2018: A Year of Innovation, Efficiency, and New Advances in Drug Therapy for the American Public
By: Janet Woodcock, M.D.
The beginning of a new year is a good opportunity to look back over the past year and see how all the valuable work done at FDA's Center for Drug Evaluation and Research (CDER) results in bringing important new drug therapies to patients in need. It is particularly clear that our work is about people—and advancing patient care and public health.
In 2018, we approved many new drugs never before marketed in the United States, known as "novel" drugs, along with a wide variety of approvals of drugs already on the market to put to new and innovative uses. Many of these new approvals will have a significant impact on improving—and indeed, saving—countless patients' lives.
This past year was important for meeting the critical needs of people suffering from rare diseases who will benefit from these advances. Among many new orphan therapies, in 2018 CDER approved the first drug to treat patients with a rare, inherited form of rickets, a condition that leads to impaired bone growth and development. Also, CDER approved the first orally-administered drug to treat Fabry disease, a rare and serious disorder that can cause many adverse symptoms, including pain and burning in the hands and feet, and damage to the kidneys and heart. We also approved a new drug to treat patients with phenylketonuria, a rare dietary condition in which patients are born with an inability to break down protein-containing foods and certain sweeteners, and which can lead to brain and nerve damage.
Many of CDER's other 2018 approvals will provide hope, relief, and enhanced quality of life for patients in need:
- CDER approved the first drug ever to treat smallpox, the first of a new class of drugs to treat patients with HIV-1 infection who have failed other therapies, and a new single dose treatment for influenza (flu).
- CDER approved a new drug to treat seizures in patients with the rare and severe forms of epilepsy Lennox-Gastaut syndrome and Dravet syndrome, and a second drug to treat seizures in patients with Dravet syndrome. Previously there had been no FDA-approved therapy for Dravet syndrome. We approved three new drugs—all in a new drug class—to treat patients with migraines. Additionally, CDER approved the first therapy to treat multiple sclerosis in children.
- We approved new advances for certain patients with breast cancer, prostate cancer, lung cancer, and thyroid cancer. We also approved a variety of new drug therapies to treat blood cancers and other blood disorders such as acute myeloid leukemia (a type of blood cancer), and classical Hodgkin lymphoma (a type of cancer of a part of the immune system called the lymphatic system); and thrombocytopenia (a deficiency of platelets in the blood) in patients with chronic liver disease scheduled to undergo a medical or dental procedure.
- We also approved seven new biosimilars, which will further help to create competition, increase patient access, and potentially reduce the cost of important biological drug therapies.
Of course, even the best drug therapies are of no use to patients if they are stuck in the approval process. I want to recognize the importance of the efficiencies with which we brought these new therapies to approval.
- Under the Prescription Drug User Fee Act (PDUFA), drug developers are assessed user fees that provide FDA with the additional resources needed to maintain an efficient and effective review process. PDUFA includes goal dates for application review agreed to with the pharmaceutical industry and approved by Congress. In 2018, CDER met its PDUFA goal dates for 100 percent of the novel drugs approved (59 of 59).
- We use four specific regulatory tools to ensure prompt and efficient expedited review for approval decisions: Fast Track, Breakthrough, Accelerated Approval, and Priority Review. Each serves a purpose in helping to speed a drug’s development or review. In 2018, 73 percent of CDER’s novel drug approvals (43 of 59) were designated in one or more of these expedited review categories. These innovative approval methods can bring a therapy to patients months or even years sooner than if their application went through the standard review process.
- In 2018, CDER approved 95 percent of its novel drug approvals (56 of 59) on the first cycle. A "cycle" is the time from when CDER accepts an application for a new drug until we decide about whether or not to approve it. A typical cycle generally takes somewhere between six months to a year, but sometimes things can go wrong. For instance, miscommunication, omissions of important data, and other issues in these complex applications, can lengthen the time it takes to complete a review and may also result in the need for a second cycle, further delaying access to the drug for patients in need. From 2011 through 2017, CDER approved 250 novel drugs, of which 205 (82 percent) were approved on the first cycle. Our consistently high first cycle approval rate reflects CDER’s commitment to working closely with applicants as they design their studies and build their application data. It also reflects our efficiency in getting new therapies to patients as quickly as possible.
- Although regulatory processes differ widely between FDA and those of regulatory agencies in other countries, 42 of the 59 novel drugs approved in 2018 (71 percent) were approved in the United States before receiving approval in any other country.
More details about CDER’s new drug therapy approvals—including many specific examples of notable new approvals for the year—are available in our annual New Drug Therapy Approvals report.
I am proud to be part of a team of dedicated professionals who work tirelessly to find innovative, efficient, and, most importantly, safe ways to bring new therapies to patients as quickly as possible.
Tomorrow I will share my thoughts on CDER’s drug safety efforts for 2018.
Janet Woodcock, M.D., is Director of FDA’s Center for Drug Evaluation and Research