The Emerging Role of Postmarketing Clinical Research: Regulatory Issues, Strategic Drivers and Overall Trends
| Publication Date | May 2008 |
|---|---|
| Publisher | Business Insights |
| Product Type | Report |
| Pages | 121 |
| ISBN Number | not applicable |
| Product Code | RBI00228 |
Summary
Emerging Role of Postmarketing Clinical Research: Regulatory Compliance, Product Differentiation and Key Issues
Report overview
The pharmaceutical industry has recently endured intense speculation and negative publicity as a result of high profile product withdrawals caused by inadequate safety profiles. Regulatory bodies have responded swiftly; the FDA now requires mandatory surveillance data submission for drugs under increased scrutiny, and the EMEA is close to implementing similar strategies as part of drug policy harmonization initiatives for phase IV trials. Postmarketing clinical research has also become a key feature of product lifecycle management. Phase IIIb/IV trials are increasingly being used in company specific initiatives to provide strategic guidance in areas such as payor approval and reimbursement, indication expansion, franchise development and marketing.
'Emerging Role of Postmarketing Clinical Research' is a new report published by Business Insights that uses detailed case studies and market scenarios to examine the latest issues surrounding phase IV trial applications. The potential to leverage competitive advantage with postmarketing research is assessed by measuring the implications for formulary access, product marketing, indication expansion and reimbursement coverage. This report also explores the regulatory issues and requirements affecting mandatory postmarketing trial conduct and identifies the key components of effective phase IV trial design and completion.
Identify the latest regulatory developments affecting postmarketing clinical research, use case studies to evaluate recent phase IV trial implementations and understand the competitive potential of successful trial designs...
Key findings...
- US Government initiatives have almost doubled the number of post-approval commitments since 2003-2004, following growing numbers of black box warnings and late-stage drug withdrawals.
- The EMEA and FDA will continue to harmonize regulatory approaches for phase IV monitoring and study commitments in areas of common interest, including pandemic vaccines, medicines for children, rare diseases and cancer medicines.
- Big Pharma companies conducted 145 (75%) of the 243 industry trials publicly registered with the FDA between 1998-2007. Of these trials, 109 were independently undertaken by big pharma as strategic initiatives. Average Big Pharma patient numbers (1743) far exceeded those of mid-tier biopharma companies (952).
- The implementation of a networked model of stakeholder involvement has become crucial to the success of drug developers by enabling access to new development platforms and facilitating effective trial management/sponsorship
- Active controls featured in 71 industry-sponsored trials, the majority of which were conducted under randomized, open label, parallel assignments. Of the 14 registered trials for medical devices, seven were undertaken with active control comparators in an interventional setting.
Key questions answered...
- How will the rising significance of postmarketing research cause pharma and biotech companies to restructure?
- How can phase IIIb/IV trials be used to successfully manage product lifecycles and market positioning?
- To what extent will the increased regulatory demands over postmarketing data collection and submission impact the pharma industry?
- What are the precise requirements for clinical data submission and how are these relevant to company-specific initiatives?
- How can market competition influence trial design and conduct?
- How has the FDA Amendment Act of 2007 affected prescription drug regulations and postmarketing commitment criterion?
Key issues examined...
- Revised R&D resource allocation. As regulators and companies increasingly apply postmarketing surveillance to justify product positioning and long term safety/efficacy profiles, financial investment in phase IIIb/IV trials will grow at a relatively higher rate than other stages of clinical development.
- New regulatory policies. The FDA will soon require mandatory submission of phase IV surveillance data over a large patient population. In addition, products approved on the grounds of accelerated procedures, or those which incorporated surrogate endpoints/biostatistical modelling techniques in early phase data, will require further commitment studies after conditional approval.
- Impact on lifecycle management. Marketing and product labelling companies are under pressure to justify claims through postmarketing study data submission, whilst indication expansion development strategies require postmarketing product data submission to support applications for extended approval.
- Importance of trial design/management. With multiple applications for trial data, trial design and management is crucial in identifying potential issues or adjustments as early as possible. Proactive adaptive designs and electronic data capture techniques are necessary for the ongoing analysis of collated datasets.
Top reasons to purchase this report
- Assess the industry impact of recent regulatory developments in postmarketing commitment trials and surveillance studies
- Use detailed case studies to understand the influence of phase IV trials upon lifecycle management, indication expansion and reimbursement
- Identify how postmarketing strategies can enhance product differentiation, market development and formulary coverage
- Evaluate the operational objectives and trial management/outsourcing trends for phase IV trials across key industry sectors
Content
- The Emerging Role of Postmarketing Clinical Research Executive Summary
- Background to postmarketing research
- Mandatory postmarketing trial requirements
- Phase IV trials for market development
- Impact of competitive pressures and pipeline strength on phase IV trials
- Appropriate trial design
- Chapter 1 Background to Postmarketing Research
- Summary
- Introduction
- The clinical trial landscape
- Priorities and end-points in clinical development
- Safety and full market approval
- Health-economic arguments
- Life cycle management
- Product positioning and differentiation
- Chapter 2 Mandatory Postmarketing Trial Requirements
- Summary
- FDA regulations for postmarketing trials
- Postmarketing commitment trials (PMC)
- Direct and indirect drivers for PMC conduct
- Indirect driver: Public health priorities
- Direct driver: Orphan drugs
- PMC Case Study: Iressa
- PMC Case study: Vioxx
- Postmarketing surveillance studies (PMS)
- PMS study drivers
- PMS design limitations
- FDA Amendment Act (FDAAA)
- Industry implications of FDAAA
- Public submission of datasets
- EMEA
- Terms of marketing approval agreement
- Joint FDA-EMEA drug monitoring initiatives
- Trials for improved clinical guidance
- Summary
- Chapter 3 Phase Iv Trials for Market Development
- Summary
- Introduction
- Phase IV trials for formulary access
- US - the importance of comparative effectiveness
- EU - the importance of added therapeutic value
- Postmarketing trials for indication expansion
- The Rx to OTC switch
- off-label physician use and risk management
- Product development for indication expansion
- Line extensions
- Case Study: Line extension launch profiles
- Case study: Zoloft (sertraline)
- Reformulations
- Follow-on compounds
- Phase IV trials for multiple indication expansion strategies
- Case study: Zyprexa
- Case study: Alimta (Pemetrexed)
- Enhanced market positioning
- Marketing regulations
- Head to Head trials
- Case study: Zyprexa vs Risperdal
- US Direct to Consumer (DTC) regulations
- EU marketing regulations
- Influence of sponsorship on trial endpoint
- Impact of budget constraints
- Big pharmaceutical firms
- Mid tier biopharma and biotechnology firms
- Big pharma's scale advantage
- Case study: Novartis
- Case study: Glivec (Imatinib mesylate)
- Case study: Aclasta (zoledronic acid)
- Misuse of phase IV trials and regulator scrutiny
- Chapter 4 Impact of Competitive Pressures and Pipeline Strength on Phase Iv Trials
- Summary
- The impact of competition
- Market scenario: Cardiovascular
- Case study: Diovan
- Market scenario: oncology
- Antineoplastics - market drivers for phase IV trials
- Summary
- Chapter 5 Effective Phase Iv Trial Design
- Summary
- Introduction
- Endpoint designation and trial purpose
- Patient and physician recruitment
- Recruitment bottlenecks
- Design limitations
- Study design
- Data management and adaptive clinical trial designs
- Operational management
- Chapter 6 Appendix
- Primary research methodology
- Glossary
- Index
- List of Figures
- Figure 2.1: Projected R&D spend by phase 2005-2009 ($bn),
- Figure 2.2: Postmarketing research and product lifecycle
- Figure 3.3: NDA and ANDA requirements for postmarketing status reports
- Figure 3.4: Biological product reporting requirements for postmarketing status reports
- Figure 3.5: Sales of Iressa in the US, 2003-2007 ($m)
- Figure 3.6: Vioxx sales in the US, 2003-2004 ($m)
- Figure 3.7: Implication of FDA requirement of REMS
- Figure 3.8: Implications of tightened FDA policies
- Figure 4.9: Market drivers for postmarketing research
- Figure 4.10: Declining return on R&D investment (US, 1990-2004)
- Figure 4.11: Payor's influence gain in prescribing decisions; US market, share of voice, 2007
- Figure 4.12: Marketing and product development strategies using phase IV trials
- Figure 4.13: Phase IV for product lifecycle management
- Figure 4.14: Sales summary for Zoloft in the US, 2000-2006
- Figure 4.15: Use of postmarketing trials for lifecycle management of Zyprexa, US and EU5, 2000-2007 ($m)
- Figure 4.16: Effect of indication expansion on sales of Alimta in the US, 2004-2007 ($m)
- Figure 4.17: Big pharma phase IV trials by strategic purpose, USA, 1998-2007
- Figure 4.18: Number of phase IV trials by different 'Big pharma' companies
- Figure 5.19: Impact of market competition on phase IV trial design and objective
- Figure 5.20: Global cardiovascular product pipeline, Q1 2008
- Figure 5.21: Diovan sales in the US, 1998-2007 ($m)
- Figure 5.22: Global cancer product pipeline, Q1 2008
- Figure 5.23: Number of phase IV trials vs sales growth, USA, 2003-2007
- Figure 6.24: Factors influencing successful Phase IV conduct
- Figure 6.25: Advantages and disadvantages posed by phase IV study designs
- List of Tables
- Table 2.1: Phase IIIb vs Phase IV postmarketing studies
- Table 4.2: on-label indication expansion drivers
- Table 4.3: Declining incremental sales revenue return with subsequent line extension launches
- Table 4.4: Zyprexa- Pivotal phase IV trials for indication expansion and formulary access
- Table 4.5: Industry vs non-industry trial objectives
- Table 4.6: Trial characteristics by commissioning organization, 1998-2008*
- Table 6.1: Influence of study participation on subsequent drug prescribing
- Table 6.2: Advantages and disadvantages of using adaptive clinical trial designs
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