Sep 2, 2020

Therapeutic Good Administration (TGA) safety advisory on the increased risk of non-melanoma skin cancers for medicines containing hydrochlorothiazide (HCTZ)

Hydrochlorothiazide (HCTZ) is used to treat high blood pressure (hypertension), generally in combination with other blood pressure-lowering medicines like Angiotensin Receptor Blockers (ARBs), Calcium Channel Blockers, Beta Blockers etc.

Recently on 24 August 2020, Australian Health Authority- Therapeutic Good Administration (aka TGA) has issued safety advisory related to increased risk of non-melanoma skin cancer for medicines containing hydrochlorothiazide. The two most common types of non-melanoma skin cancer are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC).

Hydrochlorothiazide is known to cause photosensitivity, and it is thought that this is the reason for an increased risk of developing non-melanoma skin cancer.

The findings of studies using population-level data from Denmark have been supported in a recently published study of data from Australian patients undertaken by the University of New South Wales (UNSW).

Non-Melanoma Skin Cancers

  • Basal Cell Carcinoma (BCC)
    • pearly lump 
    • a scaly, dry area that is shiny and pale or bright pink in colour
  • Squamous Cell Carcinoma (SCC) 
    • a thickened red, scaly spot
    • a rapidly growing lump
    • an area that looks like a sore but has not healed
    • an area that may be tender to touch

Preventability -

Educate patients on the signs and symptoms of non-melanoma skin cancer and advise them to use effective UV protection and to get regular skin checks.

Source: TGA Safety Information Alerts- Hydrochlorothiazide     



    

Apr 27, 2020

A brief summary from MHRA Pharmacovigilance Inspection Metrics Report: April-2018 - March 2019

During the period 01 April 2018 to 31 March 2019, the MHRA’s Good Pharmacovigilance Practice (GPvP) inspectorate conducted 18 inspections of marketing authorisation holders (MAHs). The MHRA has recently published their latest Pharmacovigilance Inspection Metrics for the period from April 2018 to March 2019. 
Since 2009, Pharmacovigilance Inspection Metrics is annually published by MHRA. As per the Pharmacovigilance Inspection Metrics Report, the purpose of these inspections was to determine compliance with EU and respective national pharmacovigilance guidelines and regulations. 
During the period 01 April 2018 to 31 March 2019, the MHRA’s Good Pharmacovigilance Practice (GPvP) inspectorate conducted 18 inspections of marketing authorisation holders (MAHs).

Inspection Summary:

    

Summary of findings:

A total of four critical, 78 major and 38 minor findings were identified during this period.

How findings were categorized –

1.   Critical findings:
 

A.     Risk management: implementation of updated patient information leaflets

B.     Risk management: additional risk minimisation measures

C.     Quality management system: management of known non-compliance in the

D.     pharmacovigilance system, mechanisms for compliance management, written procedures

E.     Provision of information for inspections

 

2.   Major findings

A.     Risk management

B.     Ongoing safety evaluation

C.     Provision of information for supervision by NCAs including via inspection

D.     Quality management system

E.     Management of adverse drug reactions

F.      Collection and collation of adverse drug reactions

G.     Clinical trials pharmacovigilance

H.    Other

The largest the proportion of major findings was composed of non-compliances in relation to risk management, ongoing safety evaluation and provision of information for supervision by NCAs including via inspection.

3. Minor findings

A.     Collection and collation of adverse drug reactions

B.     Collection and collation of adverse drug reactions

C.     Ongoing safety evaluation

D.     Risk management

E.     Management of adverse drug reactions

F.      Clinical trials pharmacovigilance

G.     Provision of information for supervision by NCAs and inspection

The largest the proportion of minor findings was composed of non-compliances in relation to the collection and collation of adverse drug reactions, followed by findings in relation to the quality management system and ongoing safety evaluation.

Specific area of concern -

               A.     Risk management

 There were 24 findings were identified from the risk management plan which was reported from 13 out of 18 inspections.  

   

        B.     Ongoing safety evaluation

There were 22 findings were identified from the risk management plan which was reported from 14 out of 18 inspections. 

 

    C.     Biological medicinal products 

   Major findings were reported for signal management activities as the MAH had not incorporated the specific requirements for biologicals as described in GVP Product- or Population Specific Considerations II: Biological medicinal products (GVP PII) into the signal management activities for these products.

Failures to evaluate signals for biologicals in the context of batch-specific exposure data to identify any changes in product safety and quality over time.

SmPC and PIL of the biological medicine did not include a prominent statement that the name and batch number of the administered product should be clearly recorded in the patient file. Such wording is important to improve the traceability of biological medicines.

Sep 30, 2019

PSUR submission summary in the United Kingdom (UK) about a possible no-deal Brexit

Periodic Safety Update Reports (PSURs):-


A. PSURs submitted after exit day

a. MHRA will continue to accept EU version of PSURs
b. MHRA specific request for information needs to be included in specific annexure
c. MHRA has developed its own submission requirements and develop a list of UK reference dates, but until this happens the EU reference date (EURD) list should be followed and PSURs
d. PSUR submission dates after exit day should be submitted to the UK the same time as submission to the EU
e. The content and format of PSUR will be the same as the EU
f. It is expected the same PSUR will be submitted to the UK and EU
g. PSURs for actives/combinations not currently on the EURD list should be submitted to us according to the usual frequency
h. MHRA submission portal for PSUR will be ready for use before exit day
i. Submission to the portal via a delivery file with the PSUR as part of eCTD
j. A fee of £890 will be payable for the assessment of PSURs for actives/ combinations currently listed on the EURD (or future UK reference date list) but there will be a reduction to £445 for each PSUR where more than one PSUR is involved in the procedure
k. MHRA will publish the outcome of the PSUR assessment procedures
l. No further fees will be payable 

B. PSURs submitted before exit day

a. Where a PSUR has been submitted before exit day but the EU single-assessment procedure has not been concluded, we will assess the PSUR considering any relevant information, including any EU decision and may request further information, where appropriate, in order to conclude the assessment
b. Where the assessment has been concluded but the outcome not implemented on exit day, the MHRA will take the necessary steps to implement the outcome

Sep 22, 2019

Service Level Agreement (SLA) in Pharmacovigilance perspective

Service Level Agreement (SLA) is generally mutual commitment between service provider and a client. In pharmacovigilance industry, pharmacovigilance service provider and pharmaceutical company (client) come together in agreement for various PV activities. This could be single PV activity or End to End PV activities on behalf of client.

Pharmacovigilance SLA is not differ from another domain like IT industry where it prevails since long. It contains following common components of any SLA like –

·         Nature and scope of work
o   Region specific (USA, EU or ROW) or Worldwide
o   Single PV activity (ICSR processing  or literature review, etc.) or End to End PV Activity (ICSR processing, Literature Review, Aggregate Reports (PSUR/ADCO/PADER), Risk Management Plan (RMP), Signal Detection, etc.)  
o   ICSR Processing - All type of ICSR processing (Regulatory, Literature, Spontaneous) or specialized ICSR processing i.e. clinical trial or litigation, processing and case submission timelines
o   Literature Review – Literature review from global databases like Embase, PubMed or local journal review or both local and global review, preparation and maintenance of search strings
o   Aggregate Reports – Aggregate Report schedule preparation and maintenance, Ad-hoc reports, Nature of report format (PSUR, PBRER or regional specific like ANVISA, CDSCO, COFEPRIS, etc.), timeline related to finalization of draft and submission
o   Risk Management Plan (RMP) – New RMP or Maintenance of RMP, preparation and management of additional risk minimization measures (ARMM) or additional pharmacovigilance activities like non-clinical studies, clinical trials or non-interventional studies.

·         Work management procedure
o   SOP to be followed (Client SOP or Service Provider SOP)
o   Work on inhouse client database or other commercially available database i.e. ARISg, ARGUS
o   Timelines to be followed for each activity

·         Quality parameters
o   Quality scoring for ICSR, Literature Review, Aggregate Reports, RMP and Signal detection activities

·         Compliance check
o   Regulatory compliance check
§  ICSR submission
§  Aggregate report submission
o   SLA compliance check
o   SDEA compliance

·         Business Continuity Plan (BCP)
o   Business Continuity Plan (BCP) details in case of natural disaster or man-made disaster

·         Audits & Inspection
o   Internal audit and frequency
o   Audit of each other
o   Audit of business partners and affiliates
o   Inspection handling plan, if any specific condition.
·         Penalty
o   Financial penalty in case of quality and quantity deviation from SLA

·         Termination clauses
o   Terms and conditions where termination of SLA to be impose like significant non-conformity in PV process
o   Critical regulatory observation due significant defect in service provider’s procedure

One should remember that SLA is a dynamic document and can be drafted and modified based upon the business need of pharmacovigilance service provider and pharmaceutical company (aka client).

Though dynamism present in SLA, each points of SLA should be thoroughly reviewed by each party who enters in to agreement.


Sep 14, 2019

Article 31 -EMA to review ranitidine medicines following detection of NDMA

     

Under Article 31 of Directive 2001/80/EC, the review of ranitidine containing medicines was initiated at the request to the European Commission. This review will be carried out by the Committee for Medicinal Products for Human Use (CHMP). The CHMP opinion will then be forwarded to the European Commission, which will issue a final legally binding decision applicable in all EU Member States.

NDMA is classified as a probable human carcinogen (a substance that could cause cancer) on the basis of animal studies. It is present in some foods and in water supplies but is not expected to cause harm when ingested in very low levels. In 2018, NDMA and similar compounds known as nitrosamines were found in several blood pressure medicines known as ‘sartans’ leading to recalls.

EMA is evaluating the data to assess whether patients using ranitidine are at any risk from NDMA and will provide information about this as soon as it is available.

Source:




Dec 16, 2018

Pharmacovigilance Abbreviations / Acronyms


Term Description
ADCO Addendum to Clinical Overview
ADRs Adverse Drug Reactions
AE Adverse Event
AERS Adverse Event Reporting System
ANDA Abbreviated New Drug Application
ATC Anatomical Therapeutic Chemical  (in Anatomical Therapeutic 
Chemical
Classification System)
ATMP Advanced Therapy Medicinal Product
CAPA Corrective And Preventive Action
CCDS Company Core Data Sheet
CCSI Company Core Safety Information
CHMP Committee for Medicinal Products for Human Use
CIOMS Council for International Organizations of Medical Sciences
CMDh Coordination Group for Mutual Recognition and Decentralised
 Procedures - Human
CMS Concerned Member State
CRO Contract Research Organization
CT Clinical Trial
CTD Common Technical Document
DCP Decentralised Procedure
DDD Defined Daily Dose
DHPC Direct healthcare professional communication
DIBD Development international birth date
DLP Data Lock Point
DME Designated Medical Event
DSUR Development safety update report
DUS Drug Utilization Study
EMA European Medicine Agency
EU European Union
EURD European Union Reference Date
EV Eudravigilance
FDA Food and Drug Administration
GCP Good Clinical Practice
GMP Good Manufacturing Practice
GVP Good Pharmacovigilance Practice
IB Investigator´s Brochure
IBD International birth date
ICH  International Council for Harmonisation of Technical Requirements for 
Pharmaceuticals for Human Use
ICSRs Individual Case Safety Reports
IME Important Medical Event
IND Investigational New Drug
INN International Non-proprietary Name
LBI Late Breaking Information
MA Marketing Authorisation
MAH Marketing Authorisation Holder
MedDRA Medical Dictionary for Regulatory Activities
MHRA Medicines and Healthcare Products Regulatory Agency
MRP Mutual Recognition Procedure
NAP National Authorised Product
NCA National Competent Authority
NDA New Drug Application
PASS Post-authorisation safety study
PBRER Periodic Benefit-Risk Evaluation Report
PI Product Information
PIL Product Information Leaflet
PL Package Leaflet
PRAC Pharmacovigilance Risk Assessment Committee
PSMF Pharmacovigilance system master file
PSUR Periodic Safety Update Report
PSUSA Periodic Safety Update Single Assessment
PT Preferred Term
PTD Patient Treatment Days
PTY Patient Treatment Years
PV Pharmacovigilance
QPPV Qulified Person responsible for Pharmacovigilance
REMS Risk Evaluation & Mitigation Strategies
RMM Risk Minimisation Measure
RMP Risk Management Plan
RMS Reference Member State
RSI Referenced Safety Information
SAE Serious Adverse Event
SAR Serious Adverse Reaction
SDEA Safety Data Exchange Agreement
SmPC Summary of Product Characteristics
SMQ Standardized MedDRA Query
SOC System Organ Class
SOP Standard Operating Procedure
TSSS Tabular Summary of Safety Signals
WHO World Health Organization 
XEVIMPD Extended EudraVigilance Investigational Medicinal Product Dictionary
XEVPRM eXtended EudraVvigilance Product Report Message

Dec 4, 2018

Privacy Policy


Privacy Policy

Effective date: December 04, 2018

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