However, the model can be quite complex and statistically
tricky, and the assigned weights can bring bias of subjectivity into the model. Other multidimensional approaches Other approaches have been proposed. In one of these,25 a rectangle is formed by multiplying the strength of the benefit (such as the magnitude of the positive efficacyresponse) by the response rate. The rectangle is then multiplied by the dimension (quantification) of evidence to form a tridimensional efficacy cuboid. For a given ADR, severity, frequency, and strength of evidence are the three dimensions to construct the safety cuboid. The positive benefit:risk ratio is Tyrphostin AG-1478 purchase demonstrated when the volume of the cuboid for benefits outbalances the sum of all Inhibitors,research,lifescience,medical cuboids for the different ADRs. The advantage Inhibitors,research,lifescience,medical is that different ADRs can be considered together. However, if the concept is theoretically interesting, there is no practical way of comparing the benefit and risk cuboids, and it is not certain that the volume represented by the sum of ADRs can be geometrically compared with a volume measuring the benefit of a drug. The methods mentioned above, despite their Inhibitors,research,lifescience,medical complexity, still do not allow determination, in a simple way, of the relative importance of the benefits and the risks of a given drug in a specific indication. So far, they have not replaced qualitative
judgments by experts. Regulatory authority views The position of regulatory authorities on the BRA question is instructive, because these authorities have the dual objective of encouraging pharmaceutical therapeutic progress, while
protecting public health. Regulatory authorities rely Inhibitors,research,lifescience,medical essentially on qualitative assessments and expert opinions. Quantitative methods such as those presented above play only a supportive role in the registration or drug surveillance process. Relying on qualitative assessment and expert opinions makes it necessary to ensure that the regulatory process is valid, consistent, and transparent.22 We present here some aspects ol the US Inhibitors,research,lifescience,medical and European regulatory authorities’ approaches. The FDA does not use a quantitative assessment of the BRA, and relies on a qualitative assessment of the quantitative data collected during drug development. For the FDA, the drug benefit derives from the efficacy end points of clinical trials, and risks are based on adverse events reported in trials and, once the drug is on the market, on spontaneous safety data.26 The assessment is based on a judgment where, in addition JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION to the benefit and risks. other factors enter into account such as the notion of unmet medical need or the risk management plan proposed to mitigate the potential safety risks of the drugs. An important element in the BRA performed by the FDA is the opinion given by the Advisory Committees before drug registration, where different specialists independent of the FDA, and sometimes also representatives from patient groups, assess the drug dossier, and take a decision by a vote.