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FDA Warning

The FDA has warned the Changzhou SPL Company, Ltd of Changzhou China that its manufacturing processes for Heparin have violated the U.S. Current Good Manufacturing Practice (CGMP).  Referencing the manufacture of active pharmaceutical ingredients (API), the raw material from which Heparin is made, the FDA stated in its warning letter: “These CGMP deviations cause your API to be adulterated within the meaning of section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act (the Act) [21 U.S.C. 351(a)(2)(B)].”

It cited four reasons for this warning:

1. That the processing steps were inadequate to assure removal of impurities:
2. Improper systems for evaluating the suppliers' crude materials;
3. The test methods for testing the product were not sufficient and
4. The equipment being used was not adequate.

We will discuss each of these findings, one at a time.  Of significant concern  is that while the FDA has previously identified a period which began in September of 2007 in terms of impurity of Heparin, the inspections discussed below are not more recent than 2004.  Further, Changzhou SPL Company, Ltd appears not to have established impurity standards, even to this date. The full text of Part One is below.

1. There is no assurance that processing steps used to manufacture heparin sodium, USP are capable of effectively removing impurities.

Our inspection disclosed that your firm lacked an adequate evaluation of the effectiveness of critical processing steps designed to remove impurities, and critical process parameters were not well defined or controlled (observation #1 of the FDA- 483). The inspection also found that an impurity profile has not been established for the heparin sodium API (observation #2 of the FDA-483). In your March 17,2008, response to observation #1, you state that the firm has conducted two successful process validation studies, one in 2002 and one in 2004. However, the validation studies failed to determine whether the process was capable of adequately removing identified and unidentified impurities. Your response does not include data to demonstrate that your process will consistently remove impurities, and your firm continues to lack established impurity limits for the API. It is essential that your firm establish that controls are in place for assuring the consistent performance of the processing steps to remove impurities in order to ensure the identity, quality and purity of the drugs your firm produces.

In your response, your firm acknowledges certain deficiencies in providing evaluations of critical processing steps. Please provide data from validation studies that assess whether the process is capable of consistently removing impurities, and your evaluation of the reliability of the controls used to establish and monitor performance of the processing steps.

In your March 17,2008, response to observation #2, you state that the current testing regimen for heparin sodium is consistent with industry practice reflected in the ICH Q7A Guidance (Laboratory Controls, Testing of Intermediates and APIs) which states that "Impurity profiles are normally not necessary for APIs from herbal or animal tissue origin." Although a full impurity profile may not be necessary as part of the batch-to- batch testing of certain APIs, it is necessary that specifications for impurities be established for the production of all API and that each API batch be tested for conformance to these specifications. The ICH Q7A guidance (Laboratory Controls, General Controls) states that appropriate specifications should be established for APIs, including for control of impurities. Your firm failed to establish appropriate specifications for identified and unidentified impurities for the heparin sodium API. Your firm also failed to perform adequate tests to detect impurities in this API.

In your March 17,2008, response to observation #2 your firm also states that the complexity of the investigation into the recent heparin product recalls demonstrates the difficulty of isolating and identifying impurities in heparin due to the nature of _____  the mixture _____.  However, the mere fact that it is difficult to isolate and identify impurities is insufficient rationale for not establishing appropriate specifications for, and routinely monitoring, impurities during production. In fact, we note that you committed in your response to include an "impurity profile update" in each DMF annual report.

Please note that it is essential for your firm to establish appropriate specifications and adequate testing to ensure the consistent removal of undesirable impurities, including those that are potentially harmful to human health. It is your responsibility to ensure that your API meets the identity, quality and purity characteristics that it is represented to possess.
</blockquote>One wonders how the FDA and Baxter could have been so naive.  Was the quality of a drug given to the very ill, so unimportant that they could have delegated it to foreigners, especially to foreigners to a country so alien to American standards and laws?  Is the greed which causes American corporations so much grief so great that not even the very ill can rely on purity over profits?

The second reason relates to suppliers. As detailed below, it appears that Changzhou SPL Company, Ltd actually went thru a screening process, determined a supplier was unacceptable, and then went ahead and use raw material from that supplier anyway.  How absurd.  This is like a school system screening for sex offenders in its teachers, and then hiring a teacher who was a sex offender, anyway.  Then when they determined they were getting bad product from an unacceptable supplier, they didn't take any corrective action.  This type of attitude goes way beyond negligence.  It is pure reckless disregard of the safety of a product, intended to be put directly in the blood stream of vulnerable human beings.

2. You fail to have adequate systems for evaluating the suppliers of heparin crude materials, and the crude materials themselves, to ensure that these materials are acceptable for use.

Our inspection found (Observation #6 of the FDA-483) that you received lots of material from an unacceptable workshop vendor that were used in your API. In your March 17,2008, response to observation #6, your firm acknowledges inadequacies in the firm's supplier qualification efforts. For example, you state that the firm received and used heparin crude materials from a workshop that had been designated by your firm in a "pre-audit" as "unacceptable" and that was ultimately not approved by your firm. Your firm used this crude material in the production of API lots that were shipped to the United States.
'
Your system for evaluating suppliers of crude heparin material is ineffective to ensure that materials are acceptable for use. As described above, your firm accepted and used heparin crude material from a supplier that you had preliminarily determined was unacceptable. Your system failed to verify that the supplier was acceptable prior to the use of the crude material. Furthermore, after your firm determined that the supplier was not acceptable, your firm failed to take any corrective action with respect to the processed raw material.

All raw materials that are received and used in producing heparin sodium API should be qualified using a system to ensure that raw materials are of acceptable identity, quality and purity before use. It is important to establish appropriate specifications for these materials and to assure your suppliers provide materials meeting these specifications.  These specifications should be approved by the quality unit. Your firm has failed to establish appropriate specifications for your incoming crude materials.

Your vendor qualification program should provide adequate evidence that the manufacturer can consistently provide reliable and safe materials. Suppliers should be monitored and regularly scrutinized to assure ongoing reliability. It is your responsibility to 'ensure that raw materials received are suitable and approved by the quality unit prior to use.' There is nothing in the FDA warning letter that an internal audit should not have demanded far more.  Did no one at SPL and Baxter care, or was this strictly: "I hear nothing, I see nothing?"

The third reason relates to the test methods.  This issue is so critical because it was at this stage that the counterfeit Heparin by-product first slipped thru the supply chain. Changzhou SPL apparently claimed to the FDA that they were not required to implement the important Protein test.  The FDA is disagreeing with this assertion and demanding that "the suitability of all testing methods used should nonetheless be verified under actual conditions of use and documented."  Which of course is the crux of the problem – when getting drug raw materials from China, there will be no way to practically determine the “actual conditions of use.” The full text of Part 3 is below:

3. The test methods performed for heparin sodium USP have not been verified
to ensure suitability under actual conditions of use.

Our inspection found (Observation #4 of the FDA-483) that you have not ensured that certain USP compendial test methods were verified under actual conditions of use. Specifically, you have failed to conduct adequate verification of USP compendial test methods as applied to the production of your firm's API. The data you provided in your March 17,2008, response did not include information about the suitability, accuracy, and detection limits of certain test methods for API, such as the protein test method, used by your firm. There was no indication from these data that your firm's test methods could reliably detect and quantify the presence of proteins in the finished API. In addition, your firm had not conducted suitability testing of the method to determine
the limit of detection for the method. The suitability for use of the protein method for in-process testing was also not established.

In your March 17, 2008, response to the FDA-483, you state that the firm has conducted suitability tests. In addition, you state that the test method was not verified because it was a basic compendial test. You assert that USP <1226>, Verification of Compendial Procedures, states that verification is not required for basic compendial test procedures that are routinely performed unless there is an indication that the compendial procedure is not appropriate for the article under test. In your response, you also state that the laboratory performed basic suitability testing on the heparin sodium API analytical
method in accordance with your standard operating procedures (SOPS).

We disagree with your assertions that verification is not required for those USP test methods used by your firm. In accordance with cGMP, analytical methods should be validated unless the methods used are included in a relevant pharmacopoeia or other recognized standard reference. If the method is a compendial method, verification of the methods should be conducted to determine that the method is suitable for its intended use under actual conditions. We acknowledge that the USP informational chapter <1226> suggests that there is a lesser need for verification for the simplest tests such as loss on drying, residue on ignition, and pH measurements. However, these do not include the test methods at issue, including the protein test method.

Further, the ICH Q7A guidance (Good Manufacturing Practices for Active
Pharmaceutical Ingredients) at section 12.8 "Validation of Analytical Methods" states clearly that "the suitability of all testing methods used should nonetheless be verified under actual conditions of use and documented." Thus, although it is not necessary to validate USP test methods, it is necessary to verify that these USP methods are suitable for the specific conditions of use.  Furthermore, the suitability tests you describe in your
response do not verify that the USP tests are suitable for the specific conditions of use. Please provide data that demonstrate that the compendia1 test method has been verified and determined to be suitable under actual conditions of use.

Delay, deny and defend.  It is the play book for corporate cover-ups.  Drug raw material continues to come from China, while the FDA argues with SPL that they are not following proper procedures.  Meanwhile people are dieing.  Perhaps more important, the quality control issues that could account for these deaths and adverse reactions, may not be as simple as first feared and may in fact expand the time frame of this debacle years prior to the September of 2007 period initially identified by the CDC.

The fourth reason relates to bad equipment. Among the problems with the equipment, the following was cited: unidentified material was sticking to tanks; the surfaces of tanks were scratched, not smooth (making it impossible to keep them completely sanitary); the cleaning methods for these tanks was not qualified; and there were no written procedures for the cleaning of these tanks.  The full text of Part 4 is below:

4. Equipment used to manufacture heparin sodium USP is unsuitable for its
intended use.

Our inspection team observed (Observation #7 of the FDA-483) that equipment tanks
used in the final _______________step were constructed of ___________.
These tanks were identified as clean. However, unidentified material was observed
adhering to the inside surfaces of tanks. It was also observed that surfaces of the tank were scratched, not smooth. We also note that volume markings on the outside of the ______ tanks had tape adhered to it with markings. In addition, the cleaning method used for cleaning these tanks was not qualified.

There should be written procedures for cleaning of equipment. Cleaning procedures should contain sufficient details to enable operators to clean each type of equipment in a reproducible and effective manner. Acceptance criteria should be established and cleaning procedures should be defined and evaluated.

In your response to observation #7, you stated that the ___________tanks
used in the final_______       step will be replaced  with ________.  This will be equipped with clean-in-place system and an automated level reader. Until the new tanks arrive, you state that you will replace the existing ______ tanks with new  _____ tanks and conduct cleaning validation on the new tanks using the manual cleaning methods after each cleaning.

Please provide data that show how the ______ tanks are qualified  and the cleaning procedures are validated.

Your corrective action to replace ______tanks with ___ tanks is
noted. However, it is your responsibility to ensure that equipment used to process
heparin sodium does not meaningfully alter quality of the API  by being additive,
reactive or absorptive.

Once you have installed and qualified the _______ please provide
information on equipment qualification and cleaning validation for these tanks.

What could be more fundamental than conducting a sterile procedure in polished and fully appropriate equipment tanks?  We all probably have some exposure to the type of stainless steel equipment restaurants are required to use. Well that is simply for preparation of food, which passes thru all of the bodies defense systems designed to filter food born toxins.  Would you eat at a restaurant where its kitchen was dirty and its equipment abused?   But Baxter felt it was OK to buy its raw Heparin destined for the human blood stream, without such fundamental concerns?

Next: Contaminated Heparin Can Do More than Kill

For information on the recall, click here:

FDA Information

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Gordon Johnson is the Owner of the Johnson Law Office.

©Gordon S. Johnson, Jr. 2008

To contact us
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The New England Journal of Medicine: MIT Study

FDA: Heparin Warning

Contaminated Heparin Can Do More than Kill

Heparin Lawsuit: Areas of Inquiry

FDA Press Releases

Scott v. Baxter Lawsuit

Reporting Heparin Problems

Understated Adverse Reactions

Baxter Widens Heparin Recall

FDA Intercepting Heparin

FDA Plans For Full-Time Staff in China

Heparin Purity - China Doesn't Seem to Care

Baxter Didn't Know About Absence of Inspection

German Heparin Also Contaminated

Heparin Contaminant Identified

Heparin Recall Timeline

Food and Drug Administration Globalization Act of 2008

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