The Tradeoffs Involved in New Drug Approval, Expanded Access, and Right to Try

This note explains some of the concepts swirling around in the media right now, relating to medicine approval. Much of what follows appears (or will appear) in an article on the U.S. “right to try” law, which I recently wrote with a colleague at the University of Bourgogne in Dijon, France.  Some of the background discussion will be useful here.

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Vaccine Approval 101

Here’s a tutorial on the usual process for vaccine development, testing and approval, for folks tracking the new coronavirus (COVID-19).  In brief: it will take a while and very large clinical trials to get a coronavirus vaccine approved at FDA. But preapproval testing is likely to happen on the ground where the coronavirus is spreading, and there is a potential for expanded access (to the unapproved vaccine) in the meantime.

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FDA’s Abandoned Proposal to Require Reporting of Data Falsification

On August 6, FDA announced that Novartis’s application for approval of Zolgensma contained “manipulated” data and that the company knew this while the application was pending, but did not tell the agency.  Three days later a group of Senators wrote FDA a letter asking, among other things, why the agency had withdrawn a proposed regulation that would have required “sponsors of certain clinical trials to promptly report suspected data falsification to FDA.”  It may be helpful to review the concerns that people raised.  Details after the jump.

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The Big “Data Manipulation” Story

One of the big end-of-summer news stories at FDA is the agency’s August 6 statement that Novartis submitted “manipulated” data to support approval of its gene therapy product, Zolgensma.  According to FDA, Novartis knew about the manipulation before FDA approved the product, and yet the company didn’t disclose the manipulation to the agency until June 28 — more than a month after approval. 

A group of Senators (including Presidential hopefuls…) has said the company’s “greed” cannot be condoned and that FDA should hold the company accountable for its “malfeasance.”  They have also asked FDA why it withdrew a proposed regulation requiring companies to report data falsification.

I take you through a brief tour of the publicly available information, after the jump.  In my next post, I’ll explain the abandoned data falsification reporting proposal.

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Patent Term Restoration – Denied!

In 1984, Congress amended the Patent Act to permit a patent extension for certain types of inventions — many (but not all) of those subject to premarket testing and federal government approval requirements.  Some people call this patent term extension; others call it patent term restoration.  Between enactment of the statute in September 1984 and the end of March 2017, the Patent and Trademark Office received 1113 applications for patent term extensions in connection with new drugs and biological products.  But by April 1, 2018, it had granted only 664 extensions.  Why do companies not get patent term extension?  Usually because this wasn’t FDA’s first approval of the active ingredient. 

More after the jump.

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The Puzzling Uncertainty about Umbrella Exclusivity

In the middle of July, FDA announced a public hearing on facilitating competition and innovation in the biologics marketplace.  Following the hearing, September 4, comments were accepted in the docket (FDA-2018-N-2689) until last Friday, September 21.

The agency’s Federal Register notice listed a series of questions, but one of them struck me — at the time — as surprising.  FDA asked for comment on the “potential application” of “umbrella exclusivity” for biologics.  Why surprising?  Because I would not have thought it controversial.  More than five dozen comments have been filed, though, and at least one company (Mylan) has argued that the statute doesn’t permit the umbrella.

So it seems like it might be timely to back up and explain this.

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The Patent Dance: A Reasonable Response to the Specter of Reasonable Royalties

Based on the dispute between Celltrion and Genentech over Celltrion’s biosimilar version of Rituxan (rituximab), it should be clear that interpretive disputes relating to the patent dance in the 2010 biosimilar law are far from over.  The patent dance is indeed the gift that keeps on giving.  And some of the interpretive conundrums lead to ridiculous results, at least, if you’re at all interested in saving litigants money.  Look at what Genentech recently found itself doing.

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Biosimilar Patent Litigation: the “Finish What You Started” Rule

As earlier posts on this blog have noted (here and here), the Supreme Court’s 2017 ruling in Sandoz v. Amgen effectively put an end to arguments that biosimilar applicants can be forced to participate in the “patent dance” with biologics innovators.  Even still, there are lots of interesting issues relating to the patent litigation provisions of the 2010 biosimilars law.  Here’s one percolating in the courts right now:  can a biosimilar company start to dance and then change its mind?  Or does it have to finish what it started?

This arises in a dispute between Genentech and Celltrion over a biosimilar copy of Rituxan (rituximab).  There’s a second issue in this dispute, which I will describe in another blog post.  First some background, and then I’ll unpack the litigation.

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FDA Law SSRN Reading List – December ’17 & January ’18

Very few folks posted papers in December and January relating to FDA law, but hopefully the February law journal submission cycle will yield a rich crop.  Here are two essays and one article of potential interest – one each on medical devices, biological products, and food.  (I am excluding my own paper.)

Sarah Duranske, Reforming Regenerative Medicine Regulation

In this article forthcoming in the Georgia State Law Review, Duranske (currently a fellow at Stanford) (* edited to correct the spelling of her last name!) evaluates proposals for regulation of regenerative medicine.  She has several interesting ideas tucked in here, any of which could have been the basis for an article in its own right.  Section I contains a nice overview of the current regulatory paradigm for therapies that fall within the umbrella of “regenerative medicine” — including the recently enacted accelerated approval pathway for “regenerative medicine advanced therapies.”  Section II responds to deregulation arguments, arguing that FDA regulation is necessary to protect patients and to ensure the development of meaningful data.  Much of this retreads familiar ground, but the discussion of “Baptists and bootleggers” alliances with respect to regenerative medicine is very interesting.  This phenomenon is pervasive in food and drug law and merits more discussion in scholarship.  Section III is where the article gets interesting.  Here, she considers proposals for “adaptive licensing” of regenerative products.  The basic idea is that FDA would approve a product on the basis of less evidence, but would restrict access while the sponsor gathered more evidence from clinical use.  She characterizes adaptive licensing as a type of adaptive management — a particular type of process that an agency might use to produce a regulatory outcome. She then assesses the suitability of regenerative medicine for adaptive licensing by running it through the various rationales in the administrative law literature for adaptive management at agencies.  This leads her to the conclusion that the benefits of adaptive licensing do not outweigh its risks.  Section IV contains a brief discussion of her proposals — for instance, shifting some regenerative therapies to the more loose regulatory paradigm governing human tissue and cell products.  But I wanted to read much more about her ideas.

Jane R. Bambauer, Dr. Robot

In this essay published in the UC Davis Law Review, Professor Bambauer considers whether health and medical artificial intelligence (AI) should be regulated more like physicians or medical devices.  When the application is a “knowledge” app rather than a “measurement” app, she argues, physicians are the better analogy.  Some of the duties of a physician (such as the duty of competence and the duty of confidentiality) translate well, but she is more guarded about other rules (rules of informed consent, for instance, and the duty to disclose conflicts of interest).

Laurie Beyranevand, Regulating Inherently Subjective Food Labeling Claims

In this essay published in Environmental Law, Professor Beyranevand essentially argues that FDA should ban claims like “natural” and “healthy” in food labeling.  The statute imposes clear rules governing specific types of claims, such as “health claims” and “nutrient content claims.”  She is focused on claims that are not covered by these specific claims-authorizing provisions of the statute.  And she argues that FDA should subject these claims to a standard of “significant scientific agreement” — that is, permitting them only if there is significant scientific agreement.  The FDCA already uses this standard for health claims, which generally characterize a specific relationship between a food product and a health condition or disease.  She also believes it would be virtually impossible to support a claim like “natural” and “healthy” under this standard.  So, in essence, she is arguing for a ban.  Finally, although the federal courts have concluded that the First Amendment requires FDA to consider disclaimers for health claims that lack significant scientific agreement, she contends that the First Amendment is no impediment to the proposal.  I think the idea is that if a claim is inherently subjective, then a disclaimer isn’t going to clear things up (there’s x amount of data, but not y).  It’s just going to confuse consumers more.

You Can Dance if You Want To

On December 14, the Federal Circuit handed down the latest decision in the dispute between Sandoz and Amgen concerning the process for patent litigation under the Biologics Price Competition and Innovation Act amendments to the Public Health Service Act (PHSA). The matter was on remand from the Supreme Court. Judge Lourie, writing for a unanimous panel, concluded that Sandoz had not waived its argument that Amgen’s state law claims were preempted by federal law and, moreover, that those state law claims were indeed preempted.  A dive into the decision below, with apologies for the length. Continue reading “You Can Dance if You Want To”