Training Workshop: Training of BE Assessors Kiev, October 2009 BCS-based Biowaivers Dr. Henrike Potthast (h.potthast@bfarm.de) Training workshop: Training of BE Assessors, Kiev, October 2009 Basis for BCS-based Biowaiver Applications/Decisions WHO – Technical Report Series No. 937, May 2006 Annex 7: Multisource (generic) pharmaceutical products: guidelines on registration requirements to establish interchangeability Annex 8: Proposal to waive in vivo bioequivalence requirements for WHO Model List of Essential Medicines immediate release, solid oral dosage forms FDA - Guidance for Industry: “Waiver of in vivo bio-equivalence studies for immediate release solid oral dosage forms containing certain active moieties/active ingredients based on a Biopharmaceutics Classification System” (2000) EU-guidance:“Note for Guidance on the Investigation of Bioavailability andBioequivalence” CPMP/EWP/QWP/1401/98; paragraph 5.1 2 | Workshop: Training of BE Assessors, Kiev, October 2009 Definitions BCS-based ‘Biowaiver’..... .....is defined as in vitro instead of in vivo ‘bioequivalence’ testing comparison of test and reference ....is not defined as no equivalence test 3 | Workshop: Training of BE Assessors, Kiev, October 2009 Definitions acc. to the FDA guidance: ”BCS-based biowaivers are intended only for bioequivalence studies. They do not apply to food effect bioavailability studies or other pharmacokinetic studies.” (e.g., rel. bioavailability) 4 | Workshop: Training of BE Assessors, Kiev, October 2009 Definitions Bioavailability – rate and extent at which a drug substance... becomes available in the general system (product characteristic!) Bioequivalence – equivalent bioavailability within pre-set acceptance ranges Pharmaceutical equivalence Bioequivalence Bioequivalence Therapeutic equivalence 5 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver In vivo bioequivalence testing is generally required but ” Such studies may be exempted if the absence of differences in the in vivo performance can be justified by satisfactory in vitro data.” for oral immediate release dosage forms with systemic action! 6 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Evaluation of drug substance and drug product Drug substance pharmacodynamic/therapeutic aspects physicochemical aspects Drug product in vitro dissolution 7 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Biowaiver justification based on ”………criteria derived from the concepts underlying the Biopharmaceutics Classification System ......” 8 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Biopharmaceutics Classification System (BCS) dissolution drug product drug substance in solution membrane transport drug substance in the system simplified mechanistic view of bioavailability 9 | Workshop: Training of BE Assessors, Kiev, October 2009 Melting point Charge Solubility Size Ionisation Shape H-bonding Lipophilicity Charge Distribution Amphiphilicity Fig.1: Physicochemical properties that affect absorption (after oral administration) [H. van de Waterbeemd/ Eur J Pharm Sci 7 (1998), 1-3] 10 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Pillars of the BCS Solubility Permeability 11 | Workshop: Training of BE Assessors, Kiev, October 2009 Dissolution BCS-based biowaiver High solubility the highest single dose is completely soluble in 250 ml or less of aqueous solution at pH 1 - 6.8 (37 °C) generate a pH-solubility profile cave: possible stability problems have to be considered Discussion on ‘intermediate solubility’, i.e., pH-dependent (high) solubility Definition of low solubility? 12 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver High permeability ♦ EU guidance: ”Linear and complete absorption reduces the possibility of an IR dosage form influencing the bioavailability” ♦ FDA guidance: absolute BA >90 % ♦ WHO guidance: at least 85 % absorption in humans Human data are preferred; in vitro data may be submitted if sufficiently justified and valid Definition of low permeability? 13 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Methods to investigate permeability ♦ PK-studies (e.g. absolute BA or mass-balance studies) ♦ Human intestinal perfusion studies ♦ Animal models ♦ Caco 2 cell lines or other suitable, validated cell lines (in-situ or in-vitro models for passively transported APIs only) To be noted: the stated methods assess the fraction dose absorbed ≠ BA, which can be reduced substantially by first-pass metabolism (see e.g. Propranolol) 14 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Solubility high low high low Permeability high high low low 15 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS classification I (e.g. Propranolol) II (e.g. Glibenclamide) III (e.g. Atenolol) IV (e.g. Azathioprine) BCS-based biowaiver RISK assessment (see e.g. WHO guidance; sect. 9.2 and 5.1.(a)) ♦ “critical use medicines” ♦ “narrow therapeutic index drugs” ♦ “documented evidence for BA or BE problems ♦ “scientific evidence that API polymorphs, excipients or the manufacturing process affects BE” 16 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver ♦ „….Risk assessment: only if the risk of an incorrect biowaiver decision and an evaluation of the consequences (of an incorrect, biowaiver-based equivalence decision) in terms of public health and risks to individual patients is outweighed by the potential benefits acrued from the biowaiver approach may the biowaiver procedure be applied…“ [WHO Technical Report Series, No. 937, 2006; Annex 8] is the concept scientifically sound? 17 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver ♦ „….if the fraction of the dose absorbed is the same, the human body should always do the same with the absorbed compound …Even in a disease state, this argument is still a valid statement.“ [Faassen et al. Clin Pharmacokinet 43 (2004)1117] what does the product do to the drug substance? 18 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver When are in vitro results sufficient for bioequivalence evaluation? When is in vitro instead of in vivo bioequivalence testing scientifically justified (or even more restrictive)? Minimizing risk by means of ‘worst case’ investigation? Which in vitro investigations may be sufficient? 19 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver in vitro dissolution objectives quality control justification of minor variations iviv-correlation (e.g. major variations; bridging) additional to BE studies proportionality based biowaiver BCS based biowaiver …. 20 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver in vitro dissolution prerequisites reasonable, stability-indicating, validated methods discriminative methods reproducible methods biorelevant methods (?) ……one fits all?! 21 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver in vitro dissolution and BCS concept 20 18 meet prerequisites 16 14 ensure risk minimization % 12 10 8 6 justify absence of difference biorelevant?! 22 | Workshop: Training of BE Assessors, Kiev, October 2009 4 2 0 0 5 10 time 15 20 BCS-based biowaiver In vitro comparison of immediate release oral drug products (T and R) first option: very rapidly dissolving products Not less than 85 % of labeled amount are dissolved within 15 min in each of three buffers (pH 1.2, pH 4.5 acetate buffer, pH 6.8 phosphate buffer) – no further profile comparison of T and R is required reasonable, validated experimental conditions/methods are strongly recommended! 23 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver In vitro comparison of immediate release oral drug products (T and R) second option: rapidly dissolving products Not less than 85 % of labeled amount are dissolved within 30 min in each of three buffers (pH 1.2, pH 4.5 acetate buffer, pH 6.8 phosphate buffer) reasonable, validated experimental conditions/methods are strongly recommended! 24 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Experimental conditions: EU guidance – no specific information yet US-FDA guidance – ‚USP‘-conditions 50 rpm (paddle) or 100 rpm (basket); 900 ml; USP buffer; 37 °C WHO – 75 rpm (paddle) or 100 rpm (basket); 900 ml or less; USP buffer; 37 °C all: no surfactants! 25 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver In vitro comparison of immediate release oral drug products (T and R) Proving similarity of dissolution profiles of T and R e.g., using f2-test, unless similarity is obvious (see e.g. WHO guidance sect. 9.2 or app. 2 of the current EU guidance; note prerequisites) 26 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver f2-test acceptance value based on 10 % difference between profiles „identical“ profiles: f2 =100 „similar“ profiles: f2 between 50 and 100 any other reasonable/justified test possible! 27 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Requirement: either “very rapid” or “similar” in vitro dissolution how similar is ‘similar’? discussion of differences usually not appropriate 28 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver BCS-based biowaiver in-vitro dissolution no iviv correlation no biorelevant conditions (except pH) concept to justify absence of difference! 29 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Evaluation of excipients (e.g., large amounts, possible interactions....; e.g. Isoniazid J Pharm Sci 96 March 2007: “…permeability changes due to excipient interaction cannot be detected in vitro…”) Evaluation of manufacturing processes in relation with critical physicochemical properties 30 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Excipients – generally - Should be ‘well-known’ - Used in ‘usual amounts’ - Without relevant impact on the absorption process Preferred for class I drugs and requested for class III: same excipients in similar amounts as the reference Critical excipients should be qualitatively and quantitatively the same 31 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Provided that ...... drug solubility is high, permeability is limited, excipients do not affect kinetics, excipients do not interact ,..... 32 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver ....then very rapid dissolution (at least >85% in 15 min) of test and reference may ensure similar product characteristics because... ....absorption process is probably independent from dissolution and not product related… limited absorption kinetics due to poor drug permeability and/or gastric emptying Biowaiver for BCS class III drugs (see WHO guidance) 33 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-class III?! Fig. 1. Mean in vitro dissolution profiles of metformin for 500mg immediate-release tablet of Glucophage® or Glucofit® in 0.1N HCI (○,●) pH 4.6 (□,■) and pH 6.8 (∆,▲) buffer solution. BCS-class III?! Fig. Fig. 2. Mean Fig. 2in vivo plasma conentration-time profiles of metformin in 12 healthy Chinese subjects after oral administration of a 500mg immediate-release tablet of 35 | Workshop: Training of BE Assessors, Kiev, October 2009 Glucophage (○) or Glucofit (●). BCS-class III?! Fig. 1. Comparison of mean cimetidine released-time profiles obtained from dissolution testing of cimetidine tablets containing methacrylate copolymer and Tagamet ® tablets in different media. Each value is the mean of six observations. Data for the Tagamet® tablet were obtained from dissolution testing in 0.01N hydrovhloric acid (HCI) and simulated intestinal fluid without pancreatin (SIFsp): (a) 0.01N HCI, pH 2; (b) phosphate buffer, pH 4.5; (c) SIFsp, pH 6.8; and (d) fasted-state simulated intestinal fluid, pH 6.5 pancreatin. 36 | Workshop: Training of BE Assessors, Kiev, October 2009 Clin Pharmacokinet. Jantratid et al 2006 BCS-class III?! Fig. 2. Comparison of mean plasma cimetidine concentration-time profiles obtained after administration of a singel oral dose of cimetidine tablets containing methacrylyte copolymer or Tagamet® tablets. Each point represents the mean plasma cimetidine concentration (standard error) from 12 subjects. 37 | Workshop: Training of BE Assessors, Kiev, October 2009 Clin Pharmacokinet. Jantratid et al 2006 BCS-based biowaiver For drugs showing .... ‘very’ high permeability pH-dependent solubility within the physiologically relevant pH range .....an ‘intermediate solubility’ class is suggested [Polli et al. J Pharm Sci 93 (2004) 1375; see WHO guidance] 38 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver “pH-dependent soluble, highly permeable, weak acidic, ionizable drug compounds may be handled like BCS class I drugs” (e.g. chpt 8 in: Drug Bioavailability, van de Waterbeemd, Lennernäs, Artursson (edts) 2003 Wiley-VCH) in vitro dissolution requirements acc. to WHO guidance at least 85% within 30 min at pH 6.8 and f2 testing for pH 1.2 and 4.5 profiles but no biowaiver for weak basic drugs 39 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver meaningful literature data may be used for drug substance characteristics (and excipients) product related data must always be actually generated for the particular product 40 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver BCS-based biowaiver are not just in-vitro dissolution, but in-vitro dissolution is meant to be an important part of BCS-based biowaiver applications 41 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Current recommendation for TB drugs no BCS-based biowaiver for RMP ‘regular’ BCS-based biowaiver possible for levofloxacin and ofloxacin (“rapid dissolution”) currently a BCS-based biowaiver is possible for isoniazid (cave: excipients!), ethambutol and pyrazinamide if the same “very rapid” dissolution (T and R) is demonstrated see specific, currently published WHO guidance documents at: http://healthtech.who.int/pq/info_applicants/info_for_applicants_BE_studies.htm 42 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Some remarks: ♦ biopharmaceutics assessment (with necessary underlying PK background!!) ≠ pure PK assessment ♦ differentiation between solubility (API) and dissolution (product performance) ♦ volume of dissolution medium (900 vs 500 ml) not relevant (no concerns regarding hydrodynamics; recent findings); sink conditions! ♦ in-vitro/in-vivo relationship rather than correlation!! ♦ note differences regarding the evaluation of excipients!! 43 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver Becker C, Dressman JB, Amidon GL, Junginger HE, Kopp S, Midha KK, Shah VP, Stavchansky S, Barends DM: Biowaiver monographs for immediate release solid oral dosage forms: Pyrazinamide; J Pharm Sci. 2008 Feb 12; [Epub ahead of print] Becker C, Dressman JB, Amidon GL, Junginger HE, Kopp S, Midha KK, Shah VP, Stavchansky S, Barends DM: Biowaiver monographs for immediate release solid oral dosage forms: ethambutol dihydrochloride; J Pharm Sci. 2008 Apr;97(4):1350-60. Vogt M, Derendorf H, Krämer J, Junginger HE, Midha KK, Shah VP, Stavchansky S, Dressman JB, Barends DM: Biowaiver monographs for immediate release solid oral dosage forms: prednisone; J Pharm Sci. 2007 Jun;96(6):1480-9. Becker C, Dressman JB, Amidon GL, Junginger HE, Kopp S, Midha KK, Shah VP, Stavchansky S, Barends DM; International Pharmaceutical Federation, Groupe BCS: Biowaiver monographs for immediate release solid oral dosage forms: isoniazid; J Pharm Sci. 2007 Mar;96(3):522-31. Kalantzi L, Reppas C, Dressman JB, Amidon GL, Junginger HE, Midha KK, Shah VP, Stavchansky SA, Barends DM: Biowaiver monographs for immediate release solid oral dosage forms: acetaminophen (paracetamol); J Pharm Sci. 2006 Jan;95(1):4-14. Potthast H, Dressman JB, Junginger HE, Midha KK, Oeser H, Shah VP, Vogelpoel H, Barends DM: Biowaiver monographs for immediate release solid oral dosage forms: ibuprofen; J Pharm Sci. 2005 Oct;94(10):2121-31. Kortejärvi H, Yliperttula M, Dressman JB, Junginger HE, Midha KK, Shah VP, Barends DM: Biowaiver monographs for immediate release solid oral dosage forms: ranitidine hydrochloride; J Pharm Sci. 2005 Aug;94(8):1617-25. Verbeeck RK, Junginger HE, Midha KK, Shah VP, Barends DM: Biowaiver monographs for immediate release solid oral dosage forms based on biopharmaceutics classification system (BCS) literature data: chloroquine phosphate, chloroquine sulfate, and chloroquine hydrochloride; J Pharm Sci. 2005 Jul;94(7):1389-95. ………. 44 | Workshop: Training of BE Assessors, Kiev, October 2009 BCS-based biowaiver THANK YOU FOR YOUR ATTENTION! 45 | Workshop: Training of BE Assessors, Kiev, October 2009