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FDA Issues Decisions on Additional E-Cigarette Products

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March 24, 2022: “The U.S. FDA took additional actions as part of the agency’s work to ensure any electronic nicotine delivery system (ENDS) products available for sale have demonstrated that marketing of the products is appropriate for the protection of the public health. 

What You Need to Know

  • The FDA authorized several tobacco-flavored ENDS products from Logic Technology Development LLC (Logic) under the Logic Vapeleaf, Logic Power and Logic Pro brands, including devices.

    These products were authorized after the agency’s review of the product applications concluded, among other things, that the likely benefit for adult smokers who significantly reduce their cigarette use (or who switch completely and experience cigarette use cessation) outweighs the risk to youth, provided that the company follows postmarketing requirements to reduce youth access and youth exposure to their marketing. While today’s action permits these specific products to be sold in the U.S., it does not mean these products are safe nor are they “FDA approved.”

    All tobacco products are harmful and potentially addictive. Those who do not use tobacco products shouldn’t start. 
  • The agency also issued marketing denial orders to Logic for multiple other ENDS products. Any of those products currently on the market must be removed or FDA may take enforcement action.

    Retailers should contact Logic with any questions about products in their inventory. Applications for Logic’s additional products, including menthol, remain under FDA review.
  • The FDA has taken action on approximately 99% of the nearly 6.7 million ENDS products submitted for premarket authorization, including issuing marketing denial orders for more than 1 million ENDS products. 
  • The agency is close to making additional decisions on applications for popular ENDS products that account for a large part of the market.

    The continued marketing of these products has the potential to have a substantial public health impact—either positively or negatively—as they hold an overall large market share and are used by a lot of people. 

“As a cardiologist, I’ve personally seen the devastating health effects of tobacco use, so I’m highly motivated for the FDA to help reduce death and disability caused by these products,” said FDA Commissioner Robert M. Califf, M.D.

“We know that there is a demand among adult smokers to use e-cigarette products to try to switch from more harmful combusted cigarettes, but millions of youth are using these products and getting addicted to nicotine.

The balance of these issues was considered by the agency’s career scientists when evaluating the potential marketing of e-cigarette products.

They have made great progress and I know they will use the best available evidence with the most robust methods to ensure that products that continue to be marketed are appropriate for the protection of the public health.”

Under the Premarket Tobacco Product Application (PMTA) pathway, manufacturers or importers must demonstrate to the agency, among other things, that marketing of a new tobacco product would be appropriate for the protection of the public health.

That statutory standard requires the FDA to consider the risks and benefits to the population as a whole, including users and non-users of tobacco products.

The FDA must also consider the likely impact of the products on people’s behavior—specifically, the likelihood that existing users will stop using such products and the likelihood that those who do not use tobacco products will start using such products.

This is especially important for youth. Before a product is authorized under the PMTA pathway, the agency reviews a tobacco product’s components, ingredients, additives, constituents and health risks, as well as how the product is manufactured, packaged and labeled.

“Ensuring new tobacco products undergo premarket evaluation by the FDA is a critical part of our work to reduce tobacco-related disease and death,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products.

“For the authorized products, the manufacturer demonstrated that possible benefits to adult smokers outweigh the risk of youth possibly initiating.

We are making progress in our review of flavored ENDS, and we will continue to deny marketing of products where the applicant hasn’t provided enough evidence to show that the potential benefit to adult smokers outweighs the considerable risk to youth.

We are committed to continuing to take the appropriate actions to protect our nation’s youth from the dangers of all tobacco products, including e-cigarettes, which remain the most commonly used tobacco product by youth in the United States.”

Logic Authorizations 

The FDA’s review of the applications for the products authorized today determined that the marketing of the tobacco-flavored products and associated components is appropriate for the protection of the public health.

The FDA authorized these tobacco-flavored ENDS products because, among several key considerations, the data submitted by the company and the available evidence show that marketing these products may help addicted adult smokers transition away from combusted cigarettes and reduce their risk of exposure to harmful and potentially harmful toxins compared to combusted cigarettes.

At the same time, the data showed there was low risk for non-users, including youth, to use the products. The risk was also low for non-users, including youth, to progress to regular use of the products.

Specifically, available data showed that current tobacco users who used these tobacco-flavored products were more likely to significantly decrease their use of combusted cigarettes and that those who don’t smoke are unlikely to start using these products.

Most study subjects decreased the number of combusted cigarettes they smoked each day by greater than 80%, from an average of 13-16 cigarettes per day at screening to 1-2 by day 59.

The data also showed that the products produce fewer or lower levels of some toxins, like carbon monoxide, than combustible cigarettes and the products’ abuse liability, or their ability to encourage continued tobacco use, addiction or dependence, was lower than combusted cigarettes. 

Additionally, today’s authorization imposes strict marketing restrictions on the company to greatly reduce the potential for youth exposure to tobacco advertising for these products.

The FDA will closely monitor how these ENDS products are marketed and will act as necessary if the company fails to comply with any applicable statutory or regulatory requirements, or if there is a notable increase in the number of non-smokers—including youth—using these products. 

As evidenced through data collected via the National Youth Tobacco Survey, compared to users of non-tobacco-flavored ENDS products, young people are less likely to start using tobacco-flavored ENDS products.

The data also suggest that most youth and young adults who use ENDS begin with flavors such as fruit, candy or mint, and not tobacco flavors.

These data reinforce the FDA’s decision today, consistent with past decisions, to authorize the marketing of the tobacco-flavored ENDS products in part because they are not significantly appealing to youth and authorizing these products may be beneficial for individual adult combusted cigarette users who completely switch to ENDS or significantly reduce their cigarette consumption.

The FDA may suspend or withdraw a marketing order issued under the PMTA pathway for a variety of reasons, including if the agency determines the continued marketing of a product is no longer “appropriate for the protection of the public health,” such as if there is a notable increase in youth initiation.”

https://www.fda.gov/news-events/press-announcements/fda-issues-decisions-additional-e-cigarette-products

FDA to Hold Advisory Committee Meeting on COVID-19 Vaccines to Discuss Future Boosters

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March 21, 2022: “The U.S. FDA is announcing a virtual meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Wed., April 6, to discuss considerations for future COVID-19 vaccine booster doses and the process for selecting specific strains of the SARS-CoV-2 virus for COVID-19 vaccines to address current and emerging variants.

Along with the independent experts of the advisory committee, representatives from the U.S. Centers for Disease Control and Prevention and the National Institutes of Health will participate in the meeting.

“As we prepare for future needs to address COVID-19, prevention in the form of vaccines remains our best defense against the disease and any potentially severe consequences,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research.

“Now is the time to discuss the need for future boosters as we aim to move forward safely, with COVID-19 becoming a virus like others such as influenza that we prepare for, protect against, and treat.

Bringing together our panel of expert scientific external advisors in an open, transparent discussion about booster vaccination is an important step to gain insight, input and expert advice as we begin to formulate the best regulatory strategy to address COVID-19 and virus variants going forward.”

The April 6 VRBPAC meeting is intended to assist the agency in developing a general framework that will inform its regulatory decision-making on:

  • What might warrant updating the composition of COVID-19 vaccines to address specific variants. 
  • Timing and populations for COVID-19 vaccine booster doses in the coming months.  

No vote is planned at this meeting and there will not be any discussion of any product-specific applications. 

The FDA intends to make background material available to the public, including the meeting agenda and committee roster, no later than two business days before the meeting. 

In general, advisory committees include a Chair, members with scientific, medical and public health expertise and a consumer and industry representative.”

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-hold-advisory-committee-meeting-covid-19-vaccines-discuss-future

COVID-19 vaccines continue to protect against hospitalization and death among adults

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March 18, 2022: “COVID-19 vaccination continues to help protect adults against severe illness with COVID-19, including hospitalizations and death, according to two reports released in today’s MMWR.

During Omicron, COVID-19-associated hospitalization rates increased for all adults, regardless of vaccination status, but rates were 12 times higher among adults who were unvaccinated compared to adults who received a booster or additional doses.

Hospitalization rates were also highest among non-Hispanic Black adults and nearly 4 times as high among Black adults than White adults during the peak of Omicron.

Additionally, mRNA vaccines continued to be highly effective at protecting against COVID-19-associated ventilation or death, including during the Omicron period.

Protection was highest in adults who received a third vaccine dose, reducing the risk for COVID-19-associated ventilation or death during the Omicron period by 94%.

CDC continues to recommend that everyone 5 years and older stay up to date on their COVID-19 vaccines, including a booster dose for those who are eligible.

We also must work to ensure everyone has equitable access to vaccines and treatments by focusing efforts on reaching people who have been disproportionately affected, so that they can be protected from the effects of the virus, including severe illness, hospitalization, and death.”

https://www.cdc.gov/media/releases/2022/s0318-COVID-19-vaccines-protect.html

Pfizer to Supply UNICEF up to 4 Million Treatment Courses of Novel COVID-19 Oral Treatment

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March 22, 2022: “Pfizer Inc. announced an agreement with UNICEF to supply up to 4 million treatment courses of its COVID-19 oral treatment, PAXLOVID™ (nirmatrelvir [PF-07321332] tablets and ritonavir tablets), to 95 low- and middle-income countries, pending authorization or approval.

This includes all low- and lower-middle-income countries and some upper-middle-income countries in Sub-Saharan Africa as well as countries that have transitioned from lower-middle to upper-middle-income status in the last five years, accounting for approximately 53% of the world’s population.

Financial details of the agreement were not disclosed. Pfizer expects supply to be available to support orders in April 2022, and supply will continue throughout 2022, pending regulatory authorization or approval and according to country needs.

All low- and lower-middle-income countries will be offered the treatment courses at the not-for-profit price while upper-middle-income countries will pay the price defined in Pfizer’s tiered pricing approach.

“We have seen the negative impacts of COVID-19 in every part of the world and know that we must work towards access for all people regardless of where they live or their circumstances,” said Albert Bourla, Chairman and Chief Executive Officer, Pfizer.

“Supplying to UNICEF is an important part of our comprehensive strategy to accelerate access to PAXLOVID to treat COVID-19 infection as quickly as possible and at an affordable price in order to decrease the strain on healthcare systems and help save lives in low- and middle-income countries.”

Our Commitment to Equitable Access
Pfizer is committed to working toward equitable access to PAXLOVID for all people, aiming to deliver safe and effective antiviral therapeutics as soon as possible and at an affordable price.

During the pandemic, Pfizer will offer its oral therapy through a tiered pricing approach, pending country authorization or approval, based on the income level of each country to promote equity of access across the globe.

High and upper-middle income countries will pay more than lower income countries.

Pfizer continues to invest to support the manufacturing and distribution of PAXLOVID, including exploring potential contract manufacturing options.

As a result of these efforts, Pfizer has raised its production projections, with the ability to produce up to 120 million courses of treatment by the end of 2022, pending global demand.

The company has initiated bilateral outreach to more than 100 countries around the world and has entered into agreements with multiple countries.

Additionally, Pfizer has signed a voluntary license agreement with the Medicines Patent Pool (MPP) for its oral treatment to help expand access, pending country regulatory authorization or approval, in 95 low- and middle-income countries that account for approximately 53% of the world’s population.

About PAXLOVID™ (nirmatrelvir [PF-07321332] tablets and ritonavir tablets)
PAXLOVID is a SARS-CoV-2 main protease (Mpro) inhibitor (also known as SARS-CoV-2 3CL protease inhibitor) therapy.

It was developed to be administered orally so that it can be prescribed at the first sign of infection or, pending clinical success of the rest of the EPIC development program and subject to regulatory authorization, at first awareness of an exposure – potentially helping patients avoid severe illness (which can lead to hospitalization and death) or avoid disease development following contact with a household member who contracts COVID-19.

Nirmatrelvir [PF-07321332], which originated in Pfizer laboratories, is designed to block the activity of the Mpro, an enzyme that the coronavirus needs to replicate.

Co-administration with a low dose of ritonavir helps slow the metabolism, or breakdown, of nirmatrelvir in order for it to remain active in the body for longer periods of time at higher concentrations to help combat the virus.

Nirmatrelvir is designed to inhibit viral replication at a stage known as proteolysis, which occurs before viral RNA replication.

In preclinical studies, nirmatrelvir did not demonstrate evidence of mutagenic DNA interactions.

Current variants of concern can be resistant to treatments that work by binding to the spike protein found on the surface of the SARS-CoV-2 virus.

PAXLOVID, however, works intracellularly by binding to the highly conserved Mpro of the SARS-CoV-2 virus to inhibit viral replication.

Nirmatrelvir has shown consistent in vitro antiviral activity against earlier and current variants of concern (i.e., Alpha, Beta, Delta, Gamma, Lambda, Mu, and Omicron).

PAXLOVID is generally administered at a dose of 300 mg (two 150 mg tablets) of nirmatrelvir with one 100 mg tablet of ritonavir, given twice-daily for five days.

One carton contains five blister packs of PAXLOVID, as co-packaged nirmatrelvir tablets with ritonavir tablets, providing all required doses for a full five-day treatment course.

U.S. FDA Emergency Use Authorization Statement

PAXLOVID has not been approved, but has been authorized for emergency use by FDA under an EUA, for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS CoV-2 viral testing, and who are at high-risk for progression to severe COVID-19, including hospitalization or death.

The emergency use of PAXLOVID is only authorized for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of drugs and biological products during the COVID-19 pandemic under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the declaration is terminated or authorization revoked sooner.

AUTHORIZED USE

The U.S. FDA has issued an EUA for the emergency use of the unapproved product PAXLOVID for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death.

LIMITATIONS OF AUTHORIZED USE

  • PAXLOVID is not authorized for initiation of treatment in patients requiring hospitalization due to severe or critical COVID-19
  • PAXLOVID is not authorized for use as pre-exposure or post-exposure prophylaxis for prevention of COVID-19
  • PAXLOVID is not authorized for use for longer than 5 consecutive days

PAXLOVID may only be prescribed for an individual patient by physicians, advanced practice registered nurses, and physician assistants that are licensed or authorized under state law to prescribe drugs in the therapeutic class to which PAXLOVID belongs (i.e., anti-infectives).

PAXLOVID is not approved for any use, including for use for the treatment of COVID-19.

PAXLOVID is authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of PAXLOVID under 564(b)(1) of the Food Drug and Cosmetic Act unless the authorization is terminated or revoked sooner.

IMPORTANT SAFETY INFORMATION
PAXLOVID is contraindicated in patients with a history of clinically significant hypersensitivity reactions (eg, toxic epidermal necrolysis [TEN] or Stevens-Johnson syndrome) to its active ingredients (nirmatrelvir or ritonavir) or any other components of the product.

PAXLOVID is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions:

  • Alpha1-adrenoreceptor antagonist: alfuzosin
  • Analgesics: pethidine, propoxyphene
  • Antianginal: ranolazine
  • Antiarrhythmic: amiodarone, dronedarone, flecainide, propafenone, quinidine
  • Anti-gout: colchicine
  • Antipsychotics: lurasidone, pimozide, clozapine
  • Ergot derivatives: dihydroergotamine, ergotamine, methylergonovine
  • HMG-CoA reductase inhibitors: lovastatin, simvastatin
  • PDE5 inhibitor: sildenafil (Revatio®) when used for pulmonary arterial hypertension
  • Sedative/hypnotics: triazolam, oral midazolam

PAXLOVID is contraindicated with drugs that are potent CYP3A inducers where significantly reduced nirmatrelvir or ritonavir plasma concentrations may be associated with the potential for loss of virologic response and possible resistance. PAXLOVID cannot be started immediately after discontinuation of any of the following medications due to the delayed offset of the recently discontinued CYP3A inducer:

  • Anticancer drugs: apalutamide
  • Anticonvulsant: carbamazepine, phenobarbital, phenytoin
  • Antimycobacterials: rifampin
  • Herbal Products: St. John’s Wort (hypericum perforatum)

There are limited clinical data available for PAXLOVID. Serious and unexpected adverse events may occur that have not been previously reported with PAXLOVID use.

Risk of Serious Adverse Reactions Due to Drug Interactions: Initiation of PAXLOVID, a CYP3A inhibitor, in patients receiving medications metabolized by CYP3A or initiation of medications metabolized by CYP3A in patients already receiving PAXLOVID, may increase plasma concentrations of medications metabolized by CYP3A. Initiation of medications that inhibit or induce CYP3A may increase or decrease concentrations of PAXLOVID, respectively. These interactions may lead to:

  • Clinically significant adverse reactions, potentially leading to severe, life-threatening, or fatal events from greater exposures of concomitant medications
  • Clinically significant adverse reactions from greater exposures of PAXLOVID
  • Loss of therapeutic effect of PAXLOVID and possible development of viral resistance

Consult Table 1 of the Fact Sheet for Healthcare Providers for clinically significant drug interactions, including contraindicated drugs.

Consider the potential for drug interactions prior to and during PAXLOVID therapy; review concomitant medications during PAXLOVID therapy and monitor for the adverse reactions associated with the concomitant medications.

Hypersensitivity reactions have been reported with PAXLOVID including urticaria, angioedema, dyspnea, mild skin eruptions, and pruritus.

Cases of anaphylaxis, TEN, and Stevens-Johnson syndrome have also been reported with components of PAXLOVID (refer to NORVIR labeling).

If signs and symptoms of a clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue PAXLOVID and initiate appropriate medications and/or supportive care.

Hepatotoxicity: Hepatic transaminase elevations, clinical hepatitis, and jaundice have occurred in patients receiving ritonavir. Therefore, caution should be exercised when administering PAXLOVID to patients with pre-existing liver diseases, liver enzyme abnormalities, or hepatitis.

Because nirmatrelvir is co-administered with ritonavir, there may be a risk ofHIV-1 developing resistance to HIV protease inhibitors in individuals with uncontrolled or undiagnosed HIV-1 infection.

Adverse events in the PAXLOVID group (≥1%) that occurred at a greater frequency (≥5 subject difference) than in the placebo group were dysgeusia (6% and <1%, respectively), diarrhea (3% and 2%), hypertension (1% and <1%), and myalgia (1% and <1%). The proportions of subjects who discontinued treatment due to an adverse event were 2% in the PAXLOVID group and 4% in the placebo group.

The following adverse reactions have been identified during post-authorization use of PAXLOVID. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Immune System Disorders: Hypersensitivity reactions.”

https://www.pfizer.com/news/press-release/press-release-detail/pfizer-supply-unicef-4-million-treatment-courses-novel

FDA Statement on Medical Device User Fee Amendments (MDUFA)

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March 22, 2022: “The FDA and representatives from the medical device industry have reached an agreement on proposed recommendations for the fifth reauthorization of the medical device user fee program.

Under the new agreement, the FDA would be authorized to collect at least $1.78 billion in user fees over five years, plus additional funding, for a total of up to $1.9 billion to further improve performance if specified goals are met.

This funding would provide critical resources to the FDA medical device review program.

The proposed recommendations have been posted on our website and will be published in the Federal Register for public comment.

Additionally, the MDUFA V public meeting will be held virtually April 19, 2022, to provide the public an opportunity to learn more about and provide their views on the proposed recommendations.

The final recommendations are scheduled to be delivered to Congress in April 2022, after FDA considers public input on the proposed recommendations and revises them as necessary.

“The agreement underscores the continued commitment by the FDA and medical device industry to prioritize innovation and increase patient access to safe and effective medical devices,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health.

“In addition, MDUFA V represents a substantial investment in the future of the agency’s medical device program and would provide for important improvements, including new hiring targets, greater engagement with developers of innovative technologies based on lessons learned from the pandemic, broadened international harmonization efforts and expanded opportunities to ensure patient perspectives are an integral part of medical device development.” 
 

https://www.fda.gov/news-events/press-announcements/fda-statement-medical-device-user-fee-amendments-mdufa

One Health is critical to addressing zoonotic public health threats and environmental issues

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March 21, 2022: “The complex links between human, animal and environmental health require coordinated multidisciplinary and multipronged collaboration to address the threats from zoonotic diseases, and the global public health community needs to act decisively now.

This can be done through One Health – an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems – which is key to addressing zoonotic public health threats, environmental issues and neglected tropical diseases (NTDs).

This is one of the main messages that surfaced from a webinar hosted by the World Health Organization (WHO) last Wednesday, with more than 800 people following live the discussions on Zoom.

The webinar formally launched the One Health companion document to the NTD road map for 2021-2030.

In their comments, both Bernadette Abela-Ridder, Veterinary epidemiologist, WHO Department of Control of Neglected Tropical Diseases, and Wendy Harrison, Chief Executive Officer, Schistosomiasis Control Initiative Foundation, commented on One Health and the objectives of the document.

Ending the neglect to attain the sustainable development goals.  One health: approach for action against neglected tropical diseases 20212030 aims to support the health community to achieve the 2030 targets through transdisciplinary, cross-cutting approaches that include:

  • building networks and increasing communication within and among sectors;
  • finding common ground to coordinate and identifying opportunities to get started;
  • recognizing that integration can take place at different levels, and will not be appropriate for everything;
  • distributing resources equitably, and investing in prevention at the source; and
  • leading change, while recognizing and encouraging individual contributions.


Unlocking political will to drive progress

Onyeka Erobu, Senior Health Advisor to Yvonne Aki-Sawyerr OBE, Mayor of Freetown, Sierra Leone

Onyeka shared how Freetown prioritized NTDs and the challenges they encountered applying One Health to address endemic zoonotic diseases.

Almost every district in Sierra Leone is endemic for at least two NTDs and the burden is high. Considering the Ebola outbreak in Sierra Leone during 2014-2016, One Health is not a new concept and many lessons have been learnt in how it can be applied.

Political commitment led to the establishment of the National One Health Platform in 2019, followed by the development of the National Strategic Plan for One Health.

Freetown is now focusing on integrated approaches for action against NTDs, demonstrating their impact beyond the health sector, and emphasizing the links between human, animal and environmental sectors for development in accordance with the Sustainable Development Goals.

For example, Freetown’s newly established multisectoral rabies control strategy goes beyond rabies interventions to include deworming, treatment of skin diseases and other animal health issues in dogs.

One Health financing to support sustainable change

Franck Berthe, Senior Livestock Specialist, World Bank, Washington DC, USA

Franck emphasized that NTDs and affected, marginalized communities are at the heart of the World Bank’s goals to end extreme poverty within a generation and boost shared prosperity.

He referred to the example of the Onchocerciasis Control Programme, funded by the World Bank in the early 1970s, which illustrated how financing a disease programme can benefit health and the environment.

He said that using a One Health approach can increase benefits tremendously compared to their costs, but sectors often compete for financing instead of having shared financing as a national investment.

In addition, funding can be diverted by outbreaks and events, leaving NTDs in a cycle of panic and neglect as attention is directed to other issues.

Franck added that to support sustainable change, the World Bank has included One Health in the 20th replenishment process of the International Development Association.

Environmental interventions for One Health

Lee Ching Ng, Director, National Environment Agency’s Environmental Health Institute, Singapore

Lee Ching explained how environmental interventions are used to mitigate the risks of vector-borne diseases in Singapore, where improved living conditions, piped drinking-water and waste management have significantly reduced the incidence of dengue and malaria.

However, environmental risk factors for dengue infections have persisted and are largely due to standing water sources such as containers (particularly in older buildings), while construction sites and vegetation, combined with a humid climate, offer perfect breeding grounds for mosquitoes.

In Singapore, these risks are being addressed through intersectoral collaboration to implement biological controls; and alert systems to detect changes in vector numbers.

Engaging the veterinary sector to strengthen surveillance

Harena Rasamoelina, Coordinator, SEGA One Health Network, Indian Ocean Commission, Mauritius

Harena discussed the ways in which the SEGA One Health Network supports disease surveillance in a network of countries of the Indian Ocean Commission comprising the Comoros, Madagascar, Mauritius, Reunion and the Seychelles.

This has enabled the establishment of a surveillance and response mechanism across sectors where health data are shared to strengthen capacity.

The network supports efforts to control and eliminate several NTDs, including rabies, taeniasis and cysticercosis, and arboviral diseases such as dengue and chikungunya. Other NTDs are included at the request of members forming part of the Indian Ocean Commission.

Harena highlighted the benefits of One Health approaches and the importance of involving communities.”

https://www.who.int/news/item/21-03-2022-one-health-is-critical-to-addressing-zoonotic-public-health-threats-and-environmental-issues

Sanofi moves forward with EUROAPI listing on Euronext Paris

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March 18 2022. Today marks a major milestone for EUROAPI, a leading European company dedicated to the development, production and marketing of active pharmaceutical ingredients* (API), as Sanofi’s Board of Directors unanimously proposed, on March 17th, to submit to its shareholders the distribution of circa 58% of the share capital of EUROAPI.

In addition to the previously proposed €3.33 cash dividend per Sanofi share, this additional extraordinary dividend, exclusively in kind, is subject to shareholders approval at Sanofi’s May 3, 2022 Ordinary and Extraordinary Shareholders’ Meeting.

If approved, the distribution will take place shortly after the listing of EUROAPI’s shares on the regulated market of Euronext Paris, subject to the approval of the French Autorité des Marchés Financiers (AMF) on EUROAPI’s French prospectus, which will be made available to the public ahead of Sanofi’s Shareholders’ Meeting.

Through this transaction, Sanofi is giving its shareholders the opportunity to take part in the success of a leading player in the API market with strong ambitions to become a global champion on a growing and dynamic market, and due to be listed on the regulated market of Euronext Paris.

In connection with the proposed spin-off, French Tech Souveraineté has agreed to purchase
12% in EUROAPI shares from Sanofi for up to €150 million, with the acquisition price to be determined based upon the thirty day volume weighted average trading price (“VWAP”) of EUROAPI’s shares on Euronext Paris, starting on the first day of trading.

As a result, French Tech Souveraineté will become a long-term reference shareholder of EUROAPI and will be represented by two non-executive members on EUROAPI’s Board of Directors, including Benjamin Paternot and another member to be determined.

French Tech Souveraineté’s investment is subject to approval of the spin-off by Sanofi’s shareholders and other customary conditions.

Post transaction, Sanofi confirms that it will hold circa 30% of the share capital and voting rights of EUROAPI and will remain a long-term strategic partner, supporting EUROAPI’s growth ambitions as an independent company over the coming years.

In addition to its highly diversified customer base of approximately 530 customers, EUROAPI benefits from a strong and long-term customer relationship with Sanofi, which represented nearly half of EUROAPI’s revenues in 2021.

In line with its “Play to Win” strategy aiming at simplifying its operations, Sanofi announced in February 2020 its ambition to create a new world leader in APIs to secure significant manufacturing and supply capacities that are critical for patients in Europe and beyond, in a context of increasing shortage of medicines essential to patient care.

In 2021, Sanofi announced several critical steps in this journey with the unveiling of the creation of EUROAPI and the appointment of Karl Rotthier as its CEO in January, the appointment of Viviane Monges as Chair of the Supervisory Board in July and the finalization of the carve-out in December 2021.

Despite volatile market conditions, Sanofi has decided to move forward with the listing process of EUROAPI.

As an independent stand-alone company, EUROAPI will be able to fully unlock its growth potential, offering the best alignment of strategy, value creation and financial objectives for all of Sanofi’s shareholders.

With a diversified technology portfolio, EUROAPI is positioned as the world’s leading manufacturer of small molecule API (including complex chemical synthesis molecules, biochemical molecules from fermentation and highly potent molecules).

It was the world’s second largest manufacturer of APIs (including both small and large molecules such as peptides and oligonucleotides) in 2021 and number seven in the global CDMO (Contract Development and Manufacturing Organization) market in 2020.

EUROAPI develops, manufactures, markets and distributes APIs and intermediates used in the formulation of medicines for human and veterinary use, both from originators and generics, through its API Solutions business and CDMO activities.

Drawing on more than 150 years of experience in the growing API market, EUROAPI has a network of six production sites, all of which are located in Europe, and delivers around 200 APIs to approximately 530 customers in over 80 countries.

The company will be able to rely on the expertise of around 3,350 employees and expects to achieve consolidated sales of around EUR 1 billion in the year ending December 31, 2022.”

https://www.sanofi.com/en/media-room/press-releases/2022/2022-03-18-12-48-38-2405963

FDA, Reagan-Udall Foundation to Hold Important Public Workshop to Discuss Naloxone Access

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March 17, 2022: “The FDA will host a virtual public workshop on Mar. 29, to discuss critical questions around access to naloxone, a drug used to reverse opioid overdoses.

The workshop is a collaboration with the Reagan-Udall Foundation for the FDA.

“An integral part of our efforts to combat opioid-related drug overdose is making naloxone more readily available and accessible,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research.

“We will continue to work with other federal, state and local officials as well as health care providers, patients and community-based organizations across the country to explore innovative and meaningful approaches that place naloxone in the hands of those who need it most.”

The workshop will provide an in-depth discussion to review the current landscape of naloxone availability, address perceived barriers to naloxone access, including current misperceptions, and address questions posed by various groups on this subject.

In addition to exploring these diverse topics, various stakeholders, including harm-reduction specialists, physicians, pharmacists and regulators will also share their experiences in addressing the availability of naloxone for opioid overdose. 

Naloxone remains a critical tool for individuals, families, first responders and communities to help reduce opioid overdose deaths.

The FDA has taken a number of steps over the last several years to support increased availability and awareness of naloxone products, including encouraging manufacturers to pursue approval of over-the-counter naloxone products, requiring drug manufacturers for all opioid pain relievers and medicines to treat opioid use disorder to add new recommendations about naloxone to the prescribing information, and extending the expiration date of naloxone nasal spray from 24 months to 36 months. 

The workshop further underscores the agency’s ongoing commitment to gain valuable insight from various stakeholders to increase access and availability to this potentially lifesaving treatment.”

https://www.fda.gov/news-events/press-announcements/fda-reagan-udall-foundation-hold-important-public-workshop-discuss-naloxone-access

Sanofi & Seagen collaborates for multiple novel antibody-drug conjugates

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March 16, 2022. Sanofi and Seagen Inc. announced an exclusive collaboration agreement to design, develop, and commercialize antibody-drug conjugates (ADCs) for up to three cancer targets.

The collaboration will utilize Sanofi’s proprietary monoclonal antibody (mAb) technology and Seagen’s proprietary ADC technology.

ADCs are antibodies engineered to deliver potent anti-cancer drugs to tumor cells expressing a specific protein and Sanofi currently has one ADC in development.

John Reed, M.D., Ph.D.
Global Head of Research and Development, Sanofi
“This collaboration will enable the synergistic combination of molecules and platforms to produce candidate medicines with the potential of bringing renewed hope to cancer patients and their families. 

We look forward to joining forces with Seagen to collaboratively design and develop promising medicines by advancing antibody-drug conjugate science.”

Clay Siegall, Ph.D.
President and Chief Executive Officer, Seagen
“We are excited to be working with Sanofi, a global biopharmaceutical leader, to identify new ways to potentially address unmet medical needs of cancer patients. 

Jointly developing novel ADCs by combining antibodies from Sanofi with Seagen’s proprietary ADC technology, aligns with our strategic priorities to expand the global potential of our pipeline with new first- or best-in-class programs.”

Under the terms of the collaboration, Seagen and Sanofi will co-fund global development activities and share equally in any future profits.

In addition, Sanofi will make an undisclosed payment to Seagen for each of the three targets as they are selected. The first target under the collaboration has already been designated.”

https://www.sanofi.com/en/media-room/press-releases/2022/2022-03-16-11-18-19-2404147

AZ reaches settlement agreement resolving patent litigation related to Ultomiris

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March 17, 2022: “Alexion, AstraZeneca’s Rare Disease group, has entered into a settlement agreement with Chugai Pharmaceutical Co., Ltd. (Chugai), resolving all patent disputes between the two companies related to Ultomiris (ravulizumab).

In accordance with the settlement agreement, Alexion and Chugai have taken steps to withdraw patent infringement proceedings filed with US District Court for the District of Delaware and Tokyo District Court. 

Marc Dunoyer, Chief Executive Officer, Alexion, said: “With this settlement, we will continue to advance our Ultomiris development programmes in new indications and focus on our mission to transform the lives of people affected by rare diseases.”

Financial considerations
Under the terms of the agreement, Alexion will make a single payment of $775m in the second quarter of 2022, for which a charge will be recognised through the non-core P&L in the first quarter of 2022.

No further amounts are payable by either party. The settlement does not impact AstraZeneca’s financial guidance for 2022.

Notes

Ultomiris patent proceedings
US
In November 2018, Chugai filed a lawsuit against Alexion in the Delaware District Court alleging that Ultomiris infringes US patent No. 9,890,377 held by Chugai.

Upon issuance of US patent No. 10,472,623 in November 2019, Chugai filed a second lawsuit in the same court alleging that Ultomiris also infringes that patent.

The two lawsuits were consolidated in December 2019.

Japan
In December 2018, Chugai filed a lawsuit in the Tokyo District Court against Alexion Pharma GK alleging that Ultomiris infringed two Japanese patents (Japanese Patent No. 4954326 and No. 641743) held by Chugai. Chugai’s complaint sought unspecified damages and certain injunctive relief.

Also beginning in 2016, Alexion had challenged the validity of four of Chugai’s Japanese patents.

The IP High Court in Japan had found these patents invalid. Chugai filed a correction of these patents with the Japanese Patent Office.

The Japanese Patent Office found the corrected patents invalid, and Chugai appealed the Patent Office’s decision to the IP High Court in Japan.  

Europe
Beginning in 2016, Alexion challenged the validity of five of Chugai’s European patents.

One patent was maintained by the Opposition Division of the European Patent Office while four were revoked.

Three of the five decisions by the Opposition Division have been appealed to the Boards of Appeal for the European Patent Office.

Ultomiris
Ultomiris (ravulizumab), the first and only long-acting C5 complement inhibitor, offers immediate, complete, and sustained complement inhibition.

The medication works by inhibiting the C5 protein in the terminal complement cascade, a part of the body’s immune system.

When activated in an uncontrolled manner, the complement cascade over-responds, leading the body to attack its own healthy cells. 

Ultomiris is administered intravenously every eight weeks or, for paediatric patients less than 20kg, every four weeks, following a loading dose. 

Ultomiris is approved in the US for the treatment of adults and children (one month of age and older) with PNH; in the EU for adults, as well as for children (with a body weight of 10kg or above) and adolescents with PNH who experience haemolysis with clinical symptom(s) indicative of high disease activity, as well as for individuals who are clinically stable after having been treated with Soliris for at least the past six months; and in Japan as a treatment for adults with PNH.

It is also approved in the US for aHUS to inhibit complement-mediated thrombotic microangiopathy in adult and paediatric (one month of age and older) patients, in the EU for the treatment of adults and children with a body weight of at least 10kg with aHUS, as well as in Japan for adults and children with aHUS.”

https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2022/astrazeneca-reaches-settlement-agreement-resolving-patent-litigation-related-to-ultomiris.html

AZ launches global R&D Postdoctoral Challenge to accelerate scientific discovery and diversity

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March 17, 2022: “AstraZeneca launched a global R&D Postdoctoral Challenge to help accelerate ideas to transform the treatment of some of the world’s most complex diseases.

The challenge, launched at EXPO 2020 Dubai, invites final year MD and/or PhD students and postdoctoral researchers from across the world to propose their innovative ideas to help accelerate drug discovery and development across AstraZeneca’s core disease areas.

Successful candidates will be awarded a fully funded postdoctoral research position and join the vibrant scientific community within AstraZeneca.

Working alongside a leading university, the researchers will also receive access to in-house expertise, compounds, novel tools and technologies and mentoring support to develop their ideas and innovate.

Prof. Sir Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, AstraZeneca, said: “The events of the past two years clearly show the need to push the boundaries of medical science has never been more urgent.

Rapid progress in disease understanding, as well as scientific and technological advances are genuinely changing our expectations of what is possible.

We are delighted to launch the R&D Postdoctoral Challenge to support the next generation of science leaders and help them translate their ideas into meaningful benefits for patients.”

Shortlisted applicants will have the chance to pitch their research ideas to a panel consisting of AstraZeneca and external life science leaders in October, with the selection of finalists decided later in the year.

Proposals will be reviewed based on scientific merit, and potential to create real impact for patients, society and healthcare systems.

Further information on the R&D Postdoctoral Challenge, including entry criteria and details on how to submit innovative research proposals, can be found at: https://openinnovation.astrazeneca.com/rd-postdoctoral-challenge.html.

The R&D Postdoctoral Challenge forms part of AstraZeneca’s Early Talent programmes, nurturing the science leaders of tomorrow and encouraging diversity of thought within an environment that enables science to thrive.

AstraZeneca’s global R&D footprint and productivity
In 2021 AstraZeneca invested $8 billion in R&D, around 21% of the Company’s turnover, in order to continue to discover and develop medicines which transform the lives of patients.

The Company has three world class strategic R&D centres including The Discovery Centre (DISC) in Cambridge in the UK, one in Gaithersburg, Maryland in the greater Washington, D.C. region of the US, and another in Gothenburg in Sweden, as well as further hubs across the world.

It has integrated R&D teams and accelerated decision-making processes, using its unique scientific capabilities, to deliver one of the most productive pipelines in the industry.

Since 2005, AstraZeneca has achieved an almost six-fold improvement in the proportion of its pipeline molecules that have advanced from preclinical investigation to completion of Phase III clinical trials – from 4% to 23%.

This improvement moves AstraZeneca well above the current industry average success rate of 14% in the 2018-2020 timeframe.1

Of the Company’s 80,000 employees, more than 13,000 work exclusively in R&D. In 2021, its scientists published a total of 871 manuscripts, with 196 in high impact peer-review journals (impact factor greater than or equal to 15 according to Reuters five-year rating), compared to one in 2010.”

https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2022/astrazeneca-launches-global-rd-postdoctoral-challenge-to-accelerate-scientific-discovery-and-diversity.html

FDA Approves First Generic of Symbicort to Treat Asthma and COPD

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March 15, 2022: “The U.S. FDA approved the first generic of Symbicort (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol for the treatment of two common pulmonary health conditions: asthma in patients six years of age and older; and the maintenance treatment of airflow obstruction and reducing exacerbations for patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.

This complex generic drug-device combination product, which is a metered-dose inhaler, should not be used to treat acute asthma attacks.

“Today’s approval of the first generic for one of the most commonly prescribed complex drug-device combination products to treat asthma and COPD is another step forward in our commitment to bring generic copies of complex drugs to the market, which can improve quality of life and help reduce the cost of treatment,” said Sally Choe, Ph.D., director of the Office of Generic Drugs in the FDA Center for Drug Evaluation and Research.

“This reflects the FDA’s continued efforts to increase competition and access to quality, safe, effective and affordable medicines for patients and consumers.” 

Asthma impacts 25 million people, more than five million of whom are children, while COPD afflicts more than 16 million, according to the National Heart, Lung, and Blood Institute.

Asthma is a chronic, long-term condition that affects the airways in the lungs, which can be worsened by physical activity and most often starts during childhood.

It can cause wheezing (a whistling sound when breathing), shortness of breath, and coughing. COPD, which includes emphysema and chronic bronchitis, is a long-term, chronic disease that causes airflow blockage and makes it difficult to breathe. 

This drug-device combination product is a metered-dose inhaler (MDI), which contains both budesonide (a corticosteroid that reduces inflammation) and formoterol (a long-acting bronchodilator that relaxes muscles in the airways to improve breathing).

Two inhalations, two times a day (usually morning and night, about 12 hours apart), treat both diseases by preventing symptoms, such as wheezing for those with asthma, and by helping with better breathing, for those with COPD.

The inhaler is approved for two strengths (160/4.5 mcg/actuation and 80/4.5 mcg/actuation).

The most common side effects associated with budesonide and formoterol fumarate dihydrate oral inhalation aerosol for those with asthma are nasopharyngitis (swelling of nasal passages and back of throat), headache, upper respiratory tract infection, pharyngolaryngeal (nose and mouth) pain, sinusitis, influenza, back pain, nasal congestion, stomach discomfort, vomiting, and oral candidiasis (thrush).

For those with COPD, the most common side effects are nasopharyngitis, oral candidiasis, bronchitis, sinusitis, and upper respiratory tract infection.

The FDA regularly takes steps to help guide industry through the development process for generic drug products, including combination products, such as MDIs, that consist of a drug and a device.

To further facilitate generic drug development, and to assist the generic pharmaceutical industry in this process, the FDA publishes product-specific guidances (PSGs) describing the agency’s current thinking and expectations on how to develop generic drug products that are therapeutically equivalent to their brand name counterparts.

In June 2015, FDA published a PSG for budesonide and formoterol fumarate dihydrate inhalation aerosol.

The FDA requires sponsors to submit appropriate data and information to demonstrate that complex generic drug-device combination products meet the agency’s rigorous approval standards.

These standards ensure that generic drug products are as safe and effective as their brand name equivalents and meet the same high quality standards.

Complex products are medical products where uncertainty concerning the approval pathway or possible alternative approaches to product development can benefit from early scientific engagement, such as products with complex active ingredients and drug-device combination products.

Since drug-device combination products can be more challenging to develop, fewer exist, resulting in less market competition.

Addressing the challenges related to complex generics, and promoting more generic competition to these medicines, is a key part of the FDA’s Drug Competition Action Plan, and the agency’s efforts to promote patient access and more affordable medicines.

The FDA granted approval of this generic budesonide and formoterol fumarate dihydrate inhalation aerosol to Mylan Pharmaceuticals, Inc.”

https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-symbicort-treat-asthma-and-copd