The Impact of Regulatory Policies on the Future of Fecal Microbiota Transplantation

• Published in: The Journal of law, medicine & ethics Vol. 47; no. 4; pp. 482 - 504
• Main Authors: Khoruts, Alexander, Hoffmann, Diane E., Palumbo, Francis B.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-12-2019; Cambridge University Press
• Subjects: Antibiotics; Banking; Clinical medicine; Drugs; FDA approval; Feces; Health technology assessment; Infections; Medical screening; Microbiota; Pathogens; Patients; Physicians; Transplants & implants
• ISSN: 1073-1105; 1748-720X
• DOI: 10.1177/1073110519897726

In this article, the authors explore the impact of a potential future regulatory decision by FDA whether or not to continue its enforcement discretion policy allowing physicians to perform, and stool banks to sell, stool product for fecal microbiota transplantation as a treatment for recurrent Clostridium Difficile infection without an Investigative New Drug (IND) application. The paper looks at the Agency's regulatory options in light of the current gut microbiota based products that are in the FDA pipeline for drug approval and the potential impact and repercussions of their approval on FDA action. In laying out FDA's options we consider the implications of market exclusivity and off-label use of newly approved drugs. Ultimately, we explore the potential impact of FDA's decision on patients, research, and innovation.