Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trials

Abstract Introduction The U.S. Food and Drug Administration (FDA)'s guidances help describe the agency's current thinking on regulatory issues and serve as a means of informal policymaking that is non‐binding. This study examines the impact of two guidance documents for Alzheimer's di...

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Main Authors: Jeffrey C. Yu, Jakub P. Hlávka, Elizabeth Joe, Frances J. Richmond, Darius N. Lakdawalla
Format: Article
Language:English
Published: Wiley 2022-01-01
Series:Alzheimer’s & Dementia: Translational Research & Clinical Interventions
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Online Access:https://doi.org/10.1002/trc2.12280
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author Jeffrey C. Yu
Jakub P. Hlávka
Elizabeth Joe
Frances J. Richmond
Darius N. Lakdawalla
author_facet Jeffrey C. Yu
Jakub P. Hlávka
Elizabeth Joe
Frances J. Richmond
Darius N. Lakdawalla
author_sort Jeffrey C. Yu
collection DOAJ
description Abstract Introduction The U.S. Food and Drug Administration (FDA)'s guidances help describe the agency's current thinking on regulatory issues and serve as a means of informal policymaking that is non‐binding. This study examines the impact of two guidance documents for Alzheimer's disease (AD) trials. The first guidance in 2013 encouraged the use of cognitive/functional endpoints, while the second in 2018 modified such recommendation. Methods Using pivotal trial data, we applied a regression discontinuity in time (RDiT) framework to examine trialist response to these guidance documents. Results were stratified by disease‐modifying therapy (DMT) status, and controlled for disease staging, FDA registration status, and trial phase. Results Among AD DMT trials, annual use of cognitive/functional composite endpoints significantly increased after the 2013 guidance (+12.9%, P < .001), and significantly decreased after the 2018 guidance (–19.9%, P = .022). Discussion Although guidance documents do not set new legal standards or impose binding requirements, our findings indicate they are broadly followed by AD trialists.
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spelling doaj-art-ccfa05ce0c8e46e28a0c63e0fded3f222024-12-03T12:37:31ZengWileyAlzheimer’s & Dementia: Translational Research & Clinical Interventions2352-87372022-01-0181n/an/a10.1002/trc2.12280Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trialsJeffrey C. Yu0Jakub P. Hlávka1Elizabeth Joe2Frances J. Richmond3Darius N. Lakdawalla4School of Pharmacy University of Southern California Los Angeles California USALeonard D. Schaeffer Center for Health Policy & Economics Los Angeles California USAKeck School of Medicine University of Southern California Los Angeles California USASchool of Pharmacy University of Southern California Los Angeles California USASchool of Pharmacy University of Southern California Los Angeles California USAAbstract Introduction The U.S. Food and Drug Administration (FDA)'s guidances help describe the agency's current thinking on regulatory issues and serve as a means of informal policymaking that is non‐binding. This study examines the impact of two guidance documents for Alzheimer's disease (AD) trials. The first guidance in 2013 encouraged the use of cognitive/functional endpoints, while the second in 2018 modified such recommendation. Methods Using pivotal trial data, we applied a regression discontinuity in time (RDiT) framework to examine trialist response to these guidance documents. Results were stratified by disease‐modifying therapy (DMT) status, and controlled for disease staging, FDA registration status, and trial phase. Results Among AD DMT trials, annual use of cognitive/functional composite endpoints significantly increased after the 2013 guidance (+12.9%, P < .001), and significantly decreased after the 2018 guidance (–19.9%, P = .022). Discussion Although guidance documents do not set new legal standards or impose binding requirements, our findings indicate they are broadly followed by AD trialists.https://doi.org/10.1002/trc2.12280Alzheimer's diseaseClinical Dementia Rating Sum of Boxesclinical trialscomposite endpointsFood and Drug Administrationguidance documents
spellingShingle Jeffrey C. Yu
Jakub P. Hlávka
Elizabeth Joe
Frances J. Richmond
Darius N. Lakdawalla
Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trials
Alzheimer’s & Dementia: Translational Research & Clinical Interventions
Alzheimer's disease
Clinical Dementia Rating Sum of Boxes
clinical trials
composite endpoints
Food and Drug Administration
guidance documents
title Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trials
title_full Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trials
title_fullStr Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trials
title_full_unstemmed Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trials
title_short Impact of non‐binding FDA guidances on primary endpoint selection in Alzheimer's disease trials
title_sort impact of non binding fda guidances on primary endpoint selection in alzheimer s disease trials
topic Alzheimer's disease
Clinical Dementia Rating Sum of Boxes
clinical trials
composite endpoints
Food and Drug Administration
guidance documents
url https://doi.org/10.1002/trc2.12280
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