![Page 1: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/1.jpg)
An agency of the European Union
Adaptive Pathways to accelerate Patient access/medicines development
The European Medicines Agency approach
Presented by: Prof Guido Rasi,
EMA Executive Director
![Page 2: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/2.jpg)
Key factors in R & D
• Medical need and available option
• Business model and clinical trial design
• Complexity of MA process
• Predictability of assessment outcomes
• Trust & Risk perception
• Economic & Social Environment (NHSs,insurances, solidarity, etc.)
• Patent protection status
![Page 3: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/3.jpg)
Adaptive Licencing / Adaptive pathways
…..”The adaptive licencing process is based on a
prospectively-planned process. It starts with the early
authorisation of a medicine in a restricted patient population,
followed by iterative phases of evidence-gathering and the
adaptation of the marketing authorisation to allow broader
patient populations to access medicine…”
Presentation title (to edit, click View > Header and Footer) 2
![Page 4: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/4.jpg)
“Adaptive licencing concept”
Final target indication in
blue, patient group with
highest need in red
the sponsor
could follow
two strategies
1st approval 2nd approval
1st approval
Time
![Page 5: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/5.jpg)
Drivers and enablers of Adaptive
Licensing (Adaptive pathways)
Drivers
•Patient expectations: demand for timely access and
emphasis on unmet medical need
•Emerging science: fragmentation of treatment
populations and early disease interception
•Healthcare systems under pressure: sustainability and
rise of payer influence
•Pharma/investors under pressure: sustainability of
drug development
![Page 6: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/6.jpg)
Drivers and enablers of Adaptive
Licensing (Adaptive pathways)
Enablers
•Improved understanding of disease processes, better
knowledge management
•Innovative clinical trial designs
•Rapid learning systems in the healthcare environment
•Bringing patients to the table: understanding acceptable
uncertainty
•From prediction to monitoring
•Targeted prescribing
![Page 7: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/7.jpg)
Who are the players?
What is their main concern?
• Patients/Regulators:
• Investors/Industry:
• Payers/HTA:
Enhanced risk
Reduced revenues
Expanded use
![Page 8: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/8.jpg)
Evidence
Access
• New methodology to generate evidence
• Redefine benefit/risk
• Adaptive trials?
• Managed entry
• Adaptive prices?
![Page 9: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/9.jpg)
How can we address the access vs. evidence
trade-off?
• Allow timely access for patients to address unmet medical need: “the safest drug that arrives too late is of no benefit to a patient”
• Provide an environment supportive of innovation
• Provide ‘complete’ information on benefits, risks, relative effectiveness
8
Competing objectives
![Page 10: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/10.jpg)
What needs to be in place to enable adaptive
pathways? 1/2
• Culture of collaboration with patients and physicians to agree on level of unmet need and acceptable uncertainty
• Collaboration of sponsor, regulators, payers/HTA bodies throughout the life-span of a product
9
![Page 11: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/11.jpg)
What needs to be in place to enable adaptive
pathways? 2/2
• Rapid learning systems for data generation across whole life-span to minimise realised risk (as opposed to inherent risk)
• Tools to provide reasonable assurance of appropriate Rx
10
![Page 12: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/12.jpg)
Product on the market
HTA / Payer
Assessment
Regulatory
Assessment
Clinical
Development
A systems approach
11
Marketing
Authorisation
Coverage
Decision
Regulatory
Submission
Comprises the entire life-span:
Development licensing coverage utilization
monitoring
•Adaptive Licensing
•Adaptive Pathways
![Page 13: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/13.jpg)
What will change with adaptive pathways?
Transition from …
Magic moment life-span management
Prediction monitoring
RCT only toolkit for evidence generation
Big populations small populations
Focus on licensing focus on patient access
Open utilisation managed utilisation
12
![Page 14: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/14.jpg)
Launch of the Adaptive Licencing Project
On March 19 the Agency launched the project:
What is this concept about?
•early access for patients starting from a niche indication
with a high unmet medical need,
•continued collection of data (both on efficacy & safety) in
this niche indication and extension to broader patient
groups.
•Involve HTAs, patient representatives and health care
professionals throughout.
13
![Page 15: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/15.jpg)
Adaptive Licencing Project: An experiment
Advantages: Early approval and access to patients with
real need, with involvement of all stakeholders and
prospective planning to collect data
Risks: Increased number of withdrawals; uncertainties
may be higher in the initial licencing
14
![Page 16: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/16.jpg)
Conclusion
• We are on a trajectory to more adaptive pathways
• The speed of change will depend on how fast preconditions can be met
• Adaptive pathways are likely the best (only?) way to cope access with evidence
• EMA is currently running the ‘Adaptive Licensing Pilots Project’; to date: 26 products submitted, 7 selected for pilot
15
![Page 17: Adaptive Pathways to accelerate Patient access/medicines ... · development . The European Medicines Agency approach . Presented by: Prof Guido Rasi, ... model and clinical trial](https://reader035.vdocuments.mx/reader035/viewer/2022071100/5fd94a997df7312f372e8646/html5/thumbnails/17.jpg)
16
Thank you
European Medicines Agency
30 Churchill Place
London E14 5EU
www.ema.europa.eu