Thumbnail image for Thumbnail image for Thumbnail image for FDA logo.jpgOn December 12, FDA held a meeting of its Drug Safety and Risk Management (“DSaRM”) Advisory Committee regarding development of a framework for addressing what risk evaluation and mitigation strategies (“REMS”) are appropriate for teratogenic drugs. Teratogenic drugs are drugs that may cause birth defects for developing fetuses. The Food and Drug Administration Amendments Act (“FDAAA”) requires FDA to bring to the DSaRM Advisory Committee for review at least one drug with Elements to Assure Safe Use (“ETASU”), and this was the topic chosen for 2012.

According to the opening remarks, FDA has recognized that over the years, its approach regarding the development of risk management programs for teratogenic drugs “appears to be inconsistent.” The DSaRM Advisory Committee began with FDA presentations, continued with stakeholder presentations from industry, prescribers, patients, and then ended with the full committee’s discussion of the questions to address:

FDA’s proposed framework would take as intrinsic factors: (1) scientific evidence of teratogenicity (biological plausibility, non-clinical data, and human data) and (2) drug-product related factors (characteristic of the drug product, efficacy, and safety profile). The proposed extrinsic factors to consider in the framework are (1) drug product-related factors (actual drug use), (2) clinical-use related factors (characteristics of medical condition, patient population profile, and context of care), (3) regulatory factors (regulatory precedent, previous REMS experience, availability of new REMS tools), and (4) anticipated consequences of REMS.
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Thumbnail image for supremecourt.pngOn December 7, 2012, the U.S. Supreme Court granted the Federal Trade Commission’s (“FTC’s”) certiorari petition and will address the question of whether settlements of Hatch-Waxman pharmaceutical patent litigation that include so-called “reverse-payments” are per se lawful unless the underlying patent litigation was a sham or the patent was obtained by fraud or, instead, are presumptively anticompetitive and unlawful.

As previously reported here, the FTC has repeatedly attacked reverse payment agreements between branded and generic pharmaceutical companies, alleging that such settlements–which the FTC also refers to as “pay-for-delay”–are a violation of antitrust laws. There is currently a split in the circuits regarding the legality of these agreements. In the decision now being reviewed by the Supreme Court, FTC v. Watson Pharmaceuticals, Inc. (involving the brand-name drug AndroGel), the Eleventh Circuit held that such settlements are legal so long as they fall within the “scope of the patent” and there is not evidence of sham litigation or fraud in obtaining the patent. Other courts have arrived at similar conclusions, including the Second Circuit (In re Tamoxifen Citrate Antitrust Litigation) and the Federal Circuit (In re Ciprofloxacin Hydrochloride Antitrust Litigation). In contrast, the Third Circuit’s recent In re K-Dur Antitrust Litigation decision held that these agreements create a rebuttable presumption that the settlement is anticompetitive. Both Merck and Upsher-Smith filed petitions to the Supreme Court to review the Third Circuit’s K-Dur decision; however, the Court has not yet announced whether it will grant those requests.

In AndroGel, the FTC asks the Supreme Court to adopt the Third Circuit’s approach. The FTC argues that the “scope-of-the-patent approach in general, and the decision of the [Eleventh Circuit] in particular, reflect a misapplication of federal competition law.” Thus, the FTC advocates for the Third Circuit’s “approach, [in which] the restraints embodied in reverse-payment agreements are presumed to be anticompetitive, and the antitrust defendants–who, after all, have settled litigation against each other by agreeing not to compete–bear the burden of advancing some countervailing procompetitive virtue.” (Internal quotation omitted).
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Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for dna.jpgFLH Partner Brian J. Malkin’s chapter in the 2013 Edition of Recent Developments in Food and Drug Law published by Aspatore / Thomas Reuters entitled: “Challenges to the Development of a Biosimilars Industry in the United States” is now available as a PDF copy. The chapter takes a hard look at the new biosimilars pathway created by the Biologics Price Competition and Innovation Act of 2009 (“the Biosimilars Act”) and attempts to answer the question why no applicant appears to have filed a biosimilars application with FDA more than two and a half years after the Biosimilars Act was enacted. Some of the topics addressed include:

  • The Impact of the Biosimilars Act and Approval Issues for Biosimilars
  • Biological Innovator Challenges to Biosimilars
  • Interchangeability Issues
  • Biosimilar Manufacturing Issues
  • Patent Litigation and Confidentiality Issues
  • The FDA’s General Approach Based on Its New Guidances
  • The FDA’s Inverted Pyramid Approach
  • Enforcement/Pharmacovigilance Issues
  • Product Shortages, Liability, and Advertising Issues
  • Key Takeaways

Biosimilars are defined under the Biosimilars Act as “highly similar” to an innovator’s biological product already approved by FDA. Biosimilars are also known around the world as follow-on biologics or biogenerics. Biosimilars are already approved in Europe and other countries and are clearly feasible given current technology and analytical methods. Ultimately, as there are less small molecule targets for generic companies to pursue over time, innovator and generic drug companies alike will be drawn to design, test, and file applications for biosimilars. FDA appears to have hoped that the new biosimilars pathway would create partnerships to form standards for analytic testing of biosimilars. Instead, the high cost and technical skills to reverse engineer the innovator’s product and manufacture biosimilars has driven innovator and generic drug companies to form unique partnerships to develop proprietary analytical methods, including methods with either trade secret or patent protection.
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On November 19, 2012, FDA issued a draft Guidance entitled, “Electronic Source Data in Clinical Investigations.” The Guidance recommends various procedures relating to the electronic capture of source data in clinical investigations in an effort to reduce errors, to provide real-time data access, and to maintain accurate records for inspection by study investigators and FDA.

Clinical Data Guidance

Source data includes all information found in original clinical investigation documents (or certified copies of original documents) and this information is used for the reconstruction and evaluation of clinical trials. Accurate transcription of source data is extremely important, and the Guidance discusses methods of identifying source data, creating easy identification methods for auditing, capturing source data, and reviewing and retaining the data. The Guidance discusses the identification of source data originators, the capture of source data, the creation of data element identifiers, and the investigator’s duty to review and retain electronic data.

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Written by Julie E. Kurzrok

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The Guidance focuses on data entered into electronic case report forms (“eCRFs”). An eCRF is an electronic record, created for all clinical study subjects, that is reported to the study sponsor as per the study protocol. eCRFs contain data elements that are entered into the system by data originators such as investigators, medical devices, and clinical investigation subjects. Data elements are the smallest units of observation made during a clinical investigation and they include observations such as weight, birth date, race, or body temperature. The Guidance recommends that each sponsor and investigator maintain a list of data originators (e.g., people and devices) authorized to enter data elements for each study protocol. These lists limit access to data entry by creating unique user names, passwords, and identifications and by setting time periods for when each data originator can enter data.
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supremecourt.pngLast Friday, the Supreme Court decided to consider the question presented by generic drug manufacturer Mutual Pharmaceutical Co. (“Mutual”) whether federal law “preempt[s] state law design-defect claims targeting generic pharmaceutical products because the conceded conflict between such claims and the federal law governing generic pharmaceutical design allegedly can be avoided if the makers of generic pharmaceuticals simply stop making their products.” This issue emerges from the First Circuit’s affirmation of a $21 million verdict against Mutual in a state law products liability action.

This case originated in the District of New Hampshire, where Karen Bartlett filed suit against Mutual alleging that its anti-inflammatory drug sulindac (reference listed drug: Clinoril®) is “unreasonably dangerous” under New Hampshire products liability law. Bartlett had a severe allergic reaction to the product resulting in the loss of more than 60% of her outer skin layer. The New Hampshire Supreme Court has adopted § 402A of the Restatement (Second) of Torts (“RS (2nd) § 402A”), which imposes strict liability for selling “any product in a defective condition unreasonably dangerous to the user or consumer.” Under New Hampshire law, this requires a showing that “the magnitude of the danger outweighs the utility of the product,” regardless of whether there is a safer alternative design. Vautour v. Body Masters Sports Indus., Inc., 784 A.2d 1178, 1182-83 (N.H. 2001).

At issue is whether the Drug Price Competition and Patent Term Restoration Act of 1984 (“Hatch-Waxman Amendments”) and corresponding FDA regulations preempt design defect claims that are based in state tort law directed towards generic pharmaceutical products, such as Bartlett’s New Hampshire claim. The relevant sections of the Hatch-Waxman Amendments require a generic drug manufacturer to show that its product (1) has the same “route of administration,” “dosage form,” and “strength” as, and (2) is “bioequivalent” to, the brand name drug that its application references, in order to gain FDA approval. See 21 U.S.C. § 355(j)(2)(A). Mutual argues that these “sameness” requirements preclude generic manufacturers from materially altering the design of their products, and that a generic’s ability to comply with both federal and state law by withdrawing its product from the market (“the stop selling theory”) is not a valid rationale for finding non-preemption.
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Thumbnail image for Thumbnail image for FDA logo.jpgOn November 30, Endo Pharmaceuticals Inc. (“Endo”) sued FDA, seeking declaratory and injunctive relief for FDA to determine that Endo’s original Opana® ER (oxymorphone hydrochloride extended-release) was withdrawn from sale for safety reasons, because the product is inherently vulnerable to misuse and abuse. The current crush-resistant formulation of Opana® ER, which goes by the same name, was approved in December 2011, and Endo began marketing this formulation, which Endo called “Opana® ER CRF” in its Complaint to distinguish it from its earlier-marketed formulation. For consistency and clarity, this blog will use the same nomenclature. Endo’s complaint states that Opana® ER CRF is bioequivalent to Opana® ER but embeds the active ingredient in a polyethylene oxide matrix to make the pill harder and less crushable, as well as more difficult to liquefy and inject.

According to the Complaint, Endo discontinued Opana® ER on May 31, 2012, because it believed Opana® ER CRF to be less susceptible to misuse and abuse. Endo believes that FDA was required to make a determination whether Opana® ER was withdrawn from the market “promptly” (emphasis in original), because, by this time, FDA had already approved two generic versions to be marketed by Impax Laboratories, Inc. (“Impax”) and Actavis South Atlantic LLC (“Actavis”). Endo’s Complaint further explains that when FDA failed to make a prompt determination. it filed a Citizen Petition, requesting that FDA make the determination that Opana® ER was discontinued for reasons of safety and cannot be a reference listed drug and that only Opana® ER CRF can have generic versions, which must be similarly crush resistant. Endo further filed a second Citizen Petition and supplemented its original Citizen Petition. The second Citizen Petition sought to classify Opana® ER CRF as a separate dosage form to Opana® ER and require generic versions of Opana® ER CRF to be similarly crush-resistant. The supplement to its original petition included data suggesting that Opana® ER CRF resulted in less reports of abuse and diversion, among other things, which is also described in the Complaint.

Endo’s Complaint asserts that Opana® ER was safe and effective when used according to its FDA-approved labeling, but it became evident over time that it posed risks to humans. First, when crushed into a fine powder and inhaled or otherwise ingested, the active ingredient could be released very quickly, risking overdose. Opana® ER could also be chewed, either inadvertently or intentionally, also causing an accelerated release of its active ingredient. Approximately one year after introduction of Opana® ER into the market, Endo decided to develop a crush-resistant formulation with a German partner to reduce these potentials for abuse and misuse, the Complaint recounts..
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DNA2.jpgOn November 30, 2012, the U.S. Supreme Court decided to consider the question of whether human genes are patentable subject matter. The American Civil Liberties Union (“ACLU”), representing petitioner Association for Molecular Pathology, challenged Myriad Genetics’ patents claiming “isolated” DNA molecules. The ACLU’s position is that such patents improperly claim laws of nature and, thus, are not patentable. The Federal Circuit Court of Appeals disagreed, however, determining that Myriad’s claims to isolated DNA molecules are patent-eligible. Now, the Supreme Court may have the final word.

At issue is the patentability of human genes, i.e., DNA. Natural DNA exists in the human body as one of forty-six large, contiguous DNA molecules. In contrast, isolated DNA is a free-standing portion of a larger, natural DNA molecule. Isolated DNA has been cleaved (i.e., had covalent bonds in its backbone chemically severed) or synthesized to consist of just a fraction of a naturally occurring DNA molecule. The Federal Circuit reasoned that isolated DNA has a “markedly different chemical structure compared to native DNA.” This is because isolated DNA results from human intervention to cleave or synthesize a discrete portion of a native chromosomal DNA, which imparts a distinctive chemical identity on that isolated DNA. Thus, the Federal Circuit decided that the “claimed isolated DNA molecules are distinct from their natural existence as portions of their larger entities” and are patent-eligible subject matter.

In its Supreme Court petition, the ACLU argued that patents on isolated DNA improperly claim products and laws of nature because isolated DNA is defined according to a naturally-occurring functional characteristic, namely coding for a naturally-occurring polypeptide. The ACLU alleges that isolated DNA does not have markedly different characteristics from DNA found in nature because both are DNA, their structures are not markedly different, the protein coded by each is the same, and their use in storing and transmitting information about a person’s heredity is identical. Based on this, the ACLU believes that isolated DNA is not patentable subject matter.
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Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for Thumbnail image for aci_header_banner.gifOn November 28-29, 2012, the American Conference Institute (“ACI”) held in Boston, Massachusetts, its inaugural conference: “Orphan Drugs and Rare Diseases: Maximizing Opportunities and Overcoming Stumbling Blocks in the Designation and Development Process“. The Conference was well attended and featured a pre-conference boot camp on the Orphan Drug Act as well as a post-conference master class on overcoming clinical trial challenges and proving the safety and efficacy for orphan drugs.

One highlight of the conference was Timothy R. Cote, M.D., M.P.H., Principal, Cote Orphan Consulting (Director of FDA’s Office of Orphan Drug Products Development (2007-2011)). Cote provided a back drop for how the Orphan Drug Act came about, emphasizing that while for each individual disease the afflicted patient population is small, when all of the orphan diseases are pooled together, actually the population is sizable and a rapidly-growing area. Dr. Cote described orphan drug development as a “high touch” field where the need for new therapies are often driven by families with afflicted members and typical “big pharma” strategies are less effective. Calling it “scrappy not crappy” science, Cote explained that unlike big pharma projects that involve thousands of patients and hundreds of millions of dollars to develop new therapies, orphan drugs often can be developed for under $10 million–in part because there are so few patients who are candidates for clinical studies and treatment. Cote said while approximately 60% of orphan drug designation requests are approved, the success stories are the products that obtain new drug application approval and win the highly-coveted seven-year exclusivity for the first orphan indication (“a horse race”). More importantly, the basic research required to find cures for orphan drugs often provides valuable medical knowledge in how our bodies work, which he called “pharma karma.”

Another highlight of the conference was Christopher-Paul Milne, D.V.M., M.P.H., J.D., Associate Director, Tufts Center for the Study of Drug Development, Tufts University. Milne said that while the initial orphan market was thought of as relatively small, there are often higher rates of return than more “mainstream” diseases, particularly for diseases with more options for treatment. One phenomena that he tracked was the “ultra orphans,” where the orphan population for treatment, which is restricted to less than 200,000 when applied for orphan drug designation in the United States, can get closer to the 200,000 number, and sometimes can expand to more mainstream numbers, if the therapy is later found to have non-orphan treatment options. While certain disease areas such as various cancers have good orphan drug representation, other therapeutic areas, such as neurology, have had less success stories, Milne reported. Milne added that amidst the tension of competition versus collaboration, it has often been important for unlikely partners to work together, with the help and motivation of patient groups, such as the National Organization for Rare Diseases (“NORD”).
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Frommer Lawrence & Haug LLP Partner Brian J. Malkin will present on “Mastering the Intricacies of the Orphan Drug Designation Process: A Step-by-Step Guide to Navigating the Pathway” on November 29, 2012. Mr. Malkin’s presentation is part of ACI’s inaugural conference, “Orphan Drugs and Rare Diseases: Maximizing Opportunities and Overcoming Stumbling Blocks in the Designation and Development Process” in Boston, Massachusetts from November 28-29, 2012. Mr. Malkin’s presentation will include how to assess whether a compound/indication qualifies for orphan drug designation, what benefits may be achieved by obtaining an orphan drug designation prior to product/indication approval, and how to respond to a rejection for an orphan drug designation request, including demonstrating clinical superiority. For more information, see here.

FDA logo.jpgOn November 13, 2012, Cumberland Pharmaceuticals Inc. (“Cumberland”) sued FDA, the Commissioner of Food and Drugs, and the Secretary of Health and Human Services in federal district court for the District of Columbia for denying Cumberland’s Citizen Petition and approving InnoPharma, Inc.’s (“InnoPharma’s”) abbreviated new drug application (“ANDA”) for an acetylcysteine injection. Cumberland asserted that the denial of the Citizen Petition and the approval of InnoPharma’s ANDA were “arbitrary, capricious, and abuse of discretion, and not in accordance with law, all in violation of the APA [Administrative Procedure Act]” and “violated the Federal Food, Drug, and Cosmetic Act (‘FDCA’),” according to its complaint.

Cumberland holds the approved new drug application (“NDA”) for the reference listed drug (“RLD”), Acetadote®, indicated to prevent or lessen hepatic injury in adults and children when administered intravenously within 8 to 10 hours after ingestion of a potentially hepatotoxic quantity of acetaminophen. The original formulation of Acetadote® contained edentate disodium (“EDTA”) as a chelating agent that was believed to be necessary for the stability of the product. FDA approved Acetadote® in January of 2004, but conditioned its approval on Cumberland’s agreement to perform post-approval studies to evaluate whether EDTA could be removed from the formulation in view of safety concerns. EDTA has been associated with a significant drop in serum calcium levels, which may result in fatality, hypokalemia, hypomagnesaemia, or hypotension as well as allergic reactions.

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Written by Shelly Fujikawa, Ph.D.

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As a result, Cumberland developed and obtained approval in January 2011 from FDA for a new EDTA-free formulation after, according to the complaint, surprisingly demonstrating that EDTA was unnecessary to maintain drug stability. Cumberland then withdrew the EDTA-containing formulation from the market.
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