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Prepared by- Debashish Sarkar
Institute of Pharmacy Nirma University

Contents to be discussed
? What is a fast track process.
? What is Serious and Life threatening condition.
? Types of drugs intended to treat Serious conditions.
? Unmet medical needs.
? Types of drugs intended to treat Unmet medical needs.
? Process for designation of a drug to a Fast Track drug.

The types of Expedited studies under FDA program are:
1. FAST TRACK DESIGNATION
2. BREAKTHROUGH THERAPY DESIGNATION
3. ACCLERATED APPROVAL
4. PRIORITY REVIEW DESIGNATION
? The above 4 FDA programs are intended to facilitate and
expedite development and review of new drugs to address unmet
medical need in the treatment of a serious or life-threatening
condition.
? The purpose of this guidance for industry is to provide a single
resource for information on FDA��s policies and procedures for
these four programs as well as threshold criteria generally
applicable to concluding that a drug is a candidate for these
expedited development and review programs.

Fast Track Drug Development is a process that is designed
to facilitate the development, and expedite the review of
drugs to treat serious conditions and fill an unmet medical
need.
? The purpose fast track drugs is to get important new drugs
to the patient earlier.
? The drugs that are approved through the Fast Track Drug
Development process are called are fast track drugs.

? The Fast track expedited study comes under the FD&C act
Section506.
Section506 contains 3 subsections-
Section 506(a),
Section 506(b),
Section 506(c).

?Section 506(a) provides that sponsors may request fast track
designation concurrently with the IND filing or any time
thereafter.
?Section 506(b) includes various standards for approvals,
limitations and conditions with the addition of the clinical
endpoints.
?Section 506(c) provides submission and review of NDA for
fast track designation.
In this guidance FDA discusses the regulations, policies and
procedures related to facilitating the development and
expediting the review of promising therapies for serious and
life threatening conditions for which there is an unmet
medical need.

What is Serious and Life threatening condition.
? A disease or condition associated with morbidity that has
substantial impact on day-to-day functioning is called as a
serious or a life threatening conditions.
? Whether a disease or condition is serious is a matter of
clinical judgment, based on its impact on such factors as
survival, day-to-day functioning, or the likelihood that the
disease, if left untreated, will progress from a less severe
condition to a more serious one.
? Acquired Immunodeficiency syndrome(AIDS) and all other
stages of HIV (Human Immunodeficiency Virus), Alzheimer��s
disease, Cancer and many other diseases are ��Serious��.

What kind of Drug are intended to Treat a
Serious Condition
? For a product to be in a fast track drug development
process, it must be intended to have a effect on a serious
condition or serious aspect of the condition.
? The products that can be designated for the Fast Track
drug development study are:
1. A product that is intended to treat a serious conditions
while avoiding the side effects of that treatment might be
designated for the fast track drug development study if
the side effects avoided are not serious.

2. A diagnostic product intended to improve diagnosis or detection
of a serious condition in a way that would lead to improved
outcomes.
3. A product intended to prevent a serious treatment-related side
effect (e.g., serious infections in patients receiving
immunosuppressive therapy).
4. A product intended to avoid or diminish a serious adverse event
associated with available therapy for a serious condition (e.g.,
product that is less cardiotoxic than available cancer therapy)
5. A product intended to prevent a serious condition or reduce the
likelihood that the condition will progress to a more serious
condition or a more advanced stage of disease .
In all the above conditions the treatments or the products may be
designated to be as a fast track drug development process.

Demonstrating the potential to Address the unmet
medical needs
? The section 506(a) apart from requesting for a Fast Track designation,
further requires that the drug demonstrates the potential to address
the unmet medical needs.
Unmet Medical Needs
? An unmet medical need is a condition whose treatment or diagnosis is
not addressed adequately by available therapy.
Now there are 2 consequences:
1. If there is no available therapy for a serious condition, there is clearly
an unmet medical need.
2. When available therapy exists for a condition.

A new treatment generally would be considered to address an
unmet medical need if the treatment:
? Has an improved effect on a serious outcome(s) of the condition
compared with available therapy.
? Has an effect on a serious outcome of the condition that is not
known to be influenced by available therapy .
? Has an effect on a serious outcome of the condition in patients
who are unable to tolerate or failed to respond to available
therapy.
? Can be used effectively with other critical agents that cannot be
combined with available therapy
? Provides safety and efficacy comparable to those of available
therapy but has a documented benefit, such as improved
compliance, that is expected to lead to an improvement in serious
outcomes.

? In some cases, a drug that is not shown to provide a direct
efficacy or safety advantage over available therapy may
provide an advantage that would be of sufficient public
health benefit to qualify as meeting an unmet medical need.
? For example, in a condition for which there are approved
therapies that have a modest response rate, a drug with a
novel mechanism of action (but comparable safety and
effectiveness) could have the potential to provide an
advantage over available therapy in some patients. In such a
case, the novel mechanism of action should have a well-understood
relationship to the disease pathophysiology.
? In addition, there should be a reasonable basis for
concluding that a significant number of patients may
respond differently to the new drug compared with available
therapy.

Process for Designation of a drug as a product in a
Fast Track Development Program.
Section 506(b) of the FD&C Act provides for the designation of a drug
as a fast track product �� if it is intended, whether alone or in
combination with one or more other drugs, for the treatment of a
serious or life-threatening disease or condition, and it demonstrates
the potential to address unmet medical needs for such a disease or
condition.��
The designation process includes several steps, they are:
1.When to Send a Designation Submission
2.Where to Send a Designation Submission
3.Content of a Designation Submission
4.FDA Response

1. When to Send a Designation Submission
? Sponsors may request Fast Track designation when the IND
is first submitted or at any time thereafter before
receiving marketing approval of their BLA or NDA.
? The IND and potential fast track designation may be
discussed before an IND submission in a pre-IND meeting,
but a decision on designation would await submission of the
IND.
? If a sponsor��s drug development program is granted fast
track designation for one indication and has subsequently
obtained data to support fast track designation for another
indication, the sponsor should submit a separate request.

2. Where to Send a Designation Submission
The IND or amendment should be sent to the IND
administrative file to the attention of the appropriate review
division or office in CDER or CBER.

3. Content of a Designation Submission
Fast track designation requests should contain the following
information:
? If the fast track designation request is submitted to the
sponsor��s IND as an amendment, identification of the
submission in the cover letter as a REQUEST FOR FAST
TRACK DESIGNATION in bold, uppercase letters.
? If the request is submitted with an initial IND,
identification of the submission in the cover letter as
both an INITIAL INVESTIGATIONAL NEW DRUG
SUBMISSION and REQUEST FOR FAST TRACK
DESIGNATION in bold, uppercase letters.

? In the cover letter of the submission, the name of the sponsor��s
contact person and the contact person��s address, email address,
telephone number, and fax number.
? If applicable, the IND application number.
? If available, for drug products, the proprietary name and active
ingredient and for biological products, the proper name and
proprietary name.
? The division or office to which the IND is being submitted or in
which it is active.
? The proposed indication(s).
? A concise summary of information that supports the fast track
designation request for the indication being studied, i.e. the
drug is intended to meet a serious or life threatening conditions.
And drug has the potential to meet the unmet medical conditions

4. FDA Response
? FDA will respond to fast track designation requests within 60 calendar
days of receipt of the request.
a. Designation letter
the Agency determines that the criteria for designation as a fast track
drug development program have been met, the designation letter will:
? State that Fast Track Designation is granted for development of the
product for use in treating the specific serious condition.
? Point out that the sponsor should design and perform studies that can
show whether the product meets an unmet medical need.
? Alert the sponsor to the need for the drug development program to
continue to meet the criteria for fast track designation

b. Nondesignation letter
? If the Agency determines that a fast track
designation request was incomplete or that the
drug development program failed to meet the
criteria for fast track designation, the Agency will
send a nondesignation letter to the sponsor.
? The nondesignation letter will state that fast
track designation is not granted and explain the
reasons for the Agency's decision

References:
? www.fda.gov./Guidance for Industry Expedited Programs
for Serious Conditions.in
? The Pharmaceutical Regulatory Process by Ira . R . Berry.

Fast track drugs- Rapid study and Approval

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