HiTech Health are delighted to have an article entitled ‘Cell and Gene Therapy Manufacturing Considerations for Early Stage Companies’ published in distinguished publications, cellandgene.com and outsourcedpharma.com. The article should be of benefit to companies who are looking for a partner to develop and manufacture their clinical products.
Over the past decade, the regenerative medicine landscape has undergone an extraordinary evolution with the continuous growth of Advanced Therapeutic Medicinal Products (ATMPs). ATMPs are medicines for human use that are based on genes, tissues or cells. They treat the root cause of diseases and disorders by altering, augmenting, repairing, replacing, or regenerating organs, tissues, cells, genes and metabolic processes in the body. This means that they can offer potentially groundbreaking new opportunities to address unmet medical needs.
10 years ago, in 2014, the ATMP sector was starting to grow but several hurdles including development, manufacturing and regulatory challenges and uncertainties needed to be addressed. Back then the field was still in its infancy, with only a few approved therapies and a rapidly growing number of early stage development programmes. The FDA had approved a small number of cell therapies, including several cord blood-based products like Hemacord and Allocord. However, there were no FDA-approved gene therapies in 2014.1
So much has changed in a positive way for patients. In 2024, the ATMP sector has expanded significantly, with therapies now available for a diverse range of medical conditions and they have become more accessible. There have been major improvements in the development, manufacturing and supply chains of ATMPs that have helped more patients receive these lifesaving and life changing medicines. There are now multiple gene therapies on the market for rare genetic disorders, such as Spinal Muscular Atrophy and Duchenne Muscular Dystrophy.
The sector has made significant advancements in 2024, driven by positive regulatory approvals, breakthroughs in scientific research, manufacturing optimisations and progress in market access and pricing. ATMPs have already saved and improved many lives, for example, a treatment for spinal muscular atrophy, Zolgensma, has been delivered to over 3,700 children globally. The sector has shown robustness and promising foundations for continued sector growth in 2025 and beyond. Developers are not only focused on proving that therapies can work but, are placing increased emphasis on refining their effectiveness, reducing side effects, expanding their indications and addressing market access and cost challenges.2
At the end of 2024, there were 39 cell and gene therapies approved in the United States by the FDA. Of the 6 new therapies approved by the FDA in 2024, 3 were gene therapies and 3 were cell therapies. In 2024 there have also been 2 new gene therapies approved by the European Medicines Agency (EMA). In addition to this, the FDA, EMA and other regulatory agencies are actively reviewing submissions made in 2024 and it is expected that a number of approval decisions will be made in the first quarter of 2025. The table below shows the therapies that were approved by the FDA and EMA in 2024.3
Therapy
Type
Indication
Developer
Approval Status
Lifileucel
Cell Therapy
Metastatic Melanoma
Iovance Biotherapeutics
FDA approved 16 February 2024
Lenmeldy
Gene Therapy
Metachromatic Leukodystrophy
Orchard Therapeutics
FDA approved 18 March 2024
Fidanacogene Elaparvovec
Gene Therapy
Hemophilia B
Pfizer
FDA approved 27 April 2024
EMA approved 25 July 2024
Tecelra
Cell Therapy
Advanced Synovial Sarcoma
Adaptimmune Therapeutics
FDA approved 1 August 2024
Obecabtagene Autoleucel
Cell Therapy
B-Cell Acute Lymphoblastic Leukaemia
Autolus Therapeutics
FDA approved 8 November 2024
Kebilidi
Gene Therapy
Aromatic L-Amino Acid Decarboxylase Deficiency
PTC Therapeutics
FDA approved 14 November 2024
Casgevy
Gene Therapy
Sickle cell Disease and Beta-Thalassemia
Vertex Pharmaceuticals and Crispr Therapeutics
EMA approved 13 February 2024
(Previously approved by the FDA in late 2023 with an expanded label approval on 16 January 2024)
Six years ago, in 2018, there were approximately 1000 clinical trials and 900 developers across the ATMP sector. By the end of the third quarter of 2024, the number of clinical trials has increased by approximately 97% in 6 years with an estimated 1,968 clinical trials. The number of developers has increased by approximately 230% during the same period to 2,981 developers. Of this estimated number of developers, 1,262 are based in North America, 1,036 are based in Asia Pacific, 587 are based in Europe and 96 are in other regions. Compared to the data in 2023, ‘other regions’ outside North America, Asia Pacific and Europe have seen the largest growth with an estimated yearly increase of 12.9% followed by Asia Pacific (12%), North America (6.6%) and Europe (3.3%).3
Similar to 2023, the majority of the clinical trials still involve cell-based therapies, accounting for approximately 70% of all trials. Oncology remains to be the most prevalent indication for ATMPs. Cancer patients, especially those who relapse, often must endure a series of arduous treatments using current standard of care chemotherapy and radiotherapy. CAR-T therapies have shown a reduction in collateral damage to healthy cells and can minimise side effects compared to traditional treatments. According to the Blood Advances Journal, 76% of all blood cancer patients who receive CAR-T treatments achieve remission. For B cell Lymphoma, overall survival is almost 9 times higher than the standard of care. Patients who receive Yescarta, a therapy used to treat B cell lymphoma, are 21% less likely to require subsequent treatment (insert reference: Vanderbilt University).3 4
Looking into the investments made in the ATMP sector, there was an estimated $13.3 billion USD invested 6 years ago in 2018 (excluding mergers and acquisitions (M&A) and grants). In the first 9 months of 2024, there has been a total estimated investment of $14.2 billion. At the time of writing, the data for the final 3 months of 2024 is not yet available but it is projected that the total annual investment will surpass $17 billion USD. There have been fluctuations in total investment over the last several years but the sector has shown robustness and positive investor sentiment. Across all regions, the largest type of investment is in the form of venture financing. North America has consistently seen the highest levels of investment since the industry was first developed.3
In Europe, in January 2022, Regulation (EU) 2021/2282 on health technology assessment (HTA) came into effect. The regulation aims to be applied in EU Member States by next month on the 12th January 2025. The HTA introduces an evidence‑based process that will allow the competent EU and national authorities to determine the effectiveness of new or existing health technologies, including cell and gene therapies. From 2025, all cell and gene therapies will undergo a single EU assessment of the value they add to patients and healthcare systems, aiming to end the need for 27 individual reviews. Companies will also meet jointly with the European Medicines Agency and Europe’s HTA coordinating group to discuss and align on the optimal clinical trial designs that deliver data, not only on safety and efficacy but also on added value to patients and healthcare systems.5
The regulation of ATMPs has progressed significantly in both the US, Europe and Asia Pacific regions over the last several years. In the US, the FDA has defined more transparent pathways for ATMPs, supported by the Regenerative Medicine Advanced Therapy designation, which facilitates expedited review and development support. The EMA has refined its guidelines for ATMPs, publishing a joint action plan with the European Commission to offer more streamlined processes for developers. There are opportunities for improvements in the regulatory pathways and we expect that the coming years will yield further changes. Developers are seeking more harmonised international regulations to help them navigate approvals across multiple regions more effectively. Notably, the regulatory agencies have also responded to the growing need for post-market surveillance, recognising the long-term nature of many ATMPs and the requirement for ongoing monitoring of their safety and efficacy.
2024 continues the trend of significant advances in the development and approval of new ATMPs which, ultimately, is great news for patients. The number of therapies receiving regulatory approval remains high with several applications still under review by the agencies. While there are challenges for ATMPs in manufacturing, pricing, and safety, the significant increase in the number of clinical trials demonstrates the potential of these medicines to enhance and transform patients’ lives. The outlook for the sector remains strong, with continued investment, technological innovation, and regulatory support propelling the industry forward in 2025 and beyond.
IDA Ireland, the agency responsible for the attraction and retention of inward foreign direct investment (FDI) into Ireland, has recently published an article entitled ‘Why Ireland is a proving ground for medicinal breakthroughs like cell and gene therapy’. Hitech Health is delighted to be featured as part of Ireland’s exciting growth in the cell and gene therapy space. Hitech was the first commercial company to have a licence to manufacture these advanced medicines in Ireland. It works with some large global companies, but Managing Director Brian Harrison says most of the companies in the cell and gene therapy space are smaller companies including university spin outs.
In many cases, these advanced medicine companies have products in development, and need expertise to manufacture pre-clinical materials as is required for toxicology studies. Hitech Health can also manufacture clinical trial materials for these advanced medicine companies once the potential treatment has been approved by regulators to be used in patients . In some cases, large pharma companies outsource these advanced medicine products to contractors and they continue to use Hitech for support.
Temperature is a critical parameter in the transportation and storage of medicinal products. The temperature must be controlled and monitored from the manufacturing site through to the distributor and site of medicine use. When temperatures go outside the specified range, there is a risk that the medicine may alter and degrade with the potential for adverse outcomes for the patient. In addition to this, there may be significant financial losses for the medicinal product owner.
The manufacturing of medicinal products is highly regulated with strict GMP quality control standards to ensure that a high-quality medicine is provided to patients. When it comes to transportation, it is just as important to maintain the same level of quality standards and ensure medicinal products are not compromised during the many touchpoints that can occur between the sending and receiving sites. Good Distribution Practice (GDP) is a set of standards, guidelines, and principles for the storage and transportation of pharmaceutical products. Developers must implement robust processes to guarantee the quality and safety of their products during distribution. GDP compliance can help avoid major quality impacts and potential product recalls.
Medicinal product shipments can generally be categorised as:
Ambient (controlled room temperature, 15°C to 25°C)
Refrigerated (2°C to 8°C)
Frozen (Below 0°C)
Cryogenic (Below -150°C)
As transportation may involve many modes of transport including road, air and sea, then continuously controlling and monitoring temperature can be challenging. Furthermore, cross border customs checks can cause unwanted delays. There is a risk that custom checks can interfere with outer packaging and cause exposure of the medicinal products to outside temperatures. The sensitivity of new advanced therapies such as cell and gene therapies increase the demand on both the shipping system and on the integrity of the entire temperature-controlled supply chain.
The FDA’s 21 CFR Part 11 guidance addresses the traceability challenges of electronic temperature records. Records must be reliable and accurate to ensure the quality and safety of the medicinal product. Pharmaceutical companies are strongly advised to use calibrated temperature monitoring dataloggers that can generate accurate and reliable reports. In addition to this, electronic records of all alarms and events must be kept.
With so many variables in transportation, successful shipments depend on reliable transportation and the correct choice of shipping system for the type of medicinal product. Using shipping systems that are validated and appropriate for the medicinal product is crucial. Performing shipping qualification studies is advised to ensure that a system is in place for seamless transportation and quality assurance.
To help navigate the challenges with temperature control, it is key to find partners experienced in handling complex medicinal products. HiTech Health have a team Responsible Personnel (RPs) who are specialists in GDP and can advise and support you with:
Minimising supply chain risks and ensuring compliance with applicable regulations
Shipping qualification studies
Due diligence and auditing of transportation providers
We can work with your team to ensure that effective processes are established to ensure that high quality medicinal products are available for patients on time.
Schedule a call with our team today to learn more about our services and how we can support your organisation.
Many Cell and Gene Therapy (CGT) companies outsource product development and manufacturing activities to a Contract Development and Manufacturing Organisation (CDMO). It is critical to ensure that an informed decision is made when selecting a CDMO to prevent future disruption to the intricate supply chains of cell and gene therapies and ultimately patients. HiTech Health explores 5 key considerations for a cross-functional team to examine when partaking in the CDMO selection process.
Does your CDMO have an experienced CGT team?
The complex and time-sensitive nature of CGT manufacturing processes makes it imperative to select a CDMO with a team who have deep knowledge of cell and gene therapies. The technical and regulatory landscapes in the CGT industry are changing frequently and ensuring your CDMO has in-depth expertise and flexibility is crucial to success. Assessing the CGT experience of the proposed CDMO team could reduce the risk of knowledge gaps later. A CDMO may have a strong track record of developing and manufacturing small molecule products and biologics but may have limited experience of CGTs. Are sufficient resources in place now and into the future?
Is there an integrated project management approach defined by the CDMO?
If you have shortlisted potential CDMO partners, have you enquired about their project management approach? How do the proposed approaches differ among the potential partners? Having an integrated project management approach that ensures seamless alignment between production, supply chain, QC testing personnel and many other functions is paramount given the stringent timeframe for supplying CGTs to patients. Understanding how frequently you will meet with the assigned CDMO project manager and how they will communicate with you should be clearly defined from the beginning.
Does the CDMO practice effective Quality by Design (QbD)?
Considering if a CDMO practices Quality by Design (QbD) is an important part of the due diligence process. The CDMO team may work closely with you to measure, analyse and report on the quality attributes of the CGT product. The team members who develop your upstream regulatory strategy and initial CMC plan need to be able to work closely with a trusted CDMO partner who can ensure quality and compliance goals are met. Have you considered an on-site audit of the CDMO before the final selection?
How flexible is the potential CDMO partner?
During the due diligence assessment, look at the CDMO’s internal systems and workflows for a true indication of their fit as a potential partner. The CDMO should be experienced and agile to help you navigate unforeseen challenges, open and transparent to help you mitigate risks and control your costs as well as being fully committed to the ultimate goal of providing CGTs to the patients who vitally need them. These are the characteristics of a resilient and long-lasting partnership, and the indicators of future success.
From the start of a project, the right CDMO will encourage an ongoing dialogue about the quality, pace and cost considerations of your project. They will focus on developing a robust and scalable approach that will work for the entire lifecycle of your project.
Is there a Business Continuity Plan (BCP) that has been implemented and managed effectively by the CDMO?
The CDMO’s ability to maintain essential functions during and after an unforeseen event has occurred is very important and should be assessed prior to signing a contract. Business continuity planning, in this case, relates to establishing risk management processes and procedures that aim to prevent interruptions to manufacturing and supplying CGTs. If an unforeseen event occurs, such as critical components not being available, how will the CDMO mitigate or manage the issues to ensure the effects on operations are minimised. Have you requested a copy of your shortlisted CDMO’s business continuity plan?
Learn more about our cell and gene therapy services by clicking here
HiTech Health today announced that the company has been granted a Manufacturer’s/Importation Authorisation (MIA) for Investigational Medicinal Products (IMP) by the Medicines and Healthcare Products Regulatory Agency (MHRA). The company is now authorised to perform batch certification and import oversight for UK clinical trials. This achievement underscores commitment to meeting the highest standards of quality and safety in pharmaceutical products and advanced therapies, as set forth by the MHRA.
HiTech Health’s Qualified Personnel (QPs) can perform batch importation and certification for EU countries and the UK, thereby streamlining clinical supply chains for the sponsors. HiTech Health is dedicated to working closely with pharmaceutical and advanced therapy developers to bring new products to patients.
