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Who we are

Xendo, a ProPharma Group company, is a leading consultancy and project management organisation in the fields of (bio)pharmaceutical products, medical devices, and healthcare. Thanks to our multi-disciplinary, knowledge-driven approach, we deliver a broad palette of services to the life sciences industry, applying the right colour to projects we participate in. For over 25 years, we have successfully completed thousands of national and international assignments for start-ups as well as for the largest, established multinational companies and organisations. ProPharma Group combined with Xendo has more than 1,000 professionals worldwide providing an unmatched variety of compliance related services including medical information, pharmacovigilance, clinical safety, regulatory affairs, and a continuously expanding range of compliance, quality assurance, validation, and consulting services; providing a full-colour spectrum.

Our clients

The spectrum of our fields of expertise is as broad as the range of clients we work for, enabling us to cater to the varied needs and wishes of the Life Science industry. By creating an integrated solution, ProPharma Group is your single-source, global independent provider of compliance, regulatory affairs, pharmacovigilance, and medical information solutions providing the insights and services needed to maintain the highest level of value and patient safety.

We bring our palette of services to companies, ranging from start-ups to multi-national organizations, to provide them with robust solutions. Whether they are a (bio)pharmaceutical or medical device company, a hospital or a pharmacy, a manufacturer or a laboratory, we match their colour.

29-11-2018
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#French GVP: 7 major changes for the pharmaceutical industry

 On February 5, 2018, the French National Security Agency for Medicines and Health Products (ANSM) updated their Good Pharmacovigilance Practices (FR-GVP)[1] with the aim of bringing the French particularities in line with EU pharmacovigilance requirements (EU-GVP)[2]. Initially, the FR-GVP were published in 2005 and last updated in 2011. This new version introduces substantial modifications in order to adapt to today’s drug safety challenges and the new version of EudraVigilance (EV) system which was launched on November 22, 2017.

So, what are the major modifications and how do you deal with these changes? Our before and after comparative analysis helps to clarify these questions by identifying the seven major changes.


1. A first time for the ANSM

Before, the FR-GVP would have been submitted by ANSM to the French government and validated by the French Minister for Solidarity and Health. However, with the aim of simplifying the procedure, the power of approval for such matters has been transferred to the General Director of ANSM, currently Dr. Dominique MARTIN, according to the Code of Public Health[3]. This responsibility gives the ANSM a full control on the FR-GVP and this new version is the first one that has been published since this decision.


2. A new tool for reporting AEs

In line with the ANSM program of continuous improvement and modernization, a web portal[4] for reporting adverse events (AEs) has been established in March 2017. This permits both patients and healthcare professionals to access the different reporting systems of AEs. Information collected through this online platform is automatically sent to the adequate regional pharmacovigilance center among the Centres Régionaux de Pharmacovigilance. In the new version of the FR-GVP, the chapter relating to the declaration of AEs describes this new tool as the preferable method to declare AEs. Furthermore, a chapter is specifically dedicated to the role of the patients in PV and explains the procedure to declare AEs through this new platform. 


3. Description of EUQPPV & LPPV roles

The FR-GVP also details the role of the EU-QPPV (Qualified Person responsible for Pharmacovigilance in EU) and of the LPPV (Local Person for Pharmacovigilance). Indeed, pharmaceutical companies need an efficient PV system by appointing an EUQPPV, responsible for all related PV activities, and an LPPV, in charge of all PV activities on a national level.

Moreover, an EU-QPPV can also handle the position of LPPV if he/she:

  • Is a medical doctor or a pharmacist
  • Is located and executes his/her activities in France
  • Has proven expertise in PV

4. Modifications of MAH and ‘’Exploitant’’ responsibilities

The ANSM published an FAQ in June 2018 which:  

  • Explains the differences between Exploitant and MAH, as the Exploitant is a local particularity. An Exploitant is a company which commercializes the pharmaceutical product without necessarily being the MAH. An Exploitant can be responsible for PV activities but in this case, the respective roles between Exploitant and MAH must be defined.
  • Clarifies the AEs declaration to the ANSM. There is no more obligation for Exploitant/MAH to report Medication Errors without AE to the “ANSM Medication Error Desk’’ or to submit reports of abuse or dependence to medicines containing psychoactive substances to the Dependence Evaluation and Information Center (CEIP).

5. Definition of the scope of audits

The new FR-GVP specifies that the Exploitant must monitor the PV system, its performance, and efficacy by conducting audits in accordance with GVP Guidelines.

The scope of the audit can vary according to the status of the Exploitant.

Indeed. if the Exploitant is also the MAH, the audit program should be based on PV audit procedures and cover at least:

  • Internal PV procedures and their correlation with the regional PV system in place at HQ level
  • Audits of affiliates where appropriate
  • Audits of vendors providing PV-related services
  • Audits of distributors, etc.

On the other hand, if the Exploitant is not the MAH (e.g a French affiliate), the scope of the audit concerns:

  • PV procedures (internal and in the interface with MAH), reference can be made to audits performed by the MAH
  • Contracted vendors
  • PV partners (local contract)

If the audit is performed by the MAH, the Exploitant (responsible Pharmacist and LPPV) must get a copy of the audit report including CAPAs.


6. Harmonization with European-GVP

France contributes to the European Medicines Agency’s Eudravigilance database. Due to Eudravigilance new functionalities from November 22, 2017, new procedures for the exchange of electronic transmission of Individual Case Safety Reports (ICSRs) have also been implemented in the FR-GVP. The ANSM no longer sends ICSRs to pharmaceutical companies by regular post but uses Eudravigilance. For ICSRs from literature, pharmaceutical companies are no longer required to forward the corresponding articles to the ANSM since 10 July 2017.


7. Clarification on the PSMF

Like the MAH, the Exploitant must have an up-to-date copy of the Pharmacovigilance System Master File (PMSF). In addition to the global PSMF, a local PSMF is also required and should include:

  • The identity, qualification and contact details of the LPPV/EUQPPV
  • The organizational chart of the local PV services and the management system
  • The description of the organization of the PV system and the management of PV related activities
  • The list of current procedures concerning PV
  • The description of all PV tools used in the company
  • The list of all the contracts between the Exploitant and the MAH
  • The description of PV training
  • The description of the archiving process

 


What’s next?

From now on, the ANSM has stated that the FR-GVP will be updated on a regular basis to give clearer guidelines on the National level, ensure a better concordance with the EU Guidelines and improve communication with pharmaceuticals companies.

Blog by: Juliette Bayle

[1] Bonnes Pratiques de Pharmacovigilance, 05-02-2018, https://ansm.sante.fr/content/download/115483/1461439/version/1/file/BPPV-fevrier_2018.pdf
[2] Good Pharmacovigilance Practices (EMA),
https://www.ema.europa.eu/en/human-regulatory/post-authorisation/pharmacovigilance/good-pharmacovigilance-practices
[3] Article 2 of the ordinance n.2016-966 (5 July 2016), Code of Public Health
[4] www.signalement.social-sante.gouv.fr
22-11-2018
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#Get the most out of your GMP effectiveness checks

The effectiveness check; a requirement after the close out of your investigation, following a deviation, suspected product defect or other problem (EU GMP Chapter 1.4.xiv).

But what exactly is the effectiveness check, and how do you apply it adequately?

The effectiveness check is the verification that the root cause was remediated. It is performed as the final act but can be defined as soon as the root cause is known.

When performing an effectiveness check, it usually belongs to one of three different categories:

  • Check for recurrence of the root cause
  • Check process data
  • Use audits and spot checks

Recurrence of the root cause

Trending for recurrence is the most common approach used. However, there are some challenges when using recurrence as an effectiveness check. The problem that was resolved should be a recurring issue, with a known rate of occurrence. This rate of occurrence should be sufficiently high, and consistent. The effectiveness check is aimed at waiting a set amount of time to ensure the issue doesn’t happen again. This only works if there is ample opportunity for it to happen, in case the root cause was not remediated adequately.

Talking about the time frame, this should not be an arbitrary period (3 months, 6 months), but should be based on the rate of occurrence. As a general guidance, the time required is three times the number of batches needed for 1 occurrence (e.g. if an issue occurs 1 in 20 batches, then the time frame should be approximately 60 batches).


Process Data

Process data is used when the corrective actions are aimed at adjustment or improvement of systems, which are regularly or continuously monitored. This can be continuous process monitoring, like conductivity or temperature, or data that is obtained on a regular basis, like IPC measurements or QC (release) tests. In both cases, it must be possible to obtain a sufficient amount of data from before and after the implementation of CAPA to trend the data. Furthermore, the adjustment or improvement should introduce a significant shift in the process monitored. The shift or difference observed should be statistically relevant.


Audits and Spot Checks

Whereas the two methods described above are data-driven and provide objective evidence for the effectiveness check, these methods are not always useable. For example, when a corrective action intends to obtain a behavioral change, there is generally no data generated by a system that can be used to verify if the intended change was achieved. In this circumstance, the only method is to go and observe the behavior as a process witness. Although there are drawbacks to this approach, it might be the only one available. As with the other methods, the conditions and requirements for the effectiveness check must be well defined, taking into account the risks associated with the type of effectiveness check performed.


Completion of the effectiveness check

When the effectiveness check is performed, and the CAPA remediated the root cause, the evidence is added to the record, and the file is closed. But what would you do when the effectiveness check fails? In that case, you have to assess where it failed. Generally, there are three possibilities.

  • Firstly, the true root cause was not found. In that case, you have to redo the root cause analysis, redefine CAPA, and set up a new effectiveness check.
  • Secondly, the CAPA did not adequately remediate the root cause. When that happened, the CAPA plan needs to be redefined. The original effectiveness check is likely still applicable, as the root cause didn’t change.
  • Lastly, the effectiveness check was not set up correctly. In that circumstance, the effectiveness check can be redefined and redone.

Another point to consider is that, in a well-developed quality management system, effectiveness checks are, to a certain extent, inherently part of your system. For example, when the deviation management system includes a check on recurrence for each new event, this could replace the effectiveness check for a recurring issue. Or, when the remediation of the root cause includes a validation, and the validation includes the verification of the desired functioning of the system, this can be used as an alternative to the effectiveness check.

At the moment, the effectiveness check is still a topic that leads to a lot of worries and is not structurally implemented in many companies. It is not always applied correctly, or occasionally, not applied at all. Even though it is the closing out, and confirmation that you adequately remediation your problem. And a regulatory requirement.

Also struggling with the effectiveness check? Don’t hesitate to contact us!

Blog by: Onno Kaandorp

14-11-2018
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#A Day in the Life of: Ton de Ridder

FACTS

Age: 47

Studied: Laboratory techniques

Experience: Computer systems Validation, Performing validation studies, Preparation Clinical Trials, GLP QA auditor, performing analyses on analytical laboratory

Goals: Taking on more responsibility as a consultant and buying a yacht to cross the atlantic


PERSONAL DESCRIPTION

I studied Laboratory techniques and subsequently achieved my Bachelor of Applied Science in Chemistry in Leiden. I worked for Astellas for 15 years first as a technician in clinical trials (preparing all clinical materials such as capsules, labelling, packaging, etc) and then as a GLP QA Associate (performing audits). In 2015, I started working at Xendo in the computer system validation team, and I am currently an associate consultant.  

As a person, I can describe myself as an honest and open-minded person who is always willing to learn and has a keen eye for quality.


MORNING

How do you get ready to start your day?

Living in Leiden, I take my bike to work permitting me to get some fresh air and energy, and I also use this time to switch my mind from family to work matters.

What is something you look forward to every day?

Regardless of the subject I feel well when I achieve the tasks I’ve planned for myself on a typical day.

So, what do you do every morning?

Working on various projects and making sure all prerequisites (GMP qualified laptops for instance) for us to do our work are available and if they’re not, coming up with solutions to get results. I also like to plan ahead to make sure I have a good overview of all the tasks and deadlines we have concerning the different projects.


LUNCH

How do you spend your lunchtime?

Depending of the workload, I preferably have lunch in the canteen with colleagues talk about just about everything, work related or not.


AFTERNOON

What is something you do every day?

Our team, as the name implies, is mostly involved in projects within pharmaceutical companies to make sure their computerized systems are compliant. So this means we write protocols, execute and report the actual validation, and we also perform project management.

Besides this, communication is key for me, so I try to keep an open channel with my colleagues so we can support each other whenever it’s needed.

What is the most challenging part of your job or day?

The most challenging part of my work is to find a balance between priorities and deadlines: because being involved in multiple projects at the same time shouldn’t mean less quality work.

What makes you happy during your day?

It’s always nice to hear that your work is being appreciated: getting a compliment gives me energy, makes me feel understood motivated. In general, I believe positive feedback works better than an overload of criticism.

And how does this company define and measure your success?

It is mostly based on facts (number of hours, daily activities,…), regular meetings with the project manager and project members who provide feedback.


CAREER

Why did you pick this job?

I enjoy the fact that I get to work in various companies of different sizes and cultures and collaborate on different levels within these companies. Besides, I also love a good challenge!

How does it fit into your career plan?

Moving forward in my career, I would like to be promoted to consultant.The reason is that I want to manage and take responsibility for my own projects and be successful in that position.  I’d get to set up my own team I’d like to focus on blockchain technology and its implications for the pharmaceutical industry. And, of course, working my way to a big yacht in the atlantic eventually.

To whom would you recommend this line of work?

I guess to people who have a common interest in IT and/or automation and regulated environments. The work covers the full lifecycle of a computerized system so you need to be able to maintain a good helicopter view and overcome obstacles as you move forward in your projects. In other words; who wants to be consultant needs to enjoy a fun rollercoaster ride!


Send us a message if you'd like to find out what your day could look like!

13-11-2018
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#The new Medical Device Regulation 2017-745: Safety by design and by vigilance

As an essential aspect of compliance to the new Medical Device Regulation 2017-745, this blog intends to shed some light on safety and performance requirements for medical devices and the way to monitor this, or better: vigilance in general. Of course, the scope of this blog also encompasses the In Vitro Diagnostic Regulation 2017-746, because vigilance is applicable to both.

Naturally, vigilance as part post-production activities, as well as post-market surveillance (PMS) are deployed to guard the safety and improve the performance of medical devices. Procedures for vigilance and PMS should be set up carefully, planned for, elaborated and where needed optimized and adjusted. Even so, PMS plans should be recorded within the technical documentation prior to CE marking and should be executed subsequent to its availability to the market. Several aspects of these processes have been intensified in the new MDR as compared to the Medical Device Directive (MDD). For instance, safety & performance, the supply chain and the Quality Management System (QMS) are affected significantly and we’ll discuss those in this blog. Potential issues can be identified by performing an audit on vigilance and PMS plans, so that identified gaps can be addressed appropriately and result in an MDR-ready system.

So who should be reading this? Basically, every economic operator in the EU who’s involved in the medical device industry and especially the manufacturer.

Or as defined in the MDR:

‘economic operator’ means a manufacturer, an authorised representative, an importer, a distributor or the person referred to in Article 22(1) and 22(3)

Note: article 22(1) and 22(3) deal with the person who combines devices bearing a CE mark into a system or a procedure pack.


Product Safety & Performance

Implementation of the mandatory vigilance is to guard the two integral focuses of any economic operator involved with medical devices: safety and product performance. In the fourth pre-amble of the MDR, vigilance is stressed as a key element of the regulatory approach and chapter VII is devoted almost entirely to describing the requirements and obligations regarding PMS and vigilance.

Over the course of development, the manufacturer is supposed to map a medical device’s safety and performance and both require accurate monitoring and where applicable adjustment.

The identification and estimation of the significance of incidents in the commercial lifecycle of a medical device and (adverse) events in the developmental (clinical) phase require in-depth research, root cause analysis and Periodic Safety Update report (PSUR). Subsequent to the results of this analysis, recurrent patterns in complaints, (adverse) events and incidents have to be precluded. Accordingly, the establishment of the Corrective and Preventive Action (CAPA) pinpoints the necessary adjustments and mitigating handlings. Consequently, the results of the analysis determine the magnitude of required adjustments for the design of the medical device and the QMS if needed.


Quality management system

In order to comply with the MDR, economic operators should invest in an efficient roadmap leading to an MDR-proof QMS for their product(s), that much is clear.

According to the MDR, this means making sure that:

  1. Emphasis on clinical data/evidence, PMS and vigilance will play a much more extensive role in addition to the clinical evaluation process.
  2. The roles and responsibilities of the economic operators, the supply chain from manufacturer to distributor (to the patient) have been outlined also regarding the handling of feedback from users, patients, healthcare providers, and other stakeholders, e.g. vigilance).
  3. The chain must be controlled.

 


Supply chain

The supply chain is the path a medical device travels from the manufacturer to the final destination of use. The parties involved are defined by the MDR as economic operators, which include manufacturer, authorised representative, importer and/or distributor, depending on what is necessary.

Depending on the organisation and the location of the manufacturer one, or more economic operators are involved/required for the supply chain. E.g., manufacturers located outside the European Union must have an authorised representative residing in the European Union.

For the supply chain of the medical devices, agreements describing the roles and responsibilities must be in place. This becomes more important in case the manufacturer and the distributor do not belong to the same organisation. Quality agreements then become essential, not only for the distribution of the devices but also for the vigilance obligations.


Set up of the QMS

A manufacturer, whose situation is matching with abovementioned concerns, might by now be interested in taking actions to set-up or insure of an MDR compliant QMS system. Manufacturers and other economic operators must keep in mind that there is not much of time left since MDR will officially be applicable from May 2020. Taking into account Brexit and the limited number of Notified Bodies that will be approved for the MDR, this limited amount of time becomes a constraint for manufacturers to:

  • Set-up an ISO13485:2016 and MDR compliant Quality System in order to get the medical device CE marked
  • Upgrade the QMS and CE marking of devices that are already compliant to the MDD on the European Market
  • Ensure that specific elements are also MDR compliant, e.g. Clinical Evaluation, Risk Management and Unique Device Identification (UDI)

Since the manufacturer is responsible for vigilance, the QMS must cover the feedback activities as well as trending and vigilance, from manufacturer to user. In case the distributors/importer are different legal entities, a quality agreement must be in place to take care of the vigilance responsibilities.


Room for improvement: pharmaceutical companies

It is a trend that pharmaceutical companies are more and more directly involved with medical devices, not only as a simple means to administer medicinal products. For example, they are involved in the development of novel combination products, where a drug is combined into a single unit with a device; also software as a medical device, better known as apps, is a new field where they are active in. Pharmaceutical companies are already familiar with pharmacovigilance, where the adverse events of a drug can be recorded and investigated. Vigilance for medical devices is at first sight similar, but it is not the same as pharmacovigilance. Therefore, pharmaceutical companies also handling medical devices must bring their systems in line with the MDD and/or the MDR to ensure that the requirements are met; to help them meet this goal, several Medical Device Guidance Documents (MEDDEVs) are available.

Within the medical device industry, the vigilance system gives input to the manufacturer to improve the safety and performance of their medical device (-s). Also, other means can be used for this, e.g. post-production information, feedback, and complaints from users, patients, healthcare providers, and other stakeholders

From a business efficiency perspective, it’s interesting for companies to investigate how to integrate their Pharmacovigilance and (material- or medical device) vigilance systems. Instead of having two separate systems with their own upkeep, a well-combined system can be both compliant and cost-effective.


Checks and balances: auditing

So, how exactly do you make sure that all is well and you’ve got yourself covered? The answer is: as a manufacturer (or any economic operator), you should perform a system audit to verify that your supply chain does not only supply to your end users but also ensures that events are reported accordingly, vigilance and that proper feedback from the market is obtained, post-market surveillance.

It’s recommended to make use of an (external) medical device vigilance auditor who evaluates and reviews your QMS throughout the chain and assesses its compliance to the MDR requirements. Additionally, an MDVA assesses also any non-conformities. Hereby the manufacturer is insured of a compliant Quality System throughout the supply chain and is primed and prepared for the audits of authorities and/or Notified Bodies.

Manufacturers of certain categories of medical devices might benefit specifically from such an audit because they are so-called ‘out of the ordinary’. Such devices are:

  • Self-certified medical devices; the classification criteria of medical devices are stricter whereby numerous Class I (self-certified) devices would be classified as Class IIa/b according to the MDR
  • Drug-device combination products; are classified as Class III whereby the safety and compatibility of the device, medicinal product and the combination of these two must be substantiated
  • Software as a medical device; is classified as Class IIa/b contingent to its (remote) options, configurational abilities, and risks with respect to the critical parameters

Naturally, for you as a manufacturer of Class II and/or higher Classes of medical devices, an audit will contribute to ensuring that the setup and maintenance of vigilance and post-market surveillance plan/method are performed appropriately. Of note, besides the benefits of an audit for medical device manufacturers, the MDR obliges the manufacturers to audit their critical subcontractors and suppliers as well. This aims to warrant accurate monitoring of the medical device’s integrity until it reaches the user/patient.

If you’d like to do your own pre-audit, you might want to start out with a free checklist for Medical Device Vigilance: request here.


In conclusion

The new MDR has been around for some time now and one of its focal points is the safety and performance of medical devices. To achieve this a manufacturer of medical devices, and even all economic operators, are legally obliged to set-up, implement and maintain an effective system for both vigilance and post-market surveillance. To check if the system is working properly, it should be subject of an internal audit. In this way, any third-party inspection will have a fully compliant outcome and, most important, the safety and performance are warranted for the patients.

Often we encounter situations within the medical device supply chain that an economic operator, manufacturer or not, is assuming its vigilance and PMS system to be compliant. Nevetherless, by asking right questions the contrary is proven. Thus, how do YOU ensure that the vigilance and post-market surveillance of YOUR product are fully compliant?

Blog by: Nadia Vazirpanah & Marc Klinkhamer

19-10-2018
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#Infographic - ATMP Development

Thanks to the popular reactions we've had on our approach to ATMP development we'd like to share this infographic.


As the face of modern medicine is changing, so should the development strategies of new medicines, including advanced therapy medicinal products (ATMPs). In the infographic, we present essential steps in ATMP development; how to design a valuable project plan, set critical milestones, and the identification of development gaps that can be intercepted without compromising on safety and efficacy, all to smoothen and speed up the process from ATMP development to marketing authorization.

Academia and startups are usually more focused on getting the science right but are often less experienced regarding the development of a medicinal product. As a guide through the development maze, it is of utmost importance to create a development plan and identifying all the interdependencies between non-clinical, CMC, and clinical development, from an early stage on. Furthermore, a tailor-made regulatory strategy should be developed. This regulatory strategy should provide guidance and focus, especially in early development where engagement with regulatory agencies supports to align development milestones and assure regulatory compliance in the end.

Although each ATMP is unique and needs a tailored development and regulatory strategy, critical steps can mostly be identified and anticipated on beforehand.

Check it out here!

11-10-2018
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#Proactive Pharmacovigilance And Its Importance: Benefits And Challenges

Feel free to download the slide deck of one of our recent talks on the proactive pharmacovigilance which was presented by Sonia Mangnoesing at the PhV Day on October 10th, 2018.


With the changes in Pharmacovigilance regulations over the last years, a shift has been seen in how we conduct Pharmacovigilance. Moving from a more reactive approach to a proactive approach. Maybe also moving from the ‘person’s approach’ to the ‘human factors’ approach. But why is this important, what are the benefits? That is a question many of us can answer in a fairly good way. Some may have had the opportunity to experience its benefits more than others, but since the changes in regulation, most will agree that this is the way forward.

Yet, when we look at how Pharmacovigilance is executed in practice, we too often see that different challenges cause a less than optimal Pharmacovigilance system. The challenges that we all can face in pharmacovigilance are not unique, but rather universal and their solutions hopefully applicable to different settings.

Download presentation here.

09-10-2018
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#Brexit & QPPV: Time to Prepare

Time is progressing, towards the official transition date in the Brexit process 30 March 2019 (actually as this is a Saturday, the implementation should be effective as of 29 March), as per notice from EMA in May of last year:

When the United Kingdom will have become a ‘third country’ all regulatory and practical consequences will become applicable. Although deeply affecting all business sectors, EU regulatory authorities, and individual citizens, the prospect of this transition, is specifically important for the pharmaceutical industry.

The English Health Authority published at 6th of August 2018 that the UK and EU agreed upon the terms of an implementation period to the end of December 2020, once finalised as part of the Withdrawal Agreement. It states amongst other things that marketing authorisation holders and qualified persons for pharmacovigilance will continue to be able to be based in the UK and access EU markets during the transition period. The Withdrawal Agreement as a whole still has to be finalised, aimed for October 2018.

QPPV

One example of where the impact will be particularly highly felt is the role of the Qualified Person for Pharmacovigilance (QPPV) with European responsibility.

EU law stipulates that companies marketing medicinal products in the EU are not just authorized in the EU/EEA, but they even enforce specifically that some activities must be performed in the EU (or EEA). For example, the execution of the QPPV role and its pertaining activities such as oversight of the pharmacovigilance system and safety of the medicinal products marketed by the EU MAH. This aspect is also directly important for patient safety in the EU and even globally. Hence, the consequences of the UK becoming a third country are therefore significant and preparatory activities need to be started in a timely fashion.

QPPVs fulfill a complex and difficult role as central pivot of the MAHs pharmacovigilance system and are uniquely responsible for the PV QMS as well as its outcomes, such as the benefit-risk balance of all the MAH’s medicinal products in the EU Market. The QPPV role requires therefore highly qualified, trained and scientifically and medically aware persons. QPPV are scarce resources and especially with so many currently established in the UK there will be a resounding impact when these QPPV drop out of the EU system more or less at the same time. According to the Article 57 database, there are about 150 UK-based QPPVs. In fact, this will be challenging to cope with for all MAH with products in the EU, since simultaneously with a move of MAH’s from the UK, the need for QPPVs will increase in the remaining EU countries. This will lessen the average available QPPV resources thereby putting the MAH already residing in the EU under additional pressure to find suitable personnel to occupy the QPPV role.

GUIDANCE

To help clarify where and how changes may be required, an extensive and very practical Guidance Document has been published on 19 June 2018 (EMA/478309/2017 Rev. 2). This document complements the Questions and Answers (Rev 03 from 19 June 2018 ) prepared jointly by the European Commission and EMA related to the United Kingdom's withdrawal from the European Union and is drafted to provide procedural and practical guidance to marketing authorisation holders (see also Notice to Applicants, updated on 23 January 2018). These documents and many more are available on the EMA website to support the MAH in their transition and it is advisable to use them.

EVALUATE AND SET UP A STRATEGY

BREXIT consequences will also enforce MAHs with their EU headquarter in the UK  to consider relocation to a remaining EU country, change the EU QPPV location accordingly as well as the location of the Pharmacovigilance System Master File (PSMF). This pivotal pharmacovigilance document, likewise, needs to be located in an EU country. Each MAH that will need to transfer the QPPV/PSMF responsibility must be aware that continued compliance with the regulations surrounding the QPPV role needs to be guaranteed throughout the change process and change control should cover all processes. This is at the same time fully under the responsibility of the QPPV incumbent at that moment, making the controlled change processes extra challenging. And at the end, the QPPV and PSMF details need to be updated in the Article 57 database.

PREPARE

It may be prudent for all MAHs affected by Brexit to evaluate carefully where in the post-Brexit EU they want to establish the QPPV and PSMF. Aspects to use for this assessment may be qualification and numbers of potential QPPV resources and reflect this e.g. against (co)rapporteurs, language as well as footprints of their company and medicinal products market to ensure a more evenly spread distribution of QPPVs. As a spin-off effect, this may even cause a more even distribution of regulatory burden for Health Authorities. 

27-09-2018
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#7 Things to Consider in Medicinal Cannabis Development

Mention the word cannabis and the confusion starts; legal or illegal, nutraceutical or medicinal product, psychoactive or non-psycho-active, clinically significant or not. At the same time, the cannabis industry is booming and attracting many investors. Currently mainly focused on the growing of the plant and exploiting the benefits of medicinal cannabis but more and more the focus shifts to the use of purified cannabinoids into medical products. In this blog, you will find out more about the regulations regarding medicinal cannabis and what to expect of it in the near future.


1. Cannabis

The first thing to set straight is the name cannabis. This is not a specific type of plant or product but more an all-encompassing term of a number of plants, materials, and products. The two common active substances (cannabinoids are called THC and CBD and are representative for the majority of endeavors in cannabinoid product development. THC and CBD are quite different from one another and in the table below you can see a comparison. Next to these two, there are over a hundred other known cannabinoids with slightly different chemical structures.

 

 

THC

CBD

Psychoactive

Yes

No

Legal status

Listed in narcotic laws, exemption needed1

Not listed in most countries (except US, UK, and some others)1

Origin

Weed plant

Hemp (grown for fiber)2,3

Growing location

Hot and humid climate/greenhouses

Moderate climate2

Products

Medicinal/recreational

Nutraceutical/medicinal

Appearance in pure form

Sticky oil/resin

Crystalline material

Stability

Unstable towards oxygen and light

Stable

Receptor activity

CB1/CB2 partial-agonist

CB1/CB2 antagonist

Proven clinical effects

Relieving chronic pain, muscle spasms, nausea

Epilepsy

Products

Marinol, Sativex (in combination with CBD)

Epidiolex (Lennox-Gastaut and Dravet Syndrome)

  1. please check the legal status if you embark on a cannabis project
  2. specially bred CBD-containing plants are grown in greenhouses. These are mainly intended for medicinal products
  3. if hemp is grown to isolate CBD, an exemption from the narcotics law is required in most countries

2. Regulations

So how is medicinal cannabis regulated? Currently, there are 27 countries, mainly in Europe and the Americas, where medicinal cannabis is permitted. It is usually prescribed by GPs and provided by pharmacies. Pharmacies obtain their packaged product from wholesalers and those from growers of cannabis plants. Both the growers and the distributors require licenses from local governments to be allowed to work with this plant material. To obtain such a license you’ll need to demonstrate aspects such as:

  • protective measures to prevent cannabis material from going missing
  • the exact handling of the material
  • growing,
  • importing,
  • re-packing,
  • storage,
  • distribution,
  • R&D-activities,

Currently more than 100 producers have been successful in obtaining the license, mainly in Canada. Having said that, it’s complicated to work in several countries at the same time because each country has its own set of regulations.


3. Quality Standards

When producing medicinal cannabis, Health Authorities may require a product to comply with the standards described in the Good Manufacturing Practice guidelines (GMP), e.g EU countries. This is managed by clearly defining specifications for possible quality risk factors like:

  • content
  • moisture
  • foreign matter
  • microbiology

Information on GMPs can be found in EU GMP “Eudralex 4” or the United States FDA 21CFR part 210 and 211

Interestingly, the GMP isn’t required for planting or seeding of cannabis plants. Instead, this typically requires Good Agricultural Practice (GAP which secures a constant quality of the plant material and is often done in a secured greenhouse).  GMP usually starts at harvest of plant buds.


4. Extract or purified substance?

Currently, the cannabis industry’s focus is still on plant material possibly because the terpenes exert a beneficial effect and dried buds are easy to get by and use. Besides this, the actual use of plant material ranges from tea made from the leaves to smoking it. It comes as no surprise that standardizing the use of cannabis to secure constant dosing for patients is key and it’s certainly worthwhile to investigate more advanced ways of delivering cannabinoids.  For instance, by presenting an extract or purified THC / CBD to patients you increase your control over the contents and dosing becomes more accurate, opening possibilities to investigate treatment efficacy in clinical trials. A number of companies are already using purified THC and CBD (essentially pure active substances) in clinical studies aimed at obtaining marketing authorization.

Example:  Sativex. By extracting the active materials from the plant and formulating it as a spray, GW Pharma obtained a marketing authorization in the EU and Australia. They did the same to register CBD in the US for treatment of rare epilepsy syndromes.

This is remarkable because the extracts used for Sativex still contain a large number of other cannabinoids as well as terpenes. Although we assume it’s because of the THC and CBD, it is not clear which components are actually responsible for the efficacy in pain reduction or reduction of seizures.


5. Formulation

Whether extracts or purified cannabinoids are used, there is a number of possibilities to administer these active substances to patients; each with their own pros and cons. Therefore, when embarking on a cannabis project (or any project in fact) it is useful to start with the patient in mind and define requirements that will treat a patient in the most comfortable way possible.

Some of the formulations:
 

 

Pros

Cons

Oral tablet

Easy to use

High first pass effect (extensive metabolism by the liver)

Cumbersome manufacturing

Inhalation

Demonstrated way of delivery (recreational use)

High plasma level leading to psycho-active effects

Patch

Easy to use

Only low doses can be given

Mouth spray

Immediate delivery

Only low doses can be given

Chewing gum/pastilles/lozenges

Easy to use

Cumbersome manufacturing


6. Stability

One aspect that needs to be considered when extracting and purifying THC is its stability, or rather its instability. Unlike CBD, THC is vulnerable to oxygen, light, and possibly moisture and it is readily decomposed by radical oxidation. This means standard formulation techniques aren’t sufficient to provide a stable drug product and instead requires encapsulation techniques. Methods have been developed to protect the THC by encapsulation into a polymeric or a liposome matrix. Surprisingly, the dissolution in aqueous ethanol mixture also exerts a stabilizing effect as demonstrated by the Sativex spray developed by GW Pharma.


7. Clinical studies

As previously stated, a number of treatments have been approved by Health Authorities. These are mainly in the area of pain reduction, emesis, nausea and symptom reduction in MS-patients. It is known that cannabinoids act on a multitude of different receptors in the body, either as agonists or antagonists, and could potentially interfere with disease mechanisms. Therefore, cannabinoids are thought to have the potential to treat or cure also diseases such as cancer (see e.g. the excellent review paper of Massi et al.)


Future

So, why haven’t we found more cures to date? Is it possible that the multi-compound containing plant material has hampered the progression of cannabinoids in approved treatments? As indicated before, these are ill-defined materials of a number of cannabinoids and terpenes and with a multitude of administration routes. So, claims using medicinal cannabis can’t be substantiated with clinical evidence. With THC and CBD now readily available as GMP-material, the scientific community is more suitably equipped to perform clinical studies. Hopefully resulting in approved drug products that treat patients safely and effectively.

Blog by: Jan Zorgdrager & Marc Stegeman