, the applicant has to include in their dossier a comparison between the newly-developed product with a previously-approved and registered medicine. For "standard" generic products evidence, such as the approved product's dosage form, strength, excipient and content can be obtained from published information and further "proof" is generated by such things as dissolution profiling and bioequivalence studies. However, there is always a question as to whether the comparison product (usually the originator's product) is the same internationally. For example, it is possible that the same active ingredient in the same dosage form could have been formulated differently from country to country, either as a result of differing timing of the drug's development and launch or on purpose to create artificial barriers, such that the follow on products will be more complex to develop. Of course, the difficulty of having what outwardly appears to be the same product, but inwardly is significantly different, creates potentially dangerous problems for both doctors and patients. Clearly, if a patient travels across borders and needs to refill their prescription, it could result in real problems, if the apparent same drug and dosage form act differently biologically.

Health authorities around the world now work much more closely together and confidential information about their registered and approved products can be passed between them, such that differences in formulations that affect bioavailability would be available to them and thus will be alert to possible issues. For a company making a follow-on product, however, this information is not available. As a result, companies wishing to make a generic product have to carry out extra studies as outlined above to investigate the differences from country to country and carry out bioequivalence studies against a local reference product.

Biological medicines are medicines that are made by or derived from a biological source. They can consist of relatively small molecules, such as human insulin or erythropoietin, or complex molecules, such as monoclonal antibodies. Biosimilar products are, thus, far more complex and need far more studies to show similarity, requiring a large number of clinical trials, as opposed to the bioequivalence studies that generic products undergo. Given the difficulty in developing, testing and registering new biological, it may well be that, unlike non-biological medicines, biological products may well be the same product internationally.

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August 31, 2012

Pediatric Inventory Consultation Begins for Europe's Medicines

Thumbnail image for pediatrics.jpgThe Pediatric Committee ("PDCO") of the European Medicines Agency ("EMA") is tasked with identifying the needs for children in a variety of therapeutic areas and aims to encourage the research and development of pediatric medicinal products. The first Inventory, which is now open for discussion and public consultation, covers medicines for cardiovascular diseases. The EMA points out that it will be releasing similar lists for other therapeutic areas for public consultation during 2012 and 2013.

According to the EMA, the Inventory aims to enable:

  • Companies to identify opportunities for business development;
  • The PDCO to judge the need for medicines and studies when assessing draft pediatric investigation plans, waivers and deferrals; and
  • Healthcare professionals and patients to have an information source available to support their decisions as to which medicines.

The Inventory is based on a report on the survey of all pediatric uses of medicinal products in Europe completed by the PDCO in December 2010.

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July 20, 2012

Europe Reviews Gene Therapy Favorably for the First Time

genetherapy.jpgThe promise of gene therapy as a commercially-available tool for treating genetic disorders may finally be inching closer to reality. On July 20, 2012 the European Medicines Agency ("EMA") Committee for Medicinal Products for Human Use ("CHMP") took the first step towards making gene therapy treatment a reality by recommending the gene therapy, Glybera® (alipogene tiparvovec), for marketing approval in the European Union ("EU"). Glybera®, which is indicated for the treatment of lipoprotein lipase ("LPL") deficiency, was developed by Netherlands-based, uniQure.

Patients lacking LPL enzymes are unable to break down fats. The CHMP press release states that:

So far, management of patients with the disorder consists of strict reduction of dietary fat to less than 20% of the daily caloric intake. It is very difficult to comply with such a dietary regimen and as a consequence many patients experience life-threatening pancreatitis attacks requiring admission to hospital.
Due to the difficult circumstances faced by individuals suffering from LPL deficiencies that trigger severe or multiple pancreatitis attacks, the CHMP has deemed the treatment benefits afforded by this gene therapy to be worth its risks.

Fundamentally, gene therapy is a method by which exogenous "functioning" or "normal" DNA replaces "abnormal" DNA that is responsible for a particular genetic disorder. Gene therapy was originally touted in the 1970s as a potential way to treat genetic disorders.

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July 5, 2012

European Pharmacovigilance Goes Into Effect July 2

eyemouthnew.jpgOn July 2, the much heralded new European Pharmacovigilance legislation came into operation. This new piece of legislation is aimed at promoting and protecting public health by strengthening the existing Europe-wide system for monitoring the safety and benefit-risk balance of medicines and provides regulators with a range of new or improved tools to ensure that patients are not exposed to unnecessary risks when taking medicines.

Highlights of the new legislation include:

  • The establishment of a new scientific committee, the Pharmacovigilance Risk Assessment Committee ("PRAC").

  • A clarification of the roles and responsibilities leading to more robust and rapid European Union ("EU") decision-making.

  • The engagement of patients and healthcare professionals in the regulatory process.

  • An improved collection of key information on medicines, e.g., through risk-proportionate, mandatory post-authorization safety and efficacy studies.

  • More transparency and better communication.

The first meeting of the new key committee, PRAC, will be on July 19 and 20, 2012. PRAC's mandate includes, among other things, "All aspects of the risk management of the use of medicinal products including the detection, assessment, minimization and communication relating to the risk of adverse reactions, having due regard to the therapeutic effect of the medicinal product, the design and evaluation of post-authorization safety studies and pharmacovigilance audit".

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June 1, 2012

EMA Side Effects Report Now Available on Public Website

EMA Logo.jpgThe European Medicines Agency ("EMA") has launched a new website that makes suspected side effect reports for medicines authorized in the European Economic Area ("EEA") publically available. The data comes from the medicines safety database EudraVigilance, and the new website is part of the EMA's continuing efforts to ensure EMA's regulatory processes are transparent and open and is in part due to implementation of the EudraVigilance access policy. The launch also highlights the importance of side effect reporting and pharmacovigilance in safeguarding public health within the European Union.

The data covers approximately 650 medicines and active substances authorized via the centralized procedure and it is hoped that the database will be expanded to cover nationally authorized products by the end of the year. The aggregated data can be viewed by age group, sex, type of suspected side effect, and by outcome. This new EMA website makes the information both readily accessible and readable to lay people, who are not familiar with the usual detailed reports provided to health care professionals. The EMA explains in its press release that a side effect (also known as an adverse drug reaction) includes side effects arising from use of a medicine within the terms of its marketing authorization, as well as from its use outside the approved indications, including overdose, misuse, abuse, and medication errors, and those associated with occupational exposure.

Most importantly the EMA explains that information on the website relates to suspected side effects, i.e., medical events that have been observed following the use of a medicine, but which are not necessarily related to or caused by the medicine. As a consequence, information on suspected side effects should not necessarily be interpreted as meaning that the medicine or the active substance causes the observed effect or is unsafe to use. A detailed evaluation and scientific assessment of all available data is required for correct conclusions to be drawn as to the benefits and risks of any medicine. It is expected that the reporting of side effects is normally to be carried out by healthcare professionals, but patients are able to report suspected side effects directly through various methods such as online patient reporting forms hosted by national medicines regulatory authorities or by telephone.

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April 12, 2012

Clinical Data Transparency Considered by Group of European Regulators

by Howard E. Rosenberg, Ph.D.

people-in-line.jpg Doshi et. al. ("Doshi") in a recent publication in PLoS Medicine highlighted their difficulties in obtaining full clinical trial data surrounding the approval of the influenza antiviral Tamiflu® (oseltamivir). Their interest in the drug was aroused when they began examining claims for the utility of drug and the differing ways that the World Health Organization ("WHO"), FDA and other health authorities around the globe interpreted the effectiveness and thus the recommended method of treatment plans for the drug. The information that was freely available to Doshi came from published trial data and meta-analyses but this proved to be unsatisfactory, as it did not allow them to really examine how the differing understandings of the drug's effectiveness and treatment patterns were decided upon by the world health authorities.

Widening their research into clinical trial reports and published data provided for other drugs that had subsequently been withdrawn or turned out to be unsatisfactory (e.g., rosiglitazone, rofecoxib, etc.), when it became clear to them that what they needed to see original clinical trial data without any "spin" attached. They pointed out that although published randomized clinical trials ("RCTs") are considered the "gold standard" source of synthesized evidence, their conclusions are vulnerable to distortion when the trial sponsors have strong interests that might benefit from suppressing or promoting selected data. From their point of view, a better method to independently assess drugs would be to enable the access and review of the clinical trial documentation and reports sent to the government drug regulators. However, these reports are historically treated as commercial confidential documents, impeding additional scrutiny by independent researchers. As a result, Doshi was unable to get all the data they required for their Tamiflu® project, despite putting in a great effort trying to get key documents released by government regulators.

A group of European regulators have replied to the Doshi article, agreeing that clinical trial data should not be considered commercial confidential information, particularly as most patients enrolling in clinical trials do so with an assumption of contributing to general medical knowledge, and that non-disclosure of complete trial results undermines this. They see many potential advantages in having public disclosure, for example, in enabling the development of predictive models for patient selection to appropriate treatments and the potential for better individualized therapeutic decisions.

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March 30, 2012

Commercially Confidential Information and Personal Data Agreement from Europe

by Howard E. Rosenberg, Ph.D.

data_protection.jpgThe general public's expectation for transparency in the regulation and assessment of the safety of medicines is characterized by the number of Freedom of Information Act ("FOIA") requests to FDA asking for detailed information regarding this data and the multitude of blog articles covering this subject matter. To some extent, public postings on FDA's website, particularly Drugs@FDA, has quelled the need for some FOIA requests. In Europe there is the same public pressure and an increasing trend for the release of information contained in the Marketing Authorization Applications ("MAAs") after they are granted. For example the release of clinical and safety data is regularly requested.

Feedback from initial European proposals found that in general the pharmaceutical industry had concerns regarding the release of contractual arrangements between companies, personal data of experts, and clinical and non-clinical data. Pharmaceutical companies also raised special concerns with regard to the disclosure of non-clinical data, while the release of clinical data was supported by most stakeholders.

The European Medicines Agency ("EMA") and the Heads of Medicines Agencies ("HMA") have now adopted a joint guidance document, providing, for the first time, a consistent Europe-wide approach to the identification of commercially-confidential information and personal data in a MAA. This "major step for transparency," will apply in the future to identify which parts of an application dossier can or cannot be released in response to requests throughout the regulatory authorities in the European Economic Area ("EEA"). This policy applies regardless of whether the product concerned was authorized using the centralized, mutual recognition or decentralized procedures.

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February 16, 2012

New Pharmacogenetics Guidelines Adopted by European Medicines Agency

by Howard E. Rosenberg, Ph.D.

gene.jpgLate last year, the European Medicines Agency ("EMA") published a new guideline, "Guideline on the use of pharmacogenetic methodologies in the pharmacokinetic evaluation of medicinal products" to provide a framework for where it is recommended that pharmacogenetics should be implemented in the drug development process. At the same time, the guideline recognizes that pharmacogenetics may not be equally important for every drug.

Patients are not all identical and different individuals may well react to a particular medicine in diverse ways. For example the manner in which a patient absorbs and/or metabolizes a particular drug may well differ form one to another. In recent years there has been a rapid development in the understanding of the influence of genes on interindividual differences in drug action. Hence the pharmacokinetics of many medicinal products is prone to interindividual variability, caused by several factors such as gender, age, weight, impaired renal and hepatic function, and genetics.

In the field of pharmacogenetics, interindividual variability in genes influencing or predicting the outcome of drug treatment (e.g., genes encoding drug transporters, drug metabolizing enzymes, drug targets, biomarker genes) is studied in relation to efficacy of drug treatment and adverse drug reactions. A knowledge of genetic factors influencing absorption, distribution, metabolism and excretion ("ADME") is centered on drug metabolism. Genetic variations in metabolizing enzymes may lead to: (i) increased or decreased clearance of the parent drug or pharmacologically active or toxic metabolites, (ii) increased or decreased production of active metabolites of the respective prodrugs, or (iii) increased or decreased formation of toxic products.

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February 6, 2012

European Union Pharmacovigilance Legislation Prepares to Take Off

by Howard E. Rosenberg, Ph.D.

Thumbnail image for Thumbnail image for european commission.jpegThe European Medicines Agency ("EMA"), together with the European Member States and the European Commission, is preparing for the introduction of the new pharmacovigilance legislation in July this year. The new legislation (Directive 2010/84/EU and Regulation (EU) No. 1235/2010) amending existing legislation was adopted in the European Union ("EU") in December 2010. The legislation aims to promote and protect public health by strengthening the Europe-wide system for monitoring the safety and benefit-risk balance of medicines.

The new legislation is designed to strengthen the procedures for the submission of risk management plans and periodic safety update reports ("PSURs") to the EMA. Currently companies submit a risk management plan at the time of application for a marketing authorization. The plan includes information on how the medicine will be monitored for safety during its lifetime and describes risk minimization activities. PSURs provide an evaluation of the benefit-risk balance of a medicine and these are submitted at defined periods during the post-authorization phase. This month the EMA will be publishing draft good pharmacovigilance practice ("GVP") modules for both risk management plans and PSURs for consultation.

The legislation provides for a new approach to the use of post-authorization safety and efficacy studies ("PASS" / "PAES") and implementation will also begin in 2012. A PASS is a study of an authorized medicine which identifies, characterizes or quantifies a safety hazard, confirms the safety profile of the medicine, or gauges the effectiveness of risk management measures during its lifetime. A PAES aims to clarify the efficacy for a medicine on the market including efficacy in everyday medical practice. The information obtained in the studies is to support regulators in decision-making on the safety and benefit-risk profile of a medicine. Like the other GVP modules above a PASS module will also be published for public consultation in February 2012. The scientific guideline for public consultation on PAES will be published by the EMA during the year.

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