From adaptive licensing to adaptive pathways: delivering a flexible life-span approach to bring new drugs to patients.

The concept of adaptive licensing (AL) has met with considerable interest. Yet some remain skeptical about its feasibility. Others argue that the focus and name of AL should be broadened. Against this background of ongoing debate, we examine the environmental changes that will likely make adaptive pathways the preferred approach in the future. The key drivers include: growing patient demand for timely access to promising therapies, emerging science leading to fragmentation of treatment populations, rising payer influence on product accessibility, and pressure on pharma/investors to ensure sustainability of drug development. We also discuss a number of environmental changes that will enable an adaptive paradigm. A life-span approach to bringing innovation to patients is expected to help address the perceived access vs. evidence trade-off, help de-risk drug development, and lead to better outcomes for patients.

EUROPLAN: a project to support the development of national plans on rare diseases in Europe.

BACKGROUND/AIMS: National Plans for Rare Diseases (RDs) are the common denominator of current public health policy concerns on RDs across the EU. With the aim of a better distribution of the available resources, they conjugate the European objective that aims at ensuring that patients with RDs have access to high-quality care - including diagnostics, treatment and rehabilitation - with the national priorities of selecting specific measures for adoption and implementation. METHODS: The European Project for Rare Diseases National Plans Development (EUROPLAN, www.europlanproject.eu) is cofunded by the EU Commission (DG-SANCO) and is coordinated by the Italian National Center for Rare Diseases of the Istituto Superiore di Sanità (ISS). The EUROPLAN goal is to promote the implementation of National Plans or Strategies to tackle RDs and share relevant experiences within countries, linking national efforts, through a common strategy at a European level. In order to fulfill these objectives, EUROPLAN involved health authorities, clinicians, scientists, the European Organisation for Rare Diseases (EURORDIS), and many other patient groups as associated and collaborating partners from several European countries. RESULTS: The project was launched in 2008 and foresaw 2 implementation phases: phase 1 (2008-2011) to build the consensus definition of operational tools (recommendations and indicators), and the ongoing phase 2 (2012-2015), mainly aimed at capacity building with the proactive involvement of multilevel stakeholders. EUROPLAN is facilitating and accelerating the implementation of National Plans in almost all EU and several non-EU Countries. CONCLUSIONS: EUROPLAN is a European and an international process more than a project, and it could be defined as a 'litmus test' demonstrating how the collaboration between institutions and patients' associations can accelerate the process of awareness and development of policies and actions.

Involvement of patient organisations in research and development of orphan drugs for rare diseases in europe.

Patients' representatives have an increasingly present voice in all aspects of drug development from fundamental research through regulatory processes to health technology assessment. Although major advances have been made in raising awareness and increasing funding for rare diseases, important challenges remain in terms of best use of resources, coordinating efforts and improving policy. This article describes actions taken by rare disease patients' organisations as well as initiatives at the national and European levels to promote research into rare diseases. A survey conducted by EURORDIS (European Organisation for Rare Diseases) on the support (financial and non-financial) provided by patients' organisations in rare disease research is described as well as the involvement of patients' representatives in regulatory processes for medicinal products at the European Medicines Agency. The importance of including patients' groups in fundamental and clinical research as equal partners has become a fact that clearly contributes to the success of an application and the research conducted.

[Neoplastic pulmonary embolism. An uncommon cause of acute respiratory distress with normal pulmonary radiography]. / L'embolie pulmonaire néoplasique. Une cause inhabituelle de détresse respiratoire aiguë avec radiographie pulmonaire normale.

The incidence of neoplastic pulmonary embolism is certainly underestimated Necroscopy series report figures varying from 2.9 to 26. The clinical manifestations are similar to those observed in cruoric pulmonary embolism. We report two cases of acute respiratory failure with normal chest X-ray in which the diagnosis was neoplastic pulmonary embolism. The difficulties encountered for diagnosis resulted from the diffuse microvascular nature of the lesions. Perfusion scintigraphy and Swan-Ganz catheterism can be contributive, but certain diagnosis requires pathology examination. Prognosis is very poor. Clinicians should be aware of this pathology and entertain the diagnosis in all cor pulmonale patients with acute respiratory failure and a normal chest X-ray.