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The European Federation of Pharmaceutical Industries and Associations (EFPIA) has conducted an annual survey of GMP/GDP inspections at sites and affiliates among its member companies from 2003 until the present time. This article describes findings of the EFPIA annual survey of site inspections among its member companies.
Good manufacturing practice (GMP) inspections are fundamental for ensuring that medicinal products are produced to the high standards required for patient safety. The European Federation of Pharmaceutical Industries and Associations (EFPIA) represents research-based pharmaceutical companies in Europe. For reasons of transparency, EFPIA conducts an annual survey of inspections among its member companies. The data generated demonstrate the workload, use of resources, and the outcome of inspection practices for oversight of GMP and good distribution practice (GDP) by domestic and foreign regulatory authorities.
Member companies are confronted with more inspections of their manufacturing sites by authorities from other countries (i.e., foreign inspections). The purpose of this data collection is to create awareness and develop potential opportunities to redirect resources toward better site coverage and, therefore, protection of the patients. Part I of this article reports, for the first time, the results of the annual inspections survey. Part II will look at additional challenges and opportunities for improving inspection efficiency (1).
According to the International Council for Harmonization of Technical Requirements for Human Use (ICH), inspections of a firm’s manufacturing operation are essential to evaluate commercial manufacturing capability, adequacy of production and control procedures, suitability of equipment and facilities, and effectiveness of the quality management system in assuring the overall state of control. Notably, pre-approval inspections include the added evaluation of authenticity of submitted data and link to dossier (2). Inspections of a firm’s manufacturing operations assess GMP and GDP compliance and are legally required for drug (medicinal) products in most countries worldwide. In some regions, inspections of API manufacturers are also mandatory. Furthermore, relevant regulations for quality systems (3) require companies to have an independent auditing scheme of their sites, contractors, and suppliers. Recent emerging regulations require regulatory authorities to inspect manufacturers in the countries where the medicines and APIs are produced.
The objective of the annual survey is to provide awareness of global health authority inspection activity, focusing on duplicate inspections as a means of determining the value to the patient while controlling risk. Through the annual survey, EFPIA aims to encourage regulatory authorities to focus their resources on activities that pose higher risks to patient safety and to drive a collaborative approach among health authorities in inspection practice and sharing of inspection outcomes. EFPIA recognizes that convergence in activities between regulators is essential to effectively evaluate commercial manufacturing capabilities.
The EFPIA member companies reported inspections at companies of research-based manufacturers. The numbers should be seen as a snapshot. Aspects of the survey are as follows:
In addition to the data collection, there are specific questions concerning inspection activities that are adapted each year to reflect areas of particular interest to EFPIA. The definitions used in the survey are available online (listed online in Table I).
Over the span of the survey so far (2003 to 2015), data have been collected from approximately 660 manufacturing sites annually. Conducting and receiving inspections involve considerable regulator and industry resources. There were 486 foreign inspections and 693 domestic inspections, which required 3951 foreign inspector days and 4456 domestic inspector days. It should be noted that these days were spent by regulators only; industry resources are not included in the figures. Also, these days do not include resources used for paper-based inspections or inspections where no inspector days had been reported. Less than 10% of the inspections were reported as unannounced. Whether announced or unannounced, there was a high level of compliance (more than 95% of the inspections had positive outcomes, with no regulatory action required).
Over the past 12 years, 64 countries have performed foreign inspections. In 2015, 34 countries performed foreign inspections, compared with 40 in 2014 and 31 in 2013. The survey results showed the number of foreign inspections per country in 2015 (see Figure 1). Group 1 is formed by countries performing more than 60 foreign inspections; Group 2 is for countries performing more than 20 and less than 60 foreign inspections. In addition to those shown in Figure 1, there were also seven countries where one foreign inspection was made.
The data show that countries in Group 1--the United States and the European Union (where all EU countries are counted as one inspectorate)--perform approximately twice the number of foreign inspections compared with countries in Group 2. A trend analysis of survey data from 2011 to 2015 revealed:
There were significantly fewer inspections from the US in Europe (approximately 40%) and from Japan in the EU (approximately 48%). Similar reductions had been reported in the 2014 data.
The maximum number of inspections at a single site within one year has been reported to be 15, including seven foreign inspections. The same workload for foreign inspections had been reported by five sites. Overall, 52 sites received more than four inspections in 2015, 570 sites report having between one to four inspections in 2015, and 118 did not receive any inspections in 2015. Although the number of sites with no inspection is decreasing, indicating better overall coverage, there are still sites that are not inspected. This observation might suggest that resources could be better balanced.
The survey asked for specific data from sites receiving multiple inspections, with the aim of addressing the question: “Are multiple inspections driven by risks?” It was noted that one manufacturing site can have several manufacturing licenses, thus there can be a need for several inspections at the same geographical location. However, there was no clear indication that these multiple inspections were always driven by risk. The data also confirmed that there is always intensive domestic oversight.
In general, the inspections cover drug products (64%, including 18% sterile operations), API (20%, including 10% biotech API sites), vaccines manufacturers (8%), others (5%), and medical devices (3%). The majority of foreign inspections target the drug product (see Figure 2). The survey results confirm the split of product types inspected remains constant among the different inspectorates with the exception of Japan. The authors believe this could be a result of the specific mutual recognition agreement (MRA) between Japan and Europe.
Of reported inspections, 85% were GMP related, 4% were GDP related, 3% covered ISO certification, and 8% were related to other GxP operations. The data show that:
Foreign inspections focused largely on GMP processes. Inspection of distribution licenses was performed mostly by the domestic regulatory authorities.
For the purpose of the survey, a GDP inspection is defined as an inspection that covers systems and processes within the scope of the distribution license. A significant number of new regulations and guidelines (4-7) were published in recent years aiming at better control of distribution channels to prevent entry of falsified products in the legal supply chain. Inspections of GDP compliance are, therefore, deemed to be important. They can be performed at a manufacturing site and/or at an affiliate of the company in the country of destination or at a hub. The survey shows that more of these inspections are performed each year.
In the 2015 survey, 203 inspections were reported to include GDP in their scope:
Out of the 22 companies surveyed in 2015, 16 reported inspections at affiliates. The majority of inspections were conducted according to distribution licence. Other topics covered are GMPs (e.g., supply chain verification by a responsible person, repackaging, relabeling), other GxP processes (e.g., pharmacovigilance), and ISO certifications. There were 309 inspections at affiliates; 96% were domestic inspections (performed by inspectorates from 99 countries), and 4% were foreign inspections:
The majority of inspections at affiliates named the GDP distribution license as the primary scope of the inspection and drug product as the product type inspected.
The survey analyzed the different forms of inspections. In 2015, there were 160 inspections flagged as pre-approval inspections (PAI) of manufacturing sites (95 were foreign and 65 were domestic inspections).
Two joint inspections were reported in 2015, which were in fact, two inspections running in parallel at the same time and were thus “concomitant” inspections rather than joint inspections: one inspection in the US from the Food and Drug Administration (FDA) and EU, and one inspection in Australia by Australia’s Therapeutic Goods Administration (TGA) and US FDA.
In the past, the industry has described positive and negative views of joint inspections, with some companies questioning the benefits and reporting that it feels like two different inspections at the same time. From the regulators’ point of view, there is an open question if joint inspections will continue to be organized. Joint inspection pilot programmes were initiated by US FDA. Later, US FDA joined the Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme (PIC/S), shifting the exchange toward mutual reliance on inspection data from partner inspectorates. The PIC/S Joint Audit Programme could still be used for alignment and training purposes.
Paper-based foreign inspections Twenty-four paper-based inspections were reported as foreign inspections in 2015. These inspections were conducted by China, Chinese Taipei, Germany, Japan, South Korea, Syria, and US FDA. Inspected companies felt a need to involve a lot of resources due to requests for specific inspection formats and questionnaires. This issue was compounded by the fact that institutionalized formats such as the PIC/S site master file were not accepted by the different regulators.
Data on compliance following inspections are shown in Figure 3. The data indicate that domestic and foreign inspections lead to similar outcomes.
Inspections are essential to evaluate commercial manufacturing capability, adequacy of production and control procedures, suitability of equipment and facilities, and effectiveness of the quality management system in assuring the overall state of control and can include the evaluation of authenticity of submitted data in a registration dossier. The results of the survey based on the 2015 inspection data and trends since 2003 demonstrate dublication, workload, use of resources, and the outcome of inspection practices for oversight of GMP and GDP inspections and cerifications.
Data were evaluated by the following members of the EFPIA GMP network reporting to the Technical Development Expert Group (TDEG): Stephan Rönninger, Amgen (moderator); Johanna Berberich, Bayer; Véronique Davoust, Pfizer; Peter Kitz, Bristol-Myers Squibb; and Andreas Pfenninger, Interpharma. Support was provided by Gerd Fischer, Boehringer Ingelheim. The authors thank Michele Hunter for technical writing.
In addition, the authors thank the companies that provided input to the survey in 2015 and before: AbbVie, Almirall, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Biogen, Bristol-Myers Squibb, Eli Lilly and Company, Grünenthal GmbH, GlaxoSmithKline, Johnson & Johnson, Merck (MSD), Merck Serono, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Servier, Takeda, and UCB.
1. S. Rönninger et al., The GMP/GDP Inspections Landscape--Part II: Opportunities and Considerations, Pharm. Tech. Europe, 2017, in press.
2. ICH, Quality Implementation Working Group on Q8, Q9, and Q10: Training Material, www.ich.org/products/guidelines/quality/training-programme-for-q8q9q10/presentations.html, accessed July 2016.
3. ICH, ICH Harmonized Tripartite Guideline, Pharmaceutical Quality System Q10, step 4 version (June 2008).
4. Amending Directive 2001/83/EC on the Community Code Relating to Medicinal Products for Human Use, Falsified Medicines Directive (1 Apr. 2011).
5. Good Distribution Practice of Medicinal Products for Human Use, Guideline 2013/C 343/01 (5 Nov. 2013).
6. Principles of Good Distribution Practice of Active Substances for Medicinal Products for Human Use, 2015/C 95/01 (19 Mar. 2015).
7. EC, Good Distribution Practice for Medicinal Products for Human Use, Questions and Answers, Ares(2014)968163 (28 Mar. 2014).
Pharmaceutical Technology Europe
Vol. 29, No. 1