The Food and Drug Administration (FDA) is facing scrutiny for delaying the approval of promising medications due to manufacturing facility-related deficiencies, even when the drugs demonstrate safety and efficacy. This cautious approach is raising concerns about hindering patient access to potentially life-improving treatments.
Acromegaly Treatment Delayed
One recent example involves a treatment for acromegaly, a rare hormonal disorder characterized by swelling, fatigue, and high mortality. While the already-approved drug octreotide offers some relief, CAM2029, a longer-acting and more effective version developed by Camurus, has been delayed indefinitely due to FDA concerns about its manufacturing process. This decision disregards evidence suggesting the medication is well-tolerated and improves patients’ lives.
Zolbetuximab Approval Timeline
Similarly, zolbetuximab, a drug designed to treat gastric/gastroesophageal cancer, was initially rejected by the FDA due to manufacturing issues. Clinical trial results indicated that zolbetuximab improved median progression-free and overall cancer survival by 2-3 months compared to chemotherapy alone. While the Japanese counterpart of the FDA approved the drug in March, the FDA only granted approval seven months later. The FDA highlighted the application’s priority review, fast track, and orphan drug designation, the delay raises questions about the efficiency of the approval process.
Manufacturing vs. Efficacy
According to the FDA’s Center for Drug Evaluation and Research (CDER) Director Patrizia Cavazzoni, the agency's approval standards are not getting stricter. Instead, she suggests there is a decline in the quality of manufacturing facilities. However, critics argue that timely and targeted recalls of faulty batches would be a better alternative to rejecting entire medications. They point out that if the FDA withdrew approval for metformin due to manufacturing issues, patients would face challenges in managing their blood sugar levels, potentially impacting life expectancy.
Call for Reform
To address these issues, there are growing calls for legislative reform. Experts suggest amending the Food, Drug, and Cosmetic Act to clarify that manufacturing issues should not be the sole basis for drug rejections. Instead, the FDA should collaborate with manufacturers on recalls of faulty batches if a drug meets safety and efficacy requirements. This tailored and flexible approach aims to improve patients’ lives while ensuring their safety.
