IMO, a great deal of thought and planning must be applied to just what will AVXL ask the FDA to do? Is it a direct assessment of a specific trial/ indication data (summary of all relevant information) for one or multiple indications (AD/PDD/RSD...)? Looking for go/no go? Are we looking for MOA validation/verification?
Will the FDA need to analyze new devices/technology applications used during PDD trials? eg (actigraphy) ?
Keeping things focused w/a risk averse regulatory body is not easy. We will be required to present strong data from systems which have all been through and accepted BY FDA V&V processes. If not they could go on for many months just agreeing on how the trials and systems used were controlled and validated. Long story which takes time to get prepared for.
The decisions made will be carefully picked at by BP and others.
FDA are risk averse. Do your homework and understand exactly what your question is. Just exactly what are we asking for? Approval of a specific trial data via Old school, or basket Validation of MOA, or some combination new trial process results assessment-acceptance.
It would be great if the FDA were an open and supportive regulatory body who are easy to do business with and are able to walk and chew gum. These are the same people who have managed a regulatory process for which symptoms have been treated as final solutions. A Regulatory body who has recently stated they were "really not sure when AD starts", after decades of chasing a/the wrong solution.
In summary: Dr.M. must be very direct with exactly what he is asking for from the FDA. What do we want them to agree to? I have no information on how long FDA will require to respond.
Anavex will have a Type B (EOP) meeting. (end of phase) Tables 1, 2 and A highlight timing issues: Anavex must request a meeting. FDA has 14 days to respond yes/no The meeting will be scheduled within 70 days of the request --- Anavex must get the meeting informational package to the FDA by day 50 and another sentence said within 6 days of meeting request. The FDA will have complete minutes for the sponsor by 30 days later.
The guidance also goes into detail about information Anavex should have available in the package (submitted shortly after meeting request). Points 14 and 15 are the most relevant for discussion.
From my understanding based on conversations in the past with an SVP Research, the most important thing to pin down with the FDA is the primary endpoint so that the sponsor and FDA are on the same page as to what constitutes a successful phase 3. Realized and potential Adverse events must also be completely discussed for the safety of participants (not a huge issue for Anavex273 compared say to immunosuppressant for MS).
The FDA does not design the study... the sponsor does. But they need to listen carefully to what the FDA says to help design features of the study. The company's statisticians will help decide population size once the primary endpoint is agreed upon. IMO, ADAS-Cog will be the primary endpoint for PDD because of precedence -- it was with Rivastigmine (success on primary and secondary endpoints) and donepezil (failed primary endpoint despite hitting almost all secondary endpoints)