Challenges in Advanced Therapy Medicinal Product Development: A Survey among Companies in Europe

Abstract

Advanced therapy medicinal products (ATMPs) hold promise as treatments for previously untreatable and high-burden diseases. Expectations are high and active company pipelines are observed, yet only 10 market authorizations were approved in Europe. Our aim was to identify challenges experienced in European ATMP clinical development by companies. A survey-based cohort study was conducted among commercial ATMP developers. Respondents shared challenges experienced during various development phases, as well as developer and product characteristics. Descriptions of challenges were grouped in domains (clinical, financial, human resource management, regulatory, scientific, technical, other) and further categorized using thematic content analysis. A descriptive analysis was performed. We invited 271 commercial ATMP developers, of which 68 responded providing 243 challenges. Of products in development, 72% were in early clinical development and 40% were gene therapies. Most developers were small- or medium-sized enterprises (65%). The most often mentioned challenges were related to country-specific requirements (16%), manufacturing (15%), and clinical trial design (8%). The European ATMP field is still in its early stages, and developers experience challenges on many levels. Challenges are multifactorial and a mix of ATMP-specific and generic development aspects, such as new and orphan indications, novel technologies, and inexperience, adding complexity to development efforts.

Keywords: ATMP; Europe; cell-based therapy; challenges; development; gene therapy; manufacturing; regulation.

Figure 1

Developer-Reported Challenge Domains and Themes Displayed per Characteristic (Company Size, ATMP Type, and Development Stage) Regulatory challenge distribution (A), technical challenge distribution (B), scientific challenge distribution (C), financial challenge distribution (D), clinical challenge distribution (E), human resource management challenge distribution (F), and other challenge distribution (G) per subgroup. Gray bars represent all developers per theme: company size (dark blue bars, SME; light blue bars, large company), ATMP type (dark green bars, GTMP; medium green bars, CTMP; light green bars, TEP; very dark green bars, combined ATMP), development stage (dark orange bars, phases I–II; medium orange bars, phase III; light orange bars, regulatory application and commercialization).