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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5577_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •About the Authors
- •Preface
- •Acknowledgements
- •Contents
- •1.1. Singapore as a British Colony
- •1.5.1. Levelling Up the Pharmaceutical Inspection System of Singapore
- •1.5.2. Advantages of PIC/S Membership to Singapore and Other Participating Authorities
- •1.6. Emergence of MNC Pharmaceutical Manufacturing Industry in Singapore
- •1.6.1. Why do MNC Pharmaceutical Manufacturers Set Up Facilities in Singapore?
- •2.2. Geographical Background of ASEAN vis-à-vis Asia and the Rest of the World
- •2.4. Formation of an ASEAN MRA Taskforce on GMP Inspection
- •2.5. Signing of ASEAN Sectoral MRA on GMP Inspection
- •2.6. Formation of ASEAN JSC on GMP Inspection and Establishing Register of ASEAN LIS
- •2.8. Assessment of FDA Philippines by ASEAN PoE
- •2.9. Register of ASEAN Listed Inspection Services (LIS)
- •3.1. Introduction: Urgency of Training ASEAN Inspectors
- •3.3. Collaboration with Korea Ministry of Food and Drug Safety (MFDS)
- •3.4. Collaboration with the Generics and Biosimilars Initiative (GaBI)
- •3.5. Pre-employment Training in Pharmacy and Pharmaceutical Science Schools
- •4.1. Introduction
- •4.2. Historical Context to WHO Reliance Initiative
- •4.3. The First NRAs to Achieve ML4 and WLA Status
- •4.5. Other International Reliance and Harmonization Initiatives
- •4.5.1. Access Consortium
- •4.5.2. Association of Southeast Asian Nations (ASEAN)
- •4.5.3. East African Community (EAC)
- •4.5.4. European Medicines Agency (EMA)
- •4.5.6. International Council for Harmonization (ICH)
- •4.5.6.1. Introduction
- •4.5.6.2. ICH Members and Observers
- •4.5.6.3. Future Direction
- •4.5.7.1. Introduction
- •4.5.7.2. Addressing Common Regulatory Issues
- •4.5.7.3. ICMRA Pilot Program for Collaborative Hybrid Inspection
- •4.5.8. International Pharmaceutical Regulators Program (IPRP)
- •4.5.9. Latin America
- •4.5.10. Pharmaceutical Inspection Co-operation Scheme (PIC/S)
- •4.5.10.1. Introduction
- •4.5.10.2. PIC/S Participating Authorities
- •4.5.11. WHO Collaborative Registration Procedure for Medical Products (CRP)
- •4.5.12.1. Introduction
- •4.5.12.3. WHO Inspection Report
- •4.5.13. ZaZiBoNa
- •4.6. Conclusion
- •5.1. Introduction to GMP
- •5.2. Overview of the PIC/S GMP Standard
- •5.3. How is an On-site GMP Inspection Conducted?
- •5.3.1. Why is the Warehouse Inspected?
- •5.3.3. Why are the Production Areas Inspected?
- •5.3.4. Why are the Packaging Areas Inspected?
- •5.3.5. Why are the QC Laboratories Inspected?
- •5.3.6. Why do GMP Inspectors Visit Other Miscellaneous Areas?
- •5.3.8. Why is there a Need to Conduct Documentation Audit/Review?
- •5.3.8.1. Assessing Product Quality Review
- •5.3.8.3. Assessing Self-Inspection Program
- •5.4. The 20 Annexes of PIC/S GMP Standard
- •5.5. PIC/S Inspection System: A Risk-based Approach
- •5.5.1. Whom can the GMP Inspector Interview?
- •5.5.2.1. Inspector’s Expectations of a Manufacturer
- •5.5.2.2. Manufacturer’s Expectations of an Inspector
- •5.6. Who Inspects the Inspectors?
- •6.1. Historical Development of Pharmaceutical Quality
- •6.2. What is a High-Quality Medicinal Product?
- •6.3. Purity of a Medicinal Product: Elimination of Impurities and Contaminants
- •6.3.1. What is a Contaminated Medicinal Product?
- •6.3.2. Why is There a Need to Control Impurities?
- •6.3.2.1. Types of Impurities from APIs
- •6.3.2.2. Types of Impurities from Container-Closure System
- •6.3.3. Control of Intrinsic Contaminants
- •6.3.4. Control of Extrinsic Contaminants
- •6.3.5. General Assessment of Cross-Contamination Risks
- •6.4. Stability and Shelf-Life Testing of a Medicinal Product
- •6.4.1. Why is Proper Storage, Distribution and Handling of a Medicinal Product Important?
- •6.6. Summary of High-Quality Medicinal Products
- •7.1. Introduction to Stability and Quality
- •7.3.1. Why is Proper Storage Important?
- •7.3.2. Why is Proper Transportation of a Medicinal Product Important?
- •7.3.3. Why is Proper Handling of a Medicinal Product during Use Important?
- •7.4.1. Number and Size of Batches
- •7.4.2. Testing Frequency
- •7.4.3. Storage Conditions
- •7.4.4. Test Methods
- •7.4.5. Container-Closure Systems
- •7.5. Stability Study Schedule and Report
- •7.6. Temperature Excursions and Product Stability
- •7.8. Cold Chain Products and Temperature Excursions
- •7.11. Conclusion
- •8.1. Christopher Columbus versus the Vikings
- •8.4. Pharmaceutical Data Integrity and ALCOA
- •8.5. Article(s) on Pharmaceutical Data Integrity
- •Introduction
- •Current trends
- •Reasons for Data Integrity violations (inadvertent and intentional)
- •Assuring and promoting Data Integrity via legislation and guidance documents
- •Legislation
- •Guidance documents
- •Proposed Solutions to Better Promote and Assure Data Integrity
- •Culture of integrity
- •Database management systems
- •Robust quality agreements
- •Collaboration between countries
- •Computerized systems validation
- •List of abbreviations
- •Conclusion
- •Authors
- •References
- •9.1. Pharmaceuticals versus Biopharmaceuticals
- •9.2. Transcription and Translation: Central Dogma of Genetics
- •9.3. Biotechnology-derived Medicinal Products: Microbial versus Mammalian Substrates
- •9.4. Manufacture of Biotechnology-derived Medicinal Products: Key Processes
- •Introduction
- •Manufacture of biopharmaceuticals — an overview
- •Procurement and testing of biological starting materials
- •Generation and characterization of cell banks/seed lots
- •Cell culturing
- •Challenges concerning manufacture of biopharmaceuticals
- •Extensive process and product understanding required
- •Inherent variability of host cells
- •Downstream processing remains a key bottleneck
- •Review of current GMP frameworks for biopharmaceuticals
- •Challenges in the regulation of biopharmaceuticals
- •Resource-intensive evaluation of biosimilarity
- •Growing number of data integrity lapses
- •Proposed solutions to challenges of biopharmaceuticals
- •Optimizing biopharmaceutical manufacturing with Industry 4.0
- •Enhancing data integrity with a culture of quality (quality culture)
- •Conclusion
- •List of abbreviations
- •Authors
- •References
- •10.1. Introduction
- •10.2. Advantages of Nanomedicines
- •10.3. Types of Nanomedicines
- •10.3.1. Nanocarrier Systems
- •10.3.2. Nanosuspensions
- •10.4. Future of Nanomedicines
- •10.5. GMP Requirements Governing Nanomedicines and Challenges
- •10.5.1. Lack of Trained Personnel to Operate Manufacturing Processes
- •10.5.2. Lack of Safety Protocol for Manufacturing Personnel
- •10.5.3. Challenges in Controlling for Nanoparticle Contamination
- •10.6. Conclusion
- •11. Novel and Traditional Vaccines
- •11.1. Historical Development and Evolution of Traditional and Novel Vaccines
- •11.2. Traditional Vaccines Versus Novel Vaccines
- •Introduction
- •Traditional vaccines
- •Novel vaccines
- •Vaccine manufacture
- •Vaccine storage, transport and distribution
- •Regulatory controls
- •Challenges, safety and quality issues and possible solutions
- •Conclusion
- •Authors
- •References
- •12.1. Cells and Tissues
- •12.2. Gene Therapy Products
- •12.3. Published Article on CTGTPs
- •Introduction
- •CTGTPs and their principles of action
- •Manufacturing of CTGTPs
- •Premises and equipment
- •Materials and processing
- •Starting material
- •Quality control
- •Cryopreservation
- •Human resource and accreditation
- •Potential solutions to the challenges encountered in manufacturing
- •Outsourcing
- •Technology
- •Control of CTGTPs
- •Current regulatory framework
- •Risk-based approach
- •Conclusion
- •Authors
- •References
- •13. Hand Sanitizers
- •13.1. What are Hand Sanitizers?
- •13.4. Published Article and Commentary on Hand Sanitizers
- •Introduction
- •The microbiology of bacteria, fungi and viruses
- •Antimicrobial compounds and their applications in hand sanitizers
- •FDA policy for testing of alcohol and USP limits for methanol
- •Common myths about hand sanitizers
- •A lack of regulatory framework
- •Proposed solutions
- •Tightening the regulatory framework
- •Training pharmacists on hand sanitizer vigilance
- •Public Education
- •Conclusion
- •Authors
- •References
- •14. Pharmaceutical Dosage Forms
- •14.1. Introduction
- •14.2. What Are Pharmaceutical Dosage Forms?
- •14.4.1. Routes of Administration
- •14.4.1.1. Oral Dosage Forms — Solids
- •14.4.1.2. Oral Dosage Forms — Liquids
- •14.4.1.3. Topical Dosage Forms
- •14.4.1.5. Inhaled Dosage Forms
- •14.4.1.6. Ophthalmic Dosage Forms
- •14.4.1.7. Nasal Dosage Forms
- •14.4.1.8. Otic Dosage Forms
- •14.4.1.9. Rectal Dosage Forms
- •14.4.1.10. Vaginal Dosage Forms
- •14.4.1.11. Transdermal Patch
- •14.4.2. Physical Forms
- •14.4.2.1. Solid Dosage Forms
- •14.4.2.2. Liquid Dosage Forms
- •14.4.2.3. Semi-solid Dosage Forms
- •14.4.2.4. Gaseous or Aerosol Dosage Forms
- •14.5. Manufacture and Important Characteristics of Common Pharmaceutical Dosage Forms
- •14.5.1. Tablets
- •14.5.2. Capsules
- •14.5.3. Solutions
- •14.5.4. Suspensions
- •14.5.5. Emulsions
- •14.5.6. Creams
- •14.5.7. Ointments
- •14.5.8. Metered Dose Inhalers
- •14.6. Overall Summary of the Manufacture of a Pharmaceutical Dosage Form
- •15.1. Introduction

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Manufacture and Supply, Science and Reg ulation Towards High-Qua lity Medicinal Products
PIC/S assessment of Malaysia NPCB — 2001

ASEAN Harmonization on Pharmaceutical Inspection
closely for this highly important mission which involved another
ASEAN Member State and a close neighbor of Singapore. I recall
clearly that Bob Tribe would communicate with me in my oce
during weekdays and even on Saturday mornings, via long-distance
landline telephone calls, to discuss the application and supporting
documents submitted by Malaysia.” There were no handphones,
WhatsApp, Skype or Zoom way back in 2001 (the pre-Industry 4.0
era). Malaysia became the 2nd Asian member of PIC/S on 1 January
2002. With 2 ASEAN Member States acceding to PIC/S in a short
span of two years, interest in ASEAN harmonization on pharmaceutical inspection with the PIC/S inspection system as the guiding framework started to gain momentum. Soon after, an ASEAN
Mutual Recognition Arrangement (MRA) Taskforce on GMP
Inspection was formed in 2005. Both Singapore and Malaysia were
appointed the Chair and Co-Chair of this newly formed Taskforce.
Singapore and Malaysia were handpicked to lead this ASEAN Taskforce on GMP Inspection by virtue of the fact that both countries
were the only ASEAN members of PIC/S at that point in time. The
main deliverable of this ASEAN MRA Taskforce was a pan-ASEAN
MRA on GMP inspection which is mutually acceptable by all the
10 ASEAN Member States. For the next four years, beginning from
2005, the ASEAN MRA Taskforce worked single-mindedly to deliver
an ASEAN MRA on GMP Inspection. On 10 April 2009, the Economic Ministers of all the 10 ASEAN Member States signed a legally
binding multilateral Sectoral MRA on GMP Inspection for Manufacturers of Medicinal Products at the beach resort city of Pattaya
in Thailand. With the signing of this MRA, all the 10 ASEAN Member States strived to work towards the recognition of one another’s
GMP Certificates and inspection reports, and to avoid duplication
of GMP inspections in each other’s territories. To implement this
MRA, the Taskforce was dissolved, and an ASEAN Joint Sectoral
Committee (JSC) on GMP Inspection established in 2012, retaining
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Manufacture and Supply, Science and Reg ulation Towards High-Qua lity Medicinal Products
Singapore and Malaysia as Chair and Co-Chair, to create a Register
of ASEAN Listed Inspection Services (LIS). The ASEAN Sectoral
MRA on GMP Inspection for Manufacturers of Medicinal Products
was benchmarked to the international PIC/S framework. The establishment of the ASEAN JSC on GMP Inspection and the creation of
a Register of LIS is elaborated under Section 6 of this chapter.
2.2. Geographical Background of ASEAN vis-à-vis Asia and the Rest of the World
Many people, especially those from outside of the Asian continent,
tend to view Asia as comprising only China, India and Japan —
the Asian giants with huge economies and long histories of civilization. Perhaps, some are also familiar with the rapidly emerging

ASEAN Harmonization on Pharmaceutical Inspection
45
South Korea — a country which is increasingly being recognized
for its excellence in science and technology, famous for its K-pop
culture, music and movie industry as well as for its pharmaceutical
and biopharmaceutical manufacturing. Unfortunately, Southeast
Asia, which is tucked away in one corner of Asia, is still relatively
unknown to many people outside of Asia.
So, let us elaborate more about Southeast Asia and ASEAN. ASEAN
is the abbreviation for the Association of Southeast Asian Nations.
It was founded in 1967, and ASEAN comprises 10 Southeast Asian
Member States. The 10 ASEAN nations, in alphabetical order, are
Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam.
The 10 ASEAN Member States have very diverse racial, religious,
socio-cultural, political, economic and geographical backgrounds.

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Manufacture and Supply, Science and Reg ulation Towards High-Qua lity Medicinal Products
Individually, each of the 10 ASEAN Member States faces strong economic competition from its Asian neighbors, which have generally
larger geographical size and bigger populations — e.g., South Korea:
51 million, Japan: 123 million, and the two Asian giants, India and
China, with approximately 1.4 billion population each. Further away
in the Western world, there is USA and the European Union (EU)
with 340 million and 450 million population respectively. But, collectively, ASEAN as a 10-member group is not small. A key strength
of ASEAN is its combined population (and, therefore, a potential
collective market) of more than 650 million people. ASEAN also
has a combined economy of more than 2.5 trillion US dollars, and
ASEAN is set to become the 4th largest world economy by 2030. This
collective strength of the 10-member ASEAN has been optimized
through the creation of an ASEAN Economic Community in 2015.
2.3. Need for ASEAN Economic Integration and
Creation of ASEAN Economic Community
The creation of an ASEAN Economic Community (AEC) was set
into motion as early as 2003. On 2 September 2003, ASEAN leaders
agreed in principle at the 35th ASEAN Economic Ministers Meeting
in Phnom Penh, Cambodia, to establish an AEC. Very soon after,
on 7 October 2003 at the 9th ASEAN Summit in Bali, Indonesia, the
ASEAN Economic Blueprint (also known as the Bali Concord II)
was published, with ASEAN committed to the establishment of an
AEC by 2020. The AEC is expected to develop ASEAN into a highly
competitive region of equitable economic development, with a single market and production base, which is fully integrated into the
global economy. The following year, on 30 November 2004, the AEC
Framework Agreement was signed at the 10th ASEAN Summit in

ASEAN Harmonization on Pharmaceutical Inspection
Vientiane, Laos. This AEC Framework Agreement on Integration
of Priority Sectors represented a first major step towards the realization of an AEC. Eleven priority sectors, including healthcare, of
which pharmaceutical products are a component, were identified.
An ASEAN Sectoral MRA on GMP Inspection for Manufacturers of
Medicinal Products was one of the priority initiatives.
With global economic competition moving at a fast and furious
pace, ASEAN also had to shift its gear in tandem. On 15 January
2007, the Cebu Declaration on the Acceleration of the Establishment
of an AEC by 2015 was signed at the 12th ASEAN Summit, held in
Cebu, Philippines. The Cebu Declaration accelerated the establishment of AEC from 2020 to 2015.
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2.4. Formation of an ASEAN MRA Taskforce on GMP Inspection
With AEC 2015 as the backdrop, and an ASEAN Sectoral MRA on
GMP Inspection as one of the priority initiatives, the idea of an
ASEAN MRA Taskforce on GMP Inspection was seriously mooted
in 2005. This Taskforce was charged with the responsibility to deliver
an ASEAN Sectoral MRA on GMP Inspection for Manufacturers of
Medicinal Products as its main outcome. Singapore and Malaysia
were appointed as the Chair and Co-Chair of this Taskforce respectively, as both countries were the only two ASEAN Member States of
the Geneva-based PIC/S. Hence, they were considered to be the most
appropriate ASEAN Member States to drive a “big, hairy, audacious
goal (BHAG)”. This BHAG was the signing and implementation of
a pan-ASEAN MRA or treaty on GMP Inspection, in tandem with
the creation of the AEC 2015. This was how the story of the ASEAN

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Manufacture and Supply, Science and Reg ulation Towards High-Qua lity Medicinal Products
Sectoral MRA on GMP Inspection unfolded. The co-author remembered very clearly that sometime in 2005, there was a long-distance
telephone call from his director in Manila — the capital city of the
Philippines. His director was then attending an ASEAN senior regulators’ meeting in Manila. “My director spoke to me in his usual
composed manner that an ASEAN Taskforce on GMP Inspection
was going to be formed, and I was considered the most suitable person to lead this Taskforce, and to drive the initiative to develop a
pan-ASEAN MRA on GMP inspection. My director asked me pointedly (at that moment in time), if it was okay for me to assume the
Chair of a soon-to-be-formed ASEAN MRA Taskforce. As I was
mentally unprepared, my knee-jerk response then was to be
non-committal, and to request for more time to think through this
request. Over the next couple of days, I had to quickly digest this
piece of breaking news. Meanwhile, the rationale was explained
clearly to me: Singapore’s Health Sciences Authority (HSA) was the
1st Asian member of PIC/S, and the ASEAN pharmaceutical community was eagerly looking forward to the leadership and experience
of Singapore HSA to drive this milestone initiative.” At that 2005
meeting in Manila, Singapore was deemed the most appropriate
ASEAN Member State for this driver role. And the rest is history.
Singapore was appointed Chair with Malaysia (the 2nd Asian member of PIC/S) as the Co-Chair of the ASEAN MRA Taskforce on GMP
Inspection. “I remained as Chair of this ASEAN MRA Taskforce for
seven consecutive years since its inception in 2005 until its dissolution in 2012.” After 2012, a JSC on GMP Inspection was established
to implement the provisions of the ASEAN Sectoral MRA, including the creation of an ASEAN Register of LIS and a training program for ASEAN pharmaceutical inspectors. “I continued to chair
the ASEAN JSC for eight years from 2012 to 2020. All in all, I served

ASEAN Harmonization on Pharmaceutical Inspection
a combined total of 15 years as Chair of the ASEAN MRA Taskforce
and Joint Sectoral Committee on GMP Inspection.”
ASEAN MRA Taskforce on GMP inspection
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2.5. Signing of ASEAN Sectoral MRA on GMP Inspection
As mentioned in the preceding section, the ASEAN MRA Taskforce
on GMP Inspection was formed in 2005. After four years of dedicated and highly focused hard work by the ASEAN MRA Taskforce
via face-to-face meetings twice a year, online discussions and teleconferences in between meetings, the ASEAN Sectoral MRA on GMP
Inspection for Manufacturers of Medicinal Products was drafted
and finalized. On 10 April 2009, the Economic Ministers of all the 10
ASEAN Member States signed this legally binding multilateral Sectoral MRA on GMP Inspection for Manufacturers of Medicinal

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Manufacture and Supply, Science and Reg ulation Towards High-Qua lity Medicinal Products
Products at the beach resort of Pattaya in Thailand. The international PIC/S inspection framework was used as the benchmark for
this landmark treaty. With the signing of this MRA, all 10 ASEAN
Member States strived towards recognizing one another’s GMP
Certificates and inspection reports, and avoided duplicating GMP
inspection in each other’s territories. This ASEAN Sectoral MRA
comprised 19 Articles, of which Articles 4 and 8 respectively covered
the scope and obligations of ASEAN Member States. Under Article
4 on the scope, it is clearly stipulated that the ASEAN Sectoral MRA
covers all medicinal products in finished dosage forms, both prescription medicines and over-the-counter products, as well as sterile and
non-sterile medicinal products. It is also clearly stated that the MRA
excludes Active Pharmaceutical Ingredients, biologics, clinical trial
products and traditional and herbal medicines. Under Article 8 concerning the obligations, all 10 ASEAN Member States are obliged to
operate a PIC/S-equivalent GMP inspection framework. In addition,
all ASEAN Member States are also obliged to accept and recognize
GMP Certificates and inspection reports issued by LIS, namely, the
inspection services or inspectorates of ASEAN Member States that
meet the technical requirements of the PIC/S framework. A grace
period of three years from the year of the signing of the MRA (2009)
ASEAN Sectoral MRA on GMP inspection (consists of 19 articles)

ASEAN Harmonization on Pharmaceutical Inspection
was given to all ASEAN Member States to comply with all the legal
obligations stipulated under Article 8. During this three-year grace
period, all ASEAN Member States had to work towards leveling up
their inspectorates to operate a PIC/S-equivalent GMP inspection
framework by 2012.
2.6. Formation of ASEAN JSC on GMP Inspection and Establishing Register of ASEAN LIS
The ASEAN MRA Taskforce was dissolved in 2012, and in its place,
a JSC on GMP Inspection was formed to implement the MRA,
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ASEAN Joint Sectoral Committee on GMP inspection
Jakarta, Indonesia: 6 November 2018
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