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  • Tackling PMTA Deficiency Letters From the FDA

    Tackling PMTA Deficiency Letters From the FDA

    Photo: Araki Illustrations

    Contributed

    Paul Hardman

    In this article, Broughton Nicotine Services Head of Scientific Affairs Paul Hardman outlines the factors that can lead to data gaps in premarket tobacco product applications (PMTAs), what prompts a deficiency letter and how you can respond quickly and appropriately.

    What is a deficiency letter?

    Deficiency letters are sent to those who have submitted a PMTA with incomplete or insufficient data for the U.S. Food and Drug Administration to make a decision on whether the product is “appropriate for the protection of the U.S. public health.”

    Why have I received a deficiency letter?

    There are common causes of deficiencies that prompt the arrival of a letter. These could include a PMTA that lacks information that was mistakenly considered unimportant by the electronic nicotine-delivery systems (ENDS) company but is actually required by the FDA.

    Applicants may also have been rushed to meet last year’s Sept. 9 deadline, leaving the company submitting the PMTA with insufficient time to collate and provide the required data. Similarly, the timeframe required to submit the application may not have left enough time to complete stability studies of the required length to provide a range of data. The FDA is, understandably, keen to understand the stability of a product over its expected shelf life.

    Other reasons include:

    • A lack of integration between different studies—often submissions provide extensive data for some workstreams but are light in others. It is important that appropriate data is provided for all product analysis, nonclinical and human subject studies—and that data and approaches are integrated across all areas.
    • Different interpretation of “scientifically justified”—many elements of the PMTA guidelines indicate that approaches applied need to be justified by scientific data. However, as all products differ, there is a level of ambiguity in terms of what this looks like and what is required.
    • Poor “bridging” of data—the FDA welcomes the bridging of scientific data between similar products where appropriate. However, bridging that is not, in the opinion of the FDA, sufficiently scientifically justified will be highlighted and raised as a deficiency.

    What will be in a deficiency letter?

    Despite the name, it won’t just be a letter. The deficiency packs issued by the FDA are very detailed, outlining positive aspects about your application and areas for improvement and attention.

    There will be multiple pages covering different points, with sections covering all products or particular products in a bundled PMTA and perhaps highlighting deficiencies for particular timepoints.

     

    What is the aim of the deficiency letter?

    Once a PMTA application has been accepted for filing, the next stage is substantive scientific review, which results in either a deficiency letter, a request for environmental information, a market order granted or a market order denied. The FDA will notify the submitting company when their application enters substantive scientific review.

    The FDA intention of the deficiency letter pack is to support you in providing the required information. Each will typically cover what you need to do to remedy the deficiency and what data you need to provide to allow the FDA to carry on with a substantive scientific review—and the FDA has confirmed that, for deemed products (those on sale in the U.S. on or before Aug. 8, 2016), you will only receive one deficiency letter based on the agency’s current high workload with the many applications in process. The FDA has said this may be reviewed in the future once the backlog is cleared. Generally, for deemed products, you will have only 90 days to respond to the deficiency letter with all the relevant data that has been requested.

    Information could include examples of what meets the FDA’s requirements and advice on how you could better explain or justify the information provided. There is no set response to a PMTA application. The FDA has received an extensive number of applications, which are reviewed by a team of people, so inconsistencies may arise between different responses. Also, take note that answering all the queries in a deficiency letter does not necessarily guarantee that your application will eventually be granted a marketing order.

    How can I prepare for a deficiency letter?

    As an ENDS company, you might have a good idea of possible data gaps within your submission and understand whether you are likely to receive a deficiency letter. Or, you may believe that what you have provided is appropriate and adequate. Either way, it is best to be prepared.

    Steps can be taken to ensure you are ready for any eventuality, the most important one being to ask for help. Scientific and regulatory ENDS specialists can undertake gap analysis to identify any possible deficiencies so that steps can be taken now to provide what is required.

    You can also ensure you fill any missing data gaps. If there is information that is clearly missing or inadequate, put studies in place to collect the data now. Remember, there are only 90 days to respond to a deficiency letter, which may not be sufficient time to obtain the information required.

    Another piece of advice would be to start stability studies now if you are in any doubt that the stability data you provided may not be sufficient in terms of duration. Putting studies in place now will help you stay ahead of the game if this aspect of your submission is questioned.

    Finally, you should always cross-check requirements. It is surprising how many companies miss out key sections, such as an executive summary or environmental assessment. Although omission of key sections is likely to lead to the FDA refusing to accept or refusing to file the application prior to reaching the substantive review phase, it makes sense to compare the detail of what you have provided with the list of requirements from the FDA to check if you have overlooked anything.

     

    Recently, the FDA confirmed that addendums of additional data can be submitted to them before the commencement of the substantive scientific review stage for the process. This is fantastic news for manufacturers who had submitted dossiers that were not as comprehensive as they would have liked; if your application has not yet entered substantive scientific review, you now have the opportunity to submit additional data at no penalty to your application. However, if you plan to do this, it is important to contact the FDA and describe the anticipated plan of data generation and submission—and be quick. If you leave this too late and your application does enter substantive scientific review, you run the risk of any addendums being detrimental to your application and a shortening of the FDA’s enforcement discretion.

    How can I be prepared for, or minimize the chance of, receiving a deficiency letter?

    ENDS companies most prepared to respond appropriately will be those that are expecting the letter and have the required data ready or those that avoid receiving a letter altogether by providing information upfront. Companies such as Broughton Nicotine Services can help at any stage of the process, either prior to submission or during substantive scientific review, troubleshooting when there is a refuse to file/accept decision and also helping with preparation for and response to deficiency letters.

    Broughton Nicotine Services can help you undertake a gap analysis on your submission and generate the required information. Contact our regulatory consulting team to book a meeting so that we can help you advance a smoke-free future. 

    This article was supplied on behalf of Broughton Nicotine Services.

  • FDA Denies Bid to Market CBD as Dietary Supplement

    FDA Denies Bid to Market CBD as Dietary Supplement

    The U.S. Food and Drug Administration on Wednesday told Charlotte’s Web Holdings Inc. that its cannabidiol product cannot be sold as a dietary supplement, signaling that CBD reform may have to wait for congressional action.

    Credit: Anankkml

    “While we disagree with FDA’s reasoning, believing we provided extensive and credible scientific evidence that supported a different outcome, this decision affirms the path to regulatory clarity must come from Congress,” Charlotte’s Web CEO Deanie Elsner said in a statement.

    The company’s bid to sell its full-spectrum hemp extract with CBD as a dietary supplement won’t be considered because of the FDA’s own prior decision to treat CBD as a drug, according to a letter posted on the agency’s website Wednesday, according to Fortune. The FDA’s latest decision rested in part on its prior approval of Epidiolex, a CBD drug to reduce seizures, which the agency said precludes it from authorizing CBD for dietary purposes.

    Even if the drug hadn’t been approved, though, the FDA said in the letter to Charlotte’s Web dated July 23 that it “has concerns about the adequacy of safety evidence” that the company submitted. The agency would have wanted more data on potential liver and reproductive toxicity.

    The decision isn’t expected to impact sales of Charlotte’s Web products or prevent other companies from continuing to sell CBD products. The market for CBD products has already grown to more than $6 billion as consumers seek help with everything from relaxation to focus to better sleep, according to reports. While generally an unregulated market, the FDA will periodically crackdown on companies that try to make unsubstantiated claims about the health benefits of CBD products.

  • U.K. Regulatory Agency Clarifies E-Cig Rules

    U.K. Regulatory Agency Clarifies E-Cig Rules

    Photo: Steheap

    The government agency overseeing the U.K.’s e-cigarettes and refill containers notification scheme as well as implementing the Tobacco and related Products Regulations (TRPR) has updated guidance on the sale of vaping products following discussions with the U.K. Vaping Industry Association (UKVIA) and Trading Standards.

    The UKVIA decided to intervene after being approached by a significant number of vape products manufacturers, distributors and retailers confused about what could and could not be legally sold in shops, particularly following the recent surge in new disposable vapes entering the U.K. market.

    As a result, the Medicines and Healthcare Products Regulatory Agency (MHRA) has now clarified its advice to both manufacturers and distributors of e-liquids and devices and vaping retailers.

    The UKVIA took part discussions with the MHRA and Trading Standards following concerns raised by retailers unsure of their compliance requirements and wary of falling foul of the law.

    “Due to the numerous enquiries we received about the legality of stocking new-to-the-market products, in particular the surge in new disposables, we decided it was imperative to talk to Trading Standards and raise this with the MRHA to seek clarification,” said John Dunne, director general of the UKVIA, in a statement.

    “Since then, we have been working with the MHRA to clarify the process around when products can legally be placed on the market for sale.

    “The first part saw the MHRA issue an e-bulletin clearly setting out the process and making it unambiguous that it is illegal to place products into the market until the ‘ECID’ numbers are published on the MHRA website as ‘approved/declared’

    “Next the MHRA updated its online advice for retailers, which is a highly satisfactory outcome as it effectively closes the loophole for when brands can place the product on the market and when a retailer can legally sell the product.”

    The MHRA’s guidance for vaping retailers previously read:

    “When sourcing new supplies of any e-cigarette or e-liquid product, check that details of the notification for the product have been published in the list of Notified Products.

    “If you cannot find the product on the MHRA’s website, ask your supplier to confirm that the product complies with the TRPR and has been notified to the MHRA. If a producer has not notified the product or it does not comply with the TRPR, they may not supply it to you.”

    The new wording says:

    When sourcing new supplies of any e-cigarette or e-liquid product, check that a compliant notification has been published in one of the Notified Product lists above.

    If you cannot find the product on the MHRA’s website, ask your supplier to confirm that it has been published and provide details to enable you to confirm the product’s status. If a product has yet to achieve publication status, they may not supply it to you.

    Dunne said the clarification demonstrates the effectiveness of open dialogue.

    “We want our sector to be known for upholding strict standards when it comes to the manufacture, distribution and sale of vaping products and this clarification from the MHRA can leave no one in any doubt about where their responsibilities lie,” he said.

    The MHRA’s full wording on the sale of vaping products is available here.

     

  • Another Study Finds Flavor Bans Would Boost Smoking

    Another Study Finds Flavor Bans Would Boost Smoking

    Photo: kurgu128

    If vapor product sales were restricted to tobacco flavors, one-third of U.S. vapers between the ages of 18 and 34 would switch to smoking combustible cigarettes, according to a new study in Nicotine & Tobacco Research.

     The study analyzed data from February to May 2020 and looked at 2,159 young adults in Atlanta, Boston, Minneapolis, Oklahoma City, San Diego and Seattle, examining support for e-cigarette sales restrictions and the perceived impact of flavor and vaping bans.

     This study precedes the FDA’s impending Sept. 9 deadline for premarket tobacco product application (PMTA) decisions, which could potentially take most vapor products off the market.

    The FDA’s deadline will be “like watching an unstoppable object hit an immovable wall,” said Charles Gardner, executive director of INNCO, a global nonprofit supporting the rights of adults using safer nicotine products. “The FDA must know flavor bans will increase teen, young adult and older adult smoking.”

    “In general, the FDA does not comment on specific studies but evaluates them as part of the body of evidence to further our understanding about a particular issue and assist in our mission to protect public health,” an FDA spokesperson said.

    Two other recent studies showed similar results. A study in JAMA Pediatrics showed that following San Francisco’s flavor ban, teens were more likely to smoke than those in other school districts. A different study in Nicotine & Tobacco Research shows that teens who vape would be smoking cigarettes if vapes hadn’t become available.

    “All hell will break loose if [the FDA] authorize[s] flavors as ‘appropriate for the protection of public health,’” said Gardner. “The Truth Initiative and the Bloomberg-funded Campaign for Tobacco-Free Kids have staked their reputations on the public health benefits of flavor bans. And many key leaders in the U.S. Congress believe them.”

  • Poda Begins Clinical Trials on Heated Tobacco Product

    Poda Begins Clinical Trials on Heated Tobacco Product

    Photo: Poda Lifestyle and Wellness

    Poda Lifestyle and Wellness has started setting up the first clinical trials for its smoking cessation products.

    “I have already initiated the process of setting up the first clinical trials related to the efficacy of Poda’s products as smoking cessation tools,” said Poda Chief Medical Officer Jagdeep Gupta, who joined the company in July, in a statement. “I am currently in the process of setting up a pilot study, which will give us a solid platform for developing strong and effective clinical trials.

    “These clinical trials will be designed to result in the publication of level 1 evidence in respected medical journals globally if the data provides evidence. The pilot studies will also be designed to establish a scientific basis for the efficacy of Poda’s products as smoking cessation tools and additionally may provide Poda with access to research grants and other funds that can be used for additional studies, clinical trials and validation research.”

    The company has also entered into an agreement with Command Marketing predominantly to develop Poda’s e-commerce platform and brand identity. As part of this branding campaign, Command Marketing will also provide investor relations services.

  • FDA: ‘Refuse to File’ Letter for JD Nova, 4.5 Million PMTAs

    FDA: ‘Refuse to File’ Letter for JD Nova, 4.5 Million PMTAs

    The JD Nova Group submitted premarket tobacco product applications (PMTAs) for an estimated 4.5 million products, approximately two-thirds of the total number of PMTA submissions. Today, the U.S. Food and Drug Administration issued a Refuse to File (RTF) letter to the company. The letter notified JD Nova that the majority of their PMTAs did not meet the filing requirements for a new tobacco product seeking a marketing order.

    Credit: Tashatuvango

    “This RTF does not apply to all product applications submitted by JD Nova. The remaining product applications the company submitted by the Sept. 9, 2020 deadline are still moving through the review process,” the FDA stated in a press release. “As a result of this RTF action, the company must remove approximately 4.5 million products from the market or risk enforcement action by FDA. The company may resubmit a complete application for these products at any time. However, the products may not be marketed unless they receive a marketing granted order.”

    During the filing stages of application review, the FDA reviews for basic information to ensure applications contain the required material for scientific review, according to the release. If required contents for filing are missing, the FDA refuses to file the application.

    “JD Nova was issued the RTF letter because the company’s applications for these products lacked an adequate Environmental Assessment (EA),” the release states. “Under FDA’s regulations implementing the National Environmental Policy Act (NEPA), an EA must be prepared for each proposed authorization, and an EA adequate for filing addresses the relevant environmental issues.”

    JD Nova was one of more than 360 companies included on a recent list of products that had submitted a timely PMTA to the FDA and was allowed to market products for up to one year, until Sept. 9 2021, or until the FDA makes a regulatory decision such as refusing to file a PMTA.

    From January through July 2021, the FDA has issued more than 135 warning letters to firms selling or distributing more than 1,470,000 unauthorized ENDS and that did not submit premarket applications by the Sept. 9 deadline. One company, Visible Vapors, had more than 15 million products registered with the FDA. On FDA’s Warning Letters page, you can find these warning letters by searching “Center for Tobacco Products” under “Issuing Office.” The regulatory agency has issued at least two warning letters in August so far.

  • Senator Paul Expresses Concern Over USPS Vape Rules

    Senator Paul Expresses Concern Over USPS Vape Rules

    U.S. Senator Rand Paul has sent a letter to Postmaster General Louis DeJoy expressing concern over the United States Postal Service’s (USPS) forthcoming ban on the mailing of vaping products. Along with his letter, the senator forwarded a letter sent to him from more than 60 vaping industry representatives who say the proposed rule exceeds the USPS’s authority by being too inclusive.

    Credit: Dragon Images

    “I have deep concerns about the potential scope of this proposed rule and the impact it may have both on
    small businesses and on the customers they serve. In this case, I am especially troubled by the concern
    raised by the coalition that no economic impact analysis has been conducted pursuant to the Regulatory Flexibility Act of 1980 (P.L. 96-354),” Senator Paul wrote. “The lack of such an economic impact analysis means that the
    implementation of this rule may have unforeseen and unintended economic consequences.”

    Paul letter then goes on to urge the USPS to take into account the interests of Americans in rural areas who
    want to access vapor products while crafting its finalized rules. The U.S. Food and Drug Administration has acknowledged that electronic nicotine delivery systems (ENDS) “can reduce the use of combustible cigarettes and may be less harmful” than combustible cigarettes, according to Paul.

    “For rural Americans residing far from brick-and-mortar stores that sell vapor products, the United States Postal Service is their most reliable means of accessing these harm-reduction products,” he states. “The science of addiction medicine suggests that if these Americans lose access to less harmful alternatives, they are likely to relapse, thereby increasing their risk of developing serious illness.”

    The letter industry representatives sent to Paul and forwarded to DeJoy states that proposed rule, the Treatment of E-Cigarettes (86 FR 10218) (Proposed Rule), has two main issues: it is counter to the principles of the Regulatory Flexibility Act, as Paul’s letter explained, and the rule “exceeds its statutory authority” by the inclusion of products not intended to be included in the rules, such as cannabis vaping products.

    “At a minimum, an economic impact analysis is warranted to better understand the implications of the proposed rule on the multiple industries that are affected,” the industry letter states. “The entire premise of the underlying bill is in relation to tobacco and nicotine, including the definition of ENDS. If the USPS sweeps in cannabis and hemp-related products and devices into the definition of ENDS, this capture of non-tobacco or nicotine products is without a legislative mandate and would subject products and devices that are already regulated and taxed under other statutory schemes to another suite of crippling regulations, unnecessarily.”

    The vapor industry group hopes that the current proposed rule can be withdrawn so that an initial regulatory flexibility analysis (IRFA) that describes the impact of the proposed rule on small entities can be published for public notice and comment, or that the USPS publish a supplemental IRFA for public notice and comment before a final rule is published in the Federal Register.

    The Consolidated Appropriations Act, 2021 contained provisions that addressed a range of issues not related to coronavirus economic relief, including legislation known as the Preventing Online Sales of E-­Cigarettes to Children Act, which placed electronic nicotine-delivery systems (ENDS) under the Prevent All Cigarette Trafficking Act of 2009, which generally prohibits the mailing of cigarettes to consumers through the USPS, requires common carriers to register with the state’s attorney generals and tobacco tax administrators as well as meet certain shipping and reporting requirements.

    In June, two U.S. Senators penned a letter urging the USPS to finalize rules for mailing vapor products. Senators Dianne Feinstein and John Cornyn asked DeJoy to implement regulations required by the PACT Act, which was signed into law on December 21, 2020.

  • Scientists Say Some EVALI Cases May Have Been Covid-19

    Scientists Say Some EVALI Cases May Have Been Covid-19

    Some victims of the mysterious vaping-related lung disease that swept through all 50 U.S. states in 2019 were actually Covid-19 patients, according to a group of Chinese scientists and radiologists. After reviewing some 250 chest CT scans from published papers, the group says they are confident in the conclusion that some patients were wrongly diagnosed with e-cigarette or vaping use-associated lung injury (EVALI).

    Credit: Kawee

    The scientists are now urging U.S. officials to start screening for Covid-19 in patients who in 2019 were diagnosed with EVALI. . According to the Global Times, sources close to the matter said that after studying 250 chest CT scans of 142 EVALI patients selected from some 60 related studies that have been published, the scientists found that 16 EVALI patients were involved in viral infections, which indicates that they could have had Covid-19. Five of the cases were determined as “moderately suspicious.”

    The 16 EVALI patients were all from the U.S., and in 12 patients symptoms started before 2020. Researchers concluded that there were viral infection cases among EVALI infections reported in the U.S. in 2019, and the possibility of Covid-19 in the vaping-related lung disease in the U.S. cannot be ruled out, sources said.

    Yang Zhanqiu, a virologist at Wuhan University, said that due to the similarity of symptoms between EVALI and Covid-19 patients and since no nucleic acid detection kits were available at the time, it’s highly likely that some Covid-19 patients were actually misdiagnosed as EVALI patients in 2019.

  • Industry Group Sues Spain Over Anti-Vape Campaign

    Industry Group Sues Spain Over Anti-Vape Campaign

    A large vaping industry association in Spain has launched legal action against the country’s central government. The Union of Vaping Promoters and Entrepreneurs (UPEV) claims a long-running anti-vaping campaign is against the law for numerous reasons.

    Credit: daBoost

    The lawsuit claims that the Ministry of Health campaign “El tabaco ata y te mata” (“Tobacco ties and kills you”) violates several articles of the Spanish General Law of Advertising and the Law of Publicity and Institutional Communication, according to an article by ECigIntelligence.

    According to the UPEV, the campaign – launched in 2019 and still continuing – “identifies vaping and smoking tobacco in a manifestly misleading way, putting both activities on the same level and attributing the same harmful effects to them”.

    The association is demanding immediate cancellation of the campaign, which has been promoted in a variety of media including on websites, social media, television and radio. In its submission to the court, the UPEV has presented a technical and scientific report that shows the benefits of vaping as a smoking cessation tool.

    The union has blamed the government campaign to discourage vaping for the closure of about 40 shops in 2019, with the loss of 400 jobs, and last year took its complaint to the Spanish Ombudsman.

  • Many Doctors Confused About Nicotine Causing Cancer

    Many Doctors Confused About Nicotine Causing Cancer

    Photo: agongallud

    More than 75 percent of U.S. physicians believe that nicotine directly contributes to cancer and cardiovascular disease, reports Filter, citing to a recent study in the International Journal of Environmental Research and Public Health.

     The study assesses the impact of wording on perceptions of nicotine use. Two versions of a questionnaire were given to 926 physicians, asking about the “extent to which they agree or disagree that ‘nicotine’ [version one] or ‘nicotine, on its own,’ [version two] directly contributes to birth defects, CVD, cancer, depression and chronic obstructive pulmonary disease (COPD).”

    For version one of the questionnaire, 85 percent and 85.2 percent of physicians “strongly agreed” that nicotine directly contributed to cancer and COPD, respectively. For version two, 69.6 percent and 67.3 percent “strongly agreed” with those statements.

    The study showed a difference in perceptions between medical specializations as well—pulmonologists were the least likely to hold misperceptions about nicotine, and family medicine physicians were the most likely to hold misperceptions about nicotine.

    “Even after accounting for question version, the proportion of surveyed physicians who believe that nicotine directly contributes to these health outcomes is alarmingly high,” the study authors wrote. “It is possible that participants are conflating the addictive effect of nicotine with the comparatively more harmful effects of tobacco use.”

    “It is very important for physicians to understand the relative harm between nicotine and the other 7,000 toxins in tobacco smoke,” said Michelle Bover Manderski, lead researcher. “This is especially important as physicians play a key role in recommending and prescribing FDA-approved nicotine-replacement medications.”