The U.S. Food and Drug Administration failed to adhere to its own guidance and internal practices during the approval process for Biogen's Alzheimer's drug Aduhelm, which was "rife with irregularities," a congressional report showed on Thursday.
The FDA's interactions with Biogen were "atypical" and did not follow the agency's documentation protocol, according to a staff report on the findings of an 18-month investigation conducted by two House of Representatives committees into the drug's regulatory review, approval, pricing, and marketing.
The FDA approved Aduhelm in June 2021 under an accelerated approval pathway over the objections of its panel of outside advisers, who did not believe data definitively proved the drug's benefit to patients.
It was authorized based on evidence that it could reduce brain plaques, a likely contributor to Alzheimer's, rather than proof that it slowed progression of the lethal mind-wasting disease.
The Medicare program restricted its coverage, which has led to severely limited use of the Biogen drug.
Biogen set an "unjustifiably high" price by initially setting Aduhelm's price at $56,000 per year despite a lack of demonstrated clinical benefit in a broad patient population, the report said, adding that the company's own internal projections showed it expected the drug to be a burden to Medicare and costly to patients.
"The findings in this report raise serious concerns about FDA's lapses in protocol and Biogen's disregard of efficacy and access in the approval process for Aduhelm," the report, prepared by the staffs of the House Committee on Oversight and Reform and House Committee on Energy and Commerce, concluded.
The agency should ensure that all substantive interactions with drug sponsors are properly memorialized, establish a protocol for joint briefing documents with drug sponsors, and update its industry guidance on the developments and review of new Alzheimer's Drugs, the report recommended.
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