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Dharani S, Mohamed EM, Rahman Z, Khan MA. Patient In-Use Stability Testing of FDA-Approved Metformin Combination Products for N-Nitrosamine Impurity. AAPS PharmSciTech 2024; 25:19. [PMID: 38267707 DOI: 10.1208/s12249-023-02724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
Between February 2020 and January 2022, the Food and Drug Administration (FDA) recalled 281 metformin extended-release products due to the presence of N-nitrosodimethylamine (NDMA) above the acceptable daily intake (ADI, 96 ng/day). Our previous studies indicated presence of NDMA levels above ADI in both metformin immediate and extended-release products. When metformin products have NDMA impurities, it is indispensable to check for the same impurities in metformin combination products. Therefore, the objective of the present study was to evaluate in-use stability of commercial metformin combination products for NDMA. For this purpose, metformin products in combination with glyburide (GB1-GB12), glipizide (GP1-GP8), pioglitazone (P1-P3), alogliptin (A1, A2), and linagliptin (L1, L2) were repacked in pharmacy vials, stored at 30°C/75% RH for 3 months, and monitored for NDMA impurity. The NDMA level varied from 0 to 156.8 ± 32.8 ng/tablet initially and increased to 25.4 ± 5.1 to 455.0 ± 28.4 ng/tablet after 3 months of exposure to in-use condition. Initially, 18 products have NDMA level below ADI limit before exposure which decreased to 7 products (GB5, GP3, GP5, A1, A2, L1, and L2) meeting specification. In conclusion, in-use stability study provides quality and safety risk assessment of drug products where nitroso impurities are detected in the probable condition of use.
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Affiliation(s)
- Sathish Dharani
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, 159 Reynolds Medical Sciences Building, College Station, Texas, 77843-1114, USA
| | - Eman M Mohamed
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, 159 Reynolds Medical Sciences Building, College Station, Texas, 77843-1114, USA
| | - Ziyaur Rahman
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, 159 Reynolds Medical Sciences Building, College Station, Texas, 77843-1114, USA
| | - Mansoor A Khan
- Irma Lerma Rangel College of Pharmacy, Texas A&M Health Science Center, Texas A&M University, 159 Reynolds Medical Sciences Building, College Station, Texas, 77843-1114, USA.
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Montefusco-Pereira CV. Steps toward nebulization in-use studies to understand the stability of new biological entities. Drug Discov Today 2023; 28:103461. [PMID: 36455828 DOI: 10.1016/j.drudis.2022.103461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
The need for novel biological drugs against respiratory diseases has been highlighted during the Coronavirus (COVID-19) pandemic. The use of inhalation presents challenges to drug product stability, which is especially true for delivery using nebulizers (jet versus mesh technologies). The late-stage process of drug development in the pharmaceutical industry requires the investigation of in-use stability. In-use studies generate data that are guided by the requirements of regulatory authorities for inclusion in the clinical trial application dossier. In this review, I introduce the initial aspects of in-use stability studies during the development of an aerosol formulation to deliver biologics with a nebulizer. Lessons learned from this experience can guide future development and planning for formulation, analytics, material compatibility, nebulization process, and clinical trial preparations.
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Chaurasiya S, Yang A, Zhang Z, Lu J, Valencia H, Kim SI, Woo Y, Warner SG, Olafsen T, Zhao Y, Wu X, Fein S, Cheng L, Cheng M, Ede N, Fong Y. A comprehensive preclinical study supporting clinical trial of oncolytic chimeric poxvirus CF33-hNIS-anti-PD-L1 to treat breast cancer. Mol Ther Methods Clin Dev 2022; 24:102-116. [PMID: 35024377 PMCID: PMC8718831 DOI: 10.1016/j.omtm.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/04/2021] [Indexed: 01/12/2023]
Abstract
CF33-hNIS-anti-PD-L1 is an oncolytic chimeric poxvirus encoding two transgenes: human sodium iodide symporter and a single-chain variable fragment against PD-L1. Comprehensive preclinical pharmacology studies encompassing primary and secondary pharmacodynamics and biodistribution and safety studies were performed to support the clinical development of CF33-hNIS-anti-PD-L1. Most of the studies were performed in triple-negative breast cancer (TNBC) models, as the phase I trial is planned for patients with TNBC. Biological functions of virus-encoded transgenes were confirmed, and the virus demonstrated anti-tumor efficacy against TNBC models in mice. In a good laboratory practice (GLP) toxicology study, the virus did not produce any observable adverse effects in mice, suggesting that the doses proposed for the clinical trial should be well tolerated in patients. Furthermore, no neurotoxic effects in mice were seen following intracranial injection of the virus. Also, the risk for horizontal transmission of CF33-hNIS-anti-PD-L1 was assessed in mice, and our results suggest that the virus is unlikely to transmit from infected patients to healthy individuals. Finally, the in-use stability and compatibility of CF33-hNIS-anti-PD-L1 tested under different conditions mimicking the clinical scenarios confirmed the suitability of the virus in clinical settings. The results of these preclinical studies support the use of CF33-hNIS-anti-PD-L1 in a first-in-human trial in patients with TNBC.
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Affiliation(s)
- Shyambabu Chaurasiya
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
| | - Annie Yang
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
| | - Zhifang Zhang
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
| | - Jianming Lu
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
| | - Hannah Valencia
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
| | - Sang-In Kim
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
| | - Yanghee Woo
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
| | - Suanne G Warner
- Department of Surgery, Mayo Clinic, Rochester, MN 55902, USA
| | - Tove Olafsen
- Small Animal Imaging Core, Shared Resources, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Yuqi Zhao
- Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Xiwei Wu
- Integrative Genomics Core, City of Hope National Medical Center, Duarte, CA 91010, USA
| | | | | | | | | | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Familian Science building, Room#1100 1500 E Duarte Road, Duarte, CA 91010, USA
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Chavda H. In-use stability studies: guidelines and challenges. Drug Dev Ind Pharm 2021; 47:1373-1391. [PMID: 34663148 DOI: 10.1080/03639045.2021.1994991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pharmaceutical products delivered in multidose containers require in-use stability studies. Moreover, those pharmaceutical products requiring dilution or reconstitution prior to use also require in-use stability studies. In-use stability can be described as how well a pharmaceutical product remains stable during in-use within a particular closure system. During the in-use period, the pharmaceutical product remains within its physical, chemical, and microbiological specifications and retains its safety, efficacy, and performance. Even though the different guidelines are available, specific information for in-use stability studies that can smoothly guide applicant for regulatory submission is not at par. In-use stability studies should be performed in accordance to the various guidelines published by the regulatory agencies or by appropriate, justifiable ways that satisfy the regulators. This review explores current in-use stability guidelines, numerous examples of performed in-use stability studies, challenges to in-use stability and other relevant aspects.
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Affiliation(s)
- Hitesh Chavda
- Technology Transfer Department, Emcure Pharmaceuticals Ltd, Gujarat, India
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Iudicello A, Genovese F, Strusi V, Dominici M, Ruozi B. Development and Validation of a New Storage Procedure to Extend the In-Use Stability of Azacitidine in Pharmaceutical Formulations. Pharmaceuticals (Basel) 2021; 14:ph14090943. [PMID: 34577643 PMCID: PMC8470010 DOI: 10.3390/ph14090943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
Stability studies performed by the pharmaceutical industry are principally designed to fulfill licensing requirements. Thus, post-dilution or post-reconstitution stability data are frequently limited to 24 h only for bacteriological reasons, regardless of the true physicochemical stability which could, in many cases, be longer. In practice, the pharmacy-based centralized preparation may require preparation in advance for administration, for example, on weekends, holidays, or in general when pharmacies may be closed. We report an innovative strategy for storing resuspended solutions of azacitidine, a well-known chemotherapic agent, for which the manufacturer lists maximum stability of 22 h. By placing the syringe with the azacitidine reconstituted suspension between two refrigerant gel packs and storing it at 4 °C, we found that the concentration of azacitidine remained above 98% of the initial concentration for 48 h, and no change in color nor the physicochemical properties of the suspension were observed throughout the study period. The physicochemical and microbiological properties were evaluated by HPLC–UV and UHPLC-HRMS analysis, FTIR spectroscopy, pH determination, visual and subvisual examination, and sterility assay. The HPLC-UV method used for evaluating the chemical stability of azacitidine was validated according to ICH. Precise control of storage temperature was obtained by a digital data logger. Our study indicates that by changing the storage procedure of azacitidine reconstituted suspension, the usage window of the drug can be significantly extended to a time frame that better copes with its use in the clinical environment.
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Affiliation(s)
- Antonella Iudicello
- Pharmaceutical Department, Azienda USL of Modena, Largo del Pozzo 71, 41121 Modena, Italy
- Nuclear Medicine Unit, Oncology and Hematology Department, Azienda Ospedaliero-Universitaria of Modena, Largo del Pozzo 71, 41124 Modena, Italy
- Correspondence: ; Tel.: +39-0594225167
| | - Filippo Genovese
- Centro Interdipartimentale Grandi Strumenti, University of Modena and Reggio Emilia, Via Campi 213/A, 41125 Modena, Italy;
| | - Valentina Strusi
- Scientific and Technological Park of Medicine “Mario Veronesi”, Via 29 Maggio 6, 41037 Mirandola, Italy; (V.S.); (M.D.)
| | - Massimo Dominici
- Scientific and Technological Park of Medicine “Mario Veronesi”, Via 29 Maggio 6, 41037 Mirandola, Italy; (V.S.); (M.D.)
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Hospital of Modena, Largo del Pozzo 71, 44125 Modena, Italy
| | - Barbara Ruozi
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 213/A, 41125 Modena, Italy;
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Selmin F, Musazzi UM, Franzè S, Scarpa E, Rizzello L, Procacci P, Minghetti P. Pre-Drawn Syringes of Comirnaty for an Efficient COVID-19 Mass Vaccination: Demonstration of Stability. Pharmaceutics 2021; 13:1029. [PMID: 34371721 DOI: 10.3390/pharmaceutics13071029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022] Open
Abstract
Moving towards a real mass vaccination in the context of COVID-19, healthcare professionals are required to face some criticisms due to limited data on the stability of a mRNA-based vaccine (Pfizer-BioNTech COVID-19 Vaccine in the US or Comirnaty in EU) as a dose in a 1 mL-syringe. The stability of the lipid nanoparticles and the encapsulated mRNA was evaluated in a “real-life” scenario. Specifically, we investigated the effects of different storing materials (e.g., syringes vs. glass vials), as well as of temperature and mechanical stress on nucleic acid integrity, number, and particle size distribution of lipid nanoparticles. After 5 h in the syringe, lipid nanoparticles maintained the regular round shape, and the hydrodynamic diameter ranged between 80 and 100 nm with a relatively narrow polydispersity (<0.2). Samples were stable independently of syringe materials and storage conditions. Only strong mechanical stress (e.g., shaking) caused massive aggregation of lipid nanoparticles and mRNA degradation. These proof-of-concept experiments support the hypothesis that vaccine doses can be safely prepared in a dedicated area using an aseptic technique and transferred without affecting their stability.
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Abstract
Monoclonal antibody (Mabs) containing medicinal products are widely used in clinical practice. Prior to parenteral administration, licensed Mab containing medicinal products are transferred to the ready-to-administer (RTA) forms. Reconstitution and/or preparation should follow the guidelines for Good Reconstitution/Good Preparation Practice. Preparation in the pharmacy must take place within the framework of a suitable quality management system. The responsible pharmacist must apply a risk assessment on the process to ensure the appropriate quality of the RTA preparation, especially because the extent of quality testing is limited by batch size (often one single unit) and time restraints. In these cases, appropriate quality is to be assured by means of qualification activities, environmental monitoring, process validation with growth medium and in-process controls. Correct labelling of the Mab containing RTA preparations includes a suitable storage advice and a defined shelf life. Physicochemical stability of a given Mab preparation can be assessed based on a specific stability study (supplied by the manufacturer in the SmPC or scientific journals, study published by an expert in a peer-reviewed scientific journal). Physicochemical stability studies require the use of various orthogonal physicochemical methods to detect accurately the degradation changes that may result from the deamidation, oxidation, disulfide formation, aggregation or fragmentation during storage. Complementary, biological activity can be measured. Compatibility studies of Mabs and devices used for preparation and administration are still scarce. Microbiological stability of Mab preparations is related to the complexity of the preparation process, the growth supporting nature of the preparation and the integrity of the container or container/closure combination. In use viability tests revealed that the potential of Mab preparations to support microbial growth was similar to that of the pure vehicle solutions used as control solutions. The enumerated microbial counts varied according to the species utilized and the type of Mab preparation. If sterility testing of the individual preparation is impossible, maximum permitted shelf life can be assessed empirically with regard to the maximum shelf lives defined in the USP <797> monograph. Finally, microbiological and physicochemical stability are to be considered concurrently when determining the shelf life of an individual Mab preparation. In each case, shelf life should be limited according to the shorter period of proven stability, either derived from the microbiological or physicochemical stability data.
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Affiliation(s)
- Irene Krämer
- Pharmacy Department, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Judith Thiesen
- Pharmacy Department, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alain Astier
- Pharmacy Department, Henri Mondor University Hospital, Créteil, France
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Rexen P, Jensen JT, Schwerin NB, Kozina E. Eptacog Alfa (Activated) Is Physically and Chemically Stable over 24 Hours when Administered as Bolus Injections in an Automated Infusion Pump. TH Open 2019; 3:e45-e49. [PMID: 31249981 PMCID: PMC6524905 DOI: 10.1055/s-0039-1678684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction
Eptacog alfa (activated) is a recombinant activated factor VII (rFVIIa) used for the treatment and prevention of bleeding episodes in patients with congenital hemophilia with inhibitors. Frequent dosing requirements make the use of an automated bolus infusion pump a promising alternative to manual administration.
Aims
The objective of this in vitro study was to evaluate the physical and chemical stability of room temperature–stable rFVIIa at 25°C over 24 hours in an automated bolus infusion pump.
Methods
An automated bolus infusion pump with preset bolus injection intervals of 2 to 6 hours was used. Samples of rFVIIa were analyzed for critical quality parameters, presence of leachables, and microbiological growth. The infusion system was evaluated visually.
Results
rFVIIa is physically and chemically stable when used in an automated bolus infusion pump system for up to 24 hours at 25°C. All critical quality parameter results were within the shelf-life limits and complied with the acceptance criteria. Leachables were observed at concentrations within their respective acceptance criteria. No visual changes in the syringe or infusion tube were observed; inherent particles in the reconstituted rFVIIa similar in size and description to those previously found in rFVIIa were seen. No microbiological growth was detected.
Conclusions
rFVIIa is stable in a bolus infusion pump system for up to 24 hours at 25°C. Bolus injection intervals of 2 to 6 hours can be used without physical or chemical changes to rFVIIa. This study supports the use of an automated bolus infusion pump in the hospital setting, across all indications for rFVIIa.
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Affiliation(s)
- Per Rexen
- Novo Nordisk A/S, Novo Allé, Bagsvaerd, Denmark
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