Similarly, the legislation authorizes FDA to require pharmaceutical companies to submit planned TV ads for agency pre-review.
And all TV and radio commercials for drugs will have to include a "major statement" of the product's side effects and contraindications.
This approach is more palatable for marketers than banning consumer advertising for the first year a drug is on the market.
The Institute of Medicine (IOM) panel that examined FDA drug safety policies backed such a moratorium, as did many members
of Congress. But the likelihood that even a one-year ad ban would violate First Amendment rights to free speech persuaded
the lawmakers to adopt the pre-review option instead.
Balancing Opinions
Giving FDA authority to require all drugs to conduct postapproval studies, to control labeling changes, and to require risk
disclosure in DTC advertising should reduce the need for broad use of REMS, says attorney Scott Lassman of WilmerHale. Moreover,
manufacturers that fail to follow the new rules or that air false and misleading ads would be subject to civil monetary penalties,
an added enforcement tool designed to boost public confidence in FDA's ability to control drug marketing and distribution
practices.
But some members of Congress believe that FDA has been slow to respond to emerging drug safety concerns because agency staffers
responsible for postapproval safety evaluation have been ignored and marginalized by those offices responsible for evaluating
and approving new drugs for market. Earlier this year, there was a push on Capitol Hill to establish a separate drug safety
office at FDA to give postapproval risk-assessment activities more clout. But both industry and agency officials opposed the
idea as likely to disrupt a balanced approach for weighing drug risks and benefits.
Instead, the legislation states that important decisions related to drug safety, such as mandating postapproval studies or
a REMS, should be evaluated by both the Office of New Drugs (OND) and postapproval safety experts in the Office of Surveillance
and Epidemiology (OSE). FDAAA calls for FDA to enhance communication between pre- and postmarket review staff and to report
to Congress in two years how well the agency is addressing safety issues identified by OSE.
At the same time, FDA will expand OSE operations with the help of additional user-fee revenues earmarked for postmarket surveillance
of any drug on the market—not just newly approved ones. OSE gains $30 million in fee revenues to contract with data banks
and health plans for access to additional information on drug adverse events. The agency envisions a "transformation of the
drug safety program" by tapping into population-based epidemiological and observational data to carry out targeted postmarketing
surveillance, to look at class effects of drugs, and to better detect safety signals. The final bill also boosts user fees
by an additional $225 million over five years, starting with $25 million more for fiscal year 2008, to support the extra work
involved in designing and overseeing the REMS program, monitoring labeling changes, and establishing the enhanced clinical
trials registry and results database.
By providing more resources for postmarket oversight, FDAAA may help elevate OSE's status. But the still-wide gulf between
the two operations was apparent at the joint meeting in July of FDA advisory committees for Endocrinologic & Metabolic Drugs
and for Drug Safety & Risk Management. The purpose was to evaluate concerns about increased risk of heart attacks for patients
taking GlaxoSmithKline's diabetes treatment Avandia (rosiglitazone) flagged by several postmarketing studies.
At this high-visibility session, OND staffers disagreed with their counterparts from OSE about removing Avandia from the market.
The safety experts said it would be better to pull a potentially safe drug from the market than to permit patient access to
an unsafe one, especially if alternative treatments are available. The advisory panels agreed that Avandia has serious adverse-event
problems, but, in the end, voted to keep the drug on the market with added safety warnings, as recommended by OND and Glaxo.
However, the contradictory messages from these FDA experts added to the perception that the agency does not have a solid grasp
on how to handle difficult drug safety decisions.
Many pharma executives agree with Novartis CEO Dan Vasella that FDA has become overly cautious in assessing new medicines
in the wake of all the highly publicized drug safety controversies. Vasella may be particularly upset that the European Medicines
Agency recently approved Novartis' diabetes drug Galvus (vildagliptin), while FDA has requested additional clinical trials
that will take several years to complete. FDA has put many drug applications on hold while it weighs the import of risk signals,
but some of those test products may never reach patients as a result.
Jill Wechsler is Pharmaceutical Executive's Washington correspondent. She can be reached at jwechsler@advanstar.com
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