What is expected of API & medicinal product manufacturers to prevent cross-contamination with beta-lactams.
Guideline requirements and observations from recent audits.
In the production of APIs and medicinal products, pharmaceutical companies must avoid cross-contamination with beta-lactams.
Various organizational and technical measures are taken in production facilities for medicinal products and final powder processing of APIs in order to prevent such cross-contamination. For most APIs, strategies generally include the use of production rooms and equipment on campaign basis, cleaning validation for multipurpose, dedicated or single-use equipment, HEPA-filtered air, along with air-locks and pressure cascades.
However, for certain highly sensitizing APIs such as ß-lactams, these standard measures may not sufficient.
What are the regulatory requirements?
According to EU GMP Part I for the production of medicinal products, dedicated facilities are required for beta-lactams. EU GMP Part II for API production specifies for penicillins and cephalosporins that dedicated production areas are required, such as facilities, air handling systems, and process equipment.
The US FDA, in turn, expects penicillin production operations to take place in separate facilities, with air handling systems that are distinct from those used for other human drugs. However, the FDA clarifies that separate buildings are not always necessary, as long as the section of the manufacturing facility dedicated to penicillin production is completely and comprehensively isolated from non-penicillin areas. Moreover, the FDA requires that non-penicillin drug products be tested for penicillin when cross-contamination risk exists, prohibiting products from reaching the market should detectable penicillin levels be found.
In 2013, the US FDA issued a guideline specifying that similar cross-contamination control strategies should apply to non-penicillin beta-lactam drugs. These non-penicillin beta-lactams include cephalosporins, penems (e.g., imipenem, meropenem), carbacephems (e.g., loracarbef), monobactams (e.g., aztreonam), beta-lactamase inhibitors (e.g., clavulanic acid, tazobactam, sulbactam), and intermediates such as 6-Aminopenicillanic acid (6-APA), a fermentation product used in penicillin synthesis. Furthermore, the FDA expects that manufacturing areas for different classes of sensitizing beta-lactams, such as penicillins and cephalosporins, be segregated.
2022 Guideline Revision
In June 2022, the FDA published a draft revision of the aforementioned guideline, with the following main difference: For penicillins and non-penicillin beta-lactams, complete and comprehensive separation from other drug manufacturing operations is still required. However, for non-antibacterial beta-lactams, the separation is now recommended, but not mandatory. Alternative cross-contamination prevention strategies may be considered if manufacturers provide robust data proving the absence of cross-contamination or can demonstrate that adverse reactions are highly unlikely. This data would need to be available for FDA assessment. A further difference is that in this draft under “non-antibacterial beta-lactam compounds” not only are beta-lactamase inhibitors (which are usually always combined with penicillins in one product) listed but also certain lipid lowering drugs (such as ezetimibe) and certain antiviral drugs (without example).
What are the audit expectations for manufacturers?
When auditing API or medicinal product manufacturers producing penicillins or other non-penicillin beta-lactams alongside other drugs at the same site, regulators will generally expect the following:
Dedicated facilities with complete and comprehensive separation, including separate air handling systems, appropriate pressure cascades, and dedicated equipment to each class of drug.
Definition of design and procedural controls to prevent cross-contamination, based on thorough risk management.
These controls typically include risk assessments for cross-contamination, well-designed material, personnel, and waste flows, as well as measures to prevent exhaust air from contaminating adjacent building air intakes. Additionally, a robust monitoring program for cross-contamination risks and clear spill response procedures are expected.
Interesting observation from recent audits
Recent audits of cell culture media manufacturers have revealed an interesting trend; some of these manufacturers also fill and pack penicillins for use in cell culture at the same site. Although the production of cell culture media is not covered by the previously mentioned guidelines, pharmaceutical companies that use these media to produce drug substances or products via cell culture are equally concerned about avoiding cross-contamination with beta-lactam antibiotics. This emphasizes the growing need for stringent control measures even outside the traditional scope of API manufacturing.
Should you require audits at API or medicinal product manufacturers and the topic of prevention of cross-contamination from beta-lactams is to be addressed, please contact us at blue inspection for further information.
High quality in outsourced audits essential to ensure product safety
Outsourcing of API audits to 3rd parties
4 points manufacturers of medicinal products need to consider
Audits at manufacturers of active ingredients are an important element of ensuring the safety of medicinal products manufactured. The quality standards applied in those audits are key to making sure that the audits serve their purpose.
For the manufacture of medicinal products in the European Union (EU), it is stipulated that the holder of a manufacturing authorisation is responsible to ensure that only active substances are used, which have been manufactured in accordance with good manufacturing practice for active substances and distributed in accordance with good distribution practices for active substances. To ensure compliance with these requirements, audits are required at the manufacturing and distribution sites of the active ingredients (for details see directive 2011/62/EU).
The manufacturers of medicinal products are required to audit active ingredient manufacturers every 3 years as described e.g. in the document EMA/196292/2014 (Guidance for the template for the qualified person’s declaration concerning GMP compliance of active substance manufacture): "Audits of each site for GMP compliance should be undertaken at regular intervals, normally within three years”.
Outsourcing API audits to independent third parties can be an effective and cost-efficient way to fulfil those requirements. However, once the auditing activities are outsourced to a third party, it is in their hands to ensure that the audits are of sufficient quality.
Here are four quality aspects of the auditing setup and processes that can help identify high quality in the work of third-party auditors.
1) Contract and Qualification
The good news is that the outsourcing of audits is accepted by the competent authorities. Specifically, section 5.29 of the EU GMP Guideline (part I) states: "The holder of the manufacturing authorisation shall verify such compliance either by himself or through an entity acting on his behalf under a contract." This means that a quality agreement between the pharmaceutical manufacturer and the service provider should be established in compliance with the requirements of EU GMP chapter 7 “outsourced activities”. Furthermore, the EMA (see Q&A section on EMA’s website) emphasizes that there should be evidence that the contract-giver has evaluated the contract-acceptor. In practice this means that audit service providers should be properly qualified within the quality management system of the pharmaceutical manufacturer.
2) Audit Duration
For each audit at an API manufacturer, there must be an appropriate timeframe available that allows the writing of comprehensive audit reports as defined in EU GMP part I 5.29: "Audits should be of an appropriate duration and scope to ensure that a full and clear assessment of GMP is made." There are different approaches to determining the time required for an on-site audit. In addition to basic factors such as the size of the company to be audited and the number of employees in the audited area, other factors must be taken into consideration such as e.g. the number of APIs in the audit scope and the complexity of the respective synthesis steps. Third party auditing companies having access to a suitable number of qualified auditors usually calculate the audit duration in so-called man-days (audit days multiplied by number of auditors). It is beneficial to perform the audit with at least two auditors who build 2 independent audit streams. This way it is possible to get the most out of the audit duration granted, while also saving time and cost for the audited company.
3) Audit Report
The audit report is the central evidence with which the holder of the manufacturing authorisation proves the performance of an audit. All GMP-relevant observations of the audit must be reproduced in the report in a precise, comprehensive and complete manner: "The report should fully reflect what was done and seen on the audit with any deficiencies clearly identified" (EU GMP part I 5.29). EU GMP Annex 16 also sets very specific requirements for reports prepared by third parties: "The audit report should address general GMP requirements, as for example the quality management system, all relevant production and quality control procedures related to the supplied product, e.g. active substance manufacturing, quality control testing, primary packaging, etc. All audited areas should be accurately described resulting in a detailed report of the audit." It is also required that the QP must ensure the evaluation of audit reports; the result of this evaluation must be recorded in writing.
4) Quality
Ideally, the quality system and audit procedures of the service provider are directly compatible with the requirements of the respective drug manufacturers, which can be reflected, for example, in the context of an audit at the service provider’s facilities. The existence of certifications (e.g. according to ISO 9001) or accreditations (e.g. according to ISO 17020) is not required by law, but such independent assessments can facilitate the qualification process. Certified or accredited service providers usually have a suitable quality management system that covers general aspects such as document control, internal audits, management reviews, corrective actions, etc. Of particular importance are training procedures for auditors and a regular exchange of experience among auditors. In addition to ISO 9001 certifications, an accreditation in accordance with ISO 17020 awarded by a national accreditation body can prove the impartiality and independence of the service provider. DIN EN ISO/IEC 17020 defines various requirements for so-called inspection bodies. Accreditation as a “Type A inspection body”, for example, excludes the simultaneous provision of consulting services and thus proves the impartiality and absence of possible conflicts of interest. Thereby, the accredited audit service provider meets the requirements mentioned in the Q&A section of the EMA website, namely that it “must also be satisfactorily demonstrated that there are no conflicts of interests.” Furthermore, the accreditation supports the manufacturing-authorisation holder in his task to ensure “the validity and impartiality of the audit report” (see EMA Q&A section for details). In the framework of the accreditation, the quality of the audit services is also regularly monitored in the form of so-called "witness audits", which are accompanied by appropriate experts (usually GMP inspectors from national authorities). In addition, accredited companies must have suitable procedures in place to handle confidential information collected during each audit.
When outsourcing audits of APIs to third parties, the manufacturers of medicinal products have a responsibility to ensure product safety for patients by applying these high-quality criteria for any outsourced audits.
Contaminations of Cough Syrups with Ethylene Glycol (EG) and Diethylene Glycol (DEG)
On the importance of thorough testing and monitoring
of supply-chain of high-risk excipients
Recent cases of contaminations of oral cough syrups, leading to tragic fatalities amongst children highlight the importance of testing high-risk excipients before use and also emphasize the importance of audits at distributors and manufacturers of such high-risk excipients.
Alarmingly, between 2022-2023 there were over 300 fatalities in at least three countries due to contaminations of excipients. Most were young children under the age of five. In January 2023 the WHO reported that in at least seven countries there were several incidents of over-the-counter cough syrups for children with confirmed or suspected contamination with high levels of diethylene glycol (DEG) and ethylene glycol (EG). These contaminants are toxic chemicals, which can be fatal when taken in even small amounts, especially by children. The tragic cases have led to tightened guidelines and stricter requirements enforced by authorities worldwide.
In May 2023, the US FDA issued as of immediate effect the “Guidance for Industry on Testing of Glycerin, Propylene Glycol, Maltitol Solution, Hydrogenated Starch Hydrolysate, Sorbitol Solution and other High-Risk Drug Components for Diethylene Glycol and Ethylene Glycol”. The guidance informed that the recent cases were not the first, citing cases in the 1930’s (USA), 1990’s (Argentina, Bangladesh, Haiti, India and Nigeria) and 2000’s (Panama) with DEG poisoning resulting in deaths of hundreds of children.
The most recent cases all had the following similarities: the manufacturers of the oral liquid drug products, mostly syrups, relied on the certificates of analysis of the supplier without their own testing of the excipients for DEG and EG contaminants. In addition, the CoA was not from the original manufacturer, nor did it disclose the origin of the excipient. Therefore, besides testing high-risk excipients for contamination with DEG and EG before use, robust supply chain knowledge is essential (e.g. involvement of distributors) in order to mitigate risks of DEG and EG contamination.
The FDA guidance clearly states that for excipients where the current USP-NF monograph includes a limit test for DEG and EG as part of the applicable identity testing, the execution of these limit tests is mandatory for each batch. It is even recommended to test each container of the excipients.
Several warning letters were issued to drug product manufacturers for not testing each batch of glycerin, propylene glycol or sorbitol solution according to the full identification test requirements, including also DEG and EG impurities. Currently, the USP is working on the addition of DEG and EG limit tests to the identification of different polyethylene glycol (macrogol) types and polyethylene glycol 40 castor oil in the respective USP monographs.
The EDQM has previously emphasized that for all monographs which include DEG or EG limit tests the execution of these tests is mandatory. In addition, the EDQM has pre-published on its website the revised monograph for propylene glycol, which will come into effect in JAN 2025 with supplement 11.6 and which now also includes a GC limit test for DEG and EG.
For liquid forms of sorbitol and mannitol, actions are ongoing to introduce analytical procedures for DEG and EG. For other ethoxylated substances (such as e.g., macrogolglycerol ricinoleate, macrogolglycerol hydroxystearate, macrogol 15 hydroxystearate, nonoxinol 9, macrogol Cetostearylether), there is already a method for DEG and EG determination described in general chapter 2.4.30. The EDQM is currently evaluating whether to include reference to this chapter in adulteration sections of the corresponding monographs. If tests are described in an adulteration section of the monograph, these tests are mandatory, however, the frequency of testing may depend on risk assessment, taking into account the level of knowledge of the whole supply chain.
High-risk excipients need to be tested before use to ensure product safety for patients worldwide. Suppliers of finished-dosage forms who purchase such high-risk excipients should ensure that thorough testing takes place, the supply-chain is monitored and, if required, the excipient distributors and suppliers should be audited on a regular basis.
Should you require audits to be performed at your excipient suppliers, please contact us at blue inspection for further information.
Increased focus on Single Use Systems pushes demand for supplier audits
The use of Single Use Systems (SUS) has risen over recent years, in parts due to the increased production of parenteral products as a consequence of the pandemic. SUS are considered as critical components, their use requires a thorough qualification of the manufacturer.
The use of Single Use Systems (SUS) has risen over recent years, in parts due to the increased production of parenteral products as a consequence of the pandemic. SUS are considered as critical components, their use requires a thorough qualification of the manufacturer.
As a result, authorities have heightened their focus and expectations on the correct application of SUS for the production of sterile medicinal products.
This has led to a rise in demand for single use systems supplier audits that is expected to continue in the future.
SUS can be individual components or assemblies of bags, filters, tubes, aseptic connectors, valves or sensors and are supplied sterile or non-sterile. They are usually used in upstream and downstream biotechnological processes and in fill-and-finish processes of sterile drug products.
Due to the lack of official guidelines describing the good manufacturing practices (GMP) for SUS, manufacturers usually have quality management systems according to ISO 9001 or ISO 13485 in place and perform gamma sterilization in accordance with ISO 11137 series.
As a result of the increase in the use of SUS, the revision of Annex 1 of EU GMP for the manufacture of sterile medicinal products which came into effect on 25 August 2023 includes now also a dedicated section about “Single Use Systems” (8.131 – 8.139) and refers to the criticality of qualifying SUS suppliers.
The SUS section describes that:
specific risks associated with SUS should be assessed as part of the Contamination Control Strategy,
the sterilization process of SUS must be validated,
the absorption and reactivity of product with contact surfaces and extractable and leachable profiles of SUS should be evaluated,
attention to the structural integrity of the SUS is important,
acceptance criteria should be established and that upon receipt and before use SUS must be inspected,
critical manual operations of SUS should be verified during aseptic process simulations, and
assessment and qualification of SUS suppliers is critical.
Audits of SUS manufacturers assess compliance of the manufacturer’s quality management system against ISO 9001 or ISO 13485 (depending on the QMS of the supplier). To compensate for the absence of more specific guidelines, audits should always assess closely the SUS user’s requirements with regard to function, integrity, extractables & leachables, particles, endotoxins, bioburden resp. sterility and reliability of supply. The validation of the sterilization process and qualification of the sterilization service supplier by the SUS manufacturer are additional important topics during an audit.
blue inspection routinely performs audits of different types of SUS manufacturers worldwide. Our auditors are familiar with the medicinal product manufacturer’s requirements and perform risk-based audits accordingly.
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