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Process of drug registration in Israel: the correlation between the number of discussions within the Ministry of Health and postapproval variations by EMA and/or FDA.
Hiayev, Stephany; Shacham-Shmueli, Einat; Berkovitch, Matitiahu; Weiss, Ilana; Ashkenazi, Shai; Vexberg, Michal Hirsch; Hershkowitz, Rami; Gorelik, Einat; Mayan, Haim; Steinmetz, Yehudit; Yanai, Noa Berar; Schlissel, Orly; Azem, Muhammad; Gutgold, Neriya; Shulman, Katerina; Divinsky, Milly; Yarom, Nirit; Vishkautzan, Alla; Ganzel, Chezi; Gatt, Moshe E; Arcavi, Lidia; Marom, Eli; Uziely, Biatrice; Zevin, Shoshana; Meirow, Hadar; Luxenburg, Osnat; Ainbinder, Denize.
Afiliação
  • Hiayev S; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Shacham-Shmueli E; Oncology Department, Sheba Medical Center, Tel Hashomer, Israel.
  • Berkovitch M; Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.
  • Weiss I; Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.
  • Ashkenazi S; Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Tzrifin, Israel.
  • Vexberg MH; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Hershkowitz R; The Adelson School of Medicine, Ariel University, Ariel, Israel.
  • Gorelik E; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Mayan H; Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.
  • Steinmetz Y; Department of Internal Medicine T, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
  • Yanai NB; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Schlissel O; Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.
  • Azem M; Department of Internal Medicine E, Sheba Medical Center, Tel Hashomer, Israel.
  • Gutgold N; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Shulman K; Nephrology Department, Hillel Yaffe Medical Center, Hadera, Israel.
  • Divinsky M; The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
  • Yarom N; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Vishkautzan A; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Ganzel C; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Gatt ME; The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
  • Arcavi L; Oncology Institute, Carmel Medical Center, Haifa, Israel.
  • Marom E; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Uziely B; Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel.
  • Zevin S; Oncology Department, Shamir Medical Center, Tzrifin, Israel.
  • Meirow H; The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel.
  • Luxenburg O; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Ainbinder D; Hematology Department, Shaare Zedek Medical Center, Jerusalem, Israel.
BMJ Open ; 13(5): e067313, 2023 05 04.
Article em En | MEDLINE | ID: mdl-37142315
OBJECTIVES: US FDA and EMA allow facilitated regulatory pathways to expedite access to new treatments. Limited supportive data may result in major postapproval variations. In Israel, partly relying on Food and Drug Administration (FDA) and European Medicines Agency (EMA), clinical data are reviewed independently by the Advisory Committee of Drug Registration (ACDR). In this study, the correlation between the number of discussions at the ACDR and major postapproval variations is examined. DESIGN: This is an observational retrospective comparative cohort study. SETTING: Applications with FDA and/or EMA approval at time of assessment in Israel were included. The timeframe was chosen to allow a minimum of 3 years of postmarketing approval experience for potential major label variations. Data regarding the number of discussions at ACDR were extracted from protocols. Data on postapproval major variations were extracted from the FDA and EMA websites. RESULTS: Between 2014 and 2016, 226 (176 drugs) applications, met the study criteria. 198 (87.6%) and 28 (12.4%) were approved following single and multiple discussions, respectively. A major postapproval variation was recorded in 129 (65.2%) compared with 23 (82.1%) applications approved following single and multiple discussions, respectively (p=0.002). Increased risk for major variation was found for medicines approved following multiple discussions (HR=1.98, 95% CI: 1.26 to 3.09) with a median time of 1.2 years, applications approved based on phase II trials (HR=2.58, 95% CI: 1.72 to 3.87), surrogate endpoints (HR=1.99, 95% CI: 1.44 to 2.74) and oncologic indications (HR=2.48, 95% CI: 1.78 to 3.45). CONCLUSIONS: Multiple ACDR discussions associated with limited supportive data are predictive for major postapproval variations. Moreover, our findings demonstrate that approval by the FDA and/or EMA does not pave the way to automatic approval in Israel. In a substantial per cent of the cases, submission of the same clinical data resulted in different safety and efficacy considerations, requiring additional supporting data in some cases or even rejection of the application in others.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Aprovação de Drogas Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans País como assunto: America do norte / Asia Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Aprovação de Drogas Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans País como assunto: America do norte / Asia Idioma: En Ano de publicação: 2023 Tipo de documento: Article