GxP Perspectives

(Original Post- UPDATE Below) The Food and Drug Administration proposed to withdraw approval of a drug treatment for low blood pressure. The drug is marketed as ProAmatine by Shire Development Inc. and as a generic by others called midodrine hydrochloride. FDA stated that “required post-approval studies that verify the clinical benefit of the drug have not been done.” This proposal takes place shortly after the Avandia advisory committee meeting sharply questioned the Phase IV study conducted by GlaxoSmithKline (GSK) called the Record study. It indicates that FDA is taking postmarketing studies much more seriously, both for safety and effectiveness. In a 2009 report by the Government Accountability Office (GAO) FDA was sharply criticized because of the number of postmarketing, or Phase IV, studies that had not been completed by the sponsors or had not been reviewed by FDA. THE GAO report said that FDA had never withdrawn a drug due to the failure to produce postmarket information. Now it looks like FDA will for the first time.

The FDA press release stated:

“We’ve worked continuously with the drug companies to obtain additional data showing the drug’s clinical benefits to patients,” said Norman Stockbridge, M.D., director of the Division of Cardiovascular and Renal Drugs in the FDA’s Center for Drug Evaluation and Research. “Since the companies have not been able to provide evidence to confirm the drug’s benefit, the FDA is pursuing a withdrawal of the product.”

Midodrine hydrochloride was originally approved in 1996 with a fast track approval for drugs that treat serious or life-threatening conditions. The condition, orthostatic hypotension, can cause people to feel dizzy or feint when standing up due to the inability to maintain blood pressure in an upright position. FDA issued a Proposal to Withdraw Marketing Approval and Notice of Opportunity for a Hearing to the companies that manufacture midodrine hydrochloride citing the failure to provide Phase IV clinical studies since that approval. After 14 years, FDA wants documentation that the drug works for the labeled indication. FDA;s current leadership is showing that they can read a GAO report, something that many of their predecessors didn’t. The companies marketing midodrine hydrochloride have the opportunity to request a hearing to contest FDA’s proposed market withdrawal.

UPDATE: 4 September 2010: The New York Times in a report by Gardiner Harris, reports that FDA returns midodrine to the market due to patient concerns. There are no alternative therapies to midodrine.

Read the NY Times Article

GxP Perspectives: From the viewpoint of this blog, it is the responsibility of sponsors to supply FDA with required postmarket data to support their applications. I certainly want patients to have access to necessary therapies. However, I do not want FDA approving drugs using anecdotal evidence. This defeats the concept of “adequate and well-controlled trials.” Drug companies should follow through on their commitments to run Phase IV trials and submit reliable data to FDA.

UPDATE: 28 August 2010- Patient Perspective: Please read the comments for a different viewpoint, that of the mother of a patient with orthostatic hypotension (the 3rd comment). You can read about this in the blog: Suzanne’s World

Read the Press Release

Link for Products Receiving Accelerated Approvals

In news from GxP Perspectives: Read the updated article on the Form FDA 1572 in

Applied Clinical Trials

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Special Notice: The Blog was published in the Journal of Diabetes Science & Technology on the topic of Supervisory Responsibilities of Investigators with my colleagues Ann Berenbaum and Patti Young.

Access the Abstract Here

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This entry was posted on Monday, August 16th, 2010 at 3:42 PM and is filed under FDA commentaries. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.