COVID-19 News: Scientific, regulatory oversight of vaccine, Guidance on vaccine development, Guidance on manufacturing, Food-Cosmetics information center, Multilingual resources

FDA’s Scientific and Regulatory Oversight of Vaccines is Vital to Public Health

Committed to making decisions guided by science and data regarding the authorization or approval of COVID-19 vaccines. Guidance on Development and Licensure of Vaccines to Prevent COVID-19 (see below), additional guidance on EUA

Importance of diversity in clinical trial participants. FDA strongly encourages enrollment of all people – including racial and ethnic minorities, older adults, pregnant women and women of childbearing age and, as appropriate, children

FDA’s career scientists and physicians facilitating development and evaluation of safe and effective vaccines. Expertise in clinical trial design and analysis, adequacy of manufacturing and facilities for producing high-quality vaccines, and post-marketing safety surveillance

Importance of being as transparent as possible.  Public meeting of Vaccines and Related Biological Products Advisory Committee on October 22

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GUIDANCE: Development and Licensure of Vaccines to Prevent COVID-19

Overview of key considerations to satisfy regulatory requirements per IND regulations and licensing regulations for chemistry, manufacturing, and controls (CMC), nonclinical and clinical data through development and licensure, and for post-licensure safety evaluation

CMC : General Considerations, Manufacture, Facilities, Inspections

Nonclinical data: Toxicity Studies, Immune Response characterization, Potential for Vaccine-associated Enhanced Respiratory Disease

Clinical trials: Populations, Design, Efficacy Considerations, Statistical Considerations, Safety Considerations

Either laboratory-confirmed COVID-19 or laboratory-confirmed SARS-CoV-2 infection is an acceptable primary endpoint

Primary efficacy endpoint point estimate for a placebo-controlled efficacy trial should be at least 50%

Post-licensure safety evaluation: Pharmacovigilance, Reqd post-marketing safety studies

Diagnostic and serological assays

Additional considerations: Vaccine effectiveness, EUA

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GUIDANCE: Resuming Normal Drug and Biologics Manufacturing Operations During the COVID-19 Public Health Emergency

Guidance for manufacturers as they transition from operations impacted by the public health emergency to normal manufacturing operations. Recommendations include:

  • Addressing deviations from established cGMP activities
  • Risk Management and other important elements of a plan to resume normal drug manufacturing
  • Prioritizing activities to resume normal drug manufacturing

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Food and Cosmetics Information Center (FCIC) Answers Your Questions

FCIC provides information and answers questions related to nutrition, safety, labeling of food, dietary supplements and cosmetics. Pandemic related, Complaints, Safety and Labeling, Expert advice

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Multilingual COVID-19 Resources

CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages


Image credit: FDA

Other News and Views: Detection of nitrosamine contaminants, Trial stimulation before spinal cord stimulator implantation, Tanning beds and booths, Right to Try act, Naloxone prescribing

Rigorous Detection of Nitrosamine Contaminants in Metformin Products: Balancing Product Safety and Product Accessibility

Since 2018, multiple drug products, including angiotensin receptor blockers (ARBs), histamine blocker ranitidine (commonly known as Zantac), have been recalled due to the presence of nitrosamines at unacceptable amounts

  • CDER scientists have developed and publicly shared gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-MS (LC-MS) technologies
  • For detecting and quantifying up to eight different nitrosamines  at levels below acceptable U.S. intake limit for the nitrosaminat low levels

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Conduct a Trial Stimulation Period Before Implanting a Spinal Cord Stimulator (SCS) 

Implanted SCS are an aid to cope with unmanageable, chronic chronic pain

  • However, FDA continues to receive reports of associated serious side effects

Health care providers should conduct a trial stimulation period with patients to confirm satisfactory pain relief before implanting a spinal cord stimulator (SCS)

  • Implant only in patients who have passed stimulation trial performed for 3-7 days showing 50% percent reduction in pain symptoms.
  • Discuss the benefits and risks of the different types of implants and other treatment options with patients
  • Several other recommendations

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Tanning Beds and Booths

Tanning beds and booths are sunlamp products used for indoor UV skin tanning

  • Risk of fire due to improper maintenance, dirty air filters blocking air flow, incompatible parts, failure to perform servicing and maintenance
  • Owners and operators should perform maintenance recommended by product manufacturers to reduce risk of smoke and fire
  • FDA monitoring adverse event reports and will keep public informed

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New Rule on Reporting Requirements for Right to Try Act

Right to Try Act provides pathway for patients with life-threatening diseases who have tried all approved treatment options and who are unable to participate in a clinical trial, to access certain unapproved treatments

  • Sponsor or manufacturer of drug/biologic is responsible for determining whether to make their product available to patients who qualify
  • New statutory requirement for sponsors and manufacturers to provide an annual summary to the FDA

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Labeling Changes Regarding Naloxone

Naloxone can be administered by individuals with or without medical training to help reduce opioid overdose deaths

  • Required labeling changes recommend health care professionals prescribe naloxone when they prescribe medicines to treat OUD
  • Also, they consider prescribing naloxone to patients being prescribed opioid pain medicines who are at increased risk of opioid overdose

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Image credit: FDA

Market Authorization, Warning: MONJUVI for B-cell lymphoma, TECARTUS for mantle cell lymphoma, EPIDIOLEX for tuberous sclerosis complex, VILTEPSO for duchenne muscular dystrophy, EVRYSDI for spinal muscular atrophy, WARNING for hangover remedies

MONJUVI® (tafasitamab-cxix) for injection

Morphosys Inc

INDICATION: in combination with lenalidomide, is indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, including DLBCL arising from low grade lymphoma, and who are not eligible for autologous stem cell transplant (ASCT).

MECHANISM OF ACTION: Tafasitamab-cxix is an Fc-modified monoclonal antibody that binds to CD19 antigen expressed on the surface of pre-B and mature B lymphocytes and on several B-cell malignancies, including DLBCL, mediates B-cell lysis through apoptosis and immune effector
mechanisms

EFFICACY:

  • Open label, multicenter single-arm trial, n=81 patients with a diagnosis of DLBCL
  • Endpoint: Overall response rate (ORR), defined as complete and partial responders and response duration
  • Best ORR : 55% (95% CI: 43%, 67%), complete responses in 37%, partial responses in 18%, median response duration was 21.7 months (range: 0, 24)

SAFETY: The most common adverse reactions (≥20%) were neutropenia, fatigue, anemia, diarrhea, thrombocytopenia, cough, pyrexia, peripheral edema, respiratory tract infection, and decreased appetite.

REGULATORY PATHWAY:

  • Accelerated approval based on ORR, one month ahead of the FDA goal date.
  • Continued approval contingent upon verification and description of clinical benefit in a confirmatory trial(s)
  • Review used the Assessment Aid, a voluntary submission from the applicant to facilitate the FDA’s assessment
  • Priority review, fast track, breakthrough, and orphan product designation

LABEL


TECARTUS™(brexucabtagene autoleucel) suspension for
intravenous infusion

Kite Pharma

INDICATION: CD19-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adult patients with relapsed or refractory mantle cell lymphoma (MCL)

MECHANISM OF ACTION: Binds to CD19-expressing cancer cells, activate downstream signaling cascades that lead to T cell activation, proliferation, acquisition of effector functions , and
secretion of inflammatory cytokines and chemokines and to killing of CD19-expressing cells

EFFICACY:

  • Open-label, multicenter, single-arm trial, n=74 patients with relapsed or refractory MCL with prior therapy
  • Primary efficacy outcome measure: Objective response rate (ORR) based on a minimum duration of follow-up for response of six months
  • ORR was 87% (95% CI: 75, 94), with a complete remission (CR) rate of 62% (95% CI: 48, 74)
  • Of all 74 leukapheresed patients, ORR was 80% (95% CI: 69, 88) with a CR rate of 55% (95% CI: 43, 67)

SAFETY:

  • Boxed Warning : Cytokine release syndrome and neurologic toxicities with a with a Risk Evaluation and Mitigation Strategy 
  • Most common Grade 3 or higher reactions: Anemia, neutropenia, thrombocytopenia, hypotension, hypophosphatemia, encephalopathy, leukopenia, hypoxia, pyrexia, hyponatremia, hypertension, infection – pathogen unspecified, pneumonia, hypocalcemia, and lymphopenia

REGULATORY PATHWAY:

  • Accelerated approval based on ORR and durability of response; continued approval contingent upon verification and description of clinical benefit in confirmatory trial
  • Orphan drug designation, breakthrough therapy designation, and priority review

LABEL


Epidiolex (cannabidiol) [CBD] oral solution 

Greenwich Biosciences Inc.

INDICATION: Treatment of seizures associated with tuberous sclerosis complex (TSC) in patients one year of age and older

ADDRESSING UNMET NEED: Only FDA-approved drug that contains a purified drug substance derived from cannabis. It is also the second FDA approval of a drug for the treatment of seizures associated with TSC

  • TSC is a rare genetic disease causing non-cancerous (benign) tumors to grow in the brain and other parts of the body like the eyes, heart, kidneys, lungs, and skin
  • Affects about 1 in 6,000 people

MECHANISM OF ACTION: CBD is a chemical component of the Cannabis sativa plant. However, CBD does not cause intoxication or euphoria (the “high”) that comes from tetrahydrocannabinol (THC). Precise mechanism of anticonvulsant effect is unknown

EFFICACY & SAFETY:

  • Randomized, double-blind, placebo-controlled trial, n=224
  • Primary endpoint: Change from baseline in seizure frequency
  • Significantly greater reduction in the frequency of seizures with Epidiolex
  • Effect seen within eight weeks; consistent throughout the 16-week treatment period
  • Dispensed with patient Medication Guide with drug’s uses and risks
  • Most serious risks: Increase in suicidal thoughts and behavior, or thoughts of self-harm
  • Most common side effects: diarrhea, elevated liver enzymes, decreased appetite, sleepiness, fever, and vomiting
  • Additional side effects: liver injury, decreased weight, anemia, and increased creatinine

REGULATORY PATHWAY: Supplemental NDA

  • FDA supporting rigorous scientific research on the potential medical uses of cannabis-derived products and working with product developers who are interested in bringing patients safe and effective, high quality products
  • Previously approved for treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS)
  • Not a controlled substance 

LABEL


VILTEPSO (viltolarsen) injection

NS Pharma

INDICATION: Treatment of Duchenne Muscular Dystrophy (DMD) in patients who
have a confirmed mutation of the DMD gene that is amenable to exon 53 skipping

ADDRESSING UNMET NEED: DMD is a rare genetic disorder characterized by progressive muscle deterioration and weakness caused by mutations in the DMD gene that results in an absence of dystrophin. First symptoms are usually seen between three and five years of age and worsen over time. Occurs in approximately one out of every 3,600 male infants worldwide; in rare cases, it can affect females.

MECHANISM OF ACTION: Binds to exon 53 of dystrophin pre-mRNA resulting in exclusion of this exon during mRNA processing. Exon 53 skipping allows production of an internally truncated dystrophin protein in patients with genetic mutations that are amenable to exon 53 skipping

EFFICACY AND SAFETY:

  • 2 clinical studies, n=32 patients with genetically confirmed DMD
  • Dystrophin levels increased, on average, from 0.6% of normal at baseline to 5.9% of normal at week 25
  • Increase in dystrophin production is reasonably likely to predict clinical benefit
  • Most common side effects: Upper respiratory tract infection, injection site reaction, cough and fever; kidney toxicity, including potentially fatal glomerulonephritis, has been observed after administration of some antisense oligonucleotides- function should be monitored

REGULATORY PATHWAY: NDA

  • Accelerated approval; based on an increase in dystrophin production in skeletal muscle -continued approval contingent upon verification and description of clinical benefit

LABEL


EVRYSDI™ (risdiplam) for oral solution

Genentech

INDICATION: Treatment of Spinal Muscular Atrophy (SMA) in patients 2 months
of age and older

ADDRESSING UNMET NEED: SMA is a rare and often fatal genetic disease affecting muscle strength and movement; second drug and the first oral drug approved to treat disease

MECHANISM OF ACTION: Increases exon 7 inclusion in survival of motor neuron 2 (SMN2) messenger ribonucleic acid (mRNA) transcripts and production of full-length SMN protein in the brain

EFFICACY & SAFETY:

  • Open-label, infantile-onset SMA study, n= 21 patients, average age 6.7 mo., 12 mo. treatment
  • Efficacy endpoint: Ability to sit without support for at least 5 sec and survival without permanent ventilation vs. natural progression of the disease
  • Meaningful improvement with 41% patients able to sit independently, 81% of patients were alive without permanent ventilation
  • Second randomized, placebo-controlled study, n=180 patients with later-onset SMA, age 2-25 yrs
  • Efficacy endpoint: Change from baseline in MFM32 (a test of motor function) total score at 1 yr; 1.36 increase in score with EVRYSDI vs. 0.19 decrease on placebo
  • Most common side effects: Fever, diarrhea, rash, ulcers of the mouth area, joint pain (arthralgia) and urinary tract infections
  • Additional side effects for the infantile-onset population: Upper respiratory tract infection, pneumonia, constipation and vomiting

REGULATORY PATHWAY: NDA

  • Fast track designation, priority review, orphan drug designation,  Rare Pediatric Disease Priority Review Voucher

LABEL


Hangover Remedies

Warning letters to seven companies whose products claim to cure, treat, mitigate, or prevent hangovers

  • Alcohol intoxication, a poisoning, causes dose-related dysfunction and damage, ranging from mild impairments to death
  • Products from these companies, labeled as dietary supplements, are unapproved new drugs and have not been evaluated by the FDA to be safe and effective for their intended use

Warning letters were sent to the following companies:

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Image credits: FDA, Morphosys, Kite, Greenwich, NS Pharma, Genentech