Ethics framework for treatment use of investigational drugs
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Ethics framework for treatment use of investigational drugs Jan Borysowski1,2* and Andrzej Górski3
Abstract Background: Expanded access is the use of investigational drugs (IDs) outside of clinical trials. Generally it is performed in patients with serious and life-threatening diseases who cannot be treated satisfactorily with authorized drugs. Legal regulations of expanded access to IDs have been introduced among others in the USA, the European Union (EU), Canada and Australia. In addition, in the USA an alternative to expanded access is treatment under the Right-to-Try law. However, the treatment use of IDs is inherently associated with a number of ethically relevant problems. Main text: The objective of this article is to present a coherent framework made up of eight requirements which have to be met for any treatment use of an ID to be ethical. These include a justified need for the use of an ID, no threat to clinical development of the ID, adequate scientific evidence to support the treatment, patient’s benefit as the primary goal of the use of an ID, informed decision of a patient, fair access of patients to IDs, independent review, as well as the dissemination of treatment results. Conclusions: While this framework is essentially consistent with the legal regulations of expanded access of the USA, the EU, Canada and Australia, it is substantially wider in scope because it addresses some important issues that are not covered by the regulations. Overall, the framework that we developed minimizes the risks and threats, and maximizes potential benefits to each of the four key stakeholders involved in the treatment use of IDs including patients, doctors, drug manufacturers, and society at large. Keywords: Expanded access, Compassionate use, Investigational drug, Right-to-try law, Declaration of Helsinki Background Expanded access, also termed compassionate use, special access, early access or preapproval access, is the use of investigational drugs (IDs) outside of clinical trials [1]. The current increase in interest in expanded access results from a number of factors including the development of novel treatments for unmet medical needs, wide access of patients to information about new drugs in the Internet and high activity of patient advocacy groups [2]. In response to the needs of the
*Correspondence: [email protected] 1 Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka Str. 59, 02‑006 Warsaw, Poland Full list of author information is available at the end of the article
growing number of patients many countries including the USA, most Member States of the European Union (EU), Canada, Australia, Japan and Brazil have introduced legal regulations to enable the use of IDs outside of clinical trials [3–5]. In general, expanded access treatment can be performed in patients with serious or life-threatening diseases who cannot be treated satisfactorily with approved drugs and are not eligible for enrollment in a clinical trial [3, 6]. Expanded access requests
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