Generating Evidence from Expanded Access Use of Rare Disease Medicines: Challenges and Recommendations

Tobias B. Polak, David G. J. Cucchi, Joost van Rosmalen, Carin A. Uyl-de Groot, Jonathan J. Darrow

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)

Abstract

Patients with rare diseases often have limited or no options for approved treatments or participation in clinical trials. In such cases, expanded access (or “compassionate use”) provides a potential means of accessing unapproved investigational medicines. It is also possible to capture and analyze clinical data from such use, but doing so is controversial. In this perspective, we offer examples of evidence derived from expanded access programs for rare diseases to illustrate its potential value to the decision-making of regulators and payers in the European Union and the United States. We discuss ethical and regulatory aspects to the use of expanded access data, with a focus on rare disease medicines. The heterogeneous approach to expanded access among countries within the European Union leaves uncertainties to what extent data can be collected and analyzed. We recommend the issuance of new guidance on data collection during expanded access, harmonization of European pathways, and an update of existing European compassionate use guidance. We hereby aim to clarify the supportive role of expanded access in evidence generation. Harmonization across Europe of expanded access regulations could reduce manufacturer burdens, improve patient access, and yield better data. These changes would better balance the need to generate quality evidence with the desire for pre-approval access to investigational medicine.
Original languageEnglish
Article number913567
JournalFrontiers in pharmacology
Volume13
DOIs
Publication statusPublished - 23 May 2022

Keywords

  • compassionate use
  • drug regulation
  • expanded access
  • perspective
  • policy recommendation
  • rare disease
  • real-world data

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