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Challenges in Advanced Therapy Medicinal Products Development: A survey amongst companies in Europe

Advanced Therapy Medicinal Products (ATMPs) hold a promise as treatments for previously untreatable and high burden diseases. Expectations are high and active company pipelines are observed, yet only ten 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 wererelated to country specific requirements (16%), manufacturing (15%) and clinical trial design (8%). The European ATMP field is still in 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