Correct Mike the regulatory process increases in size to get statistical confidence in order to “ prove” the treatment is safe.There is no absolute guarantee of safety but that is life.My understanding is that the logging of reactions very much does affect whether a pharmaceutical is considered safe and affected after launch. And depending on the severity of reactions drugs can be withdrawn.
This can also happen (both positively and negatively) during the trial phases. If a sufficient proportion of individuals have a sufficiently negative reaction when human trials start, the trial is immediately stopped. Conversely, if the trial medication is astonishingly effective, and no one has a negative reaction, it can become unethical to continue with the comparator or placebo arm (which you know will have worse outcomes than the newly discovered wonder-drug).
The whole process normally lasts about 10 years involving both pre clinical ( animal trials ) and then phase 1 which seeks to establish safety and dose level,phase 2 which tests efficacy as well as additional safety and then phase 3 which is the pivotal study normally involving 1000s of patients.
You highlight the issue that some trials have an interim analysis so normally after 75% of a phase 3 and it can be positive or negative so the trial gets stopped due to ethical considerations.
The Covid Vaccines were subject to an accelerated Approval process due to the urgency of the need for effective treatments but imo they still went through the normal regulatory process.
What made the process so rapid was the fact Oxford University already had ready candidates based on the Chimpanzee Adenovirus Vector which had been developed for other types of Covid so MERS and SARS etc and then the unprecedented cooperation between all parties to advance the process at an accelerated rate.
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