A comprehensive analysis of FDA breakthrough therapy designations reveals that nearly three-quarters of drugs granted this expedited pathway ultimately achieve regulatory approval, providing evidence of the program's effectiveness in identifying promising therapies for serious medical conditions.
The Jefferies report analyzed 599 breakthrough therapy designations (BTDs) granted between 2013 and 2025, finding that 72% of designated drugs from 2013-2022 went on to win approval, with another 13% still awaiting regulatory decisions. The analysis utilized data from the FDA, Friends of Cancer Research, and Biomedtracker to assess outcomes across therapeutic areas.
Oncology Dominates Breakthrough Landscape
Cancer treatments represented the largest category of breakthrough designations, accounting for 46% of all designations during the study period with 275 out of 599 total designations. Of the 223 drugs that received approval after breakthrough designation, 176 were oncology therapies, reflecting both the high unmet need in cancer care and the program's effectiveness in this therapeutic area.
Following oncology, infectious disease treatments comprised 11% of breakthrough designations, while metabolic diseases accounted for 8% and neurological diseases represented 7% of the total designations granted.
Rare Disease Focus Drives Program Success
Therapies targeting rare diseases across all therapeutic indications, including oncology, constituted the majority of breakthrough designations at 383 out of 599 total designations between 2013 and 2025. This emphasis on rare diseases aligns with the program's mission to expedite treatments for conditions with significant unmet medical needs.
Among therapies that failed to achieve approval, rare disease assets demonstrated superior resilience, with only 13% discontinued during the study period compared to higher failure rates in other therapeutic areas.
Clinical Development Challenges
Of the breakthrough-designated drugs that did not reach approval, 43% were discontinued during clinical studies, representing 30 of 69 failed breakthrough-designated therapies. This finding highlights the inherent risks in drug development, even for therapies identified as having breakthrough potential.
Regulatory Perspective and Confirmation Bias Concerns
The high approval rate for breakthrough-designated drugs has prompted discussion about whether the FDA's success reflects superior drug identification capabilities or potential confirmation bias in the regulatory process. Steven Grossman, a policy analyst and FDA Matters blog author, noted that "you can't tell whether the learning is that FDA has a keen ability to identify the most promising drugs relatively early in the process... or whether FDA pushes those drugs forward (in largely unconscious fashion) in a form of confirmation bias."
Expanding Expedited Pathways
The breakthrough therapy designation represents one of several FDA tools designed to accelerate promising therapies to market. Recent additions to the regulatory toolkit include the Commissioner's National Priority Voucher (CNPV) program, announced in June, and the Rare Disease Evidence Principles (RDEP) review process introduced last month.
According to Grossman, these different mechanisms serve distinct purposes in the drug development ecosystem. "Designations get you more FDA attention and a shot at a faster process long before, as well as during, the NDA review," he explained, while "vouchers are really to incentivize projects with higher risk that are in danger of never happening."
The analysis supports Jefferies' assessment that the current FDA remains "functional" in its approach to drug regulation, with the agency maintaining approval rates consistent with historical patterns while continuing to prioritize therapies addressing serious unmet medical needs.
