Uncertainties about clinical benefit and neurodevelopmental safety drive lopsided recommendation against approval; some advisory committee members say that even FDA’s REMS proposal wouldn't be enough to allow stannsoporfin to come to market without further studies.

Whether the single pivotal trial provides ‘substantial and highly persuasive evidence of effectiveness’ is a key question for advisory committee, although FDA also seeks advice on adequacy of the data to characterize adverse neurodevelopment outcomes; if approved, the heme oxygenase inhibitor could face a restrictive Risk Evaluation and Mitigation Strategy.

Division of Mitigation Assessment and Medication Error Surveillance will be established within the Office of Surveillance and Epidemiology, a change aimed at strengthening postmarketing oversight of opioids and other drugs; new Office of Safety and Clinical Evaluation will be created in Office of Generic Drugs, where Orange Book staff also will get their own division.