title: Innovating by developing new uses of already-approved drugs: trends in the marketing approval of supplemental indications.
abstract: BACKGROUND
  Much of the literature on trends and factors affecting biopharmaceutical innovation has focused overwhelmingly on the development and approval of never-before approved drugs and biologics. Little attention has been paid to new uses for already-approved compounds, which can be an important form of innovation.
  
  
  OBJECTIVE
  This paper aimed to determine and analyze recent trends in the number and type of new or modified US indication approvals for drugs and biologics. We also examine regulatory approval-phase times for new-use efficacy supplements and compare them to approval-phase times for original-use approvals over the same period.
  
  
  METHODS
  We developed a data set of efficacy supplements approved by the US Food and Drug Administration (FDA) from 1998 to 2011 that includes information on the type, approval-phase time (time from submission to the FDA of an application for marketing approval to approval of the application), and FDA therapeutic-significance rating for the approved application, which we obtained from an FDA Web site. This data set was merged with a Tufts Center for the Study of Drug Development (CSDD) data set of US new drug and biologics approvals. We developed descriptive statistics on trends in the number and type of new-use efficacy supplements, on US regulatory approval-phase times for the supplements, and on original new drug and biologics approvals over the study period and for the time from original- to new-use approval.
  
  
  RESULTS
  The total number of new-use efficacy-supplement approvals did not exhibit a marked trend, but the number of new pediatric-indication approvals increased substantially. Approval-phase times for new-use supplements varied by therapeutic class and FDA therapeutic-significance rating. Mean approval-phase times were highest for central nervous system compounds (13.8 months) and lowest for antineoplastics (8.9 months). The mean time from original to supplement approval was substantially longer for new pediatric indications than for other new uses. Mean approval-phase time during the study period for applications that received a standard review rating from the FDA was substantially shorter for supplements compared to original uses, but the differences for applications that received a priority review rating from the FDA were negligible.
  
  
  CONCLUSIONS
  Development of and regulatory approval for new uses of already-approved drugs and biologics is an important source of innovation by biopharmaceutical firms. Despite rising development costs, the output of new-use approvals has remained stable in recent years, driven largely by the pursuit of new pediatric indications. FDA approval-phase times have generally declined substantially for all types of applications since the mid-1990s following legislation that provided a new source of income for the agency. However, while the resources needed to review supplemental applications are likely lower in general than for original-use approvals, the approval-phase times for important new uses are no lower than for important original-use applications.
authors.affiliation: Tufts Center for the Study of Drug Development, Tufts University, Boston, Massachusetts 02111, USA. joseph.dimasi@tufts.edu
authors.forename: Joseph A
authors.initials: JA
authors.lastname: DiMasi
mesh_terms: D001685:Biological Factors / Q000627:therapeutic use; D062313:Databases, Pharmaceutical / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D017277:Drug Approval / Q000191:economics / Q000706:statistics & numerical data*; D058492:Drug Repositioning / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D040541:Marketing; D013997:Time Factors; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D001685:Biological Factors