Zuranolone: A case study in (regulatory) rush to judgement?

Sage, in collaboration with Biogen, submitted a new drug approval for zuranolone for postpartum depression (PPD) and major depressive disorder (MDD) in December 2022. In August 2023, the US Food and Drug Administration granted approval for PPD but denied approval for MDD. The approval process took only 7 months because it was given priority review and granted 'fast-track' designation, which is intended for drugs that fill unmet needs. This designation allows pharmaceutical companies to submit a smaller number of trials and limits evaluation to surrogate rather than clinically relevant outcomes. Indeed, policy shifts aiming to improve innovation and efficiency have lowered the threshold for evidence of benefit. In turn, this may skew the potential benefits versus potential harms for newly approved medicines in ways that are not in the public's best interest. We examine the clinical trial data submitted by the manufacturer for zuranolone and discuss how regulatory bodies may be failing in their role as gatekeepers. The approval of zuranolone for PPD can thus be seen as a case study for recent developments in drug regulatory sciences.