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U.S. Food and Drug Administration issued warning letters to 15 companies Including Several In California for illegally selling products containing cannabidiol (CBD) in ways that violate the Federal Food, Drug, and Cosmetic Act

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Nov 25, 2019: 15 companies Including Several In California received warning letters by  the U.S. Food and Drug Administration for illegally selling products containing cannabidiol (CBD) in ways that disobey the Federal Food, Drug, and Cosmetic Act (FD&C Act).

FDA continues to explore potential pathways for various types of CBD products to be legally marketed, includes ongoing work to obtain and evaluate information to address terrific questions allied to the safety of CBD products, while maintaining the agency’s rigorous public health standards.

In the coming weeks FDA plans to provide an update on its improvement regarding the agency’s approach to these products.

There are so many market preparations of CBD such as oil drops, capsules, syrups, food products such as chocolate bars and teas, and topical lotions and creams that can impact on susceptible populations such as children and pregnant or breastfeeding women. https://www.fda.gov/news-events/press-announcements/fda-warns-15-companies-illegally-selling-various-products-containing-cannabidiol-agency-details

15 Companies received warning letter by U.S. Food and Drug Administration for illegally selling products containing cannabidiol as agency details safety concerns

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Nov 25, 2019: 15 Companies received warning letter by U.S. Food and Drug Administration the for illegally selling products containing cannabidiol that violate the Federal Food, Drug, and Cosmetic Act (FD&C Act).

The FDA published a revised Consumer Update detailing safety concerns about CBD products.The FDA continues to explore potential pathways for various types of CBD products to be lawfully marketed related to the safety of CBD products.

Some of the available data raise serious concerns about potential harm from CBD including potential liver injury, interactions with other drugs, drowsiness, diarrhea, changes in mood, and decrease testosterone levels and impair sexual behavior in males.

CBD preparations are  oil drops, capsules, syrups, food products such as chocolate bars and teas, and topical lotions and creams. https://fda.einnews.com/pr_news/503206803/fda-warns-15-companies-for-illegally-selling-various-products-containing cannabidiol-as-agency-details-safety-concerns

Oxbryta (voxelotor) approved by U.S. Food and Drug Administration for the treatment of sickle cell disease (SCD)

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Nov 25, 2019 Oxbryta (voxelotor)approved by  the U.S. Food and Drug Administration  for the treatment of sickle cell disease (SCD) in adults and pediatric patients 12 years of age and older.

More than 100,000 people in the U.S., and the more than 20 million globally sufferd with this blood disorder.Sickle cell disease is a lifelong, hereditary blood disorder in which red blood cells are peculiarly shaped (sickle  shape), which restricts the flow in blood vessels that limits oxygen delivery to the body’s tissues, leading to severe pain and organ damage.

Oxbryta inhibits red blood cell sickling, and improves red blood cell deformability (ability of a red blood cell to change shape)also  improves the ability of bloods flow. https://www.fda.gov/news-events/press-announcements/fda-approves-novel-treatment-target-abnormality-sickle-cell-disease

The first oral small molecule targeting splicing Risdiplam approved by US FDA for the treatment of spinal muscular atrophy

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Nov 25, 2019: PTC Therapeutics, Inc announced that the United States Food and Drug Administration (FDA) has granted priority review for the New Drug Application (NDA) for risdiplam (RG7916) for the treatment of spinal muscular atrophy (SMA).

It gives improvements in the safety or efficiency of the treatment, diagnosis, or prevention of serious conditions when compared to standard applications. The SMA program is a collaboration between PTC, the SMA Foundation and Roche.

It is designed to supply sustained increase in SMN protein centrally and peripherally through daily dosing and is being evaluated for its potential aptitude to help the SMN2 gene produce more functional SMN protein to all over the body.

Risdiplam is being studied in a clinical trial for patients with type 1 SMA, called FIREFISH, in pre-symptomatic babies, RAINBOWFISH, in patients who have been in previous clinical trials for SMA, JEWELFISH and in SUNFISH, a placebo-controlled study in people aged 2-25 years with type 2 or 3 SMA.
http://ir.ptcbio.com/news-releases/news-release-details/ptc-therapeutics-announces-fda-grants-priority-review-risdiplam

Vaccitech announces successful recruitment and vaccination for two phase 2 Universal influenza studies FLU009 and FLU010 for the treatment and prevention of cancer and infectious diseases

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Nov 25, 2019: Vaccitech Ltd, a clinical-stage T cell immunotherapy company develop the products for the treatment and prevention of  cancer and infectious diseases, reports victorious recruitment and vaccination for its Universal influenza A vaccine MVA-NP+M1 (VTP-100), across two Phase 2 clinical studies, FLU009 and FLU010. Final data of FLU010 is expected in early 2020, the Phase 2 studies are part of a dual development pathway for VTP-100 that will deal with both pandemic and seasonal influenza vaccine markets.

FLU010 (randomised, double-blind, placebo controlled, influenza challenge) study conducted in Antwerp, Belgium, and co-funded by BARDA for $8.6M, 145 participants vaccinated, out of which 108 were challenged with the A/Belgium/4217/2015 (H3N2) influenza virus. Another group is programmed to be challenged by the end of this year. https://www.vaccitech.co.uk/vaccitech-provides-update-phase-2-influenza/

FDA approves new system for the delivery of tympanostomy tubes under local anesthesia to treat ear infection

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Nov 25, 2019 :Tusker Medical recievied approval from The U.S. Food and Drug Administration for the delivery of tympanostomy tubes (ear tubes)  that can be inserted into the eardrum to treat recurrent ear infections (i.e., otitis media).

These are the first Tubes Under Local Anesthesia (Tula) System that can be performed in young children using local anesthesi.

The Tula System consists of the anesthetic Tymbion, Tusker Medical tympanostomy tubes, and several devices essential for the delivery of the ear tubes and the anesthetic into the ear drum for the treatment of recurrent ear infections that does not require general anesthesia.

In a physician’s office setting, this System enables the delivery of an ear tube to patients under local anesthesia.

Small electrical current used to deliver a local anesthetic into the ear drum preceding to tube insertion. It is approved for use in both adults and children (more than six months). https://fda.einnews.com/pr_news/503206800/fda-approves-system-for-the-delivery-of-ear-tubes-under-local-anesthesia-to-treat-ear-infection

Takeda says cancer drug Alunbrig (brigatinib) results in longer benefit vs crizotinib After Two Years of Follow-Up

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Nov 23, 2019: Data updated by Takeda Pharmaceutical from its Phase 3 ALTA-1L trial  evaluating ALUNBRIG versus crizotinib in adults with advanced anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC) who had not been received a prior ALK inhibitor.

After two years, ALUNBRIG reduced the risk of disease progression or death by 76% as appraised by investigators in newly diagnosed patients whose disease have spread to the brain at time of registration.

Study investigators and a blinded independent review committee (BIRC) evaluates the ALTA-1L trial and results from both assessments were reported, the BIRC-assessed HR of progression-free survival (PFS), which is the primary endpoint, was 95% whereas demonstrating a reduced risk of disease progression or death by 51%.

Study showed that as compared with the ALTA study in a post-crizotinib population, the frequency of early pulmonary events (interstitial lung disease/pneumonitis) in the ALTA-1L trial was somewhat lower. https://www.takeda.com/newsroom/newsreleases/2019/takeda-presents-long-term-data-in-alk-nsclc-showing-alunbrig-brigatinib-continues-to-demonstrate-superiority-in-the-first-line-after-two-years-of-follow-up/

Roche presents pivotal First Phase III cancer immunotherapy Tecentriq in combination with Avastin to show an improvement in liver cancer patients

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Nov 22,2019: Roche presents positive results from the Phase III IMbrave150 study evaluating Tecentriq® (atezolizumab) in combination with Avastin® (bevacizumab) for the treatment  of loiver cancer.

As compared with sorafenib results shows that Tecentriq in combination with Avastin reduced the risk of death (OS) by 42% hazard ratio and reduced the risk of disease worsening or death (PFS) by 41%.

Every year, more that 750,000 individuals worldwide are diagnosed with HCC, the most common form of liver cancer and this is increasing day by day.                                                                                   https://www.roche.com/media/releases/med-cor-2019-11-22b.htm

ViiV Healthcare announces exclusive licensing agreement with NIH to develop investigational bNAb N6LS for treatment & prevention of HIV-1

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Nov 21,2019 : ViiV Healthcare, the global specialist HIV company majority owned by GSK, with Pfizer Inc. and Shionogi Limited as shareholders, announced that as part of an exclusive licensing agreement between GSK and the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), the company develop an nvestigational broadly neutralising antibody (bNAb) N6LS for the treatment and prevention of HIV-1.

These antibodies can recognise and block the entry of different strains of HIV into healthy cells.

is an antiviral bNAb that works by binding to a specific site (gp120) on the surface of HIV that prevents its entry into uninfected immune system cells (CD4+ T-cells).

By blocking HIV’s entry into human CD4+ cells, HIV replication stops, and the HIV transmission procedure may be prevented. https://viivhealthcare.com/en-gb/media/press-releases/2019/november/viiv-healthcare-announces-exclusive-licensing-agreement-with-the/

BioMarin seeks European marketing Authorization for valoctocogene roxaparvovec to treat severe hemophilia A

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Nov 21,2019: BioMarin Pharmaceutical Inc. announced that the company submitted a Marketing Authorization Application (MAA) to the European Medicines Agency (EMA) for its investigational gene therapy, valoctocogene roxaparvovec, for adults with severe hemophilia A. 

BioMarin is going to provide an update in January 2020. This submission will results in the first marketing application submission for a gene therapy product for any type of hemophilia.

If satisfactory justification for an accelerated assessment provided by the applicant time-frame will reduced to 150 days byThe CHMP and CAT, although an application initially designated can revert to the standard procedure during the review for a multiple reasons.

https://investors.biomarin.com/2019-11-21-BioMarin-Submits-Marketing-Authorization-Application-to-European-Medicines-Agency-for-Valoctocogene-Roxaparvovec-to-Treat-Severe-Hemophilia-A

Medical Device Registration in Japan-Todokede, Ninsho and Shonin Pathways

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Let’s start with brief introduction about regulatory bodies

Minister of health, labour and welfare and PMDA: It is the main regulatory body which deals with drafting and implementing rules for the safety standards, manufacturing and approval process for the drug and medical devices. It also ensures the proper implementation of those rules at ground level.

Pharmaceutical Medical Devices Agency (PMDA) is an independent entity which works along with Minister of health, labour and welfare (MHLW) and can be considered a technical arm for MHLW. PMDA keeps an eye on ADR (adverse drug reaction) and inspection of site and labs for proper compliance for GCP and GLP. PMDA works can be summarized in a single sentence: It is like FDA for JAPAN.

How Medical device is defined by the Japanese regulatory body

  • The definition of medical devices is stipulated in Article 2, Paragraph 4 of the Pharmaceutical and Medical Device Act as”
  • “Devices and equipment which are used for the purpose of diagnosis, treatment or prevention of diseases of human or animal, or affecting the structure or function of the human or animal body, and designated by the Enforcement Ordinance of the Pharmaceutical and Medical Device Act.”

Classification of Medical devices

Medical devices are classified based on the risk they impart on the body. There are four classes of Medical Devices and there are three pathways by which these devices can be approved. The approval process depends on the type of devices so first, let’s understand the type of the device.

Class I: They carry the least risk to human body in case any malfunction occurs. Let’s take an example of x ray films which are considered class I , just think what harm they can do to human body????

Class II (or controlled Medical Devices): it carries relative low risk (more than class I). MRI devices and Ultrasound devices etc.

Class III (Specially Controlled Medical Devices): The risk is high to human body if this type of devices malfunctions.

Class IV (Specially Controlled Medical Devices): Life threatening consequences can occur if this type of devices malfunctions. They are quite invasive in nature. Pacemaker and artificial heart valves are the good example for this type of devices

Approval Process-Three Pathways

1. Todokede (Notification): The applicant needs to file a notification to the PMDA. PMDA does not do any assessment. It is applicable for Class I medical devices.

2. Ninsho (certification by third party): In this process, third party provides the certificate to applicants for their Medical devices. This third party is accredited by MHLW. Many Class II devices follow this pathway.

3. Shonin (complete review and approval process): It is robust process for approval. PMDA checks the technical documents and thorough review process is required. Many Class III and all Class IV Medical devices follow this path.

Few Class III devices which have an associated certification standard (JIS), are subject to pre-market certification (Ninsho process)  Few class II devices without a Specific certification standard are subjected to follow Shonin pathway.

Is Clinical Data required?

New Medical Devices: A completely new devices need to establish its safety and efficacy in clinical trial for getting approved by PMDA.

Improved Medical Devices: A Improvement in already existing medical devices (between New and Generic).  Clinical Data may be required for approval.

Generic devices: Clinical Data is not required for approval.

Applicants must know about class (I, II, III, IV) and type (New, Improved, Generic) of Medical Devices prior seeking approval/certification/notification pathway. Japan does not accept CE labeling and/or certification from the FDA, whereas European and US approval helps speed up the review process

Market Authorization Holder

Company that gets a marketing authorization license is known as a market authorization holder (MAH). It should be noted that only registered MAH agency may import and sell medical products to the Japanese market. So it becomes compulsion for all foreign manufacturers to  designate a MAH or Designated Marketing Authorization Holder (DMAH) to manage their product registrations in Japan.

The Pharmaceuticals and Medical Devices Act (PMD Act)

It came into effect on  November 25, 2014 and replaces the Pharmaceutical Affairs Law (PAL). Key points:

  • Some Class III medical devices can be approved by  third party certification (Ninsho)
  • regulation of medical software
  • , Manufacturers are required to be registered rather than be licensed.
  • Quality management systems (QMS) are streamlined.
  • Manufacturers must comply with the new PMD Act to sell medical devices in Japan.
  • Ref: https://www.regdesk.co/an-overview-of-medical-device-regulations-in-japan/ https://www.emergobyul.com/services/japan/pmda-medical-device-registration-approval-process

Related:

Amgen Completes Acquisition Of Otezla® (apremilast) for the treatment of moderate-to-severe plaque psoriasis, psoriatic arthritis

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Nov. 21, 2019: Amgen announced the successful completion of its acquisition of worldwide rights to Otezla® (apremilast), the only oral, non-biologic treatment for moderate-to-severe plaque psoriasis,  psoriatic arthritis and also used for the treatment of adult patients with oral ulcers allied with Behçet’s Disease.

Otezla was received from Celgene Corporation from previously announced merger with BMS which was completed on Nov. 20.

Drug approved in the European Union and Japan including 50 other markets. 30 mg tablets of OTEZLA is an oral small-molecule inhibitor of phosphodiesterase 4 (PDE4) specific for cyclic adenosine monophosphate (cAMP).

This inhibition results in increased intracellular cAMP levels, which is thought to indirectly regulate the production of inflammatory mediators. Old patients (65 years or more )and patients taking medications that can lead to volume depletion or hypotension may be at a high risk complications from severe diarrhea, nausea, or vomiting. https://www.amgen.com/media/news-releases/2019/11/amgen-completes-acquisition-of-otezla-apremilast/