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All sourcesNASA NTRSDOE OSTI
DOE OSTI2025

Pivotal trial characteristics and types of endpoints used to support Food and Drug Administration rare disease drug approvals between 2013 and 2022

Background/aims Rare disease drug development faces unique challenges, such as genotypic and phenotypic heterogeneity within small patient populations and a lack of established outcome measures for conditions without previously successful drug development programs. These challenges complicate the process of selecting the appropriate trial endpoints and conducting clinical trials in rare diseases. In this descriptive study, we examined novel drug approvals for non-oncologic rare diseases by the U.S. Food and Drug Administration’s Center for Drug Evaluation and Research over the past decade and characterized key regulatory and trial design elements with a focus on the primary efficacy endpoint utilized as the basis of approval. Methods Using the Food and Drug Administration’s Data Analysis Search Host database, we identified novel new drug applications and biologics license applications with orphan drug designation that were approved between 2013 and 2022 for non-oncologic indications. From Food and Drug Administration review documents and other external databases, we examined characteristics of pivotal trials for the included drugs, such as therapeutic area, trial design, and type of primary efficacy endpoints. Differences in trial design elements associated with primary efficacy endpoint type were assessed such as randomization and blinding. Then, we summarized the primary efficacy endpoint types utilized in pivotal trials by therapeutic area, approval pathway, and whether the disease etiology is well defined. Results One hundred and seven drugs that met our inclusion criteria were approved between 2013 and 2022. Assessment of the 107 drug development programs identified 150 pivotal trials that were subsequently analyzed. The pivotal trials were mostly randomized (80%) and blinded (69.3%). Biomarkers (41.1%) and clinical outcomes (42.1%) were commonly utilized as primary efficacy endpoints. Analysis of the use of clinical trial design elements across trials that utilized biomarkers, clinical outcomes, or composite endpoints did not reveal statistically significant differences. The choice of primary efficacy endpoint varied by the drug’s therapeutic area, approval pathway, and whether the indicated disease etiology was well defined. For example, biomarkers were commonly selected as primary efficacy endpoints in hematology drug approvals (70.6%), whereas clinical outcomes were commonly selected in neurology drug approvals (69.6%). Further, if the disease etiology was well defined, biomarkers were more commonly used as primary efficacy endpoints in pivotal trials (44.7%) than if the disease etiology was not well defined (27.3%). Discussion In the past 10 years, numerous novel drugs have been approved to treat non-oncologic rare diseases in various therapeutic areas. To demonstrate their efficacy for regulatory approval, biomarkers and clinical outcomes were commonly utilized as primary efficacy endpoints. Biomarkers were not only frequently used as surrogate efficacy endpoints in accelerated approvals, but also in traditionally approved rare disease drugs. The choice of primary efficacy endpoints varied by therapeutic area, approval pathway, and understanding of disease etiology.

Hong, Kyungwan [Rare Diseases Team, Office of New ↗
DOE OSTI2022

Oak Ridge National Laboratory EPA Approval Letters and Historical Documentation for a Modification in Applying 40 CFR Part 61 Appendix D

Appendix D of Title 40 Part 61, “Methods for Estimating Radionuclide Emissions,” of the Code of Federal Regulations (CFR) provides a procedure that US Department of Energy (DOE) facility owners and operators can use to estimate radionuclide emissions to the atmosphere for dose calculations instead of measuring emissions for minor sources under 40 CFR Part 61, Subpart H, “National Emission Standards for Emissions of Radionuclides Other than Radon from Department of Energy Facilities.” The procedure assumes that any radioactive material heated above 100°C is completely vaporized and emitted to the atmosphere. In 1991, the DOE Oak Ridge Reservation (DOE-ORR) requested approval to use different release fractions (RFs) for uranium because of its high melting and boiling points (1,132°C and 3,818°C, respectively). In response to the request, Environmental Protection Agency (EPA) Region IV approved the use of modified RFs for elemental uranium provided no reaction had taken place to alter its chemical form. In 2015, DOE-ORR requested approval to use different RFs for radioactive tungsten, also because of its high melting and boiling points (3,410°C and 5,660°C, respectively). EPA Region IV approved the use of modified RFs for heated radioactive tungsten metal. In accordance with the two precedents set for heating uranium and radioactive tungsten metals, in 2016, DOE-ORR requested approval to use modified RFs in similar fashion for other radioactive solid metals and compounds with melting and boiling points above 500°C that might be heated above 100°C in future research projects and experiments, and again, the EPA Region IV granted approval to use modified RFs for the list of compounds. This document contains the EPA approval letters and historical documentation used in the process to obtain approval for the use of alternative Appendix D emission factors. The approval to DOE-ORR allows modifying the existing regulatory RFs to 1 when radioactive solid metals and compounds are heated to temperatures greater than or equal to the boiling point of the solid, to 10 -3 when radioactive solid metals and compounds are heated to temperatures greater than or equal to 90% of the melting point and less than the boiling point of the solid, and to 10 -6 when radioactive solid materials are heated to temperatures above ambient air temperature but below 90% of the melting point of the solid.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2022

Clinical pharmacology information in regulatory submissions and labeling: A comparative analysis of orphan and non-orphan drugs approved by the FDA

Clinical pharmacology is an integral discipline supporting the development, regulatory evaluation, and clinical use of drugs for the treatment of both common and rare diseases. Here, we evaluated the recommendations and information available from select clinical pharmacology studies in the therapeutic product labeling of new molecular entities (NMEs) approved from 2017 to 2019 for both common and rare diseases. A total of 151 NMEs, including 72 orphan and 79 non-orphan drugs, were analyzed for recommendations and information available related to food–drug interaction, drug–drug interaction, renal impairment, hepatic impairment, QT assessment, and human radiolabeled mass balance studies using data collected from the original labeling and other regulatory documents. The analysis showed no statistically significant difference in the recommendations between orphan and non-orphan drugs except for renal impairment related recommendations in section 8 of the labeling. Although not significant, fewer hepatic impairment labeling recommendations were available for orphan drugs when compared with non-orphan drugs. At the time of initial approval, 79 postmarketing requirements (PMRs) and postmarketing commitments (PMCs) for 33 orphan drugs and 39 PMRs and PMCs for 19 non-orphan drugs were established; with most difference observed for drug–drug interaction, hepatic impairment, and QT assessment. Overall, although there was a trend for more labeling recommendations and fewer postmarketing studies and clinical trials for non-orphan drugs, there appeared to be no substantial differences in how these select clinical pharmacology studies are leveraged during the development and approval of orphan and non-orphan drugs.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2024

Development and Demonstration of a Risk Assessment Approach for Approval of a Transportation Package of a Transportable Nuclear Power Plant for Domestic Highway Shipment

The U.S. Department of Defense (DoD) Strategic Capabilities Office (SCO) has tasked PNNL to address the regulatory challenges associated with confirming the safe transport of Transportable Nuclear Power Plants (TNPPs) containing irradiated nuclear fuel. A previous report—Proposed Risk-Informed Regulatory Framework for Approval of Microreactor Transportation Packages (PNNL-31867)—determined that the expected radioactive inventory in the irradiated fuel of a TNPP would likely require shipment in an NRC-approved Type B package (or spent nuclear fuel cask) but that a TNPP “package” is unlikely to meet the entire suite of NRC requirements set forth in Part 71 of Title 10 of the Code of Federal Regulations (CFR) for a Type B package. It was therefore concluded that shipment of this initial TNPP transportation package, as well as possibly others, under existing regulations would likely require NRC approval using the 10 CFR 71.12 (“Specific exemptions”) process that relies on risk-informed decision making supported by quantitative risk assessment (i.e., Probabilistic Risk Assessment).

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗
DOE OSTI2025

Recommendations to Improve Nuclear Licensing: Update to INL/RPT-23-72206, Recommendations to Improve the Nuclear Regulatory Commission Reactor Licensing and Approval Process

In 2023, various stakeholders had asked for BEA’s thoughts and recommendations to improve the U.S. Nuclear Regulatory Commission’s (NRC) licensing review and approval process. This included an April 14, 2023 request from the House Committee on Energy and Commerce on “information and recommendations to improve the licensing review and approval process, . . . as well as the siting, licensing, construction, and oversight of advanced nuclear reactor technologies.” In response to these requests, BEA prepared and published INL/RPT-23-72206, Recommendations to Improve the Nuclear Regulatory Commission Reactor Licensing and Approval Process (2023 Report). The 2023 Report included 13 recommendations related to streamlining NRC hearings, expediting NRC safety and environmental reviews, otherwise improving NRC licensing, and providing financial benefits to new reactor projects. Many of these earlier recommendations were addressed through various legislative actions or changes made by the NRC. Section 2 of this report addresses the current status of those earlier recommendations. BEA recently received a new request from the House Committee on Energy and Commerce seeking any suggestions for additional areas to examine or potential reforms “that may assist in modernizing the licensing and regulatory process that affects civil nuclear deployment.” Additionally, the new Secretary of Energy has identified initial DOE actions to support unleashing the golden era of American energy dominance, including “Unleash Commercial Nuclear Power in the United States” and “Streamline Permitting and Identify Undue Burdens on American Energy.” Given these developments, BEA has prepared a new set of updated recommendations in this report. The recommendations include updated versions of recommendations from the 2023 Report which have not been fully adopted, as well as entirely new recommendations. This set of recommendations has a slightly broader focus with some recommendations focused on DOE authorizations and some recommendations related to nuclear licensing beyond new reactors. Each recommendation below also identifies whether the recommendation would require legislative action or could be addressed directly by the respective agency.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗
DOE OSTI2024

Impact of structural biology and the protein data bank on us fda new drug approvals of low molecular weight antineoplastic agents 2019–2023

Abstract Open access to three-dimensional atomic-level biostructure information from the Protein Data Bank (PDB) facilitated discovery/development of 100% of the 34 new low molecular weight, protein-targeted, antineoplastic agents approved by the US FDA 2019–2023. Analyses of PDB holdings, the scientific literature, and related documents for each drug-target combination revealed that the impact of structural biologists and public-domain 3D biostructure data was broad and substantial, ranging from understanding target biology (100% of all drug targets), to identifying a given target as likely druggable (100% of all targets), to structure-guided drug discovery (>80% of all new small-molecule drugs, made up of 50% confirmed and >30% probable cases). In addition to aggregate impact assessments, illustrative case studies are presented for six first-in-class small-molecule anti-cancer drugs, including a selective inhibitor of nuclear export targeting Exportin 1 (selinexor, Xpovio), an ATP-competitive CSF-1R receptor tyrosine kinase inhibitor (pexidartinib,Turalia), a non-ATP-competitive inhibitor of the BCR-Abl fusion protein targeting the myristoyl binding pocket within the kinase catalytic domain of Abl (asciminib, Scemblix), a covalently-acting G12C KRAS inhibitor (sotorasib, Lumakras or Lumykras), an EZH2 methyltransferase inhibitor (tazemostat, Tazverik), and an agent targeting the basic-Helix-Loop-Helix transcription factor HIF-2α (belzutifan, Welireg).

60 APPLIED LIFE SCIENCES↗
DOE OSTI2024

Susceptibility of pESI positive Salmonella to treatment with biocide chemicals approved for use in poultry meat processing as compared to Salmonella without the pESI plasmid

Abstract Salmonella is a common cause of human foodborne illness, which is frequently associated with consumption of contaminated or undercooked poultry meat. Serotype Infantis is among the most common serotypes isolated from poultry meat products globally. Isolates of serotype Infantis carrying the pESI plasmid, the most dominant strain of Infantis, have been shown to exhibit oxidizer tolerance. Therefore, 16 strains of Salmonella with and without pESI carriage were investigated for susceptibility to biocide chemical processing aids approved for use in US poultry meat processing: peracetic acid (PAA), cetylpyridinium chloride (CPC), calcium hypochlorite, and sodium hypochlorite. Strains were exposed for 15 s to simulate spray application and 90 min to simulate application in an immersion chiller. All strains tested were susceptible to all concentrations of PAA, CPC, and sodium hypochlorite when applied for 90 min. When CPC, calcium hypochlorite, and sodium hypochlorite were applied for 15 s to simulate spray time, strains responded similarly to each other. However, strains responded variably to exposure to PAA. The variation was not statistically significant and appears unrelated to pESI carriage. Results highlight the necessity of testing biocide susceptibility in the presence of organic material and in relevant in situ applications.

Biotechnology & Applied Microbiology↗
DOE OSTI2022

Risk-Informed Approach for Regulatory Approval of Microreactor Transport

Pacific Northwest National Laboratory (PNNL) is addressing the challenges associated with safe transport of microreactors including the development and evaluation of regulatory options. PNNL developed a risk-informed regulatory framework for the licensing of the transportation of microreactors in which irradiated nuclear fuel is part microreactor transportation package. The framework lays out a viable regulatory pathway, including decision points for regulatory options and the supporting technical evaluations for those options in phases from near to long term. A microreactor and its contents will likely not be able to meet all the federal regulatory requirements as a Type B or fissile material transportation package under 10 CFR Part 71 (“Packaging and Transportation of Radioactive Material”). However, the regulatory framework developed by PNNL lays out a viable risk-informed licensing options that are safe and feasible. Risk assessment such as probabilistic risk assessment (PRA) can be used to show comparable safety to that provided by a Type B or fissile material package for surface transport. The framework includes guidance on applicable regulations and discusses historical precedence in using risk information for transportation licensing. The framework includes guidance for performing a microreactor transportation PRA, use and development of risk evaluation criteria, and factors such of defense-in-depth and safety margin concepts. Key advantages of using the approach are (1) increasing the likelihood of successfully obtaining regulatory transportation package approval, (2) informing the design on the relative risk significance of microreactor containment and shielding, and (3) informing the need for transportation compensatory measures. This paper focuses on two primary elements of the framework which are development of a transportation PRA for microreactor packages and development of the risk acceptance guidelines to assess the results of the PRA for regulatory decision-making.

microreactor, micro nuclear power plant, MNPP, ris↗
DOE OSTI2024

An FDA-approved drug structurally and phenotypically corrects the K210del mutation in genetic cardiomyopathy models

Dilated cardiomyopathy (DCM) due to genetic disorders results in decreased myocardial contractility, leading to high morbidity and mortality rates. There are several therapeutic challenges in treating DCM, including poor understanding of the underlying mechanism of impaired myocardial contractility and the difficulty of developing targeted therapies to reverse mutation-specific pathologies. In this report, we focused on K210del, a DCM-causing mutation, due to 3-nucleotide deletion of sarcomeric troponin T (TnnT), resulting in loss of Lysine210. We resolved the crystal structure of the troponin complex carrying the K210del mutation. K210del induced an allosteric shift in the troponin complex resulting in distortion of activation Ca 2+ -binding domain of troponin C (TnnC) at S69, resulting in calcium discoordination. Next, we adopted a structure-based drug repurposing approach to identify bisphosphonate risedronate as a potential structural corrector for the mutant troponin complex. Cocrystallization of risedronate with the mutant troponin complex restored the normal configuration of S69 and calcium coordination. Risedronate normalized force generation in K210del patient-induced pluripotent stem cell–derived (iPSC-derived) cardiomyocytes and improved calcium sensitivity in skinned papillary muscles isolated from K210del mice. Systemic administration of risedronate to K210del mice normalized left ventricular ejection fraction. Collectively, these results identify the structural basis for decreased calcium sensitivity in K210del and highlight structural and phenotypic correction as a potential therapeutic strategy in genetic cardiomyopathies.

Research & Experimental Medicine↗
DOE OSTI2022

2022 MB3a Infrasound Sensor Type Approval Evaluation

Sandia National Laboratories has tested and evaluated an updated version of the MB3a infrasound sensor, designed by CEA and manufactured by SeismoWave. The purpose of this infrasound sensor evaluation is to measure the performance characteristics in such areas as power consumption, sensitivity, full scale, self-noise, dynamic range, response, passband, sensitivity variation due to changes in barometric pressure and temperature, and sensitivity to acceleration. The MB3a infrasound sensors are being evaluated for use in the International Monitoring System (IMS) of the Preparatory Commission to the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO).

47 OTHER INSTRUMENTATION↗
DOE OSTI2022

2022 Chaparral 64S Infrasound Sensor Type Approval Evaluation

Sandia National Laboratories has tested and evaluated a new version of the Chaparral 64S infrasound sensor, designed and manufactured by Chaparral Physics. The purpose of this infrasound sensor evaluation is to measure the performance characteristics in such areas as power consumption, sensitivity, full scale, self-noise, dynamic range, response, passband, sensitivity variation due to changes in barometric pressure and temperature, and sensitivity to acceleration. The Chaparral 64S infrasound sensors are being evaluated for use in the International Monitoring System (IMS) of the Preparatory Commission to the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO).

47 OTHER INSTRUMENTATION↗
DOE OSTI2022

Container Evaluation: Analysis of the Swagelok Knuckle with Viewport as an Approved Hermetically Sealed Inner Container

This report outlines the results from the water ingress test, helium leak test and additional atmosphere testing for the Swagelok knuckle with viewport container further referred to as the SKV. This container is constructed from a standard union vacuum fitting, 1.33” conflat to 0.5” male VCR, a 1.33” conflat fused silica lensed viewport fitting, and a 0.5 inch VCR cap. The primary intended use of this container is to store Pu metal samples in the vault for a time interval exceeding 40 years. The samples need to be contained in an air free environment to ensure that the material does not oxidize over time. The container viewport is a critical design feature that will help the operators visually inspect and evaluate the state of the metal samples prior to opening the container. These containers are advertised as leak tight, but experimental tests were performed to test the water resistant criteria and the gas leaking criteria set forth by the TA-55 Criticality Safety Program. The results of the water ingress test show that the container is water-tight, with no signs of water penetrating the container within the required guidelines outlined in TA55-AP-522. The preliminary He leak test performed demonstrate that the conflat window port and VCR cap are able to maintain a hermetic seal. Additionally, all containers will be He leak tested independently by the manufacturer prior to shipping to LANL. A third voluntary test was added to assess the container’s ability to hold atmosphere, with successful results indicating the container is able to hold inert atmosphere to prevent lanthanum metal oxidation. It is the conclusion of the authorsthat there is enough evidence through the test conducted and outlined within this document that the proposed container meets the definition of a water-tight container, and it is able to provide a hermetic seal.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗
DOE OSTI2023

Recommendations to Improve the Nuclear Regulatory Commission Reactor Licensing and Approval Process

Due to the urgency around climate change and associated goals for clean energy transition, and Battelle Energy Alliance's (BEA) and Idaho National Laboratory's (INL) role as the nation's nuclear energy laboratory, numerous stakeholders have asked for BEA’s thoughts and recommendations to reduce the time and costs associated with licensing new reactors at the U.S. Nuclear Regulatory Commission (NRC). As an M&O contractor for an FFRDC, BEA is a long-term partner with the Government in seeking to achieve clean energy goals, yet has a level of independence needed to appropriately evaluate this topic. The views herein are informed by extensive BEA experience supporting nuclear energy endeavors including ongoing discussions with current and former regulators, applicants, and licensees. With this background in mind, the United States benefits from having an agency such as the NRC, which is viewed internationally as the leader in nuclear safety licensing and regulation. Nonetheless, while acknowledging the important nuclear safety role satisfied by the NRC, it is apparent that one of the most significant time and resource intensive activities for new reactor developers is the NRC licensing process. The time and cost to obtain NRC licenses add significant financial stress for new reactor projects and may result in abandonment of projects or failure to even begin new projects. The challenge is particularly acute for advanced reactors which may raise unique or new regulatory questions and may be smaller in size, resulting in a much higher proportional impact from regulatory and cost challenges. This situation presents a particularly troublesome risk for the nation given the urgency in which utilities are working to transition to clean, non-carbon-emitting energy sources like nuclear energy. Reforms to the NRC licensing process have the potential to greatly increase certainty and support the successful progress of new reactors. The NRC can retain its world-class nuclear safety reputation while becoming a world leader for regulatory efficiency and a critical enabler to the clean energy transition. This report describes potential NRC reforms, focusing on those with a statutory connection. Recognizing the potential tradeoffs with any proposed changes, the report attempts to highlight those considerations in the analysis of the reforms. The recommendations are presented as a set of options for consideration. Unless noted, they are independent options, offering stakeholders the option to select a subset for further consideration. Although difficult to calculate precise time improvements for some of the changes, the reforms have the potential for substantial improvements, perhaps even by a factor of two.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗