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VOLUME: 16 - ISSUE: JUL 2015 |
PHARMA UPTODAY
PHARMA UPTODAY
2
Inside this issue
3 News Uptoday
59 New Guidance
72 Audit Findings
483 Observations
EU Non Compliance Rep...
PHARMA UPTODAY
3
News Uptoday
China‘s Pharmaceutical Future – Both Complex and Growing
A visit to any one of the cities we...
PHARMA UPTODAY
4
ranks second for the number of FDA-registered drug establishments that the agency regulates,
and is the s...
PHARMA UPTODAY
5
quality and data integrity standards to all countries shipping drug ingredients into the United
States.
W...
PHARMA UPTODAY
6
Alonza Cruse, FDA‘s Acting Director, Pharmaceutical Quality Program, Office of Regulatory
Affairs
As Chin...
PHARMA UPTODAY
7
increasingly significant impact on the products that Americans consume, particularly
pharmaceuticals.
We ...
PHARMA UPTODAY
8
For pharmaceutical manufacturers with products in this category, I strongly suggest that you
poll your wh...
PHARMA UPTODAY
9
dispense it before the expiration date. This has happened in the past with multi-packs of some
prefilled ...
PHARMA UPTODAY
10
The USFDA said the reason for the recall is cGMP (current good manufacturing practice)
deviations and cu...
PHARMA UPTODAY
11
lead investigator Chantal Mathieu, MD, PhD, Chair of Endocrinology at the University Hospital
Gasthuisbe...
PHARMA UPTODAY
12
Data further detailing this lead-in period was accepted as a late-breaker poster (#133-LB) on
display in...
PHARMA UPTODAY
13
0069-3857-
10
Gemcitabine for Injection, USP 200 mg 10 mL 7801084 07/2015
0069-3857-
10
Gemcitabine for ...
PHARMA UPTODAY
14
were manufactured and packaged by Agila Onco Therapies Limited, a Mylan company. Lot
7801084 and 7801110...
PHARMA UPTODAY
15
On an annual basis, the TGA's Post-market Surveillance Branch prepares a report for
incorporation into t...
PHARMA UPTODAY
16
Figure 1: Origin of medicine and vaccine adverse events received by the TGA (2010-14)
In 2014 the TGA re...
PHARMA UPTODAY
17
While health professionals are encouraged to report suspected adverse events directly to the
TGA, they c...
PHARMA UPTODAY
18
'Safety through reporting' online learning modules developed for health professionals
The TGA and NPS Me...
PHARMA UPTODAY
19
o admission to hospital
o prolongation of hospitalisation
o increased investigation or treatment costs
o...
PHARMA UPTODAY
20
Goods Regulations. The functions of ACSOV are to provide advice and make
recommendations to the Minister...
PHARMA UPTODAY
21
 Epoetin alfa (Eprex) and increased risk of pure red cell aplasia with subcutaneous
administration
 Pr...
PHARMA UPTODAY
22
The TGA maintains up-to-date safety information on therapeutic products that is communicated
through a v...
PHARMA UPTODAY
23
If the TGA identifies a safety concern relating to a medicine or vaccine, we can take regulatory
action....
PHARMA UPTODAY
24
ANVISA passed Kemwell‘s manufacturing facility for oral solids in Bangalore, India following a
recent in...
PHARMA UPTODAY
25
Data Protection: Council agrees on a general approach
On 15 June 2015, the Council reached a general app...
PHARMA UPTODAY
26
 easier access to their data.
 more detailed information about what happens to their personal data onc...
PHARMA UPTODAY
27
In order to reduce compliance costs, data controllers can, on the basis of an assessment of the
risk inv...
PHARMA UPTODAY
28
to improve the quality control testing of drugs, according to Dr C S Satheesh Kumar, former
drugs contro...
PHARMA UPTODAY
29
As a suggestion to improve the quality control system, he said if the lab facilities at the
pharmacy col...
PHARMA UPTODAY
30
India scraps import duties on AIDS drugs to battle shortage
India has scrapped customs import duties for...
PHARMA UPTODAY
31
AIDS drugs sold on the open market are expensive, so in an effort to make those more
affordable, the gov...
PHARMA UPTODAY
32
K K Aggarwal of Indian Medical Association (IMA) said this will help decrease prescription
errors and it...
PHARMA UPTODAY
33
CDSCO drug inspectors soon to get online training on cGMP
Aimed at empowering the central drug regulator...
PHARMA UPTODAY
34
the pharmaceutical industry across the region. We will further continue our focus on the sector
and expa...
PHARMA UPTODAY
35
The USDFA officials visited India in March 2015 and had frank ranging discussions on the
regulatory issu...
PHARMA UPTODAY
36
While China says it has made thousands of arrests and ―joined hands‖ with foreign law
enforcement agenci...
PHARMA UPTODAY
37
The labs have also figured out how to stay one step ahead of laws banning illicit synthetic drugs
simply...
PHARMA UPTODAY
38
―We aim to help and support other countries in any way we can,‖ Liu Yuejin, the assistant
minister of pu...
PHARMA UPTODAY
39
DFN-02 (for treatment of migraines, with or without aura) is expected to go for approval from
US FDA in ...
PHARMA UPTODAY
40
training programmes to train drug inspectors on carrying out GMP inspections in the year 2013-
14 to ens...
PHARMA UPTODAY
41
21st Century Cures would extend exclusivity for 15% of drugs
A six-month extension of marketing exclusiv...
PHARMA UPTODAY
42
A senior commerce ministry official said a pilot project will begin at the end of this month for
uploadi...
PHARMA UPTODAY
43
IPA wants Regulatory Affairs Science as academic discipline for higher education in
pharmacy
The Regulat...
PHARMA UPTODAY
44
skills required to fulfill vital roles in assuring adherence with the complex regulations necessary
for ...
PHARMA UPTODAY
45
mean that Canadian importers and distributors will stop distributing products in Canada with
APIs linked...
PHARMA UPTODAY
46
With regard to the last point it is mentioned that the extent of the changes made in each
document must ...
PHARMA UPTODAY
47
will include a training device with which patients can practise; audio-visual material to show in
detail...
PHARMA UPTODAY
48
 Your family members, carers or teachers should also be instructed in the correct use of the
auto-injec...
PHARMA UPTODAY
49
Anaphylaxis is a life-threatening reaction that causes a drop in blood pressure and breathing
difficulti...
PHARMA UPTODAY
50
CDSCO regulates quality standards of drugs and is also responsible for the approval of new
drugs. The mi...
PHARMA UPTODAY
51
Last year, the IPC had issued a similar order asking all the hospitals to submit the ADRs in
particular ...
PHARMA UPTODAY
52
roles of the Assembly as well as the Management Committee. Most participants indicated their
interest fo...
PHARMA UPTODAY
53
The EWG developing an Addendum to E9 on Choosing the Appropriate Estimand and Defining
Sensitivity Analy...
PHARMA UPTODAY
54
Multidisciplinary Guidelines Update
The M2 EWG on Electronic Standards for the Transfer of Regulatory In...
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015
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Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015

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News Uptoday
New Guidance
Audit Findings
483 Observations
EU Non Compliance Report
- Polydrug Laboratories PVT. LTD., Ambernath, Maharashtra, India
- ZHUHAI UNITED LABORATORIES CO., LTD, China

Health Canada Non Compliance Report
- Pharmax Limited, Ontario Canada.

Warning Letters
- VUAB Pharma a.s., Czech Republic
- Attix Pharmaceuticals, Canada

Regulations of the Month
- Sec. 211.22 Responsibilities of quality control unit

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Pharma Uptoday Monthly Magazine Volume 16; Issue Jul 2015

  1. 1. VOLUME: 16 - ISSUE: JUL 2015 | PHARMA UPTODAY
  2. 2. PHARMA UPTODAY 2 Inside this issue 3 News Uptoday 59 New Guidance 72 Audit Findings 483 Observations EU Non Compliance Report - Polydrug Laboratories PVT. LTD., Ambernath, Maharashtra, India - ZHUHAI UNITED LABORATORIES CO., LTD, China Health Canada Non Compliance Report - Pharmax Limited, Ontario Canada. 78 Warning Letters - VUAB Pharma a.s., Czech Republic - Attix Pharmaceuticals, Canada 80 Regulations of the Month - Sec. 211.22 Responsibilities of quality control unit
  3. 3. PHARMA UPTODAY 3 News Uptoday China‘s Pharmaceutical Future – Both Complex and Growing A visit to any one of the cities we visited on this trip – Shanghai, Nanjing and Beijing – would leave anyone marveling at the scale and trajectory of modern China. But it‘s not just the sheer size of the population we were struck by. Rather, it was the seemingly tireless dedication to modernity that provided an almost palpable affirmation of what we already knew: that China — its skylines dotted with construction cranes and landscapes crisscrossed by high speed bullet trains — is inextricably connected with our own country‘s economy, and increasingly with our agency‘s ever-expanding regulatory mission. Howard Sklamberg, FDA‘s Deputy Commissioner for Global Regulatory Operations and Policy We traveled to China for a few reasons. First, we wanted to gain more on-the-ground insight into how its drug industry works. We also wanted to offer some helpful perspective to Chinese regulators and drug companies about the Food and Drug Administration Safety and Innovation Act (FDASIA), which passed three years ago and is in the process of being fully implemented. In part, the law gave the FDA new authorities to ensure the safety of the global drug supply chain, in which China plays an enormous part. How enormous? After the United States, China
  4. 4. PHARMA UPTODAY 4 ranks second for the number of FDA-registered drug establishments that the agency regulates, and is the sixth largest provider of drugs and biologics to the U.S. Our itinerary also included a meeting with the Chinese Food and Drug Administration (CFDA) and a tour of a Chinese pharmaceutical manufacturing plant. And if you asked us what the most important by-product of our trip has been, it was these face-to-face conversations with our Chinese counterparts. Specifically, we discussed the responsibilities of firms in the global drug supply chain. These days, the drugs we have in our medicine chests may seemingly come from one company, but the ingredients in them may actually come from numerous companies and countries. China is a major provider of many of the active ingredients in finished drug products Americans rely on every day. Richard Moscicki, M.D., FDA‘s Deputy Director, Center for Drug Evaluation and Research We had productive discussions with the Chinese about how seriously we are committed to making sure that everyone in the drug supply chain – from the companies that make the active ingredients to those that provide the packaging –shares in this collective commitment to quality. As we did when we spoke with our counterparts in India, we stressed that we apply the same
  5. 5. PHARMA UPTODAY 5 quality and data integrity standards to all countries shipping drug ingredients into the United States. We delivered the same message to a huge crowd of students at an event hosted by China‘s Pharmaceutical University in Nanjing. In our remarks, we set forth our expectations for the delivery of drug quality, saying: ―…ideally, our approach will complement the baseline, legal requirement of compliance with the higher bar of firms‘ self-interest in being recognized for providing quality products and engaging in a different way with FDA.‖ While in Nanjing, we had productive discussions with students and stakeholders about FDASIA, quality in contract manufacturing, inspections, regulatory science, and expedited approval pathways that FDA is using to accelerate the process for making novel drugs available to patients. Additionally, we toured a Chinese pharmaceutical facility and met with CFDA to discuss the revision of China‘s Drug Administration Law, our own FDASIA implementation, regulatory science matters, as well as continued collaborative activities. We also had a productive roundtable discussion with leaders from 17 prominent Chinese pharmaceutical companies. We addressed pharmaceutical quality, data integrity, and the approval process for generic and innovator drugs.
  6. 6. PHARMA UPTODAY 6 Alonza Cruse, FDA‘s Acting Director, Pharmaceutical Quality Program, Office of Regulatory Affairs As China‘s role on the global stage expands, FDA has significantly increased drug and medical device inspections there, but we need to continue to strengthen our efforts. The Office of Regulatory Affairs and our China office have managed a large number of pharmaceutical inspections. The FDA‘s office in China has also strengthened relationships with regulators and helped expand the country‘s expertise in regulatory operations. And we have worked with industry and academia to explain our regulations and analyze trends and events that might affect the safety of FDA-regulated products exported from China to the U.S. Given the volume of U.S. trade with China, we are working to expand our presence there to significantly increase the number of inspections we conduct. Staffing increases will allow FDA to enhance its training efforts and technical collaboration with Chinese regulators, industry and others. In fact, in November 2014, we signed a Memorandum of Understanding with the Chinese government that expands our cooperation and will facilitate those staffing increases. FDA‘s priorities in China match its global priorities: we work to ensure the safety and efficacy of FDA-regulated products. China‘s size and relentlessly expanding economy have an
  7. 7. PHARMA UPTODAY 7 increasingly significant impact on the products that Americans consume, particularly pharmaceuticals. We trust our trip to China added to the growing collaboration between FDA and our counterpart agencies there, ensuring the safety of the pharmaceutical products exchanged between our two nations. InBrief: ‗The Smallest Individual Saleable Unit‘ In The DSCSA The U.S. Drug Supply Chain Security Act(DSCSA) requires manufacturers and repackagers to place DSCSA-specific ―product identifiers‖ on all drug packages and homogeneous cases by November 27, 2017 (2018 for repackagers). These product identifiers must include a Standardized Numeric Identifier (SNI), which is composed of the drugs National Drug Code (NDC) and a unique serial number (for more on DSCSA ―product identifiers‖, see ―The DSCSA Product Identifier On Drug Packages―, for more on the SNI, see ―FDA Aligns with GS1 SGTIN For SNDC―, and for more on the NDC, see ―Anatomy Of The National Drug Code―). A common question is, what is the smallest level of packaging that must be serialized?. The DSCSA text provides the answer. This is an update to an essay I wrote back in 2013 about the same topic, but for the California pedigree law (see ―InBrief: ‗The Smallest Package Or Immediate Container‘ In California―), which was subsequently preempted by the DSCSA. The California pedigree law would have required manufacturers to serialize the smallest package of drugs that will be bought by a dispenser. The DSCSA is basically the same. For some manufacturers targeting the U.S. market, that may require serialization at a lower unit of measure than they might have thought. For products that manufacturers package into multi-packs and sell to wholesalers packaged only that way, you might assume that your ―smallest individual saleable unit‖ is the multi-pack. Think again.
  8. 8. PHARMA UPTODAY 8 For pharmaceutical manufacturers with products in this category, I strongly suggest that you poll your wholesaler customers and find out how often they break down your multi-pack today and sell the individual packages inside to their dispensing customers. The DSCSA defines the term ―Package‖ this way: ―(A) IN GENERAL.—The term ‗package‘ means the smallest individual saleable unit of product for distribution by a manufacturer or repackager that is intended by the manufacturer for ultimate sale to the dispenser of such product. ―(B) INDIVIDUAL SALEABLE UNIT.—For purposes of this paragraph, an ‗individual saleable unit‘ is the smallest container of product introduced into commerce by the manufacturer or repackager that is intended by the manufacturer or repackager for individual sale to a dispenser. [DSCSA Section 581(11)] Yes, you could probably say that your multi-pack–just like today–is the level of packaging that you intend for ultimate sale to the dispenser and so that‘s all you will be required to serialize. And theoretically, you would be right. But, if today, before serialization is required, wholesalers routinely break your multi-pack down further as part of their friendly service to their customers, they won‘t be able to do that once they begin operating under the serialization requirements of the DSCSA–November 27, 2019. After that date they will no longer be able to break any package down unless the components within are also serialized by the manufacturer or repackager. ―So what?‖ you say? If your product is routinely broken down by the wholesaler today, that is done to supply small pharmacies with a smaller amount of your product so they are able to
  9. 9. PHARMA UPTODAY 9 dispense it before the expiration date. This has happened in the past with multi-packs of some prefilled insulin syringes, some vials and similar products. Admittedly, not many products fall into this category, but if yours is one that does, you should think about what those small pharmacies might do if they will be forced to only buy your product in the full multi-pack. Will the pharmacies decide to start buying your multi-pack, since that‘s the only form available to them? Or will their wholesaler help them find some alternative drug that is serialized at a lower unit of measure instead? Poll your customers, and their customers, to find out before you establish your final serialization plan. When you are ready to serialize the individual packages contained inside your multi-packs, make sure you consult the GS1 Healthcare GTIN Allocation Rules to get theGTINs right. Then consult my essay ―Anatomy Of An FDA SNI‖ to learn how to combine a GTIN with a serial number to serialize them. Two drugs manufactured by Wockhardt recalled in the US Over 200 bottles of Captoprilused in treatment of blood pressure and antibiotics Clarithromycin tablets manufactured by Wockhardt are being recalled in the US due to deviations in current good manufacturing practice norms laid down by US health regulator. According to information on the US Food and Drug Administration (USFDA) website, 166 bottles of Captopril tablets of 50 mg strength are being recalled in the US. In case of Clarithromycin, the recall is for 50 bottles containing tablets of 500 mg strength. The recall is made by Blenheim Pharmacal Inc, which packages and repackages Captopril and Clarithromycin respectively.
  10. 10. PHARMA UPTODAY 10 The USFDA said the reason for the recall is cGMP (current good manufacturing practice) deviations and current good manufacturing practice. In both the cases, the products are being recalled "in response to a recall notice from the manufacturer, Wockhardt Ltd, following a FDA inspection which noted inadequate investigation of market complaints, resulting in unsuccessful identification of root causes, and the investigation not being expanded to prevent repeat failure", it added. Both the recalls are classified as Class II, "a situation in which use of or exposure to a violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is remote". AstraZeneca presents new positive phase III data on triple therapy approach with dapagliflozin, saxagliptin and metformin for the treatment of type 2 diabetes Data in oral presentation demonstrate that the investigational combination of dapagliflozin, saxagliptin and metformin resulted in statistically significant reductions in HbA1c in patients uncontrolled on saxagliptin and metformin AstraZeneca today announced positive results from a Phase III study comparing the efficacy and safety of dapagliflozin versus placebo as an add-on to saxagliptin and metformin immediate release (IR) in adults with type 2 diabetes who had inadequate glycaemic control (baseline HbA1c 7% - 10.5%).1 The study met its primary endpoint, with patients receiving the investigational triple combination of dapagliflozin 10 mg, saxagliptin 5 mg and metformin achieving significantly greater mean reductions in HbA1c compared to those treated with placebo, saxagliptin 5 mg and metformin at 24 weeks (–0.82% vs. -0.10%, respectively; p- value<0.0001).1 The results were presented today as an oral presentation (#105-OR) at the 75th Scientific Sessions of the American Diabetes Association (ADA) in Boston. ―In this study, when dapagliflozin was added to saxagliptin and metformin, patients demonstrated greater HbA1C reductions than those in the placebo and metformin group,‖ said
  11. 11. PHARMA UPTODAY 11 lead investigator Chantal Mathieu, MD, PhD, Chair of Endocrinology at the University Hospital Gasthuisberg Leuven, Belgium. ―With nearly 50% of type 2 diabetes patients estimated to be uncontrolled on metformin, new treatment approaches are needed, and these data add to the growing body of knowledge for combination therapies.‖ Among secondary endpoints, the dapagliflozin combination group achieved a significantly greater adjusted mean reduction from baseline in two-hour postprandial glucose (-74 mg/dL vs - 38 mg/dL, respectively; p-value<0.0001)1 and fasting plasma glucose versus the placebo group (-33 mg/dL vs -5 mg/dL, respectively; p-value<0.0001).1 More patients in the dapagliflozin combination group also achieved a HbA1c level of less than 7% compared to patients in the placebo group at week 24 (38% vs 12%, respectively, p-value<0.0001).1 In addition, patients in the dapagliflozin combination group had a greater reduction in weight (mean -1.9 kg vs -0.4 kg, respectively; p-value<0.0001)1 than those in the placebo group. Adverse events were similar across treatment groups. The most common adverse events (≥ 5%) were headache, urinary tract infection, influenza and genital infections. The rate of hypoglycaemia was 1.3% in the dapagliflozin combination group and 0.0% in the placebo group.1 Elisabeth Björk, Vice President, Head of Cardiovascular and Metabolic Diseases, Global Medicines Development, AstraZeneca, said: ―We are focused on investigating combination therapies with complementary mechanisms of action and our broad diabetes portfolio positions us well in this area.These positive results reinforce our belief that combination therapies have the potential to be used as early add-on therapy to help patients with type 2 diabetes achieve their treatment goals.‖ The study included an open-label lead-in period in which patients on metformin (baseline HbA1c 8.0%–11.5%) received open-label saxagliptin 5 mg and metformin for 16 weeks, while patients on metformin and any DPP-4 inhibitor (baseline HbA1c 7.5%–10.5%) received open- label saxagliptin 5 mg and metformin for 8 weeks. Following the end of the open-label period, patients with inadequate glycaemic control (HbA1c 7%–10.5%) were randomised to receive either placebo or dapagliflozin 10 mg in addition to open-label saxagliptin and metformin.
  12. 12. PHARMA UPTODAY 12 Data further detailing this lead-in period was accepted as a late-breaker poster (#133-LB) on display in Poster Hall B on Sunday, June 7 from noon to 2 p.m. EST.2 AstraZeneca has filed a New Drug Application (NDA) with the US Food and Drug Administration (FDA) for the approval of an investigational fixed-dose combination of saxagliptin and dapagliflozin for the treatment of type 2 diabetes and the Prescription Drug User Fee Act (PDUFA) goal date will be in the fourth quarter of 2015. Mylan is Expanding its Voluntary Nationwide Recall of Select Lots of Injectable Products Due to the Presence of Particulate Matter Mylan N.V. (Nasdaq: MYL) today announced that its U.S.-based Mylan Institutional business is expanding its voluntary nationwide recall to the hospital/user level of select lots of the following injectable products due to the presence of visible foreign particulate matter observed during testing of retention samples. Administration of a sterile injectable that has foreign particulates has the potential of severe health consequences. Intrathecal administration could result in a life threatening adverse event or result in permanent impairment of a body function. Intravenous administration has the potential to damage and/or obstruct blood vessels which could induce emboli, particularly in the lungs. If a right to left cardiac shunt is present, the particulate may lead to arterial emboli and result in stroke, myocardial infarction, respiratory failure, and loss of renal and hepatic function or tissue necrosis. Other adverse effects associated with intravenous injection of particulate matter include local inflammation, phlebitis, allergic response and/or embolization in the body and infection. Intra-arterial administration could result in damage to blood vessels in the distal extremities or organs. Intramuscular administration could result in foreign-body inflammatory response, with local pain, swelling and possible long term granuloma formation. To date, Mylan has not received any reports of adverse events related to this recall.
  13. 13. PHARMA UPTODAY 13 0069-3857- 10 Gemcitabine for Injection, USP 200 mg 10 mL 7801084 07/2015 0069-3857- 10 Gemcitabine for Injection, USP 200 mg 10 mL 7801110 08/2015 67457-463- 02 Gemcitabine for Injection, USP 2 g 100 mL 7801221 03/2016 67457-464- 20 Gemcitabine for Injection, USP 200 mg 10 mL 7801398 08/2016 67457-464- 20 Gemcitabine for Injection, USP 200 mg 10 mL 7801406 08/2016 67457-464- 20 Gemcitabine for Injection, USP 200 mg 10 mL 7801427 09/2016 67457-462- 01 Gemcitabine for Injection, USP 1 g 50 mL 7801284 05/2016 67457-467- 99 Methotrexate Injection, USP 50 mg/2 mL (25 mg/mL) 5x2 mL 7801421 09/2016 Gemcitabine for Injection, USP is an intravenously administered product indicated for the treatment of ovarian cancer, breast cancer, non-small cell lung cancer and pancreatic cancer. These lots were distributed in the U.S. between January 8, 2014, and February 10, 2015, and
  14. 14. PHARMA UPTODAY 14 were manufactured and packaged by Agila Onco Therapies Limited, a Mylan company. Lot 7801084 and 7801110 are packaged with a Pfizer Injectable label. Methotrexate Injection, USP 25 mg/mL can be administered intramuscularly, intravenously, intra-arterially, or intrathecally and is indicated for certain neoplastic diseases, severe psoriasis and adult rheumatoid arthritis. The lot was distributed in the U.S. between December 8, 2014, and December 19, 2014, and was packaged by Agila Onco Therapies Limited, a Mylan company. Mylan is notifying its distributors and customers by letter and is arranging for return of all recalled products. Distributors, retailers, hospitals, clinics, and physicians that have these products which are being recalled should stop use and return to place of purchase. Centralised procedures and use of the common repository From 1 July 2015, MHRA will fully adopt use of the common repository for centralised procedures. From that date, centralised applications submitted to the common repository do not need to be sent separately to MHRA. Any centralised submission received directly by the MHRA after this date will not be processed and will be disposed of securely. Along with other national competent authorities (NCAs,) we intend to make this change mandatory. This is in line with the EU roadmap, which has been progressed in consultation with industry, trade bodies and other NCAs and made public for some time now on the European Medicines Agency website Medicines and vaccines post-market vigilance - statistics for 2014 The Therapeutic Goods Administration (TGA) is responsible for regulating medicines, vaccines and biologicals, including monitoring the ongoing safety, quality and efficacy of these products once they have been included on theAustralian Register of Therapeutic Goods (ARTG)(link is external) through product vigilance activities.
  15. 15. PHARMA UPTODAY 15 On an annual basis, the TGA's Post-market Surveillance Branch prepares a report for incorporation into the Department of Health publication Australian Statistics on Medicines(link is external). Australian Statistics on Medicines(link is external) is produced by the Drug Utilisation Sub- Committee (DUSC) of the Pharmaceutical Benefits Advisory Committee (PBAC) and is aimed at providing comprehensive and valid statistics on the Australian use of medicines and vaccines in the public domain to allow access by all interested parties. This report from the Post-market Surveillance Branch includes a brief overview on the following aspects of post-market monitoring of medicines and vaccines in Australia:  Adverse event reporting statistics for 2014  Processing and use of adverse event reports  Database of Adverse Event Notifications  'Safety through reporting' online learning modules developed for health professionals  Reporting adverse events  Expert advisory committees  Medicines Safety Update  Product vigilance Adverse event reporting statistics for 2014 The TGA's reporting system for adverse events began in the late 1960s with the computerised database dating back to the early 1970s. By the end of 2014 there were approximately 295,000 reports of suspected adverse events in the database.
  16. 16. PHARMA UPTODAY 16 Figure 1: Origin of medicine and vaccine adverse events received by the TGA (2010-14) In 2014 the TGA received approximately 16,500 reports of adverse events. As shown in Figure 1, the majority of reports made in 2014 were by sponsors. The number of reports made by sponsors has significantly increased over the past five years, from 5612 in 2010 to 8359 in 2014. However, there was a slight decrease in 2014, from the peak of 9563 sponsor reports received in 2013. This change is believed to be due to factors including a focus on provision of better quality reports, following on from a strong rise the previous year after the release of new pharmacovigilance guidelines. Approximately 51% (8359) of adverse event reports received by the TGA in 2014 were from sponsors, 16% (2672) from State and Territory Health Departments (reports of adverse events following immunisation), 13% (2184) from hospitals and hospital pharmacists, 8% (1351) from community pharmacists, 5% (735) from general practitioners (GPs), 3% (565) from consumers and 3% (441) from other sources. The numbers of reports made by sources other than sponsors in 2014 were generally similar to those received in 2013, with reports from State and Territory Health Departments decreasing slightly (from 3011 in 2013 to 2672 in 2014) and those from hospitals and hospital pharmacists increasing (from 1794 in 2013 to 2184 in 2014).
  17. 17. PHARMA UPTODAY 17 While health professionals are encouraged to report suspected adverse events directly to the TGA, they can also report to the sponsor or manufacturer. Processing and use of adverse event reports The Post-market Surveillance Branch assessed adverse event reports submitted to the TGA by checking for the presence of 'minimum' details, including an individual patient, an adverse event, at least one (suspected) medicine or vaccine, and an identifiable reporter. The specific adverse event terms are identified along with the suspected, interacting or 'other' therapeutic products and these are entered into the database. The Post-market Surveillance Branch assesses causality of adverse event(s) and in some cases requests further clinical or laboratory information from the reporter. Medical officers review serious reports and Post-market Surveillance Branch staff regularly analyse reporting data to identify potential safety signals. Reports are forwarded to the Uppsala Monitoring Centre in Sweden, which administers the World Health Organization Collaborating Centre for International Drug Monitoring. This global database began in 1968 as a pilot program involving 10 nations, including Australia, and now receives reports from more than 80 nations. Database of Adverse Event Notifications Information in the publicly searchable Database of Adverse Event Notifications (DAEN) comes from reports made to the TGA by a wide range of sources, including members of the public, general practitioners, nurses, other health professionals and the therapeutic goods industry. Reports in this database start from 1 January 1971 up to three months prior to the date of access. The TGA uses this three-month period to investigate each adverse event report. The DAEN, which was launched in 2012, was created to support better health outcomes by providing access to the information that the TGA gathers while monitoring medicine and vaccine safety in Australia.
  18. 18. PHARMA UPTODAY 18 'Safety through reporting' online learning modules developed for health professionals The TGA and NPS MedicineWise worked together to create two interactive online learning modules designed to improve adverse event reporting by health professionals and these tools were launched in December 2014. The 'Safety through reporting' modules were developed to increase health professionals' existing knowledge around reporting adverse events associated with therapeutic products. Some of the key features include:  the importance of reporting adverse events  sharing the responsibility of reporting  how to build reporting into practice  what happens to reports once they are submitted to the TGA. Health professionals who complete the modules are eligible for continuing professional development points from the relevant accrediting health professional bodies. Reporting adverse events The TGA encourages the reporting of all suspected adverse events to medicines and vaccines available in Australia, including prescription medicines, over the counter and complementary medicines. The reporting of seemingly insignificant or common adverse events can contribute to the TGA's investigation of a potential safety signal. The TGA particularly encourages reporting of:  suspected adverse events involving new medicines and vaccines  suspected medicine and vaccine interactions  unexplained adverse events (adverse events that are not described in the Product Information)  serious adverse events, such as those suspected of causing: o inability to work
  19. 19. PHARMA UPTODAY 19 o admission to hospital o prolongation of hospitalisation o increased investigation or treatment costs o danger to life o birth defects o death. For further information about reporting suspected adverse events, visit the TGA website (click on 'Report a Problem'). Sponsors of all medicines and vaccines on the ARTG have mandatory reporting requirements regarding adverse events. Expert advisory committees Advisory Committee on the Safety of Medicines The Advisory Committee on the Safety of Medicines (ACSOM) was established in January 2010 to provide expert advice to the TGA about safety issues under investigation and the appropriateness of Risk Management Plans (RMPs). RMPs outline sponsors' plans to monitor and communicate risks, and are evaluated as part of the registration process for new medicines. RMPs accompany applications for registration of high risk medicines, such as new chemical entities. RMPs characterise and pro-actively manage risks relating to a medicine over its entire life cycle. ACSOM also provides advice to the TGA on other matters related to pharmacovigilance, including the detection, assessment, understanding and prevention of adverse events. ACSOM meeting statements are published on the TGA website. Advisory Committee on the Safety of Vaccines Following a recommendation from the government's Review of the management of adverse events associated with Panvax and Fluvax in 2012 'to consider the current governance arrangements for monitoring and responding to vaccine safety issues in Australia and make recommendations for an improved system of governance for vaccine safety monitoring', the Advisory Committee on the Safety of Vaccines (ACSOV) was established in the Therapeutic
  20. 20. PHARMA UPTODAY 20 Goods Regulations. The functions of ACSOV are to provide advice and make recommendations to the Minister for Health, the TGA and the Office of Health Protection on the safety, risk assessment and risk management of vaccines. ACSOV meeting statements are published on the TGA website. Medicines Safety Update The Medicines Safety Update was published six times during 2014. It was published within the Australian Prescriber magazine, as well as on the TGA website. Medicines Safety Update replaced the Australian Adverse Drug Reactions Bulletin in 2010. The following articles were published in Medicines Safety Update during 2014:  Quetiapine and QT prolongation  bioCSL Fluvax - not for children under 5 years  How you can play a vital role in medicine regulation  Olmesartan and sprue-like enteropathy  Codeine use in children after tonsillectomy and/or adenoidectomy  Methoxyflurane and occupational exposure  Bexsero meningococcal B vaccine - enhanced monitoring  Strontium ranelate and cardiovascular and venous thromboembolic risks  Complex regional pain syndrome and vaccines  Azathioprine and cytomegalovirus reactivation  Measles, mumps, rubella, varicella vaccine  Fentanyl patches and accidental exposure in children  Zolpidem and next day impairment  Diclofenac and arteriothrombotic events  Bupropion and serious cardiovascular adverse events  Methylphenidate and priapism  Propranolol - prescribing to patients who may be at risk of self-harm  Valproate - fetal exposure and cognitive impairment  Medicine shortages information resource
  21. 21. PHARMA UPTODAY 21  Epoetin alfa (Eprex) and increased risk of pure red cell aplasia with subcutaneous administration  Pregabalin and suicidality  Online reporting form for consumers  Topiramate and visual field defects  Combined oral contraceptives and hormone replacement therapy - inflammatory bowel disease  Metoclopramide and neurological adverse events  Publication changes for Medicines Safety Update. Product vigilance The TGA applies a risk management approach to ensure therapeutic goods supplied in Australia meet acceptable standards of quality, safety and efficacy. Once a therapeutic product is approved, the TGA continues to monitor the product in the market through therapeutic product vigilance activities. The aim of therapeutic product vigilance is to continually monitor and evaluate the safety and efficacy (performance) profile of therapeutic goods and to manage any risks associated with individual products over their life cycle. The TGA's therapeutic product vigilance framework is available on the TGA website atTherapeutic product vigilance. The maintenance and improvement of health and safety is a shared responsibility. In addition to government and industry, health professionals, consumers and their respective associations play an important role in reporting safety related issues. Sponsors have the primary responsibility for the safety of any therapeutic products they import into, supply in or export from Australia. Sponsors must comply with legislative requirements for therapeutic product vigilance under the Therapeutic Goods Act 1989 (the Act) and there are applicable offences and penalties under the Act for not complying. The legislative requirements for therapeutic product vigilance vary depending on the type of therapeutic good.
  22. 22. PHARMA UPTODAY 22 The TGA maintains up-to-date safety information on therapeutic products that is communicated through a variety of means to consumers and health professionals. The TGA is committed to advancing public health through market authorisation of beneficial, innovative therapeutic goods and by providing timely, evidence-based and authoritative information to allow consumers and health professionals to make informed decisions. The TGA defines therapeutic product vigilance tools as tools designed to facilitate the collection and evaluation of information pertaining to the benefits and risks associated with the use of therapeutic products. The main product vigilance tools used by the Post-market Surveillance Branch are adverse event reports, RMPs and Periodic Safety Update Reports (PSURs). Adverse event reports are reports of any unwanted and sometimes harmful occurrences from using medicines, vaccines or medical devices (collectively known as therapeutic goods). Importantly, adverse events related to the use of a therapeutic good are not always caused by the therapeutic good itself. RMPs provide a summary of the known important safety information about the therapeutic product, plans to identify and characterise known or potential safety concerns and plans to minimise any identified or potential safety risk. A full outline of the scope of RMPs is above (see 'Expert advisory committee'). PSURs give an annual overview of the safety of the product, including adverse events, a summary of its registration status world-wide, actions taken for safety reasons, the world-wide usage of the product and an analysis of safety requirements. Sponsors must submit PSURs to the TGA for at least three years after registration of a product. An important aspect of product vigilance is ensuring there are mechanisms to communicate safety information to both consumers and health professionals. To achieve this, the TGA publishes Australian Public Assessment Reports (AusPARs) about recently registered prescription medicines and vaccines on the TGA website. AusPARs outline the findings of the TGA's evaluation of a product including important effectiveness and safety information. Each adverse event report the TGA receives is entered into a database, which is continually analysed by TGA staff to identify potential emerging problems for detailed investigation.
  23. 23. PHARMA UPTODAY 23 If the TGA identifies a safety concern relating to a medicine or vaccine, we can take regulatory action. This can include:  informing health professionals and consumers via safety alerts, Early Warning System monitoring communications and Medicines Safety Update, which provide information and recommendations about therapeutic goods  updating the Product Information, Consumer Medicine Information and/or product labelling with new adverse effects, precautions or warnings  requiring post-marketing studies  imposing limits on their use  investigating manufacturing sites  recalling products from the market  suspending or cancelling products. When a product is cancelled, details are published on the TGA website. Version history Version Description of change Author Effective date V1.0 Original publication Post-market Surveillance Branch 12 May 2015 Exporting to Brazil? ANVISA is tough and hands-on, says Kemwell Site audits by Brazilian pharma regulator ANVISA are ―exactly the opposite‖ to the US FDA‘s, says CMO Kemwell as it prepares to export to Brazil for Johnson & Johnson.
  24. 24. PHARMA UPTODAY 24 ANVISA passed Kemwell‘s manufacturing facility for oral solids in Bangalore, India following a recent inspection. The site will now be allowed to manufacture J&J‘s TB drug Sirturo (bedaquiline) for the Brazilian market. The facility already makes drugs for the EU, US, Canada, South Africa, and Australia. ―The [US] FDA is tough but ANVISA is considered the toughest regulatory agency with respect to audits,‖ Ashok Hegde, Kemwell‘s VP, Pharmaceutical Operations, told this publication. ―Every inspector has its own methodology of auditing. The FDA mostly concentrates on the documentation part. If an audit lasts five days, four of those will be spent on documentation. ―But ANVISA is exactly the opposite – it spends most of its time focusing on the facility and live operations. They will ask you to demonstrate things about the manufacturing procedure. ―They want to be on the ‗shop floor‘ when manufacturing is going on – to see how you do granulation or a tabletting procedure. They want to witness everything.‖ Brazilian market The US and Brazilian agencies also differ in their warning notice. Since the FDA opened several offices in India in the last four years, around 12 inspectors have been based in the country and can schedule inspections at short notice. ―They will call you on Friday and say they‘re coming on Monday,‖ said Hegde. ANVISA typically gives four weeks‘ warning, he said. Brazil has historically had tight rules about pharmaceutical imports. Hegde said few foreign manufacturers are approved by ANVISA, and the region prefers home-made products or drugs imported in bulk and then packaged for consumers in Brazil. But the country is growing as a market for complex, high-quality drugs. Hegde pinpointed injectables, especially biologics, and third-generation antibiotics like cephalosporin as ―the next segments where demand is going to pick up.‖
  25. 25. PHARMA UPTODAY 25 Data Protection: Council agrees on a general approach On 15 June 2015, the Council reached a general approach on the general data protection regulation that establishes rules adapted to the digital era. The twin aims of this regulation are to enhance the level of personal data protection for individuals and to increase business opportunities in the Digital Single Market. Latvia's minister for justice Dzintars Rasnačs said: "Today we have moved a great step closer to modernised and harmonised data protection framework for the European Union. I am very content that after more than 3 years of negotiations we have finally found a compromise on the text. The new data protection regulation, adapted to the needs of the digital age, will strengthen individual rights of our citizens and ensure a high standard of protection." A general approach means that the Council has a political agreement on the basis of which it can now begin negotiations with the European Parliament with a view to reaching overall agreement on new EU data protection rules. A first trilogue with the Parliament is planned for 24 June 2015. "I salute the readiness of the European Parliament to start the trilogue negotiations already next week. Hopefully we will come to the final agreement rapidly so that our citizens can enjoy the benefits of the reform as soon as possible", said Latvia's minister for justice Dzintars Rasnačs. The incoming Luxembourg Presidency indicated that, in parallel to the negotiations on the regulation, works on the data protection directive in the law enforcement area would be accelerated with the aim to find a general approach in October. Main elements of the agreement An enhanced level of data protection Personal data must be collected and processed lawfully under strict conditions and for a legitimate purpose. Data controllers (those responsible for the processing of data) must respect specific rules, such as the requirement for unambiguous consent by the data subject (the individual whose personal data is being processed), in order to be allowed to process personal data. Strengthened data protection rights give data subjects more control over their personal data:
  26. 26. PHARMA UPTODAY 26  easier access to their data.  more detailed information about what happens to their personal data once they decide to share it: data controllers must be more transparent about how personal data is handled, for example by informing individuals about their privacy policy in clear and plain language.  a right to erasure of personal data and "to be forgotten", enabling anyone for example to require that a service provider remove, without delay, personal data collected when that individual was a child.  a right to portability enabling easier transmission of personal data from one service provider, for instance a social network, to another. This will also increase competition among service providers.  limits to the use of 'profiling', i.e. automated processing of personal data to assess personal aspects, such as performance at work, economic situation, health, personal preferences etc. To ensure improved legal redress, data subjects will be able to have any decision of their data protection authority reviewed by their national court, irrespective of the member state in which the data controller is established. Increased business opportunities in the Digital Single Market A single set of rules, valid across the EU and applicable both to European and non European companies offering their on-line services in the EU will prevent conflicting national data protection rules from disrupting cross-border exchanges of data. Moreover, increased cooperation between the supervisory authorities in the member states will ensure coherent application of those rules throughout the EU. This will create fair competition and encourage companies, especially small and medium-sized enterprises, to get the most out of the Digital Single Market. To reduce costs and provide legal certainty, in important transnational cases where several national supervisory authorities are involved, a single supervisory decision will be taken. This one-stop-shop mechanism will allow a company with subsidiaries in several member states to limit its contacts to the data protection authority in the member state where it is established.
  27. 27. PHARMA UPTODAY 27 In order to reduce compliance costs, data controllers can, on the basis of an assessment of the risk involved in their processing of personal data, define risk levels and put in place measures in line with those levels. More and better tools to enforce compliance with the data protection rules Increasing responsibility and accountability of data controllers will improve compliance with the new data protection rules. Data controllers must implement appropriate security measures and provide, without undue delay, notification of personal data breaches to the supervisory authority as well as to those significantly affected by the breach. Controllers and processors may designate data protection officers in their organisation. Moreover, Union or national law can require them to do so. Data subjects, as well as, under certain conditions, data protection organisations can lodge a complaint with a supervisory authority or seek judicial remedy in cases where data protection rules are not respected. Furthermore, when such cases are confirmed,data controllers face fines of up to €1 million or 2% of their global annual turnover. Guarantees regarding transfers of personal data outside the EU The protection of transfers of personal data to third countries and international organisations is ensured through adequacy decisions. The Commission, with the involvement of member states and the European Parliament, is competent to decide whether the level of data protection offered by a third country or an international organization is adequate. In cases where no such decision has been taken, the transfer of personal data may only take place if the appropriate safeguards (standard data protection clauses, binding corporate rules, contractual clauses) are in place. General data protection regulation - general approach Data protection reform Kerala lacks efficient quality control system for drug testing: Dr Satheesh Kumar Even as the state of Kerala consumes about 10 per cent of the medicines marketed in the country per year, the quality control system of the drugs control department continues to be weak and incompetent. Hence, a public-private-partnership (PPP) scheme may be developed
  28. 28. PHARMA UPTODAY 28 to improve the quality control testing of drugs, according to Dr C S Satheesh Kumar, former drugs controller of Kerala and vice-president, operations, of the Kochi based Agappe Diagnostics. In a telephonic interview with Pharmabiz, the former DC said a major quantity of the drugs supplied to the government hospitals are found at higher rate of substandard quality. Even ten percent of the total supply cannot be tested at state laboratories. He said Kerala government is getting around Rs. 300 crore per annum towards sales tax from the drugs market; but the drugs control department remains as a service department with poor financial assistance from the government. The law enforcement authority is unable to assure the quality of drugs marketed in the state from other states. Less than one percent of the drugs sold in Kerala are manufactured by local companies. ―Very few number of drugs marketed and distributed in various places in Kerala is taken for analysis. Out of the 2,50,000 odd batches of drugs moving in the market per annum, less than 2 percent is taken for analysis. This should be above 10 per cent for satisfactory sampling. For this, new mechanism has to be developed by joint partnership of private and public agencies‖, he suggested. According to him, measures should be made to ensure hundred percent sampling, and it should be made compulsory for government procurement. For better quality criteria, modification is required in the tender process and the lowest rate (L1) quotation system has to be avoided. Government should procure a lion portion of the requirement from the local manufacturers and price preferences and other incentives should be given to them. Regarding efficiency of the drugs testing lab (DTL) under the department, Dr Satheesh added that the government laboratory at Thiruvananthapruam is not functioning in full capacity. The second regional drugs testing lab established at Ernakulam has not started functioning fully due to non-cooperation of senior officials in the department. He alleged that the rude and distorted attitudes of lab authorities spoil the whole system of the quality control, leaving all options of quality assurance.
  29. 29. PHARMA UPTODAY 29 As a suggestion to improve the quality control system, he said if the lab facilities at the pharmacy colleges can be utilized for sample analysis, majority of the drugs distributed in the state can be tested. There are 25 pharmacy colleges working in Kerala. All these colleges altogether can contribute a minimum rate of 15000-18000 samples per year provided one college is able to do analysis of 50-70 samples per month in survey sample analysis. WHO approves China flu vaccine, lauds growing industry The World Health Organization (WHO) has approved a Chinese influenza vaccine as being safe and effective, only the second Chinese vaccine to receive such status reflecting the growing clout of the country's drug makers. The WHO said in a statement on Friday that it had "prequalified" a vaccine made by Hualan Biological Bacterin Corp, a subsidiary of Hualan Biological Engineering Inc. The approval involved stringent lab tests and a site inspection. The other made-in-China vaccine to achieve WHO prequalification was a drug against Japanese encephalitis in 2013, the WHO said. "WHO prequalification of the Hualan vaccine is another feather in the cap of China's growing vaccine manufacturing industry," Bernhard Schwartländer, WHO representative in China, said in a statement. The development "shows that the country is set to become one of the preeminent vaccine manufacturers globally," he added. Chinese drug makers saw sales growth speed up and margins widen at the start of the year, in a sign that the world's second-largest pharmaceuticals market may be rebounding from a crackdown on corruption and high prices. China is increasingly flexing its scientific muscle in drug development, approving a new polio vaccine in January a month after local authorities gave the green light for a home-grown Ebola vaccine.
  30. 30. PHARMA UPTODAY 30 India scraps import duties on AIDS drugs to battle shortage India has scrapped customs import duties for drugs and test kits used to treat AIDS in an effort to cut prices across the country, as it struggles to cope with an ongoing shortage in its national program to fight the disease. More than a third of India's 2.1 million HIV/AIDS patients depend on getting their daily antiretrovirals for free from state-run distribution centers, but many of them have been facing shortages or stock outs for months. The notice put out by the Central Board of Excise and Customs this week intends to make it cheaper to import raw materials that are used to make antiretrovirals under the national program, BB Rewari of the National AIDS Control Organisation (NACO) told Reuters. Currently, U.S. firm Mylan Inc and India's Aurobindo Pharma supply AIDS drugs to the government program. The exemption applies to certain first-line and second-line antiretroviral drugs used to treat adults and children, as well as to certain diagnostic kits and equipment that are used by NACO, Rewari said. He added the drugs under exemption make up roughly 95 percent of the antiretrovirals used by India's AIDS patients under the national program. The exemption, which will remain in effect until March 2016, is the national AIDS control department's latest effort to deal with a chronic shortage of HIV/AIDS drugs at home, even though Indian companies are some of the world's major suppliers of AIDS drugs. Local firm Cipla Ltd made headlines in 2001 by making antiretrovirals for Africa for under $1 a day. The AIDS control program has been in disarray for months after the government changed the way over $1.3 billion in federal funds were distributed, according to data and letters seen by Reuters. Construction of clinics in rural areas has been delayed and many health workers have quit. Government officials have previously told Reuters of a lack of participation by local drugmakers in the tenders floated by the National AIDS Control Organisation (NACO) to procure drugs. Industry insiders, meanwhile, cite delayed tender approvals, supply bottlenecks and late payments, as well as poor coordination between the central and state governments.
  31. 31. PHARMA UPTODAY 31 AIDS drugs sold on the open market are expensive, so in an effort to make those more affordable, the government is likely to add more AIDS drugs under price control by including them in the national list of essential medicines, people involved in the process told Reuters in April. Soon, doctors to write prescriptions in capital letters Fear of misinterpretation due to doctor's illegible handwriting may soon be a thing of the past as government is set to make it a norm for physicians to prescribe medicines "preferably" in capital letters. The Union Health Ministry will come out with a gazette notification under the Indian MCIRegulations which will mandate doctors to prescribe medicines in capital letters in a "legible" manner and also mention the generic names of the drugs. "The Health Ministry will come out with gazette notification under the MCI regulations. Under this, the prescription should be legible and preferably written in capital letters along with the names of the generic drug prescribed," a senior Union Health Ministry official told PTI. Sources said that the notification is likely to be issued by the Ministry within a week's time. Health Ministry officials said that once the prescription is written in capital letters and is legible, it would be hugely benefit patients as well as chemists who would have a clarity of the drug and it would take away the fear of misinterpretation. However, the senior health ministry official said that there would no penalties or punishment for the doctor as such for not writing in capital letters. "Like all other MCI regulations, this too will govern the doctors," the official said. Health Minister J P Nadda last year in Parliament had agreed with concerns of some MPs that illegible prescription by doctors may lead to serious implications and even death in certain cases. "The central government has approved to amend Indian Medical Council Regulations, 2002, providing therein that every physician should prescribe drugs with generic names in legible and capital latter and he/she shall ensure that there is a rational prescription and use of drugs," Nadda said.
  32. 32. PHARMA UPTODAY 32 K K Aggarwal of Indian Medical Association (IMA) said this will help decrease prescription errors and it is a cheaper alternative to electronic health records. "Prescription errors will decrease. It will become uniform. One drug has 10 odd brands. The patients will be now able to know whether the drug is generic or not," Aggarwal told PTI. "In US alone, 100,000 prescription errors occur every year. India does not have any data on this. This is a cheaper alternative to electronic health records. It will take some time for doctors to get used to it," he said. US FDA upgrades Jubilant Life's US plant status Drug firm Jubilant Life Sciences today said the US health regulator has upgraded the status of its US subsidiary's manufacturing facility at Spokane to Voluntary Action Indicated. "The company's subsidiary, Jubilant HollisterStier, has been informed by the US Food and Drug Administration (USFDA) that its pharmaceutical sterile manufacturing facility in Spokane, Washington ( USA), has been upgraded to the status of Voluntary Action Indicated (VAI)," Jubilant Life Sciences said. In a filing to BSE, the company said Spokane site's latest establishment inspection report indicates successful conclusion of inspections in April and December last year. This upgradation by the USFDA from Official Action Indicated (OAI) to VAI is "indicative of the current good manufacturing practice (cGMP) status at the facility" since receiving the warning letter in 2013, the drug maker added. Jubilant Life Sciences Chairman Shyam S Bhartia and Co-Chairman & MD Hari S Bhartiasaid: "We consider this development as another step towards building a reliable and sustainable pharmaceutical business." According to FDA, a VAI inspection classification is issued when objectionable conditions or practices were found that do not meet the threshold of regulatory significance. The company currently has 10 manufacturing facilities in India, the US and Canada with 6,200 as global headcount. The stock of Jubilant Life Sciences was today trading at Rs 173 on BSE, up 3.69 per cent.
  33. 33. PHARMA UPTODAY 33 CDSCO drug inspectors soon to get online training on cGMP Aimed at empowering the central drug regulators with the similar regulatory knowledge as offered to the US FDA officials, the Central Drugs Standard Control Organization (CDSCO) will soon equip its drug inspectors with relevant areas of current Good Manufacturing Practices (cGMP) through an online training module. The US-based global leader in safety science Underwriters Laboratories (UL) will train around 15 officers from the CDSCO West Zone on critical areas including Good Manufacturing Practices (GMP), Good Clinical Practices (GCP), audit-readiness and remedial training. UL offers about 1,200 courses globally and has trained around 38,000 US FDA inspectors till date. "Drug inspectors in the CDSCO western region require training on relevant areas of GMP and cGMP. The online training module is going to start in a couple of months time," informed an official associated with the development. UL has recently signed up as a knowledge partner with the CDSCO West Zone. UL EduNeering, the compliance education and training services business division of UL Life & Health, will lead this initiative. UL also will build custom training modules for the CDSCO West Zone that suit the learning needs of their investigators. In the first phase, 10 investigators will be trained on 40 online modules. CDSCO West Zone comprises the states of Maharashtra, Goa, Gujarat, Madhya Pradesh, Chhattisgarh and Union Territories of Daman & Diu and Silvassa. ―UL's focus on quality is based on the expertise we have garnered from more than a century of testing, certifying products and developing standards. Through this association we will be training CDSCO inspectors across western region on what is essential in the inspection and standardisation process. This association is another extension of the MoU, we recently signed with the Gujarat government. We are happy to see the increase in quality awareness amongst
  34. 34. PHARMA UPTODAY 34 the pharmaceutical industry across the region. We will further continue our focus on the sector and expand our presence in industry and across regulators,‖ said Suresh Sugavanam, managing director and vice president of UL South Asia. Considering the fact that certain Indian companies have got critical global attention due to certain evasions, violations and avoidances during US FDA inspections in the last couple of years, government regulatory agencies have started emphasising the need to ensure consistent quality of drugs manufactured in India. The drugs standardisation compliance and regulatory requirements need to be at par with the international regulations, including the US FDA, allowing drug manufacturers to maintain competitive advantage. ―UL EduNeering is a leader in providing regulatory and compliance learning solutions to the life science industry. Our CFR 21 Part 11 validated platform is used globally by top pharma and medical device companies. We partner with organisations to help them build an effective quality and compliance training programme that best suits their needs,‖ stated Scott Barnard, vice president, Life Sciences at UL EduNeering. Out of the 700 courses offered through e-learning mode, 150 courses were also made available in Gujarat FDCA for the state regulators on relevant areas of GMP, GDP and validation protocols. USFDA wants closer cooperation with Indian drug regulators The United States Food and Drug Administration (USFDA) has sought closer cooperation with its Indian counterpart Central Drugs Standard Control Organization (CDSCO) and Drug Controller General of India (DCGI) in a wide ranging issues such as "good manufacturing practices", "good clinical practices" and regulating spurious drugs. Sources told Bloomberg TV India that USFDA wants Indian drug inspectors to assist them on surprise visits. The move assumes importance as India is drawing up a 7-point vision to double pharma output to Rs 4 lakh crore by 2019 as part of the Make in India initiative but it has to step up regulations and inspection to global standards.
  35. 35. PHARMA UPTODAY 35 The USDFA officials visited India in March 2015 and had frank ranging discussions on the regulatory issues in both nations. As a follow-up to the visit, sources said that USFDA has written to the Indian government appreciating the transparency in discussion on the Narendra Modi government's plans to strengthen the regulatory systems and infrastructure. The USFDA wanted collaboration on inspection for inspection of "good manufacturing practices", "good clinical practices" and medical devices. The US drug regulator also wants to collaborate on inspection to weed out sub-standard, spurious, falsely labeled and counterfeit medical products, sources said. The USFDA will hold joint common training workshops for drug inspectors in India in September. The training workshops will focus to resolving issues pertaining to quality management, risk management and data integration. In China, Illegal Drugs Are Sold Online in an Unbridled Market SHANGHAI — Ordering illegal drugs from China is as easy as typing on a keyboard. On guidechem.com, more than 150 Chinese companies sell alpha-PVP, also known as flakka, a dangerous stimulant that is illegal in the United States but not in China, and was blamed for 18 recent deaths in one Florida county. The e-commerce portal Qinjiayuan sells air-conditioners, trampolines anda banned hallucinogen known as spice, which set off a devastating spike in United States emergency room visits in April. The stimulant mephedrone, sometimes sold as ―bath salts,‖ is banned in China but readily for sale at the Nanjing Takanobu Chemical Company for about $1,400 a pound. ―I can handle this for you legally or illegally,‖ a company salesman said by phone when asked about shipping the product overseas from the company‘s headquarters in coastal Jiangsu Province. ―How much do you want?‖ The English-language website of China Enriching Chemistry, a Shanghai company, is a veritable Amazon of synthetic drugs.
  36. 36. PHARMA UPTODAY 36 While China says it has made thousands of arrests and ―joined hands‖ with foreign law enforcement agencies, officials from several countries say Chinese authorities have shown little interest in seriously combating what they see as the drug problems of other countries. ―They just didn‘t see what was in it for them to look into their own industries exporting these chemicals,‖ said Jorge Guajardo, the former Mexican ambassador to China. China‘s chemical factories and drug traffickers have exploited this opportunity, turning the nation into a leading producer and exporter of synthetic drugs, including methamphetamine, as well as the compounds used to manufacture them, according to seizure and trafficking route data compiled by American and international law enforcement agencies. China is now the source of a majority of the ingredients needed to manufacture methamphetamine by Mexican drug traffickers, who produce 90 percent of the meth consumed in the United States, according to theDrug Enforcement Administration. As governments around the world have stepped up regulation of these so-called precursor chemicals, the Mexican cartels have increasingly turned to Chinese chemical factories. Mr. Guajardo, Mexico‘s ambassador from 2007 to 2013, said his efforts to persuade Chinese authorities to restrict the export of these chemicals, which are banned in Mexico, came to naught. Instead, he said, Chinese officials said the problem was best handled by Mexican customs agents or claimed that Mexico‘s written requests for assistance had used the incorrect typeface or were improperly translated into Chinese. ―In all my time there, the Chinese never showed any willingness to cooperate on stemming the flow of precursors into Mexico,‖ he said in a telephone interview. At the same time, clandestine Chinese labs manufacture and export their own meth and other synthetic drugs around the world. In 2013, the police dismantled nearly 390 meth labs in China, more than in any other country in the region, according to a United Nations report released in May. These manufacturers have flourished in part because the country‘s huge chemical industry is weakly regulated and poorly monitored, officials say, making it easy for criminal syndicates to divert chemicals with legitimate uses in making medicine, fertilizer and pesticides into the production of new and dangerous drugs.
  37. 37. PHARMA UPTODAY 37 The labs have also figured out how to stay one step ahead of laws banning illicit synthetic drugs simply by tweaking a few molecules, creating new and not-yet-illegal drugs. Since 2008, the number of new psychoactive substances reported to the United Nations Office on Drugs and Crime has soared more than eightfold to 541, far outpacing the 244 drugs controlled under global conventions. Often sold as ―legal highs‖ and ―research chemicals,‖ these drugs are designed specifically to exploit an outdated international legal framework. Some countries, including the United States, have banned whole ranges of chemicals that mimic illegal drugs, but many nations do not. The European Union in particular, with its open borders and disparate drug laws, provides ample opportunity for smuggling contraband. ―Drug traffickers take advantage of this,‖ said Soren Pedersen, a spokesman for the European police agency Europol. ―As soon as a substance becomes illegal in Germany, they can just divert it to Denmark, Sweden or Austria.‖ Several American officials said China was the primary source for new synthetic drugs. ―Hands down China is No. 1,‖ said a federal law enforcement official, who was not authorized to speak publicly. ―I know prosecutors in Arizona, Virginia, Minnesota,‖ said Carla Freedman, an assistant district attorney in New York who in 2013 prosecuted a ring trafficking drugs from Shanghai. ―We‘re seeing cases nationwide and ground zero always seems to be China.‖ According to the Australian Crime Commission‘s latest Illicit Drugs Report, released last month, China was the primary source of illicit amphetamine-type drugs detected at the Australian border in 2013 to 2014. In 2013, the Australian police made their largest methamphetamine seizure ever, 1,300 pounds discovered in a shipping container from China with a street value of $450 million. Since then, Australian authorities have found meth in Chinese shipments of garden hoses, handbags, lamps, aquarium pebbles, metal shafts, kayaks and 70 porcelain toilets. ―We‘ve seen it all,‖ said Detective Superintendent Scott Cook, who commands the Organized Crime Squad in the state of New South Wales, which includes Sydney. ―There‘s absolutely no limit in terms of how far they go to import drugs. They‘re ingenious.‖ Chinese officials say the government is committed to international cooperation against drug traffickers.
  38. 38. PHARMA UPTODAY 38 ―We aim to help and support other countries in any way we can,‖ Liu Yuejin, the assistant minister of public security, has said publicly. In response to faxed questions, the Chinese Foreign Ministry denied any problems in law enforcement cooperation with Mexico. But Hao Wei, a member of the ministry‘s Committee for Prevention of Synthetic Drug Abuse, said traffickers would always find loopholes. ―I really don‘t think only governments should be blamed for this,‖ he said in a telephone interview. ―Instead of pointing fingers at each other, we should confront the problem and deal with it in a comprehensive and balanced way.‖ Dr Reddy's Laboratories working on 18 new drug applications HYDERABAD: Drugmaker Dr Reddy's Laboratories Limited is working on 18 new drug applications, including the three NDAs it has already filed with the US Food and Drug Administration, and expects 2 more drugs to go for approvals before 2018. According to a filing with Securities and Exchanges Commission, DRL said the company follows a hybrid research and development model, both in-house and virtual (operations are outsourced, subject to supervision of strategic and project management functions). "As of March 31, 2015, we had 18 active products in our Proprietary Products development pipeline in various stages of development. "We have filed 3 NDAs for products from this pipeline, two in March, 2015 and one in April, 2015, all under section 505 (b)(2) of the US Federal Food, Drug and Cosmetic Act," the filing said. The three NDAs it filed with FDA -- DFD-01, DFD-09, DFN-11 -- are focussed on developing and commercialising therapies in dermatology and neurology. DFD-01 is intended for the treatment of patients suffering from psoriasis and DFD-09 is for the treatment of rosacea. DFN-11 is a drug device combination product intended to treat acute migraine episodes.
  39. 39. PHARMA UPTODAY 39 DFN-02 (for treatment of migraines, with or without aura) is expected to go for approval from US FDA in 2018, DFD-06 which is being developed for treatment of moderate psoriasis affecting up to 20 per cent of the body surface area in patients 18 years of age or older may seek approval from the US regulator by next year, the company said. "Our principal research laboratory is based in Hyderabad, India. As of March 31, 2015, we employed a total of 152 scientists, including 30 scientists who held Ph.D. degrees, across all of this segment's locations. "Our research strategy focuses on discovery of new molecular targets, designing of screening assays to screen promising molecules and developing novel formulations of currently marketed drugs or combinations thereof to address unmet medical needs," it further said. While the company continues to seek licensing and development opportunities with third parties to further develop product pipeline, it also conducts clinical development of some candidate drugs in-house. CDSCO to upgrade manpower to enhance GMP compliance and quality of drugs The Central Drug Standards Control Organization (CDSCO) would soon appoint 147 drug inspectors by the end of 2015 to ensure quality of drugs on par with global standards in line with current Good Manufacturing Practices (cGMP). The process for the appointments has already started, says a senior CDSCO official. A total of additional 1195 posts have been sanctioned for the upgradation of manpower and labs under the 12th five year plan. Central government has allocated Rs.900 crore for enhancing manpower and capacities of minilabs at port offices and mobile labs at CDSCO level. According to informed sources, ―CDSCO expects to double the manpower and enhance the lab infrastructure both at the centre and states by the end of 2017. CDSCO has also conducted 17
  40. 40. PHARMA UPTODAY 40 training programmes to train drug inspectors on carrying out GMP inspections in the year 2013- 14 to ensure quality of drugs supplied to over 200 countries from India‖. Talking about the increasing global requirement for evolving regulatory compliance in regulated and unregulated markets, an official stressed on the need for uniformity of GMP inspections for supplying quality drugs globally. "The practice of deputing drug inspectors as observers through joint inspections has been able to help draw suggestions and feedback from our global regulatory counterparts on continuing good manufacturing practices. It will help manufacturers in adopting global practices followed in other countries where our medicines are consumed. Similar kinds of inspections have also been carried from India to other importing countries for the sake of ensuring quality and consistency. Countries globally are concerned about safe and efficacy of medicines to be supplied for the sake of patient safety," he added. CDSCO had earlier started deputing drug inspectors as observers to carry out joint inspections on an event of inspection from an international regulator. The exercise done in coordination with state drug regulators was meant to monitor manufacturing plants on GMPs and equip drug inspectors on enforcing its compliance across the country. Following which, around 80 drug inspectors have been recruited at the CDSCO last year. It has been learnt that US FDA's workshops on GMP and CGMP compliance for the first time in four cities of India in partnership with CDSCO earlier this year has been well received as over 60 pharma companies participated in the workshop. The US FDA-CDSCO workshops held in Hyderabad, Goa, Chandigarh and Ahmedabad in May last year covered relevant topics for US FDA regulatory requirements like process validation, enforcements and computer system validation based on specific information.
  41. 41. PHARMA UPTODAY 41 21st Century Cures would extend exclusivity for 15% of drugs A six-month extension of marketing exclusivity proposed in the 21st Century Cures Act(H.R. 6) for drugs repurposed for Orphan indications would delay generic or biosimilar competition for about 15% of brand name drugs expected to lose exclusivity from 2016-25, according to an estimate released Tuesday by the Congressional Budget Office. The extension would cost the federal government about $869 million, according to the CBO. The estimate implies that the bill's provision would trigger a surge in new Orphan drug indications for approved drugs. The CBO estimated the full cost of H.R. 6 at $106.4 billion from 2016-2020, including $97 billion to reauthorize NIH for three years. The estimate includes an increase in NIH funding by $1.5 billion annually, as well as $8 billion for an NIH Innovation Fund. The CBO estimated that FDA's provisions in the bill would cost $872 million, including a $550 million Cures Innovation Fund for the agency. According to the CBO, the bill would reduce direct spending by a net $11.9 billion over the five- year period, based on budget offsets that were passed by the House Energy & Commerce Committee, including sales from the Strategic Petroleum Reserve, cash flow management for Medicare prescription drug programs, and cost savings from limiting Medicaid reimbursement for durable medical devices. These offsets may be changed, however, when the bill moves to the House floor India to open drugs database to global regulators Drug regulators and retailers across the world will soon be able to access a large database that India is building on domestic pharmaceutical manufacturers. India has decided to throw open the database to global stakeholders following concerns over spurious drugs emanating from the country. The government had earlier introduced barcoding on export consignments of medicines to help trace their point of origin. Now it has mandated all drug exporters to adhere to labelling of prescribed manufacturing data on various levels of packaging from October 1 while temporarily exempting barcode labelling on primary packaging.
  42. 42. PHARMA UPTODAY 42 A senior commerce ministry official said a pilot project will begin at the end of this month for uploading data provided by some select medicine exporters, even as an expert group will recommend technologies for the socalled track and trace system within four months. India had exported medicines worth $15.2 billion (about Rs 97,000 crore) in 2014-15, an increase of 5% over the previous year's figure. PV Appaji, director general of Indian Pharmaceuticals Export Promotion Council (Pharmexcil), said the medicine exporters will upload data pertaining to the parent-child relationship for all the three levels of packaging — primary, secondary and tertiary — along with the movement of goods in the supply chain. Sun Pharma, Wockhardt and Unichem are among the medicine exporters that have come forward to upload their barcoding data on the central server of National Informatics Centre, Appaji said. "We are talking to a few more top exporters including Dr Reddy's Laboratories, Mylan Labs, Sandoz and Aurobindo Pharma to take part in the pilot project," he said. Appaji is the member secretary of the expert group on technology that comprises the commerce ministry's joint secretary Sudhanshu Pandey, pharmaceuticals department's joint secretary Sudhansh Pant and the Drug Controller General of India. He is also a member secretary of the expert committee group set up for finding the right technology for implementation of the track and trace system for export of drug formulations. Indian Drug Manufacturers' Association president SV Veeramani said the industry players were waiting for clarity on technologies and guidelines for uploading the manufacturing data and its data security features. "India is the first country to implement the barcode system in the world. We are in principle willing to participate while incurring additional expenditure to comply with the new mandatory process, but we are not sure of its benefits." Appaji said the commerce ministry is scheduled to organise a meeting on Friday in Mumbai to providing clarity to various stakeholders.
  43. 43. PHARMA UPTODAY 43 IPA wants Regulatory Affairs Science as academic discipline for higher education in pharmacy The Regulatory Affairs Division (RAD) of the Indian Pharmaceutical Association (IPA) wants Regulatory Affairs Science as an academic discipline and a research topic as part of higher education in pharmacy. In respect of this field of study, RAD is conceiving ideas from experienced drug regulatory officers, expert leaders of industry and prominent academicians, said Dr Subhash Mandal, chairman of RAD of IPA. He said PG and research programmes in Regulatory Affairs Sciences have developed in some western countries and several universities offer higher level academic programmes in the subject. In India, discussions are going on among experts to justify its status as an independent academic discipline in the pharmacy education. RAD will apprise the Union government and the office of the Drugs Controller General of India (DCGI) of the necessity of introducing Regulatory Affairs as an academic discipline. He pointed out that in today‘s world when crores of rupees worth drugs are consumed everyday by people in the country and the industry manufactures millions of rupees worth drugs for domestic and international sale, regulatory professionals of the central and state agencies need to learn and acquire specialized knowledge and practical skill about regulatory aspects of pharmaceuticals, neutraceuticals, cosmetics, biotechnology, medical devices, food, herbal drugs and other life-science industries. Pharmaceutical Regulatory Affairs professionals are responsible for developing, compiling and filing documentation required to support the licensing and approval of pharmaceutical products. Dr Mandal said that with an aim to bring up this science into the pharmacy academic domain, last year RAD had organised seminars and workshops on the concept and importance of regulatory affairs in various pharmacy colleges, and discussions held among academic groups, research groups and industries. The residuary work will be carried out this year. He said once the subject becomes an academic discipline, it will provide the students with the knowledge and
  44. 44. PHARMA UPTODAY 44 skills required to fulfill vital roles in assuring adherence with the complex regulations necessary for the development, delivery and marketing of safe and effective health-care products. For an international level progress of the subject, RAD will contact regulatory authorities in foreign countries such as USFDA (USA), MHRA (UK), TGA (Australia), Health Canada (Canada), MCC (South Africa), ANVISA (Brazil), EMEA (European Union), SFDA (China), NAFDAC (Nigeria), MEDSAFE (New Zealand), MHLW (Japan), MCAZ (Zimbabwe), SWISSMEDIC (Switzerland), KFDA (Korea), MoH (Sri Lanka), etc. Regulatory Science is the science of developing new tools, standards, and approaches to assess the safety, efficacy, quality, and performance of all regulated products. The course on the subject will have several disciplines like operational regulatory affairs, strategic regulatory affairs, clinical research regulatory affairs, international regulatory affairs, regulatory compliance, and general regulatory affairs, said Dr Subhash Mandal. Health Canada requests quarantine of drug products from Polydrug Labs due to data integrity concerns Drug regulatory authority of Health Canada has requested that Canadian importers voluntarily quarantine drug products with active pharmaceutical ingredients (APIs) manufactured or tested by an Indian drug maker, Polydrug Laboratories, based in Ambernath, Maharashtra state, due to data integrity concerns. Health Canada is taking this interim precautionary measure to help mitigate any potential risk in light of recent findings from trusted regulatory partners that raised concerns about the reliability of data generated at this site. At this time there is no identified risk to health, and Health Canada is not requesting a recall of any products with API from Polydrug Laboratories currently available at Canadian market. APIs are used to make finished drug products that are sold to consumers. A quarantine will
  45. 45. PHARMA UPTODAY 45 mean that Canadian importers and distributors will stop distributing products in Canada with APIs linked to this site. Health Canada continues to review information from the trusted regulatory partners and from Canadian importers. Canadians will be updated about the list of products affected by the requested quarantine through updates on the Inspection Tracker. Canadians should not make any changes to their medication without consulting with a healthcare professional, said an official release. Health Canada will continue to work with international partners and Canadian importers to gather and assess information regarding the situation and take action as necessary to help protect Canadians. Health authority will also engage the provinces and territories to share information about the situation. HMPC Document on the systematic Review of Monographs Herbal Medicinal Products updated On 28 January 2015 the EMA's HMPC (Committee on Herbal Medicinal Products) has updated the procedure which defines the systematic review of the monographs for herbal medicinal products of the European Union and the list entries of the European Union as well as their supporting documentation. The legal basis for this is the EMA/HMPC reflection paper about the reasons and time periods for the revision of monographs and list entries. Every 5 years it has to be checked whether a monograph or a list entry is still up-to-date. The HMPC review document deals with the following aspects:  Scope of the revisions  Timelines  Documentation of the review / revision
  46. 46. PHARMA UPTODAY 46 With regard to the last point it is mentioned that the extent of the changes made in each document must be transparent. For more information please see the complete Rev 1 document Procedure for the systematic review of European Union herbal monographs and/or European Union list entries and supporting documents. Better training tools recommended to support patients using adrenaline auto-injectors Training device and audio-visual material expected to promote appropriate use of auto- injectors The European Medicines Agency (EMA) has recommended several measures, including the introduction of more effective educational material, to ensure that patients and carers use adrenaline auto-injectors successfully. Adrenaline auto-injectors are potentially life-saving treatments for anaphylaxis (severe allergic reactions) while the patient waits for emergency medical assistance. EMA carried out a review of adrenaline auto-injectors following concerns that currently available devices may deliver adrenaline under the skin instead of into a muscle, and this may delay response to treatment. Having assessed all the available data, EMA‘s Committee for Medicinal Products for Human Use (CHMP) acknowledged that giving the medicine by injection into the muscle is the preferred way to obtain a rapid response in anaphylaxis. However, the CHMP noted that several factors may affect whether adrenaline is actually delivered into a muscle; these include needle length, the thickness of fat under the skin, the way the auto-injector works (e.g. if it is spring loaded or not), the angle at which the device is placed on the skin and the force used to activate the device as well as how well the user follows the instructions for injection. The CHMP concluded that training of the user is of paramount importance. The companies that market adrenaline auto-injectors will therefore be asked to develop more effective educational material for patients, as well as for healthcare professionals, to ensure their optimal use. This
  47. 47. PHARMA UPTODAY 47 will include a training device with which patients can practise; audio-visual material to show in detail how the device is to be used; and a checklist for prescribers to ensure that sufficient information is given to the patient before they use the auto-injector. The product information of adrenaline auto-injectors will also be updated with further warnings and precautions, including a recommendation that patients should be prescribed two auto-injectors which they should carry at all times and a recommendation for family members, carers or teachers to be trained on how to use the auto-injector. The CHMP also concluded that further data should be generated to better understand how adrenaline penetrates body tissues when given with each of the different auto-injectors. The CHMP recommendation will now be sent to the European Commission for a legally binding decision that will be valid throughout the EU. Information for patients  Adrenaline auto-injectors are used to treat severe allergic reactions, while the patient awaits emergency medical assistance. They are designed so that they can be easily used by the patient themselves or a carer.  The review of adrenaline auto-injectors showed that patients could benefit from further training to use the auto-injector successfully.  You will receive training from your doctor or nurse on how to use your adrenaline auto-injector. A training device will also be developed so that you can practise with it before you need the auto-injector in an emergency. A training video will be produced to show you in detail how to use the injector properly.  It is important that you use the auto-injector correctly so that the adrenaline is delivered into your muscles and works as quickly as possible.  If you have been prescribed an adrenaline auto-injector because you are at risk of severe allergic reactions, you should ensure you are familiar with it and carry it with you at all times.  It is likely that your doctor will recommend that you carry 2 injectors, in case a second dose is needed while you wait for emergency assistance.
  48. 48. PHARMA UPTODAY 48  Your family members, carers or teachers should also be instructed in the correct use of the auto-injector.  If you have any question or concern, speak with your doctor or pharmacist. Information for healthcare professionals  The review of adrenaline auto-injectors confirmed that intramuscular injection is the preferred route of administration in the treatment of anaphylaxis in order to obtain a rapid response.  Several factors may affect whether adrenaline reaches the muscle layer. These include: needle length, the skin-to-muscle depth, the way the auto-injector works (e.g. if it is spring loaded or not), the angle of placement on the skin and the force used to activate the device.  Because of the uncertainties over drug delivery from adrenaline auto-injectors and the consequent uncertainties around the onset of pharmacodynamic response, it is recommended that healthcare professionals prescribe 2 auto-injectors, which patients should carry at all times.  Educational material will be developed to ensure that patients or carers use adrenaline auto- injectors successfully. This will include a training device that patients can practise with, audio- visual material and a prescriber checklist.  A study in 2013 by Brown et al. showed that 15% of the mothers were unable to use the auto- injector successfully in their children. This supports the introduction of proper training and comprehensive educational material for patients and healthcare professionals.  The companies that market adrenaline auto-injectors will be asked to carry out a pharmacokinetic/pharmacodynamic study to better understand how adrenaline penetrates body tissues when given through an auto-injector. More about the medicine Adrenaline (epinephrine) auto-injectors are given to people who are at risk of anaphylaxis (severe allergic reaction) or have had a previous episode of anaphylaxis, to use as a first-aid measure in case of emergencies while waiting for emergency medical assistance.
  49. 49. PHARMA UPTODAY 49 Anaphylaxis is a life-threatening reaction that causes a drop in blood pressure and breathing difficulties. An injection of adrenaline helps to relieve the symptoms of anaphylaxis quickly by narrowing the blood vessels (thereby increasing the blood pressure) and opening up the airways to help with the breathing. Adrenaline auto-injectors have been approved through national procedures in all the EU Member States. More about the procedure The review of adrenaline auto-injectors was initiated at the request of the United Kingdom in April 2014, under Article 31 of Directive 2001/83/EC. This followed a national review of all adrenaline auto-injector products approved in the UK, which concluded that there was no robust evidence that the devices deliver adrenaline into a muscle for all patients. The review has been carried out by the Committee for Medicinal Products for Human Use (CHMP), responsible for questions concerning medicines for human use, which has adopted the Agency‘s final opinion. The CHMP opinion will now be forwarded to the European Commission, which will issue a final legally binding decision applicable in all EU Member States. Source: http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2015/06/WC5 00188786.pdf Pharmaceuticals regulator set for revamp India‘s drug regulator Central Drug Standard Control Organisation (CDSCO) is all set to be revamped into a world-class body. With the rise in import alerts from the US Food and Drug Administration (USFDA), the government has geared up to increase the efficiency and quality of the pharma sector.
  50. 50. PHARMA UPTODAY 50 CDSCO regulates quality standards of drugs and is also responsible for the approval of new drugs. The ministry has floated the draft Cabinet note with an aim to upgrade the body at par with the world‘s best health regulator, US Food and Drug Administration (US FDA). ―We have floated a Cabinet note on revamping CDSCO… For it to be upgraded into a world- class health regulator. The regulator will also be renamed as Central Drug Administration, which is as easy as Food and Drug Administration,‖ said a senior official of the health ministry. ―The Cabinet may take up the proposal within July.‖ The draft note also suggests that CDSCO should fall under the direct supervision of the health ministry as currently it falls under the Directorate General of Health Services (DGHS). ―We have set USFDA as the standard to upgrade and revamp the entire health system. Upgradation is a dynamic process and our aim is to adopt best international manufacturing practices,‖ said GN Singh, drug controller general of India (DCGI), who heads CDSCO. New CDSCO is likely to have six arms divided into categories — drugs, cosmetics, medical devices, laboratories, new emerging areas and ayush. The responsibilities of CDSCO include grants of import and export license, clinical trial approvals and permissions for marketing and manufacturing. State Food and Drug Administration (FDA) work with CDSCO in each state and is responsible for issuance of license to manufacture similar biologic in India apart from regulating the drug quality. Pharmacopoeia Commission mandates pharma cos to submit ADR reports to Pharmacovigilance Programme With a view to strengthen the quality assessment of all the drugs marketed in the country and to reinforce the Pharmacovigilance Programme of India (PvPI), the Indian Pharmacopoeia Commission (IPC), the national coordination centre for the programme, has issued an order mandating all the pharmaceutical industries to submit adverse drugs reaction (ADR) reports of their respective pharmaceutical products. The order, signed by Dr G N Singh, secretary-cum-scientific-director of PvPI, has come into force from June 1, this year.
  51. 51. PHARMA UPTODAY 51 Last year, the IPC had issued a similar order asking all the hospitals to submit the ADRs in particular formats to government of India. But the responses to the order are poor hitherto, said a chief regulatory officer of a state. The latest order, concerning submission of ADR reports by manufacturers, dated May 18, 2015, states that pharma companies should submit the reports in XML-E2B format to PvPI. IPC office hopes that the particular format will enable the authorities to hasten the process of uploading Individual Case Safety Reports (ICSRs) to VigiFlow, a web-based database of the WHO–UMC (World Health Organisation – Uppsala Monitoring Centre). This measure is also expected to enhance the process of assessment and signal detection, says the order. Following the IPC directive, a Coimbatore-based pharmacovigilance consulting company, Oviya Medsafe, has informed Pharmabiz that they will provide support services for pharma companies to submit the reports to PvPI. The managing director of the company, Dr Vijay Venkataraman, claims that although pharmaceutical companies in India collect suspected ADR reports from healthcare professionals through their marketing teams, only a few of them have pharmacovigilance departments and drug safety software databases to generate ADR reports in XML-E2B format. Update From the Most Recent ICH Meeting The International Conference on Harmonisation (ICH) Steering Committee (SC) and its Expert Working Groups (EWGs) met in Fukuoka, Japan from June 5-11, 2015. The meeting was hosted by the Ministry of Health, Labour and Welfare and the Japan Pharmaceutical Manufacturers Association. The SC agreed on the key issues relating to the reform of ICH in terms of the Articles of Association, funding model and membership. An important part of the reform effort is establishing a formal organisation with a new approach to membership, governance and shared funding among ICH members. During a special session on June 10, Interested Parties were updated on the future of ICH, including issues regarding membership and governance of the new association. All participants welcomed the goals of the reform and recognised the intended
  52. 52. PHARMA UPTODAY 52 roles of the Assembly as well as the Management Committee. Most participants indicated their interest for becoming ICH members or observers and the different intended eligibility criteria were discussed. The new ICH Association under Swiss law is expected to be established over the coming months with the aim of being operational starting in 2016. Twelve working groups met in Fukuoka and achieved important progress towards their respective objectives. The Question & Answer (Q&A) document on the Q7 Guideline on Good Manufacturing Practices for Active Pharmaceutical Ingredients (APIs) has been signed off at Step 4 in Fukuoka and is thus ready for implementation in the ICH regions. In addition, two documents, the draft Addendum to the M7 Guideline on Assessment and Control of DNA Reactive (Mutagenic) Impurities in Pharmaceuticals to Limit Potential Carcinogenic Risk document and the draft Addendum to E6 on Good Clinical Practicehave reached Step 2b and will be submitted to public consultation. More details on the progress achieved by the different groups is provided hereunder. Safety Guidelines Update The M7 EWG reached agreement on the draft Addendum to the Guideline Assessment and Control of DNA Reactive (Mutagenic) Impurities in Pharmaceuticals to Limit Potential Carcinogenic Risk. The SC signed off the Step 2a/2b document in Fukuoka. thus releasing this document for public consultation. A new EWG, S5(R3), was created to revise the Guideline on Detection of Toxicity to Reproduction for Medical Products and Toxicity to Male Fertility and met in Fukuoka for the first time. This group made good progress in reviewing and revising the current guidance in developmental and reproductive toxicity studies and expects to reach Step 2 by June 2017. It was also the first meeting of the S11 EWG tasked to develop a new ICH Guideline on Nonclinical Safety Testing in Support of Development of Paediatric Medicines. Efficacy Guidelines Update The EWG developing an Addendum to E6 on Good Clinical Practice to promote innovative approaches to clinical trial design, management, oversight and conduct made good progress and reached Step 2a/2b. The draft document that will take the format of an integrated addendum will now be submitted to public consultation.
  53. 53. PHARMA UPTODAY 53 The EWG developing an Addendum to E9 on Choosing the Appropriate Estimand and Defining Sensitivity Analyses in Clinical Trials, met to focus on harmonising improved clinical trial planning, conduct, analysis and interpretation. The E11 EWG worked to develop an Addendum to the Guideline on Clinical Investigation of Medicinal Products in the Pediatric Population and made good progress towards the draft Step 1 technical document. Step 2 for this topic is expected in December 2015. The E14 Discussion Group (DG) met to develop a Concept Paper to revise the ICH E14 Guideline on the Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythmic Potential for Non-Antiarrhythmic Drugs. During the meeting in Fukuoka, the SC endorsed the Concept Paper on the revision of the Q&A 5.1 on Concentration-Response Modelling for regulatory decision making thereby allowing experts to initiate this revision. The group working on the development of the E17 Guideline on Multi-regional Clinical Trials progressed towards developing the Step 1 technical document. The E18 EWG on Genomic Sampling Methodologies for Future Use made progress towards a Step 2 document which is expected in December 2015. This Guideline will clarify points to consider in collecting genomic samples in clinical trials, resulting in further implementation of genomic research for the benefit of all stakeholders. Quality Guidelines Update The Q7 Implementation Working Group (IWG) on Good Manufacturing Practices for APIs reached agreement on the Step 3 Q&A document ahead of the Fukuoka meeting. The SC approved this document for release by signing off Step 4 in Fukuoka. The SC also signed-off on Step 2a/2b of the Q3C(R6) Guideline for Residual Solvents including two solvents: Triethylamine and Methyl Isobutyl Ketone. The Q3C maintenance EWG had reached agreement on this document ahead of the Fukuoka meeting The Q12 EWG on Technical and Regulatory Considerations for Pharmaceutical Product Lifecycle Management met for the second time in Fukuoka. This group is expected to finalise its Step 1 technical document in June 2016. The ICH SC approved an interim face-to face meeting of the Q11 IWG to develop Q&As on Selection and Justification of Starting Materials for the Manufacture of Drug Substances in September 2015.
  54. 54. PHARMA UPTODAY 54 Multidisciplinary Guidelines Update The M2 EWG on Electronic Standards for the Transfer of Regulatory Information (ESTRI) met in Fukuoka, making progress on a variety of issues. The M4E(R2) EWG working on the revision of the Common Technical Document (CTD) Efficacy Guideline to provide greater specificity on the format and structure of benefit-risk information also made progress to finalise a draft of its Step 1 technical document. The M8 EWG on electronic Common Technical Document (eCTD) met in Fukuoka and the SC signed-off at Step 4 of Version 1.27 of the eCTD Change Request Q&A document and endorsed that the M8 would update the Granularity Document based on Q&A from CTD-Quality and change requests M8 received. The M8 EWG reconciled all of the comments received on the draft eCTD Implementation Guide v.4.0 during Step 3. The next ICH meeting will be held in Jacksonville, Florida, USA on December 5 - 10, 2015. Pharma industry's struggles to tighten standards paves way for M&A deals Smaller generic drugmakers struggling to cope with a bruised reputation and tougher regulation in the United States, are under pressure to consider branching out to new, less-profitable markets or sell out to larger rivals. Two years after its most high-profile regulatory setback to date in the United States - Ranbaxy's $500 million U.S. fine for drug safety violations - India's $15 billion a year generic drug industry is still rebuilding its image in its biggest market. Many of its top firms are facing sanctions at some of their factories, as the U.S. Food and Drug Administration (FDA) tightens checks and its approvals process. Combined with government-mandated price controls on drugs at home, that is piling pressure on smaller players. "If they want to have a presence globally, they have to make investments. If they can't, then they'll have to focus on other markets or scale back their ambition outside of India, and that's probably what will happen," said Subhanu Saxena, CEO of Cipla, fourth-largest drugmaker by revenue.

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