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1、Managing Pharmaceutical Quality: Risk or Uncertainty Management? Ajaz S. Hussain, Ph.D.Office of Pharmaceutical ScienceCDER, FDAPQRI Workshop February 1, 2005What is Quality?lWhat is pharmaceutical quality?lconsistent delivery of the label performance and lack of contamination.loperationalzed via a
2、set of pre-specified quality attributes (e.g., specifications, limits) and through the CGMP regulations.lFDA, in its quality definition, is standing in for the customerand it is apparent that health care practitioners and patients highly value an additional drug attribute: product availabilitylGood
3、pharmaceutical quality represents an acceptably low risk of failing to achieve the desired clinical attributes.http:/ GoalslImproving quality and ensuring availabilitylOptimal use of our resourceslA systems approach to CMC review and CGMP investigationslBased on knowledge and process understandinglA
4、chieving “quality by design”lDemonstrating “science of design”lContinuous learning and improvement through “manufacturing science”An Approach for Quality Risk ConnectionlConcept of Quality by Design (QbD)lProduct and process performance characteristics are scientifically designed to meet specific ob
5、jectives, not merely empirically derived from performance of test batcheslCharacteristics important to desired performance must be derived from a combination of prior knowledge and experimental assessment during product development. lFrom this knowledge and data, a multivariate model linking product
6、 and process measurements and desired attributes may be constructed.lClinical study would then be viewed as confirmatory performance testing of the model.Woodcock, 2004A Systems ApproachScience of DesignManufacturing ScienceDeliverQuality by DesignState of Control &Continuous ImprovementQuality can
7、not be tested into a product; it has to be by design“Market Standards”Science of Design + Manufacturing Science = Quality by Design Risk/Benefit and QualityHarmAcceptableRisk/BenefitQualityLabelNo benefit (placebo effect)Managing Pharmaceutical QualitylQuality of a new molecular entity (a potential
8、drug)lIntrinsic pharmacological & toxicological attributeslIdentitylComplexitylA range of uncertainty with respect to identity of “active moiety”, purity and stability of materials used in evaluation of pharmacological and toxicological attributes (if a mixture; variability adds additional uncertain
9、ty)lVariability in the extent and rate of delivery of “active moiety” to the sites of action and variability in the pharmacological & toxicological response and measurement systems further adds uncertaintyManaging Pharmaceutical QualitylQuality of a drug productlFor establishing proposed therapeutic
10、 claim (label)lDrug product manufactured for clinical trials lAfter successful demonstration of therapeutic claim (acceptable risk-to-benefit ratio)lDrug product manufactured for commercial distribution lLife cycle of the product (shelf-life, exclusivity period, generic competition, post-approval ch
11、anges,)lDrug product manufactured at many different facilities, changes in the process, different manufactures, Uncertainty, Variability and RisklQuality Clinical ConnectionlHow does a product formulation and its manufacturing process impact clinical performance?lWithout a clear understanding we are
12、 uncertain (lack of knowledge)lIn decision making there are many advantages in distinguishing between uncertainty, variability (random variation) and riskGoals and Characteristics of a Quality Decision System: Example Goal: expected to have the same clinical effect and safety profile when administer
13、ed to patients under the conditions specified in the labelingCharacteristicsUncertaintyVariabilityRiskPharmaceutical EquivalentSame active, identical amount, same dosage form, and route of administration.Identity, StrengthQuality, Purity.Compendial or other standardsPrior Knowledge (NDA)Post Approva
14、l:Monitoring programSuch as MedWatchConsumer ComplaintsTherapeutic Inequivalence Coordinating CommitteeNeed for Bioequivalence AssessmentDo not present a known or potential bioequivalence problem. Acceptable in vitro standardCompendial Dissolution test methodPresent a known or potential bio -problem
15、. Appropriate bioequivalence standard90% Confidence Interval of Test/Ref ratio for rate and extent of absorption in 80 -125% rangeAdequately LabeledSimilarity with reference label, medication errors.,Certain differences due to changes in the manufacturer, distributor, pending exclusivity issues, or
16、other characteristicsManufactured in conformance to CGMPsProcess Validation and Quality SystemDeviations, Out of Specifications,.ANDA Applications: Limited Information Content (e.g., IR Capsule)lGenerally 1bio-batchlBioequivalence goal post 80-125%l90 % Confidence Interval for the Test/Reference rat
17、io for Cmax and AUC in between the goal postlNormal healthy subjects, cross-over design, fasting (and fed) conditionslCommon for all oral drugs i.e., procrusteanlTo cover “worst case” scenarioslIf mean is 100% and 90% CI is outside 80- 125 say 85 - 126.5?lExecuted batch record and master batch recor
18、d (e.g., 10X) application commitmentlPost-approval process validation and stability commitmentlPost approval changes based on SUPAC-IRDemonstration of “quality by design”?lAnalytical data + Executed batch record + bio-study + process validationlIQ, OQ, PQ,.lPQ = 3 consecutive batches in conformancel
19、Reduced testing e.g., compendial testslFor simple, conventional product designs works fine most of the time; quality by design is then the prior knowledge and what ever development data is generated (held at site)Uncertainty, Variability and Risk/cder/gmp/gmp2004/manufSciWP.pdfUncer
20、tainty?Variability?Risk?Uncertainty, Variability and RisklProcrustean standards have to address “worst case” scenarioslUncertainty is not risk, currently we have no choice but to force this equalitylUncertainty is reduced by improving knowledgelWe learn what to control and the degree of control nece
21、ssary to minimize risklFor continuous quality improvement we should focus on improving uncertainty management process Example of a CMC Regulatory Decision: Acceptability of a Post Approval Manufacturing Process ChangelOriginal NDA or ANDA = CMC Quality & Performance (“Insurance”) ContractlFor exampl
22、e in ANDAs Regulatory commitments = Conditions in executed batch recordslPrior Approval Supplement* (PAS) lProduct conforms with all established specificationslBut - “Specifications do not tell the whole story”lE.g., Shelf-life and/or bioavailability may have changed and/or a new impurity may be int
23、roduced that may not be detected with established analytical methods,sponsor may not adequately qualify changes (inspection frequency may not be sufficient),.*prior approval supplement for process optimization and continuous improvement effortsCompany X “Goes Lean”l“Cycle-time reduction subgroup mem
24、bers, for example, examine each process function, for example, dispensing, roller compaction and compression, to determine how to speed up changeover and get equipment to run faster and more efficiently.” l“The team solicits ideas at regular meetings and via email. The ideas are then rated from 1 to
25、 10 based on bang for the buck to reduce cycle time, and on how difficult they would be to achieve-e.g., whether they will require validation or prior FDA approval.” PharmaM Post Approval Process Change (SUPAC Guidance)“Within”(ChangeTarget setting)“Outside”Current Uncertainty ManagementlAt the oper
26、ational level the most efficient approach for managing uncertainty is “demand management” lStrict “checking the box” process using pre-specified requirements (recommendations) and procrustean standardslFDA guidance documents, 483 observations,.l90% CI 80-125%, in-process blend uniformity tests, . SO
27、Ps,.Current Demand Management: CharacteristicslFor conventional products and manufacturing processes - easy to implement, supervise, and mangelDecision responsibility is deferred to a set of “procrustean” standards - liability distributed to the entire pharmaceutical community (e.g., via USP, AAPS,
28、etc.)lFor innovative and/or complex products and processes no one is willing to take responsibility for decisions (e.g., develop guidance document) decision liability is then on the person willing to take a decision. Current Demand Management: CharacteristicslInnovation and continuous improvement sl
29、ows down and inefficiency increaseslThe level of quality assurance achieved is difficult to measure and is buried in historical mindset and clinical variability lWith increasing complexity a major failure is necessary to signal inadequacies of the system such a failure is often the only approach to
30、introduce new regulations or improved decision criteria lChallenge to and alternate approaches to current procrustean standards difficult to prove and debates drain resourcesWithout Continuous (Community) Learning: Demand Management is “static” until a crisis is created, it then reacts to replace a
31、current procrustean standard with another. Continuous Improvement: Enhancing Customer Satisfaction - Reducing Variability“Special Cause” or “Common Cause”Stable- Yes; Capable?UnstableCorrective ActionsEliminate “Special Cause”Reduce “Common Cause”VariabilityFrequent,MajorOOSMinor,OccasionalOOSStable
32、 & CapableOn the Continuous Improvement PathState of ControlImproving Uncertainty ManagementlDemand managementlSpecified and procrustean standardslE.g., 90% CI 80-125%, in-process blend uniformity tests, . SOPs,.OpportunitieslPAT GuidancelPAT provides the pharmaceutical context for Lean, Six Sigma!l
33、CPG 7132c.08lComparability ProtocollQuality Systems Approach to Pharmaceutical CGMPs lICH Q8, (9?), (10?)PAT GuidancelOpens the door to realize the benefits of connecting lFisher to- Shewart to- DeminglFocus on process understanding leading to control of process end-point!lResearch dataCTD-P2 Sec. Q
34、bDDrug Substanceor APIIntended UseRoute of administrationPatient population.Product DesignDesign Specifications(Customer requirements)P2.1 and 2.6P2.2, 2.4, 2.5, 2.6Drug ProductContainer Closure SystemMicrobiological AttributesCompatibility (e.g., recon)Manufacturing ProcessComponents of drug produc
35、tP2.3Manufacturing Process Development“Design Space” = f (Intended Use * Design * Control)Quality SystemQuality SystemRisk ClassificationProcess Design & ControlSpecificationsProduct DesignIntended UseDesign RequirementsReliabilityTo DeliverDesignRequirementsAssessmentBased on ICH Q8Information/Know
36、ledgeJohn C Berridge, Q8 Rapporteur (EFPIA). FDA Manufacturing Subcommittee, July 2004Knowledge Based Decisions: Require Scientific Generalizeable Knowledge the “SUPAC GAP”SUPAC Change Levels based onprior knowledge from the pharmaceutical community (AAPS SUPACWorkshops) + Research; Yet difficult to
37、 generalize because of multi factorial aspects + lot of subjectivityLimited information in NDA/ANDAPrior knowledge within a companyand a move towards mechanistic Understanding(ICH Q8 is intended to fill this gap)Gap = UncertaintyUncertainty Management: QbD & FlexibilityTime Scale & Mode of ResponseU
38、ncertainty ManagementSystem ModificationQbD FlexibilityOperationalRoot cause investigation, Efficiency, etc. Learning to R&DControl of excipients and other sources of “common cause” variabilityReduce CGMP Risk Classification Continuous Improvement of Quality SystemTacticalOn-line controlDesign for M
39、anufacturability Critical Control Points -Robust process end-pointRegulatory Specifications“Design Space”Real Time Release, Modular ValidationReg. CMC ApprovalStrategicScience of Design Design to reduce “Uncertainty”Sci. & Tech. Integration Continuous Learning & ImprovementRegulatory CommunicationIn
40、tegrate Sci - Enabling Technology Platform “Plug & Play”“Time to Market” + “Production Efficiency” Science of DesignlOften design and development activities are carried out based on experiential knowledge, intuition and rough guidelines difficult to communicate to individuals from different backgrou
41、nds (the “art” argument)lTo learn how to represent designs at a much higher level than the current descriptive “recipe” format (e.g., executed batch records, SOPs) while rigorously documenting key constrainsA Validated SystemlWe have begun updating our current thinking on validation lProcess Validat
42、ion Requirements for Drug Products and Active Pharmaceutical Ingredients Subject to Pre-Market Approval (CPG 7132c.08, Sec 490.100). lRational experimental design and ongoing evaluation of data lAchieving and maintaining a state of control for a process begins at the process development phase and co
43、ntinues throughout the commercial phase of a products life-cyclelRisk-based approaches - inspectional scrutiny; use of advanced technologies, and the role of conformance batches in the product life-cycle. lA focus on three full-scale production batches would fail to recognize the complete story on v
44、alidation. /cder/gmp/gmp2004/GMP_finalreport2004.htm#_Toc84065761Draft Guidance for IndustryQuality Systems Approach to Pharmaceutical Current Good Manufacturing Practice Regulations /cder/guidance/6452dft.docTraditional goalsNon-traditional goals(risk based, flexibility, robustness, scalability, continuous improv
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