FDA :
"We asked for outcome studies, but were not able to require them because of the argument about naproxen. And we never said that -- we generally can never say, not just in this instance -- if someone says, "Is this going to be enough blood pressure data to convince you," the answer is we don't know until we see the data, because if there had been a huge effect, maybe this would have been enough for us to decide that there was a certain benefit.
But based on these results, based on this much data, that's where we're stuck trying to make our decision. So if you're asking did the company not do what we asked, the problem is we don't have set minimum requirements for how much data you must come in for a blood pressure comparative -- to compare your blood pressure effects against an element of your compound, because as with anything, it depends on the effect size, how much data you're going to need to prove it.
What we always tell them, though, is that the studies have to be adequate and well controlled. The analyses need to be pre-specified and that the statistical analyses need to be pre-specified and appropriate.
So we give them the basic criteria, but we generally don't have the information early in development to say exactly how much has to get done."
Un peu + loin :
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DR. ROBINSON (Nicox): Dr. O'Neil, may I make a clarification, from the sponsor point of view? Certainly, we had long and ongoing discussions with the agency.
I just wanted to clarify what our understanding was at the time when we started evelopment, and of course, you have results. But our understanding was that with regard to approval, just approval, that the necessity for a safety outcome was not required because the active metabolite, the NSAID active metabolite was naproxen.
But we never -- we understood that that discussion was quite strictly limited to the indication of the osteoarthritis claim. We never thought that that discussion ever went beyond.
DR. HERTZ (FDA): Okay. That's not accurate the way it was said, but I think it might be accurate in what was meant. We always said safety had to be demonstrated. We did not say that a safety difference -- we never said that they had to be better, but we always said a safety assessment had to be done.
I don't want everyone thinking that we have ever said you don't need to be safe with an NDA.
DR. ROBINSON: No, no. And please understand that was not what I was saying either, but I think we've clarified the issue. Thank you.