COMBINATION PRODUCTS - FDA REGULATION AND DESIGN CONTROLS
Prior to 1990, FDA’s review of combination products was ad hoc and consistency in its approach across such products was elusive.
§503(g) of the FD&C Act, created by Safe Medical Devices Act of 1990 (SMDA), allows for regulation of combination products in a rational fashion.
The Medical Device User Fee and Modernization Act of 2002 mandated that FDA establish the Office of Combination Products (OCP).
● Sits within the Office of the Commissioner
● Reporting obligations designed to ensure efficient reviews and transparent standards for all combination products
● OCP has authority to determine which FDA Center has jurisdiction over a combination product
● OCP also has authority to determine whether singleentity products should be regulated as drugs, biologics, or devices based on product’s primary intended effect.
DESIGN CONTROL (21 CFR 820.30) for COMBINATIONS PRODUCTS
Design control for combination product has the following purposes:
Confirm that there are no negative interactions between constituent parts, and ensure that their combined use results in a combination product that is safe and effective and performs as expected.
Apply to activities during product development as well as to postmarket changes to the design or manufacturing process
Extent and complexity of the design controls process and associated documentation will vary based on the product
–For example, consider a drug product already legally marketed with the same formulation, route of administration and intended use when marketed as part of a combination product that also incorporates a delivery device. Design controls would begin when the delivery device configuration is judged to be feasible and appropriate to develop.
DESIGN CONTROL Apply to the whole combination product, not just the device constituent part
For example, consider a drug in an automated injector. Design controls:
–Apply to the automated injector (why was the injector designed this way – design inputs might include need for metered delivery of liquids, material selection for strength and biocompatibility)
–Apply to the combination product (why was this injector selected as appropriate for this drug product – design inputs might include force to activate for intended patient population, ability to dispense drug of a certain viscosity)
•May also be appropriate to apply design controls to drug constituent part, for example, if newly formulated specifically for the combination
Design Control, General (21 CFR 820.30)
–Explain how you utilized the design control process to develop the combination product and provide a description of your design control procedures.
–Address how requirements for design and development planning, design input, design output, design review, design verification, design validation, design transfer, design changes, and design history file are being met.
Combination products are Governed by Primary Mode of Action (PMOA) – 21 CFR 3.2m
Primary mode of action is the therapeutic action that is expected to make the greatest contribution to the overall intended therapeutic effect of the combination product.
Whichever product has the greatest therapeutic effect, the center that the product is regulated in will have jurisdiction
The term combination product includes:
(1) A product comprised of two or more regulated components, i.e., drug/device, biologic/device, drug/biologic, or drug/device/biologic, that are physically, chemically, or otherwise combined or mixed and produced as a single entity;
(2) Two or more separate products packaged together in a single package or as a unit and comprised of drug and device products, device and biological products, or biological and drug products;
(3) A drug, device, or biological product packaged separately that according to its investigational plan or proposed labeling is intended for use only with an approved individually specified drug, device, or biological product where both are required to achieve the intended use, indication, or effect and where upon approval of the proposed product the labeling of the approved product would need to be changed, e.g., to reflect a change in intended use, dosage form, strength, route of administration, or significant change in dose; or
(4) Any investigational drug, device, or biological product packaged separately that according to its proposed labeling is for use only with another individually specified investigational drug, device, or biological product where both are required to achieve the intended use, indication, or effect.
In order to confirm if a product is a combination product a Request for Designation (RFD) might be needed:
The request is submitted to the Office of Combination Products (OCP)
– Each center will review the RFD and write a short memo agreeing or disagreeing with the sponsor
– OCP will make final determination
FDA has 60 days to make the decision
Combination products are assigned to a Center based on Primary Mode of Action (PMOA) – FDCA 503(g) and 21 CFR 3.2(m)
–Drug PMOA = CDER
–Device PMOA = CDRH
–Biologic PMOA = CDER (e.g., therapeutic protein) or CBER (e.g., vaccine)
EXAMPLE: PRE-FILLED SYRINGES
In 2005 the worldwide market for pre-filled syringe was ~ 1 billion units in 2010 that number has increased to over 2 billion units
The growth of the market is anywhere from 12.5% to 20% yearly
Ease of administration
Easier for patients to use at home or in emergency situations
Prefilled dosage reduces medication errors
Elimination of vial overfill
Greater assurance of sterility
Technical challenges for developing and manufacturing
Leachable and Extractable
Greater cost of development
cGMP Rule for Combination Products (21 CFR part 4)
Existing CGMP regulations established minimum requirements to assure the safety, identity, strength, quality and purity, as applicable, of drugs, devices, biological products, and HCT/Ps.
Combination products rule (final rule issued on January 22, 2013) addresses how to satisfy these CGMP requirements to ensure manufacture of a safe and effective product while avoiding redundant regulatory obligations.
Co-packaged and single-entity combination products manufacturers that are subject to both the drug CGMPs and device QS regulation may:
–Implement either the drug CGMPs (at 21 CFR 210 and 211) or device quality system regulation (at 21 CFR 820) rather than both,
–IF they also implement specified provisions of the other of these two sets of CGMP requirements.
•The CGMPs for biological products under parts 600 through 680 and for HCT/Ps under part 1271 also must be met if applicable.
Specified Requirements from QS Regulation
•21 CFR 820.20 – Management responsibility
•21 CFR 820.30 – Design controls
•21 CFR 820.50 – Purchasing controls
•21 CFR 820.100 – Corrective and preventive action
•21 CFR 820.170 – Installation (as applicable)
•21 CFR 820.200 – Servicing (as applicable)
Specified Requirements from Drug CGMPs
•21 CFR 211.84 – Testing and approval or rejection of components, drug product containers, and closures.
•21 CFR 211.103 – Calculation of yield
•21 CFR 211.132 – Tamper-evident packaging for over-the- counter (OTC) human drug products
•21 CFR 211.137 – Expiration dating
•21 CFR 211.165 – Testing and release for distribution
•21 CFR 211.166 – Stability testing
•21 CFR 211.167 – Special testing requirements
•21 CFR 211.170 – Reserve samples
Current Good Manufacturing Practice Requirements for Combination Products, January 2017
Selection of CGMP operating system:
Combination product manufacturers can choose whichever they prefer among:
•211-based streamlined approach
•820-streamlined approach, or
•non-streamlined approach (comply with both sets of regulations)
PMOA does not determine or dictate choice
Human Factor Studies
Demonstrates and provides evidence that a medical device, as designed, can be used safely
– By people who are representative of the intended users
– Under expected use conditions
– For essential and critical (high‐risk) tasks
Changing regulatory landscape
– These are now required instead of “nice to do”
– Relying on controlled clinical studies will not substitute for Human Factor Studies
Human Factor Premarket Evaluation Team is part of CDRH Office of Device Evaluation
– Collaborates with CDER’s Division of Medication Errors Prevention and Analysis
Human Factor Studies Guidance
• Guidance for Industry and FDA Staff: Medical Device Use‐Safety: Incorporating Human Factors Engineering into Risk Management (2000)
• Draft Guidance for Industry and FDA Staff: Applying Human Factors and Usability Engineering to Optimize Medical Device Design (2011)
Guidance for Industry
• Guidance for Industry and FDA Staff – Early Development Considerations for Innovative Combination Products (2006)
• FDA Guidance: Container Closure Systems for Packaging Human Drugs and Biologics (May 1999)
• DRAFT Guidance for Industry: Technical Considerations for Pen, Jet, and Related Injectors Intended for Use with Drugs and Biological Products (2009)
•Final CGMP rule and guidance available on Office of Combination Products webpage (https://www.fda.gov/CombinationProducts/default.htm)
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