US FDA proposes framework to speed rare disease gene therapy approvals

WASHINGTON, Feb 23 (Reuters) – The U.S. Food and Drug Administration proposed on Monday a new framework to speed approvals of personalized treatments for rare and life-threatening genetic diseases, allowing drugmakers to rely on small, well-controlled studies when traditional trials are not possible.

The plan aims to update approval standards for individualized genetic medicines, creating a pathway for therapies aimed at patient groups too small for traditional trials.

It could provide patients earlier access to treatments that would otherwise stall because only limited data can be gathered, with safety still monitored through post-approval requirements.

The proposal offers drugmakers clearer rules for developing genome-editing and RNA-based drugs, while requiring them to justify why randomized trials are not feasible, collect real-world evidence after approval and have confirmatory studies underway for accelerated clearance. The agency warned it could withdraw products if those studies fail or are not completed.

The draft guidance, first outlined in November, would permit companies to seek approval based on early efficacy signals and a therapy’s biological rationale, rather than full-scale randomized trials. It covers genome-editing and RNA-based therapies, and could extend to other targeted products.

Drugmakers would still need to gather real-world evidence after approval to confirm effectiveness and monitor safety and must also ensure patient protections, including informed consent and oversight by review boards.

The agency urged early collection of baseline and natural-history data. For treatments targeting multiple mutations within the same gene, it recommended observational studies and “master protocol” designs to allow evidence-sharing across related products.

“We anticipate that we’re going to get a flood of applications for treatments of rare diseases,” a senior FDA official told reporters.

Manufacturing standards would remain unchanged, though companies can draw on prior experience and validated methods to move faster.

(Reporting by Ahmed Aboulenein; Editing by Nia Williams)