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Diagnostics and biomarker development: priming the pipeline

Abstract

The decrease in the rate at which novel medical products are reaching the market, despite major scientific achievements and investment that might have predicted otherwise, is causing much concern. Although this 'pipeline problem' has often been discussed in the context of drug development, it is also crucial to examine the unique characteristics of the pipeline for biomarkers and diagnostics. Here, we characterize the pipeline problem for biomarkers and diagnostics, and consider what steps could be taken to solve it.

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Figure 1: Medical products and diagnostics development models.
Figure 2: Prototype of possible approach to developing and regulating combined test–drug products.

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References

  1. US Department of Health and Human Services, Food and Drug Administration. Innovation or Stagnation: Challenge and Opportunity on the Critical Path to New Medical Products [online], (2004). This White Paper written by the US FDA details a regulatory initiative to facilitate the translation of medical products to improved health.

  2. US Department of Health and Human Services, Food and Drug Administration. Critical Path Opportunities Report [online], (2006). This report written by the US FDA, in collaboration with a range of stakeholders, identifies six key areas where focused research has great potential to stimulate product development. An accompanying list of research projects, the 'Critical Path Opportunities List', is also available at http://www.fda.gov/oc/initiatives/criticalpath/reports/opp_list.pdf .

  3. AdvaMed. AdvaMed's submitted comments on FDA's Critical Path Intitiative [online], (2004).

  4. Tsongalis, G. J. A reality check for molecular diagnostics in clinical practice. Pharmacogenomics 4, 667–668 (2003).

    Article  Google Scholar 

  5. Woodcock, J. The Critical Path: One Year Later. Presentation at the FDA/DIA/BIO Meeting: Use of Medical Imaging as a Drug Development Tool [online], (2005).

  6. AdvaMed. The medical technology industry at a glance [online], (2004).

  7. US Food and Drug Administration & Gutman, S. OIVD Requests a Meeting with Roche Diagnostics Regarding the AmpliChip CYP450 Microarray [online], (2005).

  8. US Department of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health. Center for Devices and Radiological Health: Promoting and Protecting the Public Health [online, (2004).

  9. Hall, S. & Casper, A. Presentation at FDA/Industry IVD Roundtable 10 November (2004).

  10. The Lewin Group Inc. The Value of Diagnostics: Innovation, Adoption and Diffusion Into Health Care [online], (2005). A comprehensive report on the diagnostics industry.

  11. Melzer, D., Zimmern, R. L. & Ling, T. Regulatory options for pharmacogenetics. Pharmacogenomics 4, 527–530 (2003).

    Article  Google Scholar 

  12. US Department of Health and Human Services. Secretary's Advisory Committee on Genetics, Health, and Society — Third Meeting 1–2 March 2004 [online], (2004).

  13. Institute of Medicine. Medicare Laboratory Payment Policy Now And In The Future [online], (2000).

  14. Department of Health and Human Services, Secretary's Advisory Committee on Genetics Health and Society. Coverage and Reimbursement of Genetic Tests and Services: Report of the Secretary's Advisory Committee on Genetics, Health, and Society, Public Comment Draft [online], (2005).

  15. Kessler, L., Ramsey, S. D., Tunis, S. & Sullivan, S. D. Clinical use of medical devices in the 'Bermuda Triangle'. Health Affairs 23, 200–207 (2004).

    Article  Google Scholar 

  16. Hoag, H. Testing new ground. Nature 429, 682–683 (2004).

    Article  CAS  Google Scholar 

  17. Ito, R. K. & Demers, L. M. Pharmacogenomics and pharmacogenetics: future role of molecular diagnostics in the clinical diagnostic laboratory. Clin. Chem. 50, 1526–1527 (2004).

    Article  CAS  Google Scholar 

  18. Sannes, L. J. Molecular Diagnostics: Technological Advances Fueling Market Expansion CHI Report #33 (Cambridge Healthtech Institute; http://www.chireports.com; 2003).

    Google Scholar 

  19. Danzon, P. M., Nicholson, S. & Pereira, N. S. Productivity in pharmaceutical-biotechnology R&D: the role of experience and alliances. J. Health Econ. 24, 317–339 (2005).

    Article  Google Scholar 

  20. Womack, C. In 'Critical Path' Update, Novartis Official Said Industry Should Share Biomarker Data. The Pharmacogenomics Reporter 12/9 (2004).

    Google Scholar 

  21. US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER), Center for Biologics Evaluation and Research (CBER), Center for Devices and Radiological Health (CDER). Guidance for Industry: Pharmacogenomic Data Submissions [online], (2005). Guidance on voluntary genomic data submissions.

  22. Frueh, F. W. HHS Efforts and Future Directions in Pharmacogenomics — An Update on FDA Guidances Related to Pharmacogenomics. Presentation June 16, 2005 to the Secretary's Advisory Committe on Genetics, Health, and Society [online], (2005).

  23. Department of Health and Human Services, Food and Drug Administration. Drug-Diagnostic Co-Development Concept Paper [online], (2005). Concept paper on how drugs and diagnostics might be co-developed and regulated in the near future.

  24. Wechsler, J. Drug development linked more closely to diagnostics. Pharmaceutical Technol. October (2004).

    Google Scholar 

  25. Brazma, A. et al. Minimum information about microarray experiment (MIAME)- towards standards for microarray data. Nature Genet. 29, 365–371 (2001).

    Article  CAS  Google Scholar 

  26. Biotechnology Industry Organization. BIO Comments to Docket No. 2004N-0181 [online],(2004).

  27. Swain, E. Forging new regulatory pathways at FDA [online], (2004).

  28. Wadman, M. Drug safety special: the safety catch. Nature 434, 554–556 (2005).

    Article  CAS  Google Scholar 

  29. Lindpaintner, K. Pharmacogenetics and the future of medical practice. J. Mol. Med. 81, 141–153 (2003).

    Article  Google Scholar 

  30. Rothstein, M. A. Genetic exceptionalism and legislative pragmatism. Hastings Cent. Rep. 35, 27–33 (2005).

    PubMed  Google Scholar 

  31. Lai, E. Pharmacogenetics The GSK Perspective. Presentation June 16, 2005 [online], (2005).

  32. Zineh, I. et al. Availability of pharmacogenomics-based prescribing information in currently approved drugs. Pharmacogenomics J. 4, 354–358 (2004).

    Article  CAS  Google Scholar 

  33. Buchanan, A. et al. Pharmacogenetics: ethical issues and policy options. Kennedy Inst. Ethics J. 12, 1–15 (2002).

    Article  Google Scholar 

  34. Robertson, J. A., Brody, B., Buchanan, A., Kahn, J. & McPherson, E. Pharmacogenetic challenges for the health care system. Health Affairs 21, 155–167 (2002).

    Article  Google Scholar 

  35. Secretary's Advisory Committee on Genetics Health and Society. Second Meeting, October 22–23 2003.

  36. Manasco, P. K. & Arledge, T. E. in Pharmacogenomics: Social, Ethical, and Clinical Dimensions (Rothstein, M. A. ed.) 83–97 (John Wiley & Sons, New Jersey, 2003).

    Book  Google Scholar 

  37. Gutman, S. The role of Food and Drug Administration Regulation of in vitro diagnostic devices — applications to genetics testing. Clin. Chem. 45, 746–749 (1999).

    CAS  PubMed  Google Scholar 

  38. Berry, C. Coverage and Reimbursement of Genetic Tests and Services: Review of Public Comments and Finalization of SACGHS Report. Presentation June 16, 2005 [online], (2005).

  39. Phillips, K. A., Veenstra, D., Van Bebber, S. L. & Sakowski, J. An introduction to cost-effectiveness and cost–benefit analysis of pharmacogenomics. Pharmacogenomics 4, 231–239 (2003).

    Article  Google Scholar 

  40. Phillips, K. A. & Van Bebber, S. L. Measuring the value of pharmacogenomics. Nature Rev. Drug Discov. 4, 500–509 (2005). Presents a population-based perspective for measuring value of pharmacogenomics using CYP2D6 as an example.

    Article  CAS  Google Scholar 

  41. Gurwitz, D., Weizman, A. & Rehavi, M. Education: teaching pharmacogenomics to prepare future physicians and researchers for personalized medicine. Trends Pharmacol. Sci. 24, 122–125 (2003).

    Article  CAS  Google Scholar 

  42. Feigal, D. W. & Gutman, S. in Pharmacogenomics: Social, Ethical, and Clinical Dimensions (Rothstein, M. A. ed.) 99–108 (John Wiley & Sons, New Jersey, 2003).

    Book  Google Scholar 

  43. US Food and Drug Administration. Guidance for Industry and FDA Staff: Class II Special Controls Guidance Document: Drug Metabolizing Enzyme Genotyping System [online], (2005).

  44. US Food and Drug Administration. Analyte Specific Reagents: Small Entity Compliance Guidance — Guidance for Industry [online], (2003).

  45. Gold, M., Siegel, J., Russell, L. & Weinstein, M. Cost-Effectiveness in Health and Medicine (Oxford Univ.Press, New York, 1996).

    Google Scholar 

  46. Phillips, K. A. & Van Bebber, S. L. Cost-effectiveness of pharmacogenomic interventions: a systematic review of the literature. Pharmacogenomics 5, 1139–1149 (2004)

    Article  Google Scholar 

  47. Issa, A. M. The regulation of pharmacogenomics-based drugs and policy making. Curr. Top. Med. 4, 1455–1460 (2004).

    CAS  Google Scholar 

  48. Phillips, K. A., Ackerman, M. J., Sakowski, J. & Berul, C. I. Cost-effectiveness analysis of genetic testing for familial long QT syndrome in symptomatic index cases. Heart Rhythm. 2, 1294–1300 (2005).

    Article  Google Scholar 

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Acknowledgements

We are grateful to our anonymous interviewees and thank them for their time and interest. This work was partially supported by the Center for Devices and Radiological Health at the FDA through an independent consulting agreement with K.A.P. All opinions are those of the authors and should not be construed as endorsement by the FDA.

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Evaluation of Genomic Applications in Practice and Prevention

Minimum Information About a Microarray Experiment

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Phillips, K., Van Bebber, S. & Issa, A. Diagnostics and biomarker development: priming the pipeline. Nat Rev Drug Discov 5, 463–469 (2006). https://doi.org/10.1038/nrd2033

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