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      Examining the Use of Real‐World Evidence in the Regulatory Process

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          Abstract

          The 21st Century Cures Act passed by the United States Congress mandates the US Food and Drug Administration to develop guidance to evaluate the use of real‐world evidence (RWE) to support the regulatory process. RWE has generated important medical discoveries, especially in areas where traditional clinical trials would be unethical or infeasible. However, RWE suffers from several issues that hinder its ability to provide proof of treatment efficacy at a level comparable to randomized controlled trials. In this review article, we summarized the advantages and limitations of RWE, identified the key opportunities for RWE, and pointed the way forward to maximize the potential of RWE for regulatory purposes.

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          Most cited references70

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          Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs

          New England Journal of Medicine, 342(25), 1887-1892
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            The path to personalized medicine.

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              Medication adherence: its importance in cardiovascular outcomes.

              Medication adherence usually refers to whether patients take their medications as prescribed (eg, twice daily), as well as whether they continue to take a prescribed medication. Medication nonadherence is a growing concern to clinicians, healthcare systems, and other stakeholders (eg, payers) because of mounting evidence that it is prevalent and associated with adverse outcomes and higher costs of care. To date, measurement of patient medication adherence and use of interventions to improve adherence are rare in routine clinical practice. The goals of the present report are to address (1) different methods of measuring adherence, (2) the prevalence of medication nonadherence, (3) the association between nonadherence and outcomes, (4) the reasons for nonadherence, and finally, (5) interventions to improve medication adherence.
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                Author and article information

                Contributors
                brett_beaulieu-jones@hms.harvard.edu
                Kun-Hsing_Yu@hms.harvard.edu
                Journal
                Clin Pharmacol Ther
                Clin. Pharmacol. Ther
                10.1002/(ISSN)1532-6535
                CPT
                Clinical Pharmacology and Therapeutics
                John Wiley and Sons Inc. (Hoboken )
                0009-9236
                1532-6535
                14 November 2019
                April 2020
                14 November 2019
                : 107
                : 4 , Data Science ( doiID: 10.1002/cpt.v107.4 )
                : 843-852
                Affiliations
                [ 1 ] Department of Biomedical Informatics Harvard Medical School Boston Massachusetts USA
                [ 2 ] Departments of Bioengineering, Genetics, Medicine, and Biomedical Data Science Stanford University Stanford California USA
                [ 3 ] Division of Hematology Oncology Department of Public Health and Preventive Medicine Center for Health Care Ethics Knight Cancer Institute Oregon Health & Science University Portland Oregon USA
                Author notes
                [*] [* ] Correspondence: Brett Beaulieu‐Jones ( brett_beaulieu-jones@ 123456hms.harvard.edu )

                and

                Kun‐Hsing Yu ( Kun-Hsing_Yu@ 123456hms.harvard.edu )

                Author information
                https://orcid.org/0000-0002-6700-1468
                https://orcid.org/0000-0003-3859-2905
                https://orcid.org/0000-0001-9892-8218
                Article
                CPT1658
                10.1002/cpt.1658
                7093234
                31562770
                97d67c38-97fc-4fbb-9ebc-550b729488e7
                © 2019 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 20 August 2019
                : 17 September 2019
                Page count
                Figures: 0, Tables: 2, Pages: 10, Words: 9020
                Funding
                Funded by: National Library of Medicine (NLM) , open-funder-registry 10.13039/100000092;
                Award ID: T15LM007092
                Funded by: National Institute of General Medical Sciences (NIGMS) , open-funder-registry 10.13039/100000057;
                Award ID: T32GM007753
                Categories
                Review
                Reviews
                Reviews
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.0 mode:remove_FC converted:14.04.2020

                Pharmacology & Pharmaceutical medicine
                Pharmacology & Pharmaceutical medicine

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