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Ремедиум. 2018; : 6-20

Проблемы прорывной терапии и ускоренной регистрации в России и ЕАЭС

Ниязов Р. Р., Васильев А. Н., Гавришина Е. В., Драницына М. А., Куличев Д. А.

https://doi.org/10.21518/1561-5936-2018-11-6-20

Аннотация

Сроки разработки и вывода на рынок лекарственных препаратов велики, в т. ч. в связи с необходимостью пошагового согласования многих аспектов с государственными органами. За рубежом в целях ускорения вывода на рынок лекарств, удовлетворяющих наиболее насущные нужды здравоохранения, созданы процедуры, позволяющие оптимизировать процессы согласования и принятия решений на основе предварительных данных. В России и ЕАЭС также есть необходимость в скором выводе на рынок лекарств, которые приносили бы пользу пациентам, однако текущие инфраструктурные и регуляторные реалии требуют глубокого осмысления преимуществ и недостатков ускоренных процедур и продуманного подхода к их внедрению. В работе проведен анализ зарубежных регуляторных подходов к обеспечению ускоренного доступа лекарственных препаратов на рынок и рассмотрены существующие препятствия в отечественной системе регулирования и возможные варианты их преодоления.
Список литературы

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13. CFR, Subpart H-Accelerated Approval of New Drugs for Serious or Life-Threatening Illnesses (current as of September 20, 2018). URL: https:// www.ecfr.gov/cgi-bin/text-idx?SID=4549523904af93d53e78a645cd55e24e &mc=true&node=sp21.5.314.h&rgn=div6 (дата обращения: 24.09.2018).

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20. European Medicines Agency (2018). Qualification of novel methodologies for medicine development. URL: http://www.ema.europa. eu/ema/index.jsp?curl=pages/regulation/document_listing/docu-ment_listing_000319.jsp&mid=WC0b01ac0580022bb0 (дата обращения: 25.09.2018).

21. U.S. Food and Drug Administration and U.S. National Institutes of Health (2018). CDER Small Business & Industry Assistance (SBIA). URL: https://www.fda.gov/Drugs/DevelopmentApprovalProcess/ SmallBusinessAssistance/default.htm (дата обращения: 25.09.2018).

22. European Medicines Agency (2018). User guide for micro, small and medium-sized enterprises. URL: http://www.ema.europa.eu/docs/en_GB/ document_library/Regulatory_and_procedural_guideline/2009/10/ WC500004134.pdf (дата обращения: 25.09.2018).

23. U.S. Food and Drug Administration (2013). Drug Approval Package for Sovaldi (sofosbuvir) tablet, oral / Summary Review. URL: https://www. accessdata.fda.gov/drugsatfda_docs/nda/2013/2046710rig1s000SumR.pdf (дата обращения: 28.09.2018).

24. European Medicines Agency (2013). European Public Assessment Report for Sovaldi (EMA/CHMP/688774/2013). URL: http://www.ema. europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_ report/human/002798/WC500160600.pdf (дата обращения: 26.09.2018).

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30. Sherman R.E., Li J., Shapley S., Robb M., Woodcock J. Expediting drug development -- the FDA's new «breakthrough therapy» designation. N Engl J Med. 2013 Nov 14; 369(20): 1877-80. doi: 10.1056/NEJMp1311439.

31. European Medicines Agency (2018). PRIME: a two-year overview. URL: https://www.ema.europa.eu/documents/report/prime-two-year-overview_ en.pdf (дата обращения: 28.09.2018).

32. Kim C., Prasad V. Cancer drugs approved on the basis of a surrogate end point and subsequent overall survival: an analysis of 5 years of US Food and Drug Administration approvals. JAMA Intern Med. 2015 Oct 19. doi:10.1001/jamainternmed.2015.5868.

33. Naci H., Wouters O.J., Gupta R., Ioannidis J.P.A. Timing and characteristics of cumulative evidence available on novel therapeutic agents receiving Food and Drug Administration accelerated approval. Milbank Q. 2017; 357: 261-90. doi:10.1111/1468-0009.12261. pmid: 28589600.

34. Kesselheim A.S., Hwang T.J., Franklin J.M. Two decades of new drug development for central nervous system disorders. Nat Rev Drug Discov. 2015 Dec; 14(12): 815-6. doi: 10.1038/nrd4793. Epub 2015 Nov 20.

35. Marciniak Th.A., Serebruany V. Are drug regulators really too slow? BMJ. 2017; 357: j2867 doi: 10.1136/bmj.j2867.

36. Bejan-Angoulvant T., Cornu C., Archambault P., et al. Is HbA1c a valid surrogate for macrovascular and microvascular complications in type 2 diabetes? Diabetes Metab. 2015 Jun; 41(3): 195-201. doi: 10.1016/j.dia-bet.2015.04.001. Epub 2015 May 6.

37. Kogure S., Koyama N., and Hidaka Sh. Utilization of the Bridging Strategy for the Development of New Drugs in Oncology to Avoid Drug Lag. J Clin Pharmacol. 2017 Nov; 57(11): 1479-1490. doi: 10.1002/ jcph.951. Epub 2017 Jun 19.

38. Watters J.T., Pitzen J.H., Sanders L.J., et al. Transforming the Activation of Clinical Trials. Clin Pharmacol Ther. 2018 Jan; 103(1): 43-46. doi: oi:10.1002/cpt.898. Epub 2017 Nov 6.

39. Pinnow E., Amr S., Bentzen S.M., et al. Postmarket Safety Outcomes for New Molecular Entity (NME) Drugs Approved by the Food and Drug Administration Between 2002 and 2014. Clin Pharmacol Ther. 2018 Aug; 104(2): 390-400. doi: 10.1002/cpt.944. Epub 2017 Dec 20.

40. Breckenridge A. & Liberti L. Accelerated approval of medicines: fit for purpose? Nature Reviews Drug Discovery. 2018; 17: 379-380. doi: 10.1038/nrd.2017.245.

Remedium. 2018; : 6-20

Issues of breakthrough therapy and accelerated market authorization in Russia and the EAEU

Niyazov R. R., Vasiliev A. N., Gavrishina E. V., Dranitsyna M. A., Kulichev D. A.

https://doi.org/10.21518/1561-5936-2018-11-6-20

Abstract

The time needed for the development and placing medicinal products on the market is rather long, which, among others, is due to the need for stepwise approval of many different aspects by the regulatory authorities. In other countries, procedures streamlining the approval and decision-making processes based on the preliminary data were instituted to accelerate the market access for medicines satisfying unmet healthcare needs. In Russia and the EAEU, there is also a need in the accelerated market access for the medicinal products, which are beneficial for the patients. However, the current infrastructure and regulatory environment need a great deal of reflection to assess advantages and drawbacks of the accelerated pathways, and a robust approach should be taken. In this paper, the analysis of the foreign regulatory procedures enabling the accelerated access for the medicinal products on the market has been performed, and current impediments within the domestic regulatory framework and the possible ways to overcome thereof have been discussed.
References

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2. The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), 2009. Guidance on Nonclinical Safety Studies for the Conduct of Human Clinical Trials and Marketing Authorization for Pharmaceuticals (ICH M3(R2)). URL: http:// www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/ Multidisciplinary/M3_R2/Step4/M3_R2_Guideline.pdf (23.09.2018).

3. The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), 2011. Preclinical Safety Evaluation of Biotechnology-Derived Pharmaceuticals (ICH S6(R1)). URL: http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/ Safety/S6_R1/Step4/S6_R1_Guideline.pdf (23.09.2018).

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5. Duijnhoven R.G., Straus S.M.J.M., Raine J.M., de Boer A., Hoes A.W., De Bruin M.L. Number of Patients Studied Prior to Approval of New Medicines: A Database Analysis. PLoS Med. 2013 Mar; 10(3): e1001407. Published online 2013 Mar 19. doi: 10.1371/journal.pmed.1001407.

6. U.S. Food and Drug Administration (1998). Providing Clinical Evidence of Effectiveness for Human Drug and Biological Products. URL: https://www.fda.gov/downloads/Drugs/ GuidanceComplianceRegulatoryInformation/Guidances/UCM072008.pdf (data obrashcheniya: 23.09.2018).

7. European Medicines Agency (2001). Application with 1. Meta-analyses; 2. One pivotal study (CPMP/EWP/2330/99). URL: http://www.ema. europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003657.pdf (data obrashcheniya: 23.09.2018).

8. European Medicines Agency (2015). European Public Assessment Report for Zontivity (voraxapar) (EMA/CHMP/671361/2015 Rev. 1). URL: https:// www.ema.europa.eu/medicines/human/EPAR/zontivity (data obrashcheniya: 28.09.2018).

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12. USC 356: Expedited approval of drugs for serious or life-threatening diseases or conditions. Text contains those laws in effect on September 23, 2018. URL: http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section356&num=0&edition=prelim (data obrashcheniya: 24.09.2018).

13. CFR, Subpart H-Accelerated Approval of New Drugs for Serious or Life-Threatening Illnesses (current as of September 20, 2018). URL: https:// www.ecfr.gov/cgi-bin/text-idx?SID=4549523904af93d53e78a645cd55e24e &mc=true&node=sp21.5.314.h&rgn=div6 (data obrashcheniya: 24.09.2018).

14. U.S. Food and Drug Administration (2017). Drug Development Tools (DDT) Qualification Programs. URL: https://www.fda.gov/Drugs/DevelopmentApprovalProcess/ DrugDevelopmentToolsQualificationProgram/default.htm (data obrashcheniya: 24.09.2018).

15. U.S. Food and Drug Administration (2018). Drug Development Tool Programs and Initiatives. URL: https://www.fda.gov/Drugs/ DevelopmentApprovalProcess/ucm426815.htm (data obrashcheniya: 24.09.2018).

16. U.S. Food and Drug Administration and U.S. National Institutes of Health (2018). BEST (Biomarkers, EndpointS, and other Tools) Resource. URL: https://www.ncbi.nlm.nih.gov/books/NBK326791/pdf/Bookshelf_ NBK326791.pdf (data obrashcheniya: 24.09.2018).

17. U.S. Food and Drug Administration and U.S. National Institutes of Health (2018). BEST (Biomarkers, EndpointS, and other Tools) Resource / Resurs BEST (biomarkery, konechnye tochki i drugie instrumenty). PharmAdvisor. URL: http://pharmadvisor.ru/document/tr3877/ (data obrashcheniya: 24.09.2018).

18. Hwang T.J., Darrow J.J., Kesselheim A.S. The FDA's Expedited Programs and Clinical Development Times for Novel Therapeutics, 2012-2016. JAMA. 2017; 318(21): 2137-2138.

19. European Medicines Agency (2016). Guideline on the scientific application and the practical arrangements necessary to implement the procedure for accelerated assessment pursuant to Article 14(9) of Regulation (EC) No 726/2004 (EMA/CHMP/671361/2015 Rev. 1). URL: http:// www.ema.europa.eu/docs/en_GB/document_library/Scientific_guide-line/2016/03/WC500202629.pdf (data obrashcheniya: 25.09.2018).

20. European Medicines Agency (2018). Qualification of novel methodologies for medicine development. URL: http://www.ema.europa. eu/ema/index.jsp?curl=pages/regulation/document_listing/docu-ment_listing_000319.jsp&mid=WC0b01ac0580022bb0 (data obrashcheniya: 25.09.2018).

21. U.S. Food and Drug Administration and U.S. National Institutes of Health (2018). CDER Small Business & Industry Assistance (SBIA). URL: https://www.fda.gov/Drugs/DevelopmentApprovalProcess/ SmallBusinessAssistance/default.htm (data obrashcheniya: 25.09.2018).

22. European Medicines Agency (2018). User guide for micro, small and medium-sized enterprises. URL: http://www.ema.europa.eu/docs/en_GB/ document_library/Regulatory_and_procedural_guideline/2009/10/ WC500004134.pdf (data obrashcheniya: 25.09.2018).

23. U.S. Food and Drug Administration (2013). Drug Approval Package for Sovaldi (sofosbuvir) tablet, oral / Summary Review. URL: https://www. accessdata.fda.gov/drugsatfda_docs/nda/2013/2046710rig1s000SumR.pdf (data obrashcheniya: 28.09.2018).

24. European Medicines Agency (2013). European Public Assessment Report for Sovaldi (EMA/CHMP/688774/2013). URL: http://www.ema. europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_ report/human/002798/WC500160600.pdf (data obrashcheniya: 26.09.2018).

25. Wieschowski S., Chin W., Federico C., et al. Preclinical efficacy studies in investigator brochures: Do they enable risk-benefit assessment? PLoS Biol. 2018 Apr; 16(4): e2004879. doi: 10.1371/journal.pbio.2004879.

26. Moscicki R.A. and Tandon P.K. Drug-Development Challenges for Small Biopharmaceutical Companies. N Engl J Med. 2017; 376:469-474. doi: 10.1056/NEJMra1510070.

27. Reshenie Soveta Evraziiskoi ekonomicheskoi komissii ot 3 noyabrya 2016 g. № 78 «O pravilakh registratsii i ekspertizy lekarstvennykh sredstv dlya meditsinskogo primeneniya». Evraziiskaya ekonomicheskaya komissiya (2016). URL: https://docs.eaeunion.org/docs/ ru-ru/01411969/cncd_21112016_78 (data obrashcheniya: 28.09.2018).

28. Chabner B.A. Considerations About the Use of Biomarkers in Cancer Clinical Trials. Clin Pharmacol Ther. 2018 Jan; 103(1): 25-27. doi: 10.1002/ cpt.895. Epub 2017 Nov 14.

29. Puthumana J., Wallach J.D., Ross J.S., Puthumana J., Wallach J.D., Ross J.S. JAMA. 2018; 320(3): 301-303. doi:10.1001/jama.2018.7619.

30. Sherman R.E., Li J., Shapley S., Robb M., Woodcock J. Expediting drug development -- the FDA's new «breakthrough therapy» designation. N Engl J Med. 2013 Nov 14; 369(20): 1877-80. doi: 10.1056/NEJMp1311439.

31. European Medicines Agency (2018). PRIME: a two-year overview. URL: https://www.ema.europa.eu/documents/report/prime-two-year-overview_ en.pdf (data obrashcheniya: 28.09.2018).

32. Kim C., Prasad V. Cancer drugs approved on the basis of a surrogate end point and subsequent overall survival: an analysis of 5 years of US Food and Drug Administration approvals. JAMA Intern Med. 2015 Oct 19. doi:10.1001/jamainternmed.2015.5868.

33. Naci H., Wouters O.J., Gupta R., Ioannidis J.P.A. Timing and characteristics of cumulative evidence available on novel therapeutic agents receiving Food and Drug Administration accelerated approval. Milbank Q. 2017; 357: 261-90. doi:10.1111/1468-0009.12261. pmid: 28589600.

34. Kesselheim A.S., Hwang T.J., Franklin J.M. Two decades of new drug development for central nervous system disorders. Nat Rev Drug Discov. 2015 Dec; 14(12): 815-6. doi: 10.1038/nrd4793. Epub 2015 Nov 20.

35. Marciniak Th.A., Serebruany V. Are drug regulators really too slow? BMJ. 2017; 357: j2867 doi: 10.1136/bmj.j2867.

36. Bejan-Angoulvant T., Cornu C., Archambault P., et al. Is HbA1c a valid surrogate for macrovascular and microvascular complications in type 2 diabetes? Diabetes Metab. 2015 Jun; 41(3): 195-201. doi: 10.1016/j.dia-bet.2015.04.001. Epub 2015 May 6.

37. Kogure S., Koyama N., and Hidaka Sh. Utilization of the Bridging Strategy for the Development of New Drugs in Oncology to Avoid Drug Lag. J Clin Pharmacol. 2017 Nov; 57(11): 1479-1490. doi: 10.1002/ jcph.951. Epub 2017 Jun 19.

38. Watters J.T., Pitzen J.H., Sanders L.J., et al. Transforming the Activation of Clinical Trials. Clin Pharmacol Ther. 2018 Jan; 103(1): 43-46. doi: oi:10.1002/cpt.898. Epub 2017 Nov 6.

39. Pinnow E., Amr S., Bentzen S.M., et al. Postmarket Safety Outcomes for New Molecular Entity (NME) Drugs Approved by the Food and Drug Administration Between 2002 and 2014. Clin Pharmacol Ther. 2018 Aug; 104(2): 390-400. doi: 10.1002/cpt.944. Epub 2017 Dec 20.

40. Breckenridge A. & Liberti L. Accelerated approval of medicines: fit for purpose? Nature Reviews Drug Discovery. 2018; 17: 379-380. doi: 10.1038/nrd.2017.245.