Current challenges of the proposed framework for the pharmaceutical industry

The new draft framework leaves some significant gaps with regard to a defined approach that pharmaceutical manufacturers should take in their RWE trial design for regulatory approval. The guidelines do not yet completely define the RWE trial design approaches that are approvable, nor the regulatory submission process. The FDA is actively soliciting feedback (deadline: Feb 5, 2019) that will be used in the final RWE guidance.


The FDA has stated they will review on a case-by-case basis and will use three criteria for evaluation:


  1. If the RWD selected is fit for use to generate data for product effectiveness decisions
  2. If the study design used to generate RWE can provide robust scientific evidence to help address the regulatory question
  3. If the execution of the studies generating RWE meets FDA regulatory requirements


The last criterium forms a catch-22 as the current FDA regulatory requirements regarding RWE do not specifically outline use in regulatory approval. Several FDA regulations and guidance documents are available for the use of electronic data, eHealth records in clinical investigations, electronic informed consents Q&A’s that could potentially be used for the FDA RWE program. These include Electronic Source Data in Clinical Investigations and Use of Electronic Health Records in Clinical Investigations, among others. Per the draft guidance: “FDA has gained considerable experience assessing electronic health care data (e.g., EHRs, medical claims data, registries) through experience with the Sentinel System and other data systems.” The FDA will be using this experience to guide their perspective on data submissions within the RWE Program.

The new draft framework leaves some significant gaps with regard to a defined approach that pharmaceutical manufacturers should take in their RWE trial design for regulatory approval. The guidelines do not yet completely define the RWE trial design approaches that are approvable, nor the regulatory submission process. The FDA is actively soliciting feedback (deadline: Feb 5, 2019) that will be used in the final RWE guidance.


The FDA has stated they will review on a case-by-case basis and will use three criteria for evaluation:


  1. If the RWD selected is fit for use to generate data for product effectiveness decisions
  2. If the study design used to generate RWE can provide robust scientific evidence to help address the regulatory question
  3. If the execution of the studies generating RWE meets FDA regulatory requirements


The last criterium forms a catch-22 as the current FDA regulatory requirements regarding RWE do not specifically outline use in regulatory approval. Several FDA regulations and guidance documents are available for the use of electronic data, eHealth records in clinical investigations, electronic informed consents Q&A’s that could potentially be used for the FDA RWE program. These include Electronic Source Data in Clinical Investigations and Use of Electronic Health Records in Clinical Investigations, among others. Per the draft guidance: “FDA has gained considerable experience assessing electronic health care data (e.g., EHRs, medical claims data, registries) through experience with the Sentinel System and other data systems.” The FDA will be using this experience to guide their perspective on data submissions within the RWE Program.

The FDA intends to review gaps in both the RWE Framework and in RWE data systems as well as the interoperability and provide strategies to address them. The following summaries gaps currently identified by the FDA which may need to be addressed while framing guidance for the RWE program.


1. Lack of enough data showing concordance between the results of traditional clinical trials vs observational studies

2. Lack of reporting requirements for various observational studies

3. Lack of data recording standards and interoperability across various health care data collection systems

4. Challenges in integrating data for the same patient across various data sources

5. Challenges in collecting data from electronic patient reported outcomes, wearables, biosensors and mobile app


Interestingly, the RWE framework also opens the door for possible inclusion of data derived from outside of the United States of America. The continued evaluation and publication of data and systems gaps with strategic recommendations by the FDA will have to address how to support these issues and how to address HIPPA within RWE.