FDA Inspection Shutdown Increasingly Delays Approvals

In March 2020, FDA halted most field inspections of biopharmaceutical facilities and clinical research sites due to travel and contact restrictions imposed by the COVID-19 pandemic. Agency officials said they would rely more on the past compliance history of a production site, quality control documents requested from the manufacturer, and inspection reports and other information from other trusted regulatory authorities to determine whether an inspection was needed to approve a new or changed product from that facility. The agency also has weighed the viability of conducting virtual inspections, with limited success. More commonly, FDA has expanded product inspections in its labs or import control facilities to assure quality.

The inspection hiatus did not delay most new product approvals for much of 2020, as many drugs came from facilities that had been recently inspected or had a sufficiently strong compliance record to support a regulatory decision. But now inspection issues are delaying more new product approvals. In December 2020, FDA postponed approval of an important new cholesterol therapy, inclisiran, from Novartis because of concerns about the European contract manufacturer producing the new product. FDA sent Novartis a Complete Response Letter (CRL) on Dec. 18, 2020, explaining that it could not approve the drug by its user fee action date due to “unresolved facility inspection-related conditions” that could not be overcome due to foreign travel restrictions (1).

FDA also delayed approval in November 2020 of a chimeric antigen receptor T cell (CAR-T) liso-cel therapy to treat adults with large B-cell lymphoma from Bristol Myers Squibb (BMS) when travel restrictions prevented an inspection of the contract manufacturer’s (Lonza) production facility in Texas (2). Also in November, Revance Therapeutics acknowledged it would not be able to market a new injectable anti-wrinkle skin treatment because FDA was unable to inspect the company’s California manufacturing facility on time (3). FDA similarly delayed the review of Spectrum’s neutropenia drug, Rolontis, which the company licensed from a South Korean firm that FDA was unable to inspect (4). And Alkermes said it received a CRL for its new treatment for schizophrenia and bipolar disorder when a remote records review done in place of a preapproval inspection found issues related to a tablet-coating process at its Ohio facility (5). Alkermes resubmitted its application in late December and now expects an approval decision by mid-2021.

Although agency officials indicated in July 2020 they might start conducting some critical domestic site visits, few occurred as infection rates accelerated again. FDA issued guidance in August addressing a range of questions related to the inspection situation to help manufacturers cope (6).

The agency further acknowledged the growing difficulties created by the inspection hiatus in guidance posted Dec. 21, 2020 to clarify how quickly (or slowly) it would act following a manufacturer’s response to a CRL when a facility assessment remains necessary before FDA can approve an original drug application or important supplement (7). The advisory states that reviews of resubmitted applications for products that require an inspection may take four or six months or more.

Little support for remote methods

The December guidance notes the difficulties in conducting necessary facility assessments and acknowledges that it often is not feasible to rely on alternative tools, such as records requests or review of inspection reports from trusted foreign regulators, and that such strategies “can be as resource intensive as inspections” (7). Analysts note, moreover, that some FDA requests for GMP-related documents have been extensive, involving line listings, lab reports, and adverse event notices, requiring multiple data submissions that raise concerns about data security.

The agency’s distrust of alternative oversight methods applies particularly to production sites with past compliance problems, observed Don Ashley, director of Office of Compliance at the Center for Drug Evaluation and Research (CDER). He reported that the agency is doing more product sampling this past year, relative to site inspections, in weighing the need to issue warning letters or import alerts, at a December 2020 FDA enforcement conference sponsored by the Food & Drug Law Institute (FDLI).

Ashley further expressed skepticism about utilizing alternative oversight strategies for follow-up inspections of companies looking to remedy issues raised in earlier Official Action Indicated (OAI) citations. He noted that most follow-up inspections of such sites in prior years revealed that earlier problems had not been corrected, giving him “reason for pause” in relying closely on company reports on resolving serious issues.

An interesting point is that an FDA prior-approval inspection is not required to authorize an Emergency Use Authorization (EUA) for a drug or biologic. FDA officials emphasized that they were not cutting corners in moving quickly to approve EUAs for critical vaccines to counter COVID-19 based on accelerated clinical testing, and that companies had to submit full information on manufacturing processes and to establish quality control operations. But actual site inspections are not required until the manufacturer files a biologics licensing application for its vaccine, although enforcement officials may take other steps to ensure quality production.

In granting an EUA in November 2020 to Eli Lilly for a monoclonal antibody (bamlanivimab) to treat moderate COVID-19 infections on an outpatient basis, FDA directed Lilly to retain an independent third party to review batch records for discrepancies in drugs made at a New Jersey facility that had been cited for quality control issues at previous inspections (8).

References

1. Novartis, “Novartis receives complete response letter from U.S. FDA for inclisiran,” Press Release, Dec. 18, 2020.
2. BMS, “Bristol Myers Squibb Provides Regulatory Update on Lisocabtagene Maraleucel (liso-cel),” Press Release, Nov. 16, 2020.
3. Revance Therapeutics, “FDA Defers Approval of DaxibotulinumtoxinA for Injection in Glabellar Lines Due to COVID-19 Related Travel Restrictions Impacting Manufacturing Site Inspection,” Press Release, Nov. 25, 2020.
4. Spectrum Pharmaceuticals, “Spectrum Pharmaceuticals Announces that the FDA is Deferring its Action on the BLA for ROLONTIS (eflapegrastim),” Press Release, Oct. 26, 2020.
5. Alkermes, “Alkermes Receives FDA Complete Response Letter Related to ALKS 3831 Manufacturing Records Review,” Press Release, Nov. 17, 2020.
6. FDA, Manufacturing, Supply Chain, and Drug and Biological Product Inspections During COVID-19 Public Health Emergency Questions and Answers, Guidance for Industry (CDER, CBER, August 2020).
7. FDA, Review Timelines for Applicant Responses to Complete Response Letters When a Facility Assessment Is Needed During the COVID-19 Public Health Emergency Guidance for Industry (CDER, CBER, December 2020).
8. FDA, Letter to Eli Lilly and Company, Nov. 10, 2020, www.fda.gov.

About the Author

Jill Wechsler is BioPharm International’s Washington editor, jillwechsler7@gmail.com.

Article Details

Pharmaceutical Technology
Vol. 45, No. 2
February 2021
Pages: 14-15

Citation

When referring to this article, please cite it as J. Wechsler, "FDA Inspecti34 on Shutdown Delays Drug Approvals," Pharmaceutical Technology 45 (2) 2021.