In March 2022, the Tufts Center for the Study of Drug Development (CSDD) issued an impact report that examines clinical trial budgets and factors that drive commonly observed variations and cost. “Part of the focus of all of these studies is to understand how complexity, how increased customization in our trials, more fragmentation as we have different parties involved, contributes to longer cycle times and larger budgets than comparable studies when we control by therapeutic area,” explains Tufts CSDD Executive Director and Professor Ken Getz, who also serves as board chair for the Center for Information and Study on Clinical Research Participation. “Not only are we seeing longer timelines today, and larger budgets, but we see more variation around the mean for any of these measures, which means that it's getting more difficult for companies to predict or to anticipate and manage an expected timeline or an expected budget.”
While COVID-19 sharpened global understanding of the importance of efficient medicines review and regulation, the Pan American Health Organization (PAHO) has been systematically assessing national medicines regulatory authorities in the Americas since 2010. "It's inevitable that we reflect on what happened during the pandemic but also that we take that as an enormous opportunity to move forward in a way that can take the lessons out of regulation in a time of crisis to prevent crisis," suggests PAHO Medicines Health & Technologies Unit Chief Analía Porrás in this conversation with Susan Zavala Coloma (DIGEMID, Peru) and Global Forum Regional Editor for Latin America Cammilla Gomes (Roche). “The idea of the assessment is not just to showcase what's going well in a regulatory authority but, with the regulatory authority, to decide on the priorities for opportunities for improvement. We gained the trust of our regulatory authorities and our other stakeholders like the industry; with that trust, the authorities know that we're going to push them to be their best.”
“The ground is shifting in terms of how we will continue using randomized clinical trial data and real-world data in many different disease settings,” says Veronica Miller, co-author of Use of External Controls in FDA Regulatory Decision Making. In this research article, Miller (Forum for Collaborative Research) and Adora Ndu (Bridgebio Pharma, Inc.) describe where and how FDA has used external controls to support development and approval of drugs for rare and pediatric diseases. “We're seeing, not just in rare diseases but in many other diseases, this coming together of what used to be totally separate silos. In part, that's facilitated through electronic health records and other mechanisms of capturing data and being able to follow data at a bigger level, but also just because of understanding the importance of clinical data.”
In Part 2 of this interview, Chief Executive Officer Francisco Nogueira discusses the practicalities of data capture, data management, and machine learning within the framework of Accumulus Synergy’s proposed global cloud-based platform for regulatory submissions. “In terms of enthusiasm and shifting to database- from dossier-based submissions, this work had started before Accumulus was even conceived,” he explains. “Many companies already have data lakes in how they gather and collect and house the data that they are working through today. What I'm seeing in the ecosystem, both our sponsors and nonsponsors, is a high level of enthusiasm and high level of engagement towards what we define as data-centricity.” Listen to Part 1 of this interview.
In January 2021, 10 of the world’s leading biopharmaceutical companies announced the formation of Accumulus Synergy, a nonprofit corporation intended to enable global, real-time collaboration and data exchange and submission between industry and health authorities. “Our aim is to be at the intersection of where those who develop medicines, and those who approve them, can interact differently,” explains CEO Francisco Nogueira. “Our technology will provide the ability for a sponsor to work with as many regulators as that sponsor chooses to in a much more streamlined fashion. We will enable the platform. We will enable it with the know-how and the technology. But ultimately the business rules remain with the business.” Listen to Part 2 of this interview.
Global Forum Co-Editors Gary Kelloff and David Parkinson discuss translational science milestones in 2021 against the backdrop of disruptive technologies advancing disease diagnostics and therapies. “The sensitivity of the diagnostic assays is getting better and better, and so is the analytical validation,” says Gary. “We have now the opportunity with liquid biopsies that allow from 20 cc of blood whole exome sequencing, whole transcriptome sequencing, and therefore deep DNA and RNA interrogation, real biology characterization. And that has fantastic opportunities for drug development, for patient diagnosis and prognostication, but also for the longitudinal monitoring of patients,” concurs David.
Innovations in therapeutic product development will only be effective when patients can access and use them. But establishing and explaining the value and price of these innovations among so much unmet need, and ensuring access by patients who need them, has proven difficult throughout Europe and elsewhere. “Policymakers more often or too often have a short-term view, short-term perspective, rather than a long-term perspective, and sometimes are driven more by political goals than promoting patient access in a real way,” suggests Andras Incze, Akceso Advisors. “We want the breakthrough innovations to reach patients throughout Europe. We want the best products and to get them to patients as fast as possible,” explains Rick Vreman, Utrecht University, the Netherlands. “But then it gets a bit more tricky when we start to think about what we need to make that happen.”
“There are good reasons to explore the use of artificial intelligence in pharmacovigilance. There are an increasing number of sources of drug safety information, and efficient screening, processing, or evaluation of them would benefit from accurate automated methods,” explains Gerald Dal Pan, Director, Office of Surveillance and Epidemiology (OSE), CDER. “First, there’s the potential application of AI to the processing of case reports. Second, there’s the potential application of AI for assessing causality in a case report. Third, we’re exploring the use of AI in real-world data as part of the Sentinel Initiative.”
COVID has demonstrated the importance of regulatory systems that ensure the safety and efficacy of therapeutic products as well as patient access to these products, especially in the complex network of healthcare, scientific, pharmaceutical, regulatory, and patient communities in Europe. “Regulators and industry have worked day and night over the last two years to bring vaccines and therapies forward. We know very clearly that sustainability of the system is an issue. More regulatory resources and simpler processes are desperately needed,” explains Isabelle Stoeckert, Bayer AG vice president and head of regulatory affairs for Europe, Middle East, and Africa. “Many countries have learned that reliance and collaboration between regulators is a really good thing. COVID-19 has really shown that,” suggests Henrik Nielsen, Novo Nordisk vice president of global regulatory sciences. “And I think this will stay, so we will see more reliance between regulatory sources, and we'll probably see increased use of different collaboration schemes around the world.”
How are clinical research and clinical care industries in Japan responding to the new challenges emerging in the post-pandemic world? “During 2020, it became a very difficult time to initiate a clinical trial, a difficult time to recruit patients to clinical trials which were ongoing, especially if those were clinical trials in patients who were elderly or in cancer therapies. Patients were a little bit reluctant to go to hospitals, even though we had very few cases in Japan,” explains E. Stewart Geary, global safety officer and senior vice president, Eisai Company Limited. “The healthcare system in Japan has one big challenge in that a lot of people are concentrated in large cities, and that's also where healthcare professionals are concentrated. But you have a large elderly population which is still in the countryside in towns which are kind of dying off, are very small, and are probably underserved by healthcare professionals. Because of that, there had been ongoing debate about telehealth.”