FDA's proposed rule and its regulatory impact on emerging and reemerging neglected tropical diseases in the United States.

Diagnosing infectious diseases significantly influences patient care, aiding in outbreak identification, response, and public health monitoring. However, the range of FDA-approved molecular tests remains notably limited, especially concerning neglected tropical diseases (NTDs). Drawing upon our experience as one of the largest healthcare networks in the greater New York metropolitan area, this viewpoint manuscript aims to spotlight the existing diagnostic landscape and unmet clinical needs for 4 emerging NTDs increasingly prevalent in the United States, additionally, it delves into the possible adverse effects of the FDA's Proposed Rule on Laboratory-Developed Tests for these clinical conditions and the broader spectrum of NTDs.

Clinical Benefit and Regulatory Outcomes of Cancer Drugs Receiving Accelerated Approval.

Importance: The US Food and Drug Administration's (FDA) accelerated approval pathway allows approval of investigational drugs treating unmet medical needs based on changes to surrogate measures considered "reasonably likely" to predict clinical benefit. Postapproval clinical trials are then required to confirm whether these drugs offer clinical benefit. Objective: To determine whether cancer drugs granted accelerated approval ultimately demonstrate clinical benefit and to evaluate the basis of conversion to regular approval. Design, Setting, and Participants: In this cohort study, publicly available FDA data were used to identify cancer drugs granted accelerated approval from 2013 to 2023. Main Outcomes and Measures: Demonstrated improvement in quality of life or overall survival in accelerated approvals with more than 5 years of follow-up, as well as confirmatory trial end points and time to conversion for drug-indication pairs converted to regular approval. Results: A total of 129 cancer drug-indication pairs were granted accelerated approval from 2013 to 2023. Among 46 indications with more than 5 years of follow-up (approved 2013-2017), approximately two-thirds (29, 63%) were converted to regular approval, 10 (22%) were withdrawn, and 7 (15%) remained ongoing after a median of 6.3 years. Fewer than half (20/46, 43%) demonstrated a clinical benefit in confirmatory trials. Time to withdrawal decreased from 9.9 years to 3.6 years, and time to regular approval increased from 1.6 years to 3.6 years. Among 48 drug-indication pairs converted to regular approval, 19 (40%) were converted based on overall survival, 21 (44%) on progression-free survival, 5 (10%) on response rate plus duration of response, 2 (4%) on response rate, and 1 (2%) despite a negative confirmatory trial. Comparing accelerated and regular approval indications, 18 of 48 (38%) were unchanged, while 30 of 48 (63%) had different indications (eg, earlier line of therapy). Conclusions and Relevance: Most cancer drugs granted accelerated approval did not demonstrate benefit in overall survival or quality of life within 5 years of accelerated approval. Patients should be clearly informed about the cancer drugs that use the accelerated approval pathway and do not end up showing benefits in patient-centered clinical outcomes.

Paucity of intellectual property rights information in the US biologics system a decade after passage of the Biosimilars Act.

In this Policy Forum piece, Robin Feldman discusses how current legislation contributes to informational deficits around drug patents for biologic drugs in the United States.

The FDA in the Crosshairs-Science, Politics, and Abortion.

In this Viewpoint, the Supreme Court case FDA v AHM is used to illustrate the tension the FDA faces between science and politics, and state authority over abortion vs federal authority over which drugs may be marketed nationwide.

Understanding the Impacts of the Supreme Court Case FDA v Alliance for Hippocratic Medicine.

This Viewpoint outlines the potential effects of the Supreme Court case regarding mifepristone restrictions: a decision for the FDA would allow current dispensing, while ruling against the FDA would severely curtail access to reproductive health options.

State-Regulated Psychedelics on a Collision Course With FDA.

This Viewpoint examines how US states are reforming legislation to allow access to psychedelics for therapeutic use, but federal laws consider these agents to be Schedule I drugs, and the discordance between state and federal law may create confusion and conflict.

FDA Green-Lights Tirzepatide, Marketed as Zepbound, for Chronic Weight Management.

This Medical News article discusses the November 8 US Food and Drug Administration approval of the drug tirzepatide for chronic weight management in people with obesity or overweight with weight-related conditions.

Including E-Cigarettes in the FDA Rule Limiting Nicotine.

This Viewpoint discusses why the US Food and Drug Administration (FDA) should include e-cigarettes in its proposed cap of the nicotine concentration in combustible cigarettes to address the public health problem of vaping among adolescents.

Predicting the molecular mechanism-driven progression of breast cancer through comprehensive network pharmacology and molecular docking approach.

Identification of key regulators is a critical step toward discovering biomarker that participate in BC. A gene expression dataset of breast cancer patients was used to construct a network identifying key regulators in breast cancer. Overexpressed genes were identified with BioXpress, and then curated genes were used to construct the BC interactome network. As a result of selecting the genes with the highest degree from the BC network and tracing them, three of them were identified as novel key regulators, since they were involved at all network levels, thus serving as the backbone. There is some evidence in the literature that these genes are associated with BC. In order to treat BC, drugs that can simultaneously interact with multiple targets are promising. When compared with single-target drugs, multi-target drugs have higher efficacy, improved safety profile, and are easier to administer. The haplotype and LD studies of the FN1 gene revealed that the identified variations rs6707530 and rs1250248 may both cause TB, and endometriosis respectively. Interethnic differences in SNP and haplotype frequencies might explain the unpredictability in association studies and may contribute to predicting the pharmacokinetics and pharmacodynamics of drugs using FN1.

The Mifepristone Case and the Legitimacy of the FDA.

This Viewpoint discusses a recent federal court decision that invaliated the Food and Drug Administration's (FDA) approval of mifepristone, a drug used to end pregnancies and manage miscarriage when used with misoprostol, and how that decision challenges the legitimacy and independence of the FDA.