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The Potential Risks of Expedited Approval of Drugs for Acute Bacterial Infections

James S. Floyd, MD, MS1; Bruce M. Psaty, MD, PhD1,2,3,4
[+] Author Affiliations
1Department of Medicine, University of Washington, Seattle
2Department of Health Services, University of Washington, Seattle
3Department of Epidemiology, University of Washington, Seattle
4Group Health Research Institute, Group Health Cooperative, Seattle, Washington
JAMA Intern Med. 2014;174(9):1436-1437. doi:10.1001/jamainternmed.2014.3055.
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Each year, about 23 000 people in the United States die from antibiotic-resistant infections. For many of these infections, safe and effective treatments are lacking. To address this problem, the US Food and Drug Administration (FDA) has updated several expedited approval programs for new antibacterial therapies, some of which alter the evidentiary standard for drug approval.1,2 For instance, a drug may be eligible for “accelerated approval” if it “has an effect on a surrogate end point that is reasonably likely to predict clinical benefit.”2 Since 1992, the accelerated approval program has been available for drugs likely to offer a therapeutic benefit over available treatments for serious or life-threatening diseases. Now, the program’s scope has been expanded to include drugs with marginal ancillary benefits, such as a novel mechanism of action without improvements in safety or efficacy. These well-intentioned new standards for drug approval have increased the risk that the FDA will approve antimicrobial therapies that are less effective or more harmful than available treatments.

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