ALS Community Tells FDA ‘We Have No Time To Waste’; Urges Changes in Trial Design and Review Process
Rare FDA hearing on ALS provides a chance for organizations, scientists, clinicians, patients and families to tell their urgent stories
TUCSON, Ariz., Feb. 25, 2013 — It was a full house as members of the amyotrophic lateral sclerosis (ALS) community presented, commented and listened in during the first-ever public hearing for ALS held by the FDA's Neurology Division in Washington today.
The unprecedented hearing included presentations from the nation's ALS nonprofit organizations, research scientists, clinicians, industry representatives, people with ALS, family members and caregivers.
One of the first to speak at the hearing was Muscular Dystrophy Association President and CEO Steven M. Derks, who thanked the FDA for including the ALS patient perspective in its decision-making process.
"Today's hearing is proof that you understand the views of those living with ALS are instrumental and must be taken into account throughout the drug development and approval process," Derks said. "We are asking you to also include these voices in your discussions regarding expanded access to trials, accelerated approval decisions and clinical trial design and enrollment."
Along with other ALS patient organizations, MDA played a significant role in making the FDA hearing a reality. The Association is the largest nongovernmental funder of ALS research, and has served the ALS community since the 1950s when Lou Gehrig's widow, Eleanor Gehrig, was MDA's honorary national chair.
Because of the relentless effects of ALS, a diverse group of ALS voices — patients, families, organizations and the community — came together to speak about their experiences with ALS and to urge the FDA to work with them to overcome some of the obstacles faced in ALS research, clinical trials and standards of care.
Among the strongest and most poignant voices in the room — some of them computer-generated — came from people with ALS, whose common themes included weighing the benefits versus risks in participating in early-phase clinical trials.
"When a trial is going well, those with ALS should be able to keep taking the drugs," said Robert Anderson, an individual living with ALS. "What is the risk — you think it might kill him sooner? It does not matter, if you may be dying in a year from ALS anyway. You need to step beyond that in your heads."
Physical therapist Sara M. Feldman, who works at the MDA/ALS Center of Hope in Philadelphia, underscored Anderson's comments.
"The people we work with that come into these clinical trials are truly heroes," she said. "They're doing this not because they think they're going to benefit from it, but because they are hoping that someone will benefit in the future."
International ALS expert Stan Appel, a physician-scientist who directs the MDA/ALS Clinic at Methodist Neurological Institute in Houston and is a member of the MDA Board of Directors, asked the FDA for help in more quickly assessing the probable success of an experimental therapy.
"ALS can progress extremely rapidly and time is of the essence in assisting respiratory function," stated Appel. "Our patients suffer when such devices are not available because of the time it may take to get something approved. Accelerated review of such devices, and rapid implementation would be of tremendous value to the ALS patients and would help prolong meaningful quality and length of life."
Appel wants the FDA to work with to the ALS community to design trials that answer questions in a timely and cost-effective manner.
"ALS is a heterogeneous disease with varying sites of onset, rates of progression and survival, and this heterogeneity complicates our clinical efforts at therapy," he said. "In order to move faster toward effective therapeutics, it may be necessary to develop short, less-expensive trials to determine if a drug can hit a therapeutic target in order to test therapeutic hypotheses, prior to the initiation of efficacy trials. This will give a quicker answer to whether a potential therapeutic has any chance of success in treating ALS."
Throughout the day, the panel heard similar comments urging the FDA to think differently about its clinical trial and drug approval process.
"Regulatory barriers inhibit treatment, based on a traditional model that I believe should be updated," said Jonathan Glass, a physician conducting a phase 2 clinical trial at Emory University in Atlanta involving the injection of neural stem cells into the spines of people with ALS. "A major impediment to developing new treatments is adherence to standardized paths that are counterproductive and do not address the complexities of this disease."
The ALS community made it clear it wants to work with the FDA to address and fast-track solutions to its unique needs.
"Today's hearing was a historic opportunity to bring the ALS community together around a therapeutic development partnership with the FDA," said MDA Senior Vice President of Advocacy Annie Kennedy. "MDA is eager to leverage our national clinical infrastructure and MDA-funded ALS experts around the world to help move the ball down the field as quickly and safely as possible."
ALS (also known as Lou Gehrig's disease) attacks the nerve cells that control muscles, ultimately resulting in paralysis of all voluntary muscles, including those used for breathing. Average life expectancy for people with the disease is three to five years after diagnosis.
MDA is the nonprofit health agency dedicated to finding treatments and a cure for ALS and related muscle diseases by funding worldwide research. The Association also provides comprehensive health care and support services, advocacy and education.
Over the years, MDA has led the fight against ALS, investing more than $307 million in its ALS research, services and information programs. MDA currently funds more than 250 research projects worldwide. It also operates 200 clinics across the county, 42 of which are designated as ALS-specific research and care centers.
The Association's unparalleled research, health care services, advocacy and education programs provide help and hope to more than 1 million Americans affected by ALS and the more than 40 other progressive neuromuscular diseases in MDA's program. MDA also facilitates hundreds of support groups for families affected by neuromuscular diseases.