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The FDA Accelerated Approval Program: Data Transparency for Public Health

Journal of Science Policy & Governance
Volume 23, Issue 01 | October 23, 2023

Policy Memo: The FDA Accelerated Approval Program: Data Transparency for Public Health

Zhuoying Lin 
  • University of California, Los Angeles, Department of Chemistry and Biochemistry, Los Angeles, CA, USA ​
​
Corresponding author: [email protected] ​
​
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Keywords: clinical trial data; data transparency; Accelerated Approval Program; FDA
https://doi.org/10.38126/JSPG230107​

Executive Summary

The Accelerated Approval Program (AAP) of the US Food and Drug Administration (FDA) authorizes earlier approval of drugs based on surrogate endpoints to fulfill unmet medical need. Compared to the standard approval process, drugs approved through the AAP have greater uncertainty in clinical benefits due to the reliance on surrogate endpoints and lack of initial confirmatory studies, which raises concerns regarding the rigor and transparency of the program. While the Consolidated Appropriations Act enacted on December 29, 2022 requires the FDA to start reporting its postmarket analysis and decision making publicly, it is neither sufficient nor comprehensive to inform the public of the existing public health risks and benefits of the accelerated approved drugs when the preliminary clinical trial data remains confidential. The lack of data transparency and inherent uncertainty surrounding accelerated approved drugs prevents patients from making fully informed choices and puts public health at greater risk. Thus, we propose that the FDA proactively release the de-identified clinical trial data upon accelerated approval. Disclosure of de-identified clinical trial data would strengthen independent, public health-prioritized data interpretation and analysis, which allows physicians and patients to make better informed decisions about their medical treatment. ​

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Zhuoying Lin is a Ph.D. student in Materials Chemistry at the University of California, Los Angeles, where she conducts battery research for energy storage applications. She enjoys science journalism and is a news writer for her home department. 

Acknowledgements 
The author thanks the Science Policy Group at UCLA and Ge Yang for their valuable feedback on the manuscript.

​Disclaimer 
The author declares no conflicts of interest. ​

References

  1. Beakes‑Read, Ginny, Madison Neisser, Patrick Frey, and Mara Guarducci. 2022. “Analysis of FDA's Accelerated Approval Program Performance December 1992-December 2021.” Therapeutic Innovation & Regulatory Science 56: 698-703 http://doi/org/10.1007/s43441-022-00430-z
  2. Belluck, Pam. 2022. "Medicare Officially Limits Coverage of Aduhelm to Patients in Clinical Trials." New York Times, May 7, 2022. https://www.nytimes.com/2022/04/07/health/ad uhelm-medicare-alzheimers.html 
  3. European Medicine Agency (EMA). 2019. “European Medicines Agency policy on publication of clinical data for medicinal products for human use.” https://www.ema.europa.eu/en/documents/other/ european-medicines-agency-policy-publication-clinical-data-medicinal-products-human-use_en.pdf
  4. Cooley. 2023. “FDORA's Changes to the FDA Accelerated Approval Program. Access August 12th, 2023. https://www.cooley.com/news/insight/2023/202 3-01-31-fdora-changes-to-the-fda-accelerated-appro val-program 
  5. Federal Food, Drug and Cosmetic Act. 2018, United States Code, Title 21. 
  6. Institute of Medicine. 2015. Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risk. Washington, DC: The National Academies Press. https://doi.org/10.17226/18998 
  7. Kapczynski, Amy, and Jeanie Kim. 2018. “Clinical Trial Transparency: The FDA Should and Can Do More.” The Journal of Law, Medicine & Ethics 45, no.2: 33-38. https://doi.org/10.1177/107311051775 
  8. Naci, Huseyin, Katelyn R. Smalley, and Aaron S. Kesselheim. 2017. “Characteristics of Preapproval and Postapproval Studies for Drugs Granted Accelerated Approval by the US Food and Drug Administration.”. JAMA 318: 626-636. http://doi.org/10.1001/jama.2017.9415 
  9. Rosenberg, Jaime. 2022. “Global Assessment of Nusinersen Reimbursement Highlights Need for More Transparency.” AJMC. 
  10. https://www.ajmc.com/view/global-assessment-o f-nusinersen-reimbursement-highlights-need-for-m ore-transparency 
  11. Rubin, Rita. 2021. “Recently Approved Alzheimer Drug Raises Questions That Might Never Be Answered”. JAMA 326 469–472. http://doi.org/10.1001/jama.2021.11558 
  12. Tampi, Rajesh R., Brent P Forester, and Marc Agronin. 2021. “Aducanumab: evidence from clinical trial data and controversies.” Drugs in context 10: 2021-7-3. https://doi.org/10.7573/dic.2021-7-3 
  13. Tsang, Lincoln, and Hannah Kerr-Peterson. 2023. “Relaunch of the EMA’s policy on the proactive publication of clinical data.” Ropes&Gray. Access August 12th, 2023. https://insights.ropesgray.com/post/102ieyv/rela unch-of-the-emas-policy-on-the-proactive-publicati on-of-clinical-data 
  14. U.S. Food and Drug Administration (FDA). 2014. “Expedited Programs for Serious Conditions––Drugs and Biologics.” ​https://www.fda.gov/regulatory-information/search-fda-gui dance-documents/expedited-programs-serious-con ditions-drugs-and-biologics 
  15. U.S. Food and Drug Administration (FDA). 2015. Freedom of Information Annual Report FY 2014. http://www.hhs.gov/foia/reports/annual-reports/ 2014/index.html 
  16. U.S. Food and Drug Administration (FDA). 2020. “Combined FDA and Applicant PCNS Drugs Advisory Committee Briefing Document.” https://fda.report/media/143503/PCNS-20201106 -CombinedFDABiogenBackgrounder_0.pdf 
  17. U.S. Food and Drug Administration (FDA). 2023. “Accelerated Approval Program.” https://www.fda.gov/drugs/nda-and-bla-approvals /accelerated-approval-program 
  18. U.S. Health and Human Services. 2016. HHS Fiscal Year 2015 Freedom of Information Annual Report. https://www.hhs.gov/foia/reports/annual-reports /2015/

DISCLAIMER: The findings and conclusions published herein are solely attributed to the author and not necessarily endorsed or adopted by the Journal of Science Policy and Governance. Articles are distributed in compliance with copyright and trademark agreements.

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    • GHFUTURES2030 Strengthening Youth-centered Policy and Governance of Digital Transformations in Health.
    • UNESCO AND MGCY OPEN SCIENCE POLICIES AS AN ACCELERATOR FOR ACHIEVING THE SUSTAINABLE DEVELOPMENT GOALS
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