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Principles of quality control of
  registered medicines, non-
   registered medicines and
counterfeits of medical products
                   Jean-Marc Spieser,
   Head of Department of Biological Standardisation, OMCL
              Network & HealthCare (DBO),
            EDQM/ Council of Europe, Strasbourg
Content
•   EDQM – General Background
•   Legal environment of registered medicines
•   Tools available for the quality control of registered medicines
•   The case of non-registered medicines and their vast
    environment
•   How to control non-registered products
•   Counterfeits of medical products
•   How, why, and where it happens
•   How to control it


     Jean-Marc Spieser, 23/09/09
     ©2009 EDQM, Council of Europe, All rights reserved   2
The Council of Europe
 – Founded in 1949
 – Development of European common and democratic
   principles
 – 47 member countries
 – Strasbourg




  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   3
The Council of Europe
 – Founded in 1949
 – Development of European
   common and democratic
   principles
 – 47 member countries
 – Strasbourg




      European Convention on Human Rights
      (protection of individuals) &
      European Court of Human Rights

  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   4
Jean-Marc Spieser, 23/09/09
©2009 EDQM, Council of Europe, All rights reserved   5
The European Union




   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   6
EDQM - Short History
  1964:
      – Convention on the Elaboration of a European
        Pharmacopoeia signed by 8 Member States
  1992:
      – 1st co-operation contract with the EU Commission on the
        Biological Standardisation Programme
  1994:
      – European Community signs the Convention
      – CEP – Implementation of the “Certification of Suitability
        scheme”
      – Official Medicines Control Laboratory (OMCL) – Creation of
        the Network
   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   7
Short History
    Change of name: the Secretariat of the
    European Pharmacopoeia becomes the
    European Department (and later
    “Directorate”) for the Quality of Medicines
    (and later “& HealthCare”)…



   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   8
Progressive Transfer of Activities
2007 – Blood Transfusion and Organ
       Transplantation
2008 – Pharmaceuticals and Pharmaceutical

       Care (general pharmaceutical
       activities)
2009 – Cosmetics and Food Packaging
  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   9
Ph.Eur.+ Eur. Observers




   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   10
In the World




 Jean-Marc Spieser, 23/09/09
 ©2009 EDQM, Council of Europe, All rights reserved   11
European Directorate for the Quality of
Medicines & HealthCare (EDQM)
Mission: to contribute to the basic human right
         of access to good quality medicines
         and healthcare

 Health is a social human right indispensable
 for the exercise of all other human rights, for
 prosperity and democratic stability of people
 in Europe

  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   12
European Directorate for the Quality of
      Medicines & HealthCare




  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   13
European Regulatory Network
                                             European Authorities
European Union
                                                    European Union

                                                                                                        European
                                                  Council   Parliament                               Medicines Agency
                                                      Commission                                      EMEALondon
                                                     DG Entreprise
                                                        Brussels
Council
of Europe                                           Pharmaceuticals
                                                                            EuropeanDirectorate       Ph. Eur.**
                                                   Pharmaceutical care
                                                                               for the Quality
*OMCL :Official Medicines Control                                        of Medicines & HealthCare
Laboratories                                      Blood Transfusion                                  Certification***
**Ph.Eur : European Pharmacopoeia
***Certification : Certification of Suitability                                  EDQM
of Monographs of the European
Pharmacopoeia                                        Organ Transplantation     Strasbourg            OMCL*
                                                                                                     Network
                          Jean-Marc Spieser, 23/09/09
                          ©2009 EDQM, Council of Europe, All rights reserved                                       14
Quality Assurance
Quality is obtained through the combination of:
• Definition and concept of the product based on development
  work
• Good manufacturing processes steadily under control
   - starting, in-process and final controls
   - continuous optimisation
   - VALIDATED controls of the final product based on
     suitable and appropriate limited testing (necessary and
     fully sufficient),
                   All the above should be totally traceable

   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved          15
Quality Assurance
As a general concept

                                  QUALITY
 is manufactured and not only
          controlled

  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   16
Quality Control
QC Principles
  • Laboratory of high quality
        Good equipment: validated, regularly
         maintained
        Good reagents
        Good operators



  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   17
Quality Control
QC Principles
  • Working environment
                  QA/QMS in place
                  Good reporting
                  Procedures
                  PTS
                  Follow up and corrective actions
                  Procedures in place
                  Training
  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   18
Regulations
• Medicines are submitted to very strict
  regulations
• Each individual preparation requires a
  Marketing Authorisation (MA)




  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   19
Regulations
A fully detailed registration dossier is filed
based on:
Quality – Production using appropriate
process, suitable ingredients controlled and
released by validated tests
Safety - toxicology and pharmacology
Efficacy – clinical

   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   20
Regulations
All information and documentation
compiled by producers and/or authorised
importer are filed to Health Authorities in
accordance with legal procedures and
assessed by experts using defined rules
                      Official Authorisation

  Jean-Marc Spieser, 23/09/09
  ©2009 EDQM, Council of Europe, All rights reserved   21
Regulations
• The product is continually assessed
  throughout its lifetime:
 Inspections
 Controls
         through laboratory testing
 Pharmacovigilance

If non-conformities are found  administrative, legal
              and/or financial penalities


   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   22
Tools
• The MAA: QA part
• CTD part
• Pharmacopoeias such as National Pharmacopoeias, International
  Pharmacopoeias, Ph. Eur., USP
- General Chapters
- Individual Monographs
• Guidelines/ aide mémoire for inspections, sampling
• Literature/ data


   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   23
Sampling
• Ensure representativity
- withdrawn by authority or mandated persons
- not by manufacturer
- define place where samples are taken, how and how much

• Ensure good storage
- temperature
- humidity
- transportation


    Jean-Marc Spieser, 23/09/09
    ©2009 EDQM, Council of Europe, All rights reserved   24
Non registered “medicines”
• Traditional origin
- Mostly oral and very restricted data available
- Origin not always traceable but should be
- How to control the claims and attributes given to these
  products
- What to control, which criteria and indicative parameters

• Legal environment??


    Jean-Marc Spieser, 23/09/09
    ©2009 EDQM, Council of Europe, All rights reserved   25
Non registered “medicines”
• Controls
- Based on visual recognition of the substance or the plant
- If plant is chopped or ground use of of organoleptic
  properties, microscopic aspect and basic wet chemistry(test
  tube ) assays
- Important to verify that the right species is there
- Need of specialists




    Jean-Marc Spieser, 23/09/09
    ©2009 EDQM, Council of Europe, All rights reserved   26
Non registered “medicines”
• Controls
- Based on traditional knowledge
- Sometimes described in literature bust mostly oral
- No official standards but need to develop it in known
  recognised compendia


- Be carefull on adulterated, counterfeits
- ILLEGAL


    Jean-Marc Spieser, 23/09/09
    ©2009 EDQM, Council of Europe, All rights reserved    27
COUNTERFEITED MEDICINES
• By definition not known
• When and where it will happen


- ILLEGAL of course by defition

- 2 basic areas attacked
  - Blockbusters, expensive, well known, attractive…….organised crime
  - Local , smallsmugglers for small quantities of every possible things

   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved         28
COUNTERFEITED MEDICINES
• How to combat these products
- Through multisectorial surveillance
  - Forensic analysis
  - Custom vigilance
  - Police controls




   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   29
COUNTERFEITED MEDICINES
• To start with
  – Visual check of packaging very important


• Followed by analysis
  – Simple and more and more sophisticated


• Need to have comparator
  – Reference substance(s)
  – Authentic samples



   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved   30
COUNTERFEITED MEDICINES
• Simple comparative tests

• Then sophisticated
  – HPLC using different detectors, coupled with mass spectrum


• Usefulness of network



   Jean-Marc Spieser, 23/09/09
   ©2009 EDQM, Council of Europe, All rights reserved       31
Thank you!
Jean-Marc Spieser, 23/09/09
©2009 EDQM, Council of Europe, All rights reserved   32

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1 1 quality-principles

  • 1. Principles of quality control of registered medicines, non- registered medicines and counterfeits of medical products Jean-Marc Spieser, Head of Department of Biological Standardisation, OMCL Network & HealthCare (DBO), EDQM/ Council of Europe, Strasbourg
  • 2. Content • EDQM – General Background • Legal environment of registered medicines • Tools available for the quality control of registered medicines • The case of non-registered medicines and their vast environment • How to control non-registered products • Counterfeits of medical products • How, why, and where it happens • How to control it Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 2
  • 3. The Council of Europe – Founded in 1949 – Development of European common and democratic principles – 47 member countries – Strasbourg Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 3
  • 4. The Council of Europe – Founded in 1949 – Development of European common and democratic principles – 47 member countries – Strasbourg European Convention on Human Rights (protection of individuals) & European Court of Human Rights Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 4
  • 5. Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 5
  • 6. The European Union Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 6
  • 7. EDQM - Short History 1964: – Convention on the Elaboration of a European Pharmacopoeia signed by 8 Member States 1992: – 1st co-operation contract with the EU Commission on the Biological Standardisation Programme 1994: – European Community signs the Convention – CEP – Implementation of the “Certification of Suitability scheme” – Official Medicines Control Laboratory (OMCL) – Creation of the Network Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 7
  • 8. Short History Change of name: the Secretariat of the European Pharmacopoeia becomes the European Department (and later “Directorate”) for the Quality of Medicines (and later “& HealthCare”)… Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 8
  • 9. Progressive Transfer of Activities 2007 – Blood Transfusion and Organ Transplantation 2008 – Pharmaceuticals and Pharmaceutical Care (general pharmaceutical activities) 2009 – Cosmetics and Food Packaging Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 9
  • 10. Ph.Eur.+ Eur. Observers Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 10
  • 11. In the World Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 11
  • 12. European Directorate for the Quality of Medicines & HealthCare (EDQM) Mission: to contribute to the basic human right of access to good quality medicines and healthcare Health is a social human right indispensable for the exercise of all other human rights, for prosperity and democratic stability of people in Europe Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 12
  • 13. European Directorate for the Quality of Medicines & HealthCare Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 13
  • 14. European Regulatory Network European Authorities European Union European Union European Council Parliament Medicines Agency Commission EMEALondon DG Entreprise Brussels Council of Europe Pharmaceuticals EuropeanDirectorate Ph. Eur.** Pharmaceutical care for the Quality *OMCL :Official Medicines Control of Medicines & HealthCare Laboratories Blood Transfusion Certification*** **Ph.Eur : European Pharmacopoeia ***Certification : Certification of Suitability EDQM of Monographs of the European Pharmacopoeia Organ Transplantation Strasbourg OMCL* Network Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 14
  • 15. Quality Assurance Quality is obtained through the combination of: • Definition and concept of the product based on development work • Good manufacturing processes steadily under control - starting, in-process and final controls - continuous optimisation - VALIDATED controls of the final product based on suitable and appropriate limited testing (necessary and fully sufficient), All the above should be totally traceable Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 15
  • 16. Quality Assurance As a general concept QUALITY is manufactured and not only controlled Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 16
  • 17. Quality Control QC Principles • Laboratory of high quality  Good equipment: validated, regularly maintained  Good reagents  Good operators Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 17
  • 18. Quality Control QC Principles • Working environment  QA/QMS in place  Good reporting  Procedures  PTS  Follow up and corrective actions  Procedures in place  Training Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 18
  • 19. Regulations • Medicines are submitted to very strict regulations • Each individual preparation requires a Marketing Authorisation (MA) Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 19
  • 20. Regulations A fully detailed registration dossier is filed based on: Quality – Production using appropriate process, suitable ingredients controlled and released by validated tests Safety - toxicology and pharmacology Efficacy – clinical Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 20
  • 21. Regulations All information and documentation compiled by producers and/or authorised importer are filed to Health Authorities in accordance with legal procedures and assessed by experts using defined rules  Official Authorisation Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 21
  • 22. Regulations • The product is continually assessed throughout its lifetime:  Inspections  Controls through laboratory testing  Pharmacovigilance If non-conformities are found  administrative, legal and/or financial penalities Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 22
  • 23. Tools • The MAA: QA part • CTD part • Pharmacopoeias such as National Pharmacopoeias, International Pharmacopoeias, Ph. Eur., USP - General Chapters - Individual Monographs • Guidelines/ aide mémoire for inspections, sampling • Literature/ data Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 23
  • 24. Sampling • Ensure representativity - withdrawn by authority or mandated persons - not by manufacturer - define place where samples are taken, how and how much • Ensure good storage - temperature - humidity - transportation Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 24
  • 25. Non registered “medicines” • Traditional origin - Mostly oral and very restricted data available - Origin not always traceable but should be - How to control the claims and attributes given to these products - What to control, which criteria and indicative parameters • Legal environment?? Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 25
  • 26. Non registered “medicines” • Controls - Based on visual recognition of the substance or the plant - If plant is chopped or ground use of of organoleptic properties, microscopic aspect and basic wet chemistry(test tube ) assays - Important to verify that the right species is there - Need of specialists Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 26
  • 27. Non registered “medicines” • Controls - Based on traditional knowledge - Sometimes described in literature bust mostly oral - No official standards but need to develop it in known recognised compendia - Be carefull on adulterated, counterfeits - ILLEGAL Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 27
  • 28. COUNTERFEITED MEDICINES • By definition not known • When and where it will happen - ILLEGAL of course by defition - 2 basic areas attacked - Blockbusters, expensive, well known, attractive…….organised crime - Local , smallsmugglers for small quantities of every possible things Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 28
  • 29. COUNTERFEITED MEDICINES • How to combat these products - Through multisectorial surveillance - Forensic analysis - Custom vigilance - Police controls Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 29
  • 30. COUNTERFEITED MEDICINES • To start with – Visual check of packaging very important • Followed by analysis – Simple and more and more sophisticated • Need to have comparator – Reference substance(s) – Authentic samples Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 30
  • 31. COUNTERFEITED MEDICINES • Simple comparative tests • Then sophisticated – HPLC using different detectors, coupled with mass spectrum • Usefulness of network Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 31
  • 32. Thank you! Jean-Marc Spieser, 23/09/09 ©2009 EDQM, Council of Europe, All rights reserved 32