ICTW Punta del Este, Uruguay Perspectivas de la industria farmacéutica en el patrocinio y financiación en investigación clínica académica Jorge Pignataro.

Presentación del tema: "ICTW Punta del Este, Uruguay Perspectivas de la industria farmacéutica en el patrocinio y financiación en investigación clínica académica Jorge Pignataro."— Transcripción de la presentación:

1 ICTW Punta del Este, Uruguay Perspectivas de la industria farmacéutica en el patrocinio y financiación en investigación clínica académica Jorge Pignataro Otman TALLER INTERNACIONAL SOBRE ENSAYOS CLÍNICOS SIMPOSIO BARRERAS PARA LA INVESTIGACIÓN CLÍNICA EN AMÉRICA LATINA 24 al 26 de marzo de 2011 - Conrad Resort Hotel - Punta del Este

2 ICTW Punta del Este, Uruguay I.C. académica: Situación y perspectivas Inv.clínica académica escasa –Independiente o co-financiada ? –Proyectos puntuales financiados a través de la ley de Fundaciones No se trata de competencia entre IC académica y la patrocinada por la industria farmacéutica, sino de complemento. Era de toma de decisiones basada en la evidencia y criterios económicos –Equidad?

3 ICTW Punta del Este, Uruguay I.C. académica: Situación y perspectivas El necesario compromiso y compra de todos los sectores –Político y autoridades ( M.E.F. !) –Academia –Industria –De la intención a la implementación –Poner el dinero donde se ponen las palabras (ej.: TI, desocupación y estímulos) Diagnóstico claro de la situación –Fase III y IV OK, hacia Fase II. Caminar enfocados y paso a paso.

4 ICTW Punta del Este, Uruguay El mundo exige resultados. No le cuentes a otros tus dolores del parto. Muéstrales al niño. Indira Gandhi

5 ICTW Punta del Este, Uruguay LA Oncología requiere diseños de estudios clínicos de mayor complejidad en comparación con otras áreas terapéuticas. Fuente : Datamonitor

6 ICTW Punta del Este, Uruguay Academic clinical trials are a valuable component of the health care system; they benefit patients and help determine the safety and efficacy of new drugs and devices. A typical area of academic clinical trials is the advancement and optimization of already existing therapies. Thus, academic clinical trials may for instance test how a combination of registered drugs may improve treatment outcomes; or they may apply registered treatments in additional, less frequent indications. Such research questions are not a primary focus of for-profit companies, and thus these trials are typically initiated by individual investigators or many different organizations which have an interest in academic clinical trials and facilitate or take part in their conduct. These organizations include: Academic clinical trials are run at academic sites, such as medical schools, academic hospitals, and universities; and non-academic sites which may be managed by so- called site management organizations (SMOs). Site management organizations are for-profit organizations which enlist and manage the physician practice sites that actually recruit and follow patients enrolled in clinical trials. In some cases, academic members participate in clinical trialsas members of SMOs.

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8 Estudios clínicos en el ciclo de vida de un medicamento $

9 ICTW Punta del Este, Uruguay Entorno regulatorio cada vez más estricto El número de aprobaciones de nuevas moléculas por FDA 2010, demuestra el estado crítico de caída de la productividad. Source: US FDAs Center for Drug Evaluation and Research and Drugs@FDA. Graph represents NME and BLA approvals by year. Source: PhRMA Statistics $ Billions

10 ICTW Punta del Este, Uruguay La tasa de éxito es baja *R&D Spending by Research-Based Pharmaceutical Companies Fuente: Parexels Bio/Pharmaceutical R&D Statistical Sourcebook 2009/2010 El modelo tradicional de desarrollo clínico debe cambiar porque el largo proceso de lanzar un nuevo medicamento se transformó en una proposición insostenible para la industria Pre- clinical Phas e 1 Phase 2 Phase 3 Launch

11 ICTW Punta del Este, Uruguay El desarrollo biofarmacéutico está liderado por los tratamientos para el cáncer Fuente : PhRMA 2010

12 ICTW Punta del Este, Uruguay March 14, 2011 Study suggests long-term tamoxifen use reduces breast cancer deaths, medical costs Last Updated:March 14, 2011 17:14 Study results published Monday in the journal Cancer suggests that for certain women at an increased risk of breast cancer, tamoxifen can protect against the disease for a decade after treatment ends. March 21, 2011 Roche, Curis drug vismodegib meets goal of mid-stage skin cancer trial Last Updated:March 21, 2011 16:59 In the ERIVANCE BCC trial, 104 patients with advanced basal cell carcinoma received the Hedgehog Pathway Inhibitor once daily until disease progression. Results showed that vismodegib shrank tumours in a predefined percentage of patients in the study. Las …ómicas han influido en el diseño de las plataformas de Inv. Clínica

13 ICTW Punta del Este, Uruguay Estudios Fases I - III C.E.R. S.B.P.s Oportunidades para el desarrollo de estudios clínicos en LA C.E.R. : Comparative Effectiveness Research S.B.P.s : Similar Biotherapeutic Products $ O.M.S. April 2010 E.M.A. Nov. 2010 F.D.A. (2011 ?) ANVISA Mar 2011

14 ICTW Punta del Este, Uruguay Algunas conclusiones La inversión en investigación clínica en Oncología alcanza aproximadamente el 20% del total de la inversión en I+D farmacéutica. Se estima el costo de desarrollo de un nuevo fármaco en 1.2 billones de dólares pero la preocupación de las empresas es como ser más eficientes, incrementando la seguridad, aportando diferencias tangibles, reduciendo costos y tiempo al mercado. Latinoamérica ha avanzado en la mejora de marcos regulatorios y recursos humanos, con ventajas competitivas frente a países emergentes (China) y Europa Oriental. Surgen nuevas áreas de diseño de estudios clínicos dentro del ciclo de vida de un medicamento que son especialmente atractivas para LA. Fuentes: PhRMA; DATAMONITOR, Spectrum, PharmaVenture

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16 Muchas gracias..

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18 18 Increasing duration of clinical trials Evaluation of clinical trial duration by indication and phase of development, 2001–06 In 2002–04, the average time taken for a drug entering Phase I clinical trials to completing Phase III was 7.0 years, a rise of 1.2 years over calculations made in 1999–2001, in part driven by the heightening safety concerns of the FDA. The Agencys advisory panel has recently recommended that the FDA demand additional cardiovascular testing for all new diabetes drugs, and that companies conduct long-term studies to rule out unacceptable cardiovascular risks for new diabetes compounds. Similar recommendations could conceivably be made across other therapy areas in the future, further prolonging clinical trial durations. Source: Datamonitor adapted from Pharmaprojects Pharmapredict (2006)

19 ICTW Punta del Este, Uruguay 19 Growing size of clinical trials The size of clinical trials is increasing due to the requirement for growing quantities of clinical data in response to more stringent regulatory scrutiny, and concerns over drug safety. In order to increase the power and potential statistical significance of a study, a larger number of enrollees are required. However, increasing patient recruitment is directly linked to study duration and cost. Drugs to treat cancer, cardiovascular disease, diabetes and endocrinology recruited a considerably larger number of enrollees than for the remaining therapy areas. This is likely to be attributed to the large patient populations within these therapy areas and therefore ease of recruitment of such patients. Numbers of enrollees by therapy area for Phase III clinical trials conducted in the US in 2007–08 Source: Datamonitor adapted from Thomson Pharma (August 23 2008), Copyright Thomson Scientific

20 ICTW Punta del Este, Uruguay 20 The cost of R&D is increasing The growing complexity of clinical trial protocols has resulted in patient recruitment rates dropping from 75% in 1999–2002 to 59% in 2002–06, while volunteer retention rates fell from 69% to 48% over the same period. Increasing the size, complexity and duration of clinical trials generates a greater volume of data, which increases the time and costs of data capture and analysis, as well as management of the clinical trial process. Source: Datamonitor adapted from Fast Track Systems (2006) Clinical trials with a high degree of complexity are more costly, 2006

21 ICTW Punta del Este, Uruguay 21 Clinical trial success rates are declining Pharma will have to become more astute when selecting which compounds to progress to Phase III development. This is further hampered by falling success rates for clinical trials. The success rates for drugs entering a clinical development stage (Phase I, II, and III) and progressing to actual launch has fallen by 23%, 20% and 11%, respectively (2001–06), an observation common to all individual indications analyzed and at every stage of clinical development. Source: Datamonitor adapted from Pharmaprojects Pharmapredict (2006) Evaluation of clinical trial to launch success rates by indication and phase, 2001–06

22 the home of Business Intelligence Trends in Clinical Trials, DMHC2445, September 2008 © Datamonitor 22 Why Phase III drugs fail? Source: Datamonitor adapted from Why products fail in Phase III? (2006) Why Phase III drugs fail – therapy area analysis Approximately 58% of Phase III clinical trials are unsuccessful, with the primary cause for failure being the inability of the trial data to demonstrate efficacy of the tested product against placebo. Success, or rather failure of a Phase III trial is also dependent on the following two factors: –whether a drug has an established or novel mechanism of action; –whether trial endpoints are objective or subjective.