The landscape of rare disease drug development is undergoing significant transformation as industry experts advocate for more flexible and patient-centered approaches to clinical research and regulatory approval pathways.
Evolving Clinical Trial Methodologies
Traditional randomized controlled trials often prove impractical in rare disease settings, leading to increased adoption of non-interventional and observational studies. Dr. Brad Carlin, senior advisor of data science and statistics at Cencora, emphasizes that statistical tools like propensity score matching can help address potential bias in non-randomized designs.
"Sometimes patients have been enrolled in a patient registry for a long time and a new treatment becomes available," Carlin explains. "If we then give this treatment to a subset of the patients, each can act as their own control just by looking at what happens before and after the intervention."
Dennis Earle, senior director of development consulting & scientific affairs, notes the varying quality of non-interventional study data: "Some disease registries have data approximating clinical trial data in terms of rigor, and others are a lot looser."
Quality of Life and Innovative Endpoints
The focus in rare disease development increasingly extends beyond survival metrics to encompass quality of life improvements. This shift requires careful coordination with regulatory authorities to ensure such endpoints are considered meaningful for development programs.
Dr. Erika Wissinger, senior director within market access and healthcare consulting, emphasizes the importance of comprehensive benefit assessment: "It's the holistic view of the overall benefit to the patient, to the caregiver, and, in some cases, the overall societal benefit; for example, ability to return to the workforce."
Regulatory Innovation and Support
Regulatory bodies are demonstrating increased flexibility and support for innovative approaches. The FDA's Complex Innovative Trial Design (CID) Meeting Program offers sponsors additional opportunities to discuss novel trial designs with the agency. Similarly, the EMA has published guidance on single-armed trials in rare diseases.
"The CID program is just one example of FDA's recent encouragement to use Bayesian method, causal inference tools, and other novel methods to try to bridge some of the gaps that arise when you can't do traditional randomised trials," notes Carlin.
Patient-Centric Development Strategy
A successful rare disease development program requires putting patients at the center of all considerations. This includes leveraging telemedicine to reduce patient burden and implementing innovative access pathways.
"There are a number of clinical evaluations, including limited history, adverse event assessments, and drug administration that can be done by remote nursing staff to reduce the burden on the patient," Earle points out.
The approach extends to market access considerations, with companies needing to plan early for patient support schemes and practical logistics like cold chain management. Understanding symptom burden and disease impact remains crucial for demonstrating value to payers, particularly in areas without established standards of care.
