May 27, 2015

Quality Takes Time, FDA’s CDER Reminds Drug Makers

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Scholars still debate how long it took to build the Great Wall of China, but it’s generally agreed it was built in stages between the Fifth Century B.C. and the Sixteenth Century A.D.. The Great Pyramid of Giza took about twenty years to construct, according to ancient historians, but it must be remembered that Egypt’s rulers were pretty rough on their non-volunteer workforce. Deadlines had a deeper meaning back then.

By contrast, the Center for Drug Evaluation and Research (CDER) quality initiative has been with us some ten years, or about the time it took to build the Panama Canal. Both projects have had to dig through – and around – a lot of muck. At the peak of work, excavators in Panama carved out the equivalent of the English Channel Tunnel every 14 weeks. It’s not fair to hold the agency to that same standard.

Pharmaceutical manufacturingInstead, let’s acknowledge that FDA just completed its own new structure called the Office of Pharmaceutical Quality (OPQ). Less bricks and mortar than a shift in human capital, the OPQ will take on some of the functions and staff at the Office of Pharmaceutical Science (OPS), take some preapproval and surveillance inspections duties from the Office of Compliance (OC), and absorb some of the inspection-related activities for bioequivalence/bioavailability and non-clinical studies from OC’s Office of Scientific Investigations. The idea is to make the drug review more integrated with FDA and improve communications both ways.

The agency hopes OPQ will streamline the processes that monitor drug quality throughout the product lifecycle, including drug application review, post-approval improvements, and surveillance and inspections of global manufacturing facilities.

OPQ was built, in part, in response to the falling number of drug-related product recalls over the past few years. FDA believes OPQ will help it better organize and quantify the state of manufacturing at drug facilities in the US and abroad. FDA’s recently been pushing a new approach to quality metrics, as highlighted by CDER’s Russell Wesdyk. His presentation outlines CDER’s revised way of looking at surveillance and adoption of quality metrics that promote the use of a common language to improve measurement.

According to Wesdyk, quality metrics will be used to assist segment sites and producers based on risk when it comes to inspection and reviews. But it won’t issue “restaurant style grades” reporting how one facility stacks up against industry groupings. Wesdyk encourages any interested parties to reach out to him as FDA’s thinking evolves. That’s a good thing.

Remember, it’s not as if the Panama Canal doesn’t require some maintenance now and then. The FDA’s got the right idea here.

The alternative is to build something and then forget about it. We’ve all seen how that usually turns out.  Take a look at the Pyramid of Giza lately?

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FDA’s CDRH Tempers 2015 Goals with a Dash of Pessimism

Tamar June

Tamar June, VP, Strategic Marketing, AssurX, Inc.

Unlike its sister Center for Drug Evaluation & Research  (CDER), CDRH’s (Center for Devices & Radiological Health) new proposed guidance development and goals for 2015 reminds industry not to get its hopes up too high.  “Our experience over the years has shown that there are many reasons why CDRH does not complete the entire annual agenda of guidance documents it undertakes,” it admits toward the front of the new document. CDER emerges as the more world-weary older sibling, optimism tempered a bit by experience in the real world.

FDAlogoThe agency’s priorities guidance lists keep it pretty simple: the A-list are guidance’s it “fully intends” to publish. The B-list are ones it will publish “as resources permit.”  CDRH reminds us that if we weigh in heavily on a particular guidance, it’s always possible the Center will move it up the waiting list.

They list just over a dozen final guidance topics and draft guidance topics on their A-list, as it were. Those include:

  • Applying Human Factors and Usability to Optimize Medical Device Design
  • 510(k) Submissions for Medical Devices that Include Antimicrobial Agents
  • Balancing Premarket and Postmarket Data Collection for Devices Subject to Market Approval
  • FDA Notification and Medical Device Reporting for Laboratory Developed Tests
  • Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling

A-list draft guidance topics include:

  • Medical Device Accessories
  • Medical Device Decision Support Software
  • Benefit-Risk Factors to Consider When Reviewing IDE Submissions
  • Adaptive Design for Medical Device Clinical Studies
  • UDI FAQs.

The B-list is shorter. The only Final Guidance Topic it holds is one finalizing existing draft guidance documents (see above).

It does include some draft guidance topics we might see in 2015, though it’s not so likely given CDRH’s workload. Here are a few:

  • Medical Device Interoperability
  • 3D Printing
  • Use of Symbols in Labeling

CDRH further lists some two dozen retrospective guidances it is due to review in 2015. Those mostly focus on specific guidance for various 501(k) premarket notifications, e.g., short-term and long-term intravascular catheters, electromyography needle electrodes, and powered tables and multifunctional physical therapy tables.

All in all, CDRH is to be applauded to laying out what looks to be a realistic wish list for 2015. Of course, the proof’s in the pudding. We’ll report back as they hit various milestones.

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FDA’s CDER Unveils Ambitious 2015 Wish List

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

The holidays came a little early for the folks at the Center for Drug Evaluation and Research (CDER). They just released their sometimes optimistic, but always enlightening guidance wish list and overall priorities for 2015. Let’s take a look.

CDER Director Janet Woodcock recently said these are her agencies “front burner” priorities:

  • Implementing and clarifying statutory provisions on drug compounding.
  • Meeting Generic Drug User Fee Amendments (GDUFA) review goals that went into effect Oct. 1 last year.
  • Continue the build out of Office of Generic Drugs “super office.”
  • Build out the Office of Pharmaceutical Quality.
  • Implement and continue to develop Program Alignment Group agreements with the Office of Regulatory Affairs.

She singled out the implementation of a new process, data and document management IT system as a “big deal” goal this year

But there’s plenty more on FDA’s big front burner:

  • Respond as needed and participate in “21st Century Cures” legislative activities.
  • Rapidly re-evaluate regulation of drug advertising and promotion.
  • Execute immediate actions required by the Sunscreen Innovation Act and implement a longer-term plan.
  • Respond to Ebola outbreak.
  • Issue final guidances on abuse-deterrent opioid formulations.

She’s also hoping to fill more than 600 staff vacancies and recruit for a slew of executive positions.

prescription drugsWoodcock’s ambitious goals include five more bulleted pages of additional “important” priorities ranging from implementing a biosimiliars program, working on the Drug Label Improvement Initiative and developing a strategic plan for managing a growing pile of drug imports.

In the agency’s spare time, the plan is to issue nearly fifty guidances in advertising, biopharmaceuticals, biosimiliars, clinical medical/pharmacology/statistical/drug safety, electronic submissions, generics, and labeling, among others. Each of these guidances are already under development, CDER said earlier this month.

It’s certainly important to have goals, and a person’s reach should exceed their grasp, etc, but there’s also the problem of over-promising and under-delivering.

FDA’s got a big front burner but maybe not enough cooks, or oven space, to get it all done in 2015. We’ll keep an eye on it and report back throughout the year. Bon appetit.

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Are Energy and Utility Companies Ready for Risk Based Compliance?

Vice President, Energy & Utilities Compliance, AssurX Inc.

Vice President, Energy & Utilities Compliance, AssurX Inc.

Part 1: How the NERC Registered Entities are Preparing

As we enter into the New Year, many NERC Registered Entities are focused on their game plan to prepare and implement the “ERO Enterprise Risk-Based Compliance Monitoring and Enforcement Program.” This new program is different because it places an emphasis on the risk to the bulk power system (BPS) versus the existing oversight where the Regional Entities treat all Registered Entities equal no matter their size or risk to bulk power system.

Since the end of 2012, the ERO Enterprise and the Registered Entities have launched a multi-year effort called the Reliability Assurance Initiative (RAI). There have been multiple initiatives underway with the eight Regional Entities and some Registered Entities that have volunteered for RAI pilot programs. Lessons learned from these RAI pilot programs have been documented on the ERO websites. NERC and the regions continue to conduct outreach efforts throughout North America.

Many Registered Entities are having internal discussions on how to implement this new ERO Enterprise program. Some companies are looking internally to their compliance and risk-management departments to make recommendations for implementation. Other entities are reaching out to third party consultants to assist with their approach and implementation. The program is still voluntary and the ERO Enterprise is focused on the review of the potential risk posed by individual Registered Entities that would have the greatest impact on the reliability of the BPS.

The ERO Enterprise staff, Board of Trustees (BOT), Registered Entities, and the Reliability Issues Steering Committee (RISC) have been working to identify these key risk areas. These risks are identified and prioritized in the “ERO Enterprise Strategic Plan.”

The ERO Enterprise is using the “Risk Based Compliance Oversight Framework” to identify, prioritize and address these risks to the BPS.

Source: NERC

Source: NERC

AssurX, an industry leading GRC solution provider, is working closely with our energy and utility customers to address the implementation of the “ERO Enterprise Risk-Based Compliance Monitoring and Enforcement Program.” In a series of blog posts, we will be addressing Risk-Management and how having the proper Objectives, Sub-Objectives, Controls, Testing and Mitigation tools in place to successfully implement this new ERO initiative. We have customers that have taken part in the RAI pilot programs. They are working with us to enhance their risk-management and compliance programs and we want to share these lessons learned and best practices with other industry stakeholders.

On the NERC website, there are some excellent resource documents that are posted. We recommend the following documents for a good understanding of this ERO Enterprise program:

The next area of discussion – addressing the results of the ERO Inherent Risk Assessment (IRA). We will discuss the development of internal controls with each risk including preventive, detective, and/or corrective internal controls.

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FDA FastStats: A Look Back at all FDA 483 Inspectional Observations for Fiscal Year 2014

In our last FDA FastStats series of the year, we look back at all FDA 483 Inspectional Observations for Fiscal Year 2014. 483s increased in foods from the prior fiscal year to 2476, an increase of 3.8%. However, medical devices and drugs were down -11.6% and -6.5%, respectively, from FY 2013. Interestingly, medical device 483s bucked their recent upward trend with the lowest number of observations since FY 2009.

FastStatsALL483s2014

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FDA Update on UDI Implementation for Registered Medical Device Establishments

In case you missed it, the FDA issued this update on UDI yesterday:

Having passed the first Unique Device Identification System compliance date of September 24, 2014 (for Class III devices and devices licensed under the Public Health Service Act), the FDA’s Center for Devices and Radiological Health (CDRH) would like to take this opportunity to summarize recent and upcoming UDI activities and deadlines. The next two compliance dates for UDI requirements are:

September 24, 2015 for non-class III implantable, life-supporting, and life-sustaining (I/LS/LS) devices

September 24, 2016 for class II devices

Global Unique Device Identification Database (GUDID) Data Submission:

FDAlogoIn January 2015, we will begin accepting GUDID account requests from labelers of I/LS/LS devices. Later in 2015, we plan to accept GUDID account requests from labelers of class II devices. We strongly encourage all device labelers to take steps to ensure their readiness to meet UDI requirements well before actual data submission to GUDID. This will provide labelers with ample opportunity to assess their ability to meet requirements, including data submission to the GUDID, by their deadline and to work with us if they have any difficulties coming into compliance. Suggested steps are included on the UDI website.

Also in January, we will host a webinar to help Class II and I/LS/LS device labelers prepare to comply with the UDI rule. Notification of webinar specifics will be sent directly to these device labelers in early January. The webinar will include overviews of UDI requirements and how to get started with the GUDID.

UDI Policy:

We continue to work with industry on UDI implementation issues that surfaced in 2014, including GUDID data submission for contact lenses/IOLs and development of approaches to ensure the UDI is available at the point of use for non-sterile implants. We recognize there are several other policy issues that are of significant interest to industry; we hope to address a number them in 2015, such as UDI direct marking requirements, convenience kits, posting of decisions on UDI exceptions and alternatives, and issuance of additional Frequently Asked Questions (FAQs).

The use of National Health Related Items Code (NHRIC) and National Drug Code (NDC) numbers for devices is being phased out over a time period that corresponds with thecompliance dates for UDI requirements. Device labelers that want to retain the use of FDA-issued NHRIC or NDC labeler codes under a system for the issuance of UDIs were required to request such continued use by September 24, 2014. If you intend to retain the use of a previously issued FDA labeler code within your UDI system but have not made such a request, we urge you to do so as soon as possible.

UDI Adoption and Use:

We continue to collaborate with stakeholders, such as the Pew Charitable Trusts, the Office of the National Coordinator for Health IT (ONC), and the Brookings Institution to promote and facilitate UDI adoption in health care settings.

We are working with the National Library of Medicine (NLM) to give the public search and download access to published records in the GUDID in the spring of 2015. GUDID search will allow published GUDID data to be retrieved based on parameters of interest to the user. The GUDID download function will let users download all published GUDID data at once.

Finally, we’d like to reaffirm our plans to implement this important system over several years—and underscore the fact that we fully intend to be flexible during this time. Our main focus is getting the system implemented correctly and actively helping companies comply with system requirements. As with the implementation of many new systems, it can take time to understand and comply with new requirements—widespread, strict enforcement of associated deadlines and requirements is not necessarily the best way to achieve compliance at this time.

To date, industry has been very willing to work with CDRH, and we have experienced excellent efforts and strong feedback. We urge labelers that are having difficulty fulfilling UDI requirements to let us know through the FDA UDI Help Desk.

We will continue to work diligently to give the medical device industry, health care systems, clinicians and patients the assistance and information needed to implement and use UDI successfully. For additional information, please see www.fda.gov/udi or contact us at the FDA UDI Help Desk.

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Got Safe Beef? New Report Suggests the US Doesn’t

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

The next time you want a cheeseburger, you might consider hopping a plane and flying to Germany. Or France. Or New Zealand. Basically, anywhere but the United States of America.

Almost across the board, the US ranks at the bottom (“regressive”) for produce traceability programs as ranked by a new Institute of Food Technologists (IFT) report.

IFT checked out 21 countries and rated them “Progressive,” “Moderate,” or “Regressive” based on a handful of criteria.

While the landmark Food Safety Modernization Act of 2010 (FSMA) is expected to improve things here in America, “development of regulations are still in the early stages,” the study noted. Technically, the study is called “Comparison of Global Food Traceability Regulations and Requirements.” That’s quite a mouthful, pun intended. An earlier IFT powerpoint presentation also examined this important issue.

FSMA was signed into law by President Obama on January 4, 2011. FSMA was designed to give the Food and Drug Administration (FDA) new power to regulate the way foods are grown, harvested and processed. The law grants FDA a number of new tools, the most important of which is mandatory recall authority. But that’s all in the future. The IFT report tells us what’s going on right now.

Where to start when reading the report? The ranking of 21 countries (EU, China, Japan and a few elsewhere including Brazil and the land of the Kiwis) found that the US was only one of two major beef exporters without mandatory red-meat traceability systems. It also lagged behind most of the group with a weak consumer access program.

Generally, countries in the EU (France, UK, Germany, Ireland et al) led the group. That’s thanks, in part, to tough standards imposed in 2005 that include mandatory traceability programs for food, feed, food-producing animals and any other substance incorporated into food or feed.

livestockBlog

The US did achieve some distinctions — pretty much all bad. For example, it joined China as the only countries rated regressive when it comes to the breadth of products regulatory traceability regulations.

The US, China and Canada are also the only members of another not-so-attractive-club: Regressive electronic livestock traceability programs.

In its summary, the report diplomatically notes the obvious: The US “trails most other nations.”

Let’s wrap this up on something of a positive note.The US did make the top category for voluntary traceability programs. An optimist might say US meat exporters are significantly exceeding their nation’s relatively lax regulatory requirements. Pessimists might still urge you to think twice before buying that next cheeseburger, chicken sandwich, or tilapia in America — at least until the FSMA kicks in.

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FDA FastStats: A Look Back at 2013 Medical Device Warning Letters with Quality System Deficiencies

In our latest infographic analysis, today’s post highlights medical device warning letters with quality system deficiencies. Surprisingly, warning letters were actually down 12.2% from 2012. However, they are almost double the number (77) issued in 2009. Are we looking at a downward trend? The jury’s still out. The highest number of warning letters issued in the past 10 years was in 2012, with a total of 164. The lowest was 2007, with only 74 warning letters issued.

FDA FastStats 2013 - Warning Letters

 

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FDA FastStats: A Look Back at 2013 Medical Device 483 Observations

As we approach the end of 2014, we will take a look back at FDA’s stats on various topics sourced from their Case for Quality initiative. The FDA believes that the following type of information will:

  • Help industry improve medical device quality by sharing common observations
  • Identify possible areas of emerging concern, and
  • Possibly help firms avoid warning letters

Our first in the series of infographics is 483 inspectional observations.

FDAFastStats2013cr

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FDA’s Local Offices Flex Regulatory Muscle

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

Michael Causey, Editor & Publisher, eDataIntegrityReport.com

In our latest round-up, it was the District Offices turn to chime in on medical device company alleged shortcomings.

As expected, FDA is shifting more and more of its regulatory focus toward Medical Device Reporting (MDR). In an October 1 letter, the agency’s Baltimore District Office hit Baltimore-based Electronic Development Labs for not having an MDR procedure. Bad idea.

The company may not have recovered very well, either. “The adequacy of your firm’s response dated November 20, 2013, cannot be determined at this time,” FDA’s warning letter said. “Your firm’s response indicates that the development of an MDR procedure was added to a list of action items. In order to determine adequacy, FDA must receive a copy of the MDR procedure for review.” Electronic Develop makes the NervoScope.

The agency also gently encouraged the company to look into eMDR.

As we’ve noted before, FDA eMDR Final Rule requiring manufactures and importers to submit electronic Medical Device Reports (eMDRs) to FDA was published on February 13, 2014. The requirements of this final rule will take effect on August 14, 2015. If a firm is not currently submitting reports electronically, FDA politely encourages it look into it on FDA’s web page devoted to eMDR.

The FDA demonstrated its ongoing interest in CAPA in an October 7 letter from its Los Angeles Office to Alpha Medical, a maker of angiographic balloon catheters.

warning640After Alpha tried to respond to a September inspection, FDA made it clear the reply needed some work. Example: “CAPA 104 was opened on January 10, 2013, concerning non-conformities regarding balloon extension air leaks. The CAPA report references multiple root causes for these leaks; however not all of these potential causes were analyzed and investigated.”

The agency went on, “Your records reference that personnel were retrained, but the corrective actions for which they were retrained were not documented. Additionally, this CAPA was closed on February 22, 2013 without documentation that an effectiveness check was performed.

In an October 10 letter from the Cincinnati District Office, local regulators challenged West Lake Enterprises, maker of medical gas pressure regulators and suction regulators, with CAPA and other violations, including installation that’s not in conformity with the Current Good Manufacturing Practice (CGMP) requirements of the Quality System (QS) regulation. The company responded, and FDA came back with additional questions.

The Denver District Office joined in with an October 28 letter to Xanacare Technologies, maker of SimulCare II, a therapeutic lamp/nerve stimulator/massager. The agency hit them for several issues, including problematic design control, device history records (DHR) and complaint handling. As of late October, the agency said it had not received a response from Xanacare.

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