Maximizing Regulatory Review Efficiency: The Evolution of the FDA OCE RTOR Pilot

To promote the efficient review of oncology drug applications, the US Food and Drug Administration (FDA) Oncology Center of Excellence (OCE) launched the Real-Time Oncology Review (RTOR) pilot program in 2018. RTOR allows FDA to review individual sections of eCTD modules of a drug application for oncology drugs in contrast to requiring the applicant to submit complete modules or the complete application before review is initiated. Initially, the program accepted only supplemental applications with simple study designs and easily interpretable endpoints, but the scope has since been expanded to include applications for New Molecular Entities (NME), and other applications with more complex features. Though many applicants experience faster approvals under RTOR, it is difficult to isolate the effect of the RTOR program on review timelines as its contribution is masked by other expedited programs like priority review and breakthrough therapy designation (BTD). This article discusses the expanded scope of RTOR, its interplay with other OCE initiatives to modernize regulatory review, summarizes Genentech’s experiences in planning RTOR submissions from February 2019 to July 2021, and provides considerations for the future of the program.

Joint Medicines Regulatory Procedure in the East African Community: Registration Timelines and Way Forward

A review of the East African Community (EAC) joint regulatory review process was conducted, registration timelines analyzed and key milestones, challenges and opportunities documented for the period of July 2015 to January 2020. A total of 113 applications were submitted for joint scientific review. Among these, 109 applications were assessed, 57 were recommended for marketing authorisation, 52 applications had queries to applicants and four applications were under review. A total median approval time for all products ranged from 53 to 102 days. The maximum time taken by a regulator to review the dossier was 391 days and the minimum time was 44 days. For applicants, the maximum time to respond to queries was 927 days and the minimum time was nine days. The total median time for granting marketing authorisation by the National Medicines Regulatory Authorities (NMRA) decreased from 174 to 39 working days in 2015 and 2019 respectively. However, not all EAC NMRA has granted marketing authorisation to all 57 products due to non-payment of applicable fees by applicants. Long regulatory approval timelines were contributed by limited capacity for timely scientific review of dossier by some NMRA, lack of online portal to share dossiersand assessment reports, delay in responding to queries by applicants and deficiencies in dossier. The metric tool and register of medical products submitted for joint scientific review had incomplete data. Challenges were identified and actions recommended to ensure regional regulatory system optimization, efficiency, transparency, sustainability and accountability.

Clinical trial emulation can identify new opportunities to enhance the regulation of drug safety in pregnancy.

From the perspective of most regulatory agencies, it is usually unethical to perform interventional clinical trials on pregnant people. While this policy recognizes the vulnerability of an expectant mother and unborn child, it has created a public health emergency for millions of pregnant patients through a dearth of robust safety data for many common drugs. To address this problem, we harnessed an enterprise collection of 2.8M electronic health records (EHRs) originally collected from routine primary care, leveraging the data linkage between mothers and their babies to create a surrogate for randomized, controlled drug trials in this population. To demonstrate the feasibility of our clinical trial emulation platform to stimulate new hypotheses for post-market drug surveillance, we identified 1,054 drugs historically prescribed to pregnant patients and developed a medication history-wide association study and follow-up evidence synthesis platform (leveraging expert clinician review and real-world data analysis) to test the effects of maternal exposure to these drugs on the incidence of neurodevelopmental defects in their children. Our results replicate known teratogenic risks and existing knowledge on drug structure-related teratogenic risks. Herein, we highlight 5 common drug classes that we believe warrant further assessment of their safety in pregnancy. We also discuss our efforts to develop a discovery-to-regulatory framework that could allow for pragmatic translation of our results to enhanced regulatory policy. Collectively, our work presents a simple approach to evaluating the utility of EHRs in guiding new regulatory review programs focused on improving the delicate equipoise of accuracy and ethics inherent to assessing drug safety in an extremely vulnerable patient population.

Community Cooperative: A New Legal Form for Enhancing Social Capital for the Development of Renewable Energy Communities in Italy

This paper investigates the suitability of the community cooperatives (CC) model for the implementation of renewable energy communities (REC), as prescribed by art. 22 of EU Directive 2018/2001, and temporarily transposed into the Italian law by art. 42-bis of the Law Decree n. 162/2019. The hypothesis explored analyses the potential synergies between RECs and CC, based on their similarities. In particular, the article takes into consideration: the actors involved in both the RECs and the CCs; the geographical scope in which they develop, and the purposes that these two legal forms intended to achieve. Through a literature review and the analysis of EU, national and regional legislations, the paper aims at (1) clarifying the main features of RECs and the CCs in Italy; (2) exploring the main differences between CCs and the other legal forms of cooperative (e.g., mutual cooperative, cooperative benefit, etc.) and assessing the extent to which CCs are more suitable to implement renewable energy communities. As a result of the literature and regulatory review, several similarities between CCs and RECs can be detected, particularly, in reference to the strategic valorization of the cooperation between citizens and the local public entities. These similarities allow the authors to provisionally conclude that, in Italy, CCs may be adopted as a tool to implement RECs.

Regulatory Procedure of Post Approval Changes and Comparative Requirements of EU and USA Regulatory Regions

Aim: The current research paper describes the “Regulatory procedure of post approval changes and comparative regulatory requirement of EU and USA regulatory regions”. Study Design: The present study is a type of Retrospective analysis of Regulatory requirements and the reviewed data was subjected to systemic review. Understanding of the same led to several observations regarding regulatory requirements of EU and USA regulatory regions. Place and Duration of Study: The present study was carried out at Amneal Pharmaceutical Ltd., Ahmedabad, Gujarat, India from January, 2021 to April, 2021. Methodology: Several guidelines were profoundly reviewed to compare the requirements of post approval changes in EU and USA regulatory regions. Various regulatory review aspects were focused i.e. requirements for manufacturing sites addition/or Transfer, process parameters, container and closures, packaging and labelling of medicinal products. Results: The post approval changes in manufacturing sites of solid or semisolid dosage form considered as a major change for USA while considered as Moderate change for EU. The transfer of manufacturing section is major variation for USA while it is a minor but immediate inform type for EU. Change in manufacturing processes, containers, labelling section of sterile products considered as major variation for both. Semisolid and solid categories are falling under the same type of variation for EU and USA regulatory regions. Conclusion: This work demonstrated that the drug approvals in US, EU are the most demanding globally and the available guidance and procedures for the triggered changes are clear in both countries. Applicant should have scientific rationale to any change pertaining to Approved product ; Since the all change control are falling under the scope of Audit, so Applicant should maintain the all the records online.

Human Abuse Liability Assessment of Tobacco and Nicotine Products: Approaches for Meeting Current Regulatory Recommendations

Many regulatory bodies now recommend that tobacco product manufacturers provide information regarding new tobacco products’ abuse liability to inform regulatory authorization of currently marketed tobacco products or new product applications (including premarket tobacco product applications in the United States). In addition, the US Food and Drug Administration (FDA) recommends including this information as part of modified risk tobacco product applications. Regulators, including FDA, and many public health officials and researchers consider abuse liability assessment a model which predicts the likelihood that the use of the tobacco product would result in addiction and be used repeatedly or even sporadically resulting in undesirable effects. Abuse liability of a new, potentially reduced harm product can also inform its ability to substitute completely for more harmful tobacco products. While many methods exist, no standard tobacco product abuse liability assessment has been established. The purpose of this review is to provide background information and practical recommendations for human abuse liability testing methods to meet tobacco regulatory needs. A combination of nicotine test product pharmacokinetic, subjective effect and/or behavioral response, and physiological response data relative to comparator products with known abuse liability satisfies some regulatory requirements. Implications: This review provides a practical inspection of the current, international regulatory recommendations for abuse liability assessment of tobacco and regulatory review of such information within the United States and also recommends study designs and methods for abuse liability testing of tobacco products based on scientific and regulatory knowledge. Given that tobacco product abuse liability testing is of increasing interest to regulatory bodies globally, especially with the emergence of novel tobacco products, this timely work provides background and functional recommendations for tobacco product abuse liability testing.