Saturday, 16 June 2018

Are there any Indian Government Pharmaceutical Manufacturing Industries?

Why there are no any Indian Government Pharmaceutical Manufacturing Industries?

OVERVIEW
The number of purely Indian pharma companies is fairly low. Indian pharma industry is mainly operated as well as controlled by dominant foreign companies having subsidiaries in India due to availability of cheap labor in India at low cost. In 2002, over 20,000 registered drug manufacturers in India sold $9 billion worth of formulations and bulk drugs. 85% of these formulations were sold in India while over 60% of the bulk drugs were exported, mostly to the United States and Russia. Most of the players in the market are small-to-medium enterprises; 250 of the largest companies control 70% of the Indian market.Thanks to the 1970 Patent Act, multinationals represent only 35% of the market, down from 70% thirty years ago.
Most pharma companies operating in India, even the multinationals, employ Indians almost exclusively from the lowest ranks to high level management. Homegrown pharmaceuticals, like many other businesses in India, are often a mix of public and private enterprise.
In terms of the global market, India currently holds a modest 1–2% share, but it has been growing at approximately 10% per year. India gained its foothold on the global scene with its innovatively engineered generic drugs and active pharmaceutical ingredients (API), and it is now seeking to become a major player in outsourced clinical research as well as contract manufacturing and research. There are 74 US FDA-approved manufacturing facilities in India, more than in any other country outside the U.S, and in 2005, almost 20% of all Abbreviated New Drug Applications (ANDA) to the FDA are expected to be filed by Indian companies. Growth in other fields notwithstanding, generics are still a large part of the picture. London research company Global Insight estimates that India’s share of the global generics market will have risen from 4% to 33% by 2007.The Indian pharmaceutical industry has become the third largest producer in the world and is poised to grow into an industry of $20 billion in 2015 from the current turnover of $12 billion.

Quality[edit]

The Quality of drugs and APIs (Active Pharmaceutical Ingredients) made by Indian pharmaceutical companies is often poor. In the past three years 2015 - 2017, there were 31 FDA warning letters to Indian pharmaceutical companies citing serious Data Integrity issues, including data deletion, manipulation or fabrication of test results, see “An Analysis Of 2017 FDA Warning Letters On Data Integrity” By Barbara Unger, Unger Consulting Inc. https://www.pharmaceuticalonline.com/doc/an-analysis-of-fda-warning letters-on-data-integrity-0003
See the very long list of Indian pharmaceutical companies which have been placed on Import Alert by the FDA due to serious noncompliance with Good Manufacturing Procedures http://www.accessdata.fda.gov/cms_ia/importalert_189.html
See the European Medicines Agency EudraGMDP Noncompliance Reports based on Inspections of companies that revealed serious noncompliance with Good Manufacturing Procedures: http://eudragmdp.ema.europa.eu/inspections/gmpc/searchGMPNonCompliance.do
See FDA Warning Letters detailing serious noncompliance with Good Manufacturing Procedures: http://www.fda.gov/iceci/enforcementactions/WarningLetters/default.htm

Exports[edit]

Exports of pharmaceuticals products from India increased from US$6.23 billion in 2006-07 to US$8.7 billion in 2008-09 a combined annual growth rate of 21.25%.[2] Some of the major pharmaceutical firms include Sun PharmaceuticalCadila Healthcare and Piramal Enterprises.[2]
India exported $11.7 billion worth of pharmaceuticals in 2014. The 10 countries below imported 56.5% of that total:[12]
RankCountryValue (US$)Share
1United States$3.8 billion32.9%
2South Africa$461.1 million3.9%
3Russia$447.9 million3.8%
4United Kingdom$444.9 million3.8%
5Nigeria$385.4 million3.3%
6Kenya$233.9 million2%
7Tanzania$225.2 million1.9%
8Brazil$212.7 million1.8%
9Australia$182.1 million1.6%
10Germany$178.8 million1.5%

Patents[edit]

A significant change in intellectual property protection in India was the 1 January 2005 enactment of an amendment to India’s patent law that reinstated product patents for the first time since 1972. The legislation took effect on the deadline set by the WTO’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, which mandated patent protection on both products and processes for a period of 20 years. Under this new law, India will be forced to recognise not only new patents but also any patents filed after 1 January 1995.[13] Indian companies achieved their status in the domestic market by breaking these product patents, and it is estimated that within the next few years, they will lose $650 million of the local generics market to patent-holders.[needs update]
In the domestic market, this new patent legislation has resulted in fairly clear segmentation. The multinationals narrowed their focus onto high-end patents who make up only 12% of the market, taking advantage of their newly bestowed patent protection. Meanwhile, Indian firms have chosen to take their existing product portfolios and target semi-urban and rural populations.[citation needed]

Product development[edit]


Small and medium enterprises
[edit]Indian companies are also starting to adapt their product development processes to the new environment. For years, firms have made their ways into the global market by researching generic competitors to patented drugs and following up with litigation to challenge the patent. This approach remains untouched by the new patent regime and looks to increase in the future. However, those that can afford it have set their sights on an even higher goal: new molecule discovery. Although the initial investment is huge, companies are lured by the promise of hefty profit margins and thus a legitimate competitor in the global industry. Local firms have slowly been investing more money into their R&D programs or have formed alliances to tap into these opportunities.[14]
As promising as the future is for a whole, the outlook for small and medium enterprises (SME) is not as bright. The excise structure changed[when?] so that companies now have to pay a 16% tax on the maximum retail price (MRP) of their products, as opposed to on the ex-factory price. Consequently, larger companies cut back on outsourcing and what business is left shifted to companies with facilities in the four tax-free states – Himachal PradeshJammu and KashmirUttarakhand, and Jharkhand. Consequently, a large number of pharmaceutical manufacturers shifted their plant to these states, as it became almost impossible to continue operating in non-tax free zones. But in a matter of a couple of years the excise duty was revised on two occasions,[when?] first it was reduced to 8% and then to 4%. As a result, the benefits of shifting to a tax free zone was negated. This resulted in, factories in the tax free zones, to start up third party manufacturing. Under this these factories produced goods under the brand names of other parties on job work basis.
As SMEs wrestled with the tax structure, they were also scrambling to meet the 1 July deadline[when?] for compliance with the revised Schedule M Good Manufacturing Practices (GMP). While this should be beneficial to consumers and the industry at large, SMEs have been finding it difficult to find the funds to upgrade their manufacturing plants, resulting in the closure of many facilities. Others invested the money to bring their facilities to compliance, but these operations were located in non-tax-free states, making it difficult to compete in the wake of the new excise tax. Swas Medicare is one of the small scale leading pharmaceutical company of India , which is owned and founded by a Physician.

Largest companies[edit]

Sales, marketing, and business[edit]

Multinational Pharmaceutical Companies ranked as per active presence of sales, marketing and business in India[15]

Publicly traded pharmaceuticals[edit]

Top 9 Publicly Listed pharmaceutical companies in India by Market Capitalization as of 2017.[16]
RankCompanyMarket Capitalization 2017 (INR crores)
1Sun PharmaceuticalRs 1,55,716 Crore
2Lupin LtdRs 68,031 Crore
3Dr. Reddy's LaboratoriesRs 49,293 Crore
4CiplaRs 47,319 Crore
5Aurobindo PharmaRs 41,283 Crore
6Zydus Cadila HealthcareRs 31,631 Crore
7Piramal EnterpriseRs 30,975 Crore
8Glenmark Pharmaceuticals25,302 Crore
9Torrent PharmaceuticalsRs 22,742 Crore

Biotech[edit]

Top 20 Biotechnology companies in India, as of 2013.[17]
RankCompany
1Serum Institute of India
2Biocon
3Nuziveedu Seeds Private Limited
4Novo Nordisk
5Syngene International
6Reliance Life Sciences
7Eli Lilly and Company
8Bharat Serums
9Biological E. Limited
10Fortis Clinical Research
11Novozymes South Asia
12Ankur Seeds
14Indian Immunologicals Limited
15GlaxoSmithKline Pharmaceuticals Ltd
13Bharat Biotech International
16Tulip Group
17Hafkine Biopharmaceutical
18Mahyco
19Advanced Enzymes
20Raasi Seeds
Top 20 Biotechnology companies in India, as of 2016.
RankCompany
1Serum Institute of India[18]
2Biocon[19]
3Jubilant Life Sciences[20]
4Syngene International[21]
5Biological E[22]
6Nuziveedu Seeds[23]
7AstraZeneca Pharma India[24]
8Mahyco[25]
9Bharat Biotech International[26]
10GSK India[27]
11Anthem Biosciences[28]
12Metahelix Life Sciences[29]
13Advanced Enzyme Technologies
14Concord Biotech
15Panacea Biotec
16Ankur Seeds
17Ecron Acunova
18Zytex
19Accurex Biomedical
20Bhat Bio-Tech India

Relation between pharma and biotech[edit]

Unlike in other countries, the difference between biotechnology and pharmaceuticals remains fairly defined in India, with biotech a much smaller part of the economy. India accounted for 2% of the $41 billion global biotech market and in 2003 was ranked 3rd in the Asia-Pacific region and 13th in the world in number of biotech. In 2004-5, the Indian biotech industry saw its revenues grow 37% to $1.1 billion. The Indian biotech market is dominated by bio pharmaceuticals; 76% of 2004–5 revenues came from bio-pharmaceuticals, which saw 30% growth last year. Of the revenues from bio-pharmaceuticals, vaccines led the way, comprising 47% of sales. Biologics and large-molecule drugs tend to be more expensive than small-molecule drugs, and India hopes to sweep the market in bio-generics and contract manufacturing as drugs go off patent and Indian companies upgrade their manufacturing capabilities.[30]
Most companies in the biotech sector are extremely small, with only two firms breaking 100 million dollars in revenues. At last count there were 265 firms registered in India, over 92% of which were incorporated in the last five years. The newness of the companies explains the industry’s high consolidation in both physical and financial terms. Almost 30% of all biotech are in or around Bangalore, and the top ten companies capture 47% of the market. The top five companies were homegrown; Indian firms account for 72% of the bio-pharma sector and 52% of the industry as a whole.[4,46] The Association of Biotechnology-Led Enterprises (ABLE) is aiming to grow the industry to $5 billion in revenues generated by 1 million employees by 2009, and data from the Confederation of Indian Industry (CII) seem to suggest that it is possible.[31]

Comparison with the United States[edit]

The Indian biotech sector parallels that of the US in many ways. Both are filled with small start-ups while the majority of the market is controlled by a few powerful companies. Both are dependent upon government grants and venture capitalists for funding because neither will be commercially viable for years. Pharmaceutical companies in both countries see growth potential in biotechnology and have either invested in existing start-ups or ventured into the field themselves.[3]

Government support[edit]

The Indian government established the Department of Biotechnology in 1986 under the Ministry of Science and Technology. Since then, there have been a number of dispensations offered by both the central government and various states to encourage the growth of the industry. India’s science minister launched a program that provides tax incentives and grants for biotech start-ups and firms seeking to expand and establishes the Biotechnology Parks Society of India to support ten biotech parks by 2010. Previously limited to rodents, animal testing was expanded to include large animals as part of the minister’s initiative. States have started to vie with one another for biotech business, and they are offering such goodies as exemption from VAT and other fees, financial assistance with patents and subsidies on everything ranging from investment to land to utilities.[32]
The biotechnology sector faces some major challenges in its quest for growth. Chief among them is a lack of funding, particularly for firms that are just starting out. The most likely sources of funds are government grants and venture capital, which is a relatively young industry in India. Government grants are difficult to secure, and due to the expensive and uncertain nature of biotech research, venture capitalists are reluctant to invest in firms that have not yet developed a commercially viable product.[33]
The government has addressed the problem of educated but unqualified candidates in its Draft National Biotech Development Strategy. This plan included a proposal to create a National Task Force that will work with the biotech industry to revise the curriculum for undergraduate and graduate study in life sciences and biotechnology. The government’s strategy also stated intentions to increase the number of PhD Fellowships awarded by the Department of Biotechnology to 200 per year. These human resources will be further leveraged with a "Bio-Edu-Grid" that will knit together the resources of the academic and scientific industrial communities, much as they are in the US.[33]

Foreign investment[edit]

An initiative passed earlier this year[when?] allowed 100% foreign direct investment in the biotech sector without compulsory licensing from the government.[citation needed]

Saturday, 10 February 2018

Pharmacists fume over neglect of Pharm D graduates as Clinical/Community Pharmacist in India*

Pharmacists fume over neglect of Pharm D graduates as Clinical/Community Pharmacist in India*
Pharm D courses were introduced to create a special cadre of clinical pharmacists to record adverse drug reaction.Pharmacists were unhappy with the Pharmacy Council of India stating that the Central and state governments must amend rules to recruit pharmacists, without specifying that a separate post had to be created for clinical pharmacists in hospitals. The Doctor of Pharmacy Association (DPA), which includes Pharm D graduates, said this was the same reply they got in 2015. DPA national president Dr Sai Kumar Katam said, “Pharm D courses were introduced to create a special cadre of clinical pharmacists to record adverse drug reaction, advise on drug dosage to patients on prescription from doctors and also carry out other works like immunisation in all hospitals with JCI/NABH/ISO accrediatation and as a Community Pharmacist in the Community healthcare centres.
There is a reason for creating these specialists.“But instead of recognising and placing them in the right sector, they are merely stating that they must be placed as pharmacists in Clinical Pharmacy. There are already B Pharm and M Pharm graduates working in the sector. But it must be understood that these two courses are not equivalent to Pharm D which is a grade higher.”
Pharm D graduates could work along with Physicians,Surgeons and Nurses along with other medical professionals, during bedside practice and be of great help in monitoring various drugs advised to patients and update the knowledge of entire medical team. Presently, the complete system depended on Physicians for the diagnosis, drug delivery and also observes & reports drug reaction. A Pharm D specialist can monitor drug delivery, dosage and drug reaction reducing the work of Physicians. Hence the course was not merely to dispense medicines but to also follow up, they said.
Senior pharmacist Dr Sanjay Reddy said, “It is high time the government gave due recognition to pharmacists as Clinical pharmacist in clinical pharmacy, Pharmacovigilancer, Community pharmacist in Community health centers, Industrial Pharmacist in Manufacturing companies, Researcher/ Pharma-Scientist, Clinical Preceptor in Pharmacy colleges and Dispensing pharmacist by involving them actively in the healthcare system. Health is a state subject and for that reason the policies of the Central governments have to be implemented by states and review the same routinely. The PCI has to actively follow not only with the Centre but also states.”
The issues of Clinical pharmacists now took centrestage again as PharmD students passing out of colleges did not get jobs and lack of proper salary scheme similar to other medical professionals, which was leading to frustration, and forcing them to opt for change in their profession which is taking advantage by MNC,. TS health minister Dr Laxma Reddy had been approached nearly four times in the last two months as Pharm D students were getting agitated over the government failure to make them part of the healthcare system

PHARM-D and Scope of Pharmacy

Doctor of Pharmacy (Pharm.D.New Latin Pharmaciae Doctor) is a professional doctorate in pharmacy. In some countries, it is a first professional degree, and a prerequisite for licensing to practice the profession of pharmacy or to become a Clinical pharmacist. In many countries they are allowed to practice independently and can prescribe the brand of drugs directly to the patients. Pharm.D program has significant experiential or clinical education components in introductory and advanced levels for the safe and effective use of drugs. Experiential education prepares graduates to be practice-ready as they already spent a significant amount of time training in areas of direct patient care and research. A Pharm D graduate can also use the prefix 'Dr' along with their name. [1]

Pharm D, a 6-year integrated course.
"Being a pharmacist is the most obvious choice.
THERE is tremendous scope for research and higher studies in pharmacy and job opportunities are vast. In the last few years, there has been a revolutionary growth in every area of the pharma field. With the increasing number of life-saving drugs and new methods and techniques of manufacturing and analysis of drugs, the responsibility of pharmacists has increased considerably.
Clinical Pharmacy,Hospital Pharmacy and Community Pharmacy are emerging in India, which involve planning, procuring, dispensing drugs apart from patient counselling. It is interesting to note that a considerable percentage of drug stores in the US are now owned by Indian pharmacy graduates.State and Central Governments appoint Drugs Inspectors to implement the Drugs and Cosmetics Act. A pharmacy graduate alone is eligible for this post and they are the only regulators in the field of Drugs Control Administration. A career in the field of pharmaceutical education combines teaching with research and sometimes, administrative activities. Though the posts require M.Phar/PhD degree, it is not difficult as the government and pharmaceutical industry support PG and research students through scholarships and fellowships. Research in drug development is another exciting area. In India many pharmaceutical industries like Dr. Reddy's, Ranbaxy, Cadilla, Glen-mark, Cipla, Aurobindo, Hetro have excellent divisions in R&D.
A degree in Pharmacy makes you eligible not only to seek employment in various drug, chemical, biotechnology and health care industries but also to start your own business. Pharmaceuticals is a fast growing industry. Government-sponsored industries are engaged in manufacture of live-saving drugs while manufacture of a major portion of bulk drugs and formulations is in the private sector. Here a young and enthusiastic pharmacist can make a mark with his entrepreneurial skills. There are opportunities for pharmacy graduates in marketing and pharmaceutical journalism also. They can serve as technical advisors or consultants for project-funding agencies to banks, financial institutions etc. By becoming a manufacturing chemist, a pharmacist can rise from the position of production supervisor to production manager and vice president.
Pharmacy education is set to undergo a sea-change in the next few years. The introduction of Pharm D., a six-year integrated postgraduate programme, is expected to take pharmacy education to international levels. Pharm D., is expected to provide plenty of opportunities to Indian students to practice pharmacy abroad. They can pursue careers in various fields, including institutional practice; community pharmacy practice;managed care; drug information and long-term care; consultant's role; clinical liaisons with pharmaceutical industry; patient education; and clinical trial research.
The 6-year course provides intensive training in pharmacy practice and clinical pharmacy services. It will include five years of clinical and community-based theory with ward rounds and one-year internship in hospitals. Students will work in coordination with doctors to treat patients. In the final year, the students will come out as clinical pharmacists, an essential component of health care, equal to doctors. Graduates will study in detail about drugs for different diseases. Pharmacists will advise patients about dose, action and side effects, while B.Pharm deals with different drug sources, synthesizing drugs,formulations, analysis, regulations, pharmacological actions, dosage and toxicology.
In a way, pharmacy is coming full circle, and we're seeing it lean more towards direct patient care. As the population grows and ages, people are taking more prescriptions, and there is more demand for pharmacists to have hands-on time with patients. More advanced-practice pharmacists are specialising and rounding with physicians and other health care providers in hospitals as part of a health care team. That's a win-win situation for patients.
The profession is changing and the opportunities are growing. There's more depth and breadth to what pharmacists are expected and asked to do. In a nutshell, pharmacy assures a bright and prosperous future.
Dr. Joel Thomas, Pharm D

M.PHAR

Sunday, 4 February 2018

PHARMACY PRACTICE RESEARCH (PPR)

The Pharmacy Practice Research Trust (PPRT) was an independent charity established in July 1999, by the Royal Pharmaceutical Society. It aims were support and promote the professional practice and development of pharmacists and develop the field of Pharmacy Practice Research. In January 2013 the PPRT was wound up and a new charity Pharmacy Research UK was launched in its place.

PHARMACY PRACTICE RESEARCH (PPR) is research that focuses on the practice of pharmacy in contrast to lab-based research and establishes a solid evidence for new pharmacy practices and services. This is how we can frame our own set of guidelines for management of all diseases rather than adopting them from western countries. 

Even after a decade of this clinical course; there were fewer research activities. Pharmacy Practice Research is equally important in India which can fetch 1000's of job opportunities in various Central and State Research Organizations.

Sunday, 27 August 2017

generic drug

generic drug is a pharmaceutical drug that is equivalent to a brand-name product in dosage, strength, route of administration, quality, performance, and intended use. The term may also refer to any drug marketed under its chemical name without advertising, or to the chemical makeup of a drug rather than the brand name under which the drug is sold.
Although they may not be associated with a particular company, generic drugs are usually subject to government regulations in the countries where they are dispensed. They are labeled with the name of the manufacturer and a generic nonproprietary name such as the United States Adopted Name or international nonproprietary name of the drug. A generic drug must contain the same active ingredients as the original brand-name formulation. The U.S. Food and Drug Administration (FDA) requires that generics be identical to, or within an acceptable bioequivalent range of, their brand-name counterparts with respect to pharmacokinetic and pharmacodynamic properties. (The FDA's use of the word "identical" is a legal interpretation, not literal.)
Biopharmaceuticals such as monoclonal antibodies differ biologically from small molecule drugs. Generic versions of these drugs, known as biosimilars, are typically regulated under an extended set of rules.
In most cases, generic products become available after the patent protections afforded to a drug's original developer expire. Once generic drugs enter the market, competition often leads to substantially lower prices for both the original brand-name product and its generic equivalents. In most countries, patents give 20 years of protection. However, many countries and regions, such as the European Union and the United States, may grant up to five years of additional protection ("patent term restoration") if manufacturers meet specific goals, such as conducting clinical trials for pediatric patients. Manufacturers, wholesalers, insurers, and drugstores can each increase prices at various stages of production and distribution.
In 2014, according to an analysis by the Generic Pharmaceutical Association, generic drugs accounted for 88% of the 4.3 billion prescriptions filled in the United State

Nomenclature

Generic drug names are constructed using standardized affixes that distinguish drugs between and within classes and suggest their action.

Economics

When a pharmaceutical company first markets a drug, it is usually under a patent that, until it expires, the company can use to exclude competitors by suing them for patent infringement. Pharmaceutical companies that develop new drugs generally only invest in drug candidates with strong patent protection as a strategy to recoup their costs to develop the drug (include the costs of the drug candidates that fail) and to make a profit. The average cost to a brand-name company of discovering, testing, and obtaining regulatory approval for a new drug, with a new chemical entity, was estimated to be as much as $800 million in 2003 and $2.6 billion in 2014. Drug companies that bring new products have several product line extension strategies they use to extend their exclusivity, some of which are seen as gaming the system and referred to by critics as "evergreening", but at some point there is no patent protection available. For as long as a drug patent lasts, a brand-name company enjoys a period of market exclusivity, or monopoly, in which the company is able to set the price of the drug at a level that maximizes profit. This profit often greatly exceeds the development and production costs of the drug, allowing the company to offset the cost of research and development of other drugs that are not profitable or do not pass clinical trials.
Large pharmaceutical companies often spend millions of dollars protecting their patents from generic competition. Apart from litigation, they may reformulate a drug or license a subsidiary (or another company) to sell generics under the original patent. Generics sold under license from the patent holder are known as authorized generics.
Generic drugs are usually sold for significantly lower prices than their branded equivalents and at lower profit margins. One reason for this is that competition increases among producers when a drug is no longer protected by patents. Generic companies incur fewer costs in creating generic drugs—only the cost of manufacturing, without the costs of drug discovery and drug development—and are therefore able to maintain profitability at a lower price. The prices are often low enough for users in less-prosperous countries to afford them. For example, Thailand has imported millions of doses of a generic version of the blood-thinning drug Plavix (used to help prevent heart attacks) from India, the leading manufacturer of generic drugs, at a cost of 3 US cents per dose.
Generic drug companies may also receive the benefit of the previous marketing efforts of the brand-name company, including advertising, presentations by drug representatives, and distribution of free samples. Many drugs introduced by generic manufacturers have already been on the market for a decade or more and may already be well known to patients and providers, although often under their branded name.
In the United Kingdom, generic drug pricing is controlled by the government's reimbursement rate. The price paid by pharmacists and doctors is determined mainly by the number of license holders, the sales value of the original brand, and the ease of manufacture. A typical price decay graph will show a "scalloped" curve, which usually starts at the brand-name price on the day of generic launch and then falls as competition intensifies. After some years, the graph typically flattens out at approximately 20% of the original brand price. In about 20% of cases, the price "bounces": Some license holders withdraw from the market when the selling price dips below their cost of goods, and the price then rises for a while until the license holders re-enter the market with new stock.
In 2012, 84% of prescriptions in the US were filled with generic drugs, and in 2014, the use of generic drugs in the United States led to $254 billion in health care savings.
In the mid 2010s the generics industry began transitioning to the end of an era of giant patent cliffs in the pharmaceutical industry; patented drugs with sales of around $28 billion were set to come off patent in 2018, but in 2019 only about $10 billion in revenue was set to open for competition, and less the next year. Companies in the industry have responded with consolidation or turning to try to generate new drugs.

Regulation

Most nations require generic drug manufacturers to prove that their formulations are bioequivalent to their brand-name counterparts.
Bioequivalence does not mean generic drugs must be exactly the same as the brand-name product ("pharmaceutical equivalent"). Chemical differences may exist; a different salt or ester may be used, for instance. However, the therapeutic effect of the drug must be the same ("pharmaceutical alternative"). Most small molecule drugs are accepted as bioequivalent if their pharmacokinetic  parameters  of area under the curve (AUC) and maximum concentration (Cmax) are within a 90% confidence interval of 80–125%; most approved generics are well within this limit. For more complex products—such as inhalerspatch delivery systemsliposomal preparations, or biosimilar drugs—demonstrating pharmacodynamic or clinical equivalence is more challenging.



INDIA:
The Indian government began encouraging more drug manufacturing by Indian companies in the early 1960s, and with the Patents Act in 1970. The Patents Act removed composition patents for foods and drugs, and though it kept process patents, these were shortened to a period of five to seven years. The resulting lack of patent protection created a niche in both the Indian and global markets that Indian companies filled by reverse-engineering new processes for manufacturing low-cost drugs. The code of ethics issued by the Medical Council of India in 2002 calls for physicians to prescribe drugs by their generic names only
CHINA:
Generic drug production is a large part of the pharmaceutical industry in China. Western observers have said that China lacks administrative protection for patents. However, entry to the World Trade Organization has brought a stronger patent system
USA:
Enacted in 1984, the Drug Price Competition and Patent Term Restoration Act, informally known as the Hatch-Waxman Act, standardized procedures for recognition of generic drugs. In 2007, the FDA launched the Generic Initiative for Value and Efficiency (GIVE): an effort to modernize and streamline the generic drug approval process, and to increase the number and variety of generic products available.
Before a company can market a generic drug, it needs to file an Abbreviated New Drug Application (ANDA) with the Food and Drug Administration, seeking to demonstrate therapeutic equivalence to a previously approved "reference-listed drug" and proving that it can manufacture the drug safely and consistently. For an ANDA to be approved, the FDA requires the bioequivalence of a generic drug to be between 80% and 125% of the innovator product.(This range is part of a statistical calculation, and does not mean that generic drugs are allowed to differ from their brand-name counterparts by up to 25 percent.) The FDA evaluated 2,070 studies conducted between 1996 and 2007 that compared the absorption of brand-name and generic drugs into a person’s body. The average difference in absorption between the generic and the brand-name drug was 3.5 percent, comparable to the difference between two batches of a brand-name drug. Non-innovator versions of biologic drugs, or biosimilars, require clinical trials for immunogenicity in addition to tests establishing bioequivalency. These products cannot be entirely identical because of batch-to-batch variability and their biological nature, and they are subject to extra rules.
When an application is approved, the FDA adds the generic drug to its Approved Drug Products with Therapeutic Equivalence Evaluations list and annotates the list to show equivalence between the reference-listed drug and the generic. The FDA also recognizes drugs that use the same ingredients with different bioavailability, and divides them into therapeutic equivalence groups. For example, as of 2006, diltiazem hydrochloride had four equivalence groups, all using the same active ingredient, but considered equivalent only within each group.
In order to start selling a drug promptly after the patent on innovator drug expires, a generic company has to file its ANDA well before the patent expires. This puts the generic company at risk of being sued for patent infringement, since the act of filing the ANDA is considered "constructive infringement" of the patent. In order to incentivize generic companies to take that risk the Hatch-Waxman act granted a 180-day administrative exclusivity period to generic drug manufacturers who are the first to file an ANDA.
When faced with patent litigation from the drug innovator, generic companies will often counter-sue, challenging the validity of the patent. Like any litigation between private parties, the innovator and generic companies may choose to settle the litigation. Some of these settlement agreements have been stuck down by courts when they took the form of reverse payment patent settlement agreements, in which the generic company basically accepts a payment to drop the litigation, delaying the introduction of the generic product and frustrating the purpose of the Hatch-Waxman Act.
Innovator companies sometimes try to maintain some of the revenue from their drug after patents expire by allowing another company to sell an authorized generic; a 2011 FTC report found that consumers benefitted from lower costs when an authorized generic was introduced during the 180 exclusivity period, as it created competition.
Innovator companies may also present arguments to the FDA that the ANDA should not be accepted by filing an FDA citizen petition. Citizen petitions are part of the basic law governing everything the FDA does - at any time, any “interested person” can request that the FDA “issue, amend, or revoke a regulation or order,” or “take or refrain from taking any other form of administrative action.”

Acceptance

A series of scandals around the approval of generic drugs in the late 1980s shook public confidence in generic drugs; there were several instances in which companies obtained bioequivalence data fraudulently, by using the branded drug in their tests instead of their own product, and a congressional investigation found corruption at the FDA, where employees were accepting bribes to approve some generic companies' applications and delaying or denying others.
Some generic drugs are viewed with suspicion by doctors. For example, warfarin (Coumadin) has a narrow therapeutic window and requires frequent blood tests to make sure patients do not have a subtherapeutic or a toxic level. A study performed in Ontario showed that replacing Coumadin with generic warfarin was safe, but many physicians are not comfortable with their patients taking branded generic equivalents. In some countries (for example, Australia) where a drug is prescribed under more than one brand name, doctors may choose not to allow pharmacists to substitute a brand different from the one prescribed unless the consumer requests it.
Recalls
In 2007, North Carolina Public Radio's The People's Pharmacy began reporting on consumers' complaints that generic versions of bupropion (Wellbutrin) were yielding unexpected effects. Subsequently, Impax Laboratories's 300 mg extended-release tablets, marketed by Teva Pharmaceutical Industries, were withdrawn from the US market after the FDA determined in 2012 that they were not bioequivalent.
Litigation
Two women, each claiming to have suffered severe medical complications from a generic version of metoclopramide, lost their Supreme Court appeal on June 23, 2011. In a 5-4 ruling in PLIVA, Inc. v. Mensing, in which the court held that generic companies cannot be held liable for information, or the lack of information, on the originator's label.

Wednesday, 16 August 2017

Clinical trials in India:rising outsourcing of clinical trials to India, with concerns about little benefit or relevance to the public health needs of the country

Clinical trials in India continue to be in the news, unfortunately a fair bit being negative coverage. Over the last few years, there has been continuing outrage on the issue of rising outsourcing of clinical trials to India, with concerns about little benefit or relevance to the public health needs of the country. While this dust has not even settled, allegations of unethical conduct in clinical trials have again brought a focus on the need for regulatory reform and stringent ethical safeguards.

THE CONTROVERSY ON TRIALS IN INDORE

The recent reporting of controversial drug trials being conducted by doctors of the government medical college and private practitioners on ‘mentally challenged’ patients in Indore has caused uproar. It was alleged that for more than two years, from 2008 to 2010, trials were conducted flouting ethics guidelines. The Madhya Pradesh government levied a fine of Rs 5000 each on the doctors involved, and this was seen widely as being paltry and insufficient punishment. As details emerged, questions were raised about the role of independent or commercial (as compared to institutional) ethics committees, improper documentation of consent, vulnerability of research participants as well as the thorny issue of private practice (and in this case, research in private clinics) by government doctors.

GROWTH OF THE CLINICAL TRIAL INDUSTRY IN INDIA AND ETHICS VIOLATIONS: IS REGULATORY REFORM ENOUGH

Research being conducted by pharmaceutical and biotechnology companies in India has been on the increase. Added to this, has been the mounting quantum of outsourced research facilitated by Contract Research Organizations (CROs) with the promise of cheaper and faster conduct of trials as compared to the west. From 40 to 50 trials in 2003, the country saw around 1850 trials registered with the government registry in June 2011. Mushrooming clinical research courses, often unregulated, have sprung up with an aim of servicing the need of personnel for conducting clinical research.
While the escalating research quantum has, to some extent, served to benefit the Indian population which now is undergoing a demographic transition with both infectious and non-communicable diseases being commonplace, it has also raised concerns that ethical conduct is often forgone when the primary interest increasingly is profit generation. The specter of unethical trials being frequently reported is a reflection of an ailing and substantially ineffective research regulation system in India. While biomedical research in the country has increased exponentially in the last decade, reforms in regulations have only occurred at snail's pace. Intent has been demonstrated towards such reform, but needs to be substantiated with priority policy changes. Regulatory progress is only one element of the solution—other steps are also needed to move forward in this area.

WHAT NEEDS TO BE DONE?

It's quite clear that there is a need for reform. Improvement has already been seen in certain areas, such as the stress on clinical trial registration in India through the medium of the Clinical Trial Registry -India (as well as Indian journals insisting on such registration for accepting resultant manuscripts). The increasing awareness about ethical requirements in research, as well as the role of activists in questioning trial conduct when deemed exploitative, has also resulted in a positive change to some extent. However, a lot still needs to be done. This requires a multi-faceted approach and involvement of all the stakeholders with an aim for more robust science, which incorporates a strong commitment to ethics.

Stringent regulations and laws

The role of stronger legal oversight, in light of the guidelines not serving to be enough in curbing deviant research conduct, cannot be emphasized enough. Advocacy is needed, so that the draft bill on Biomedical Research on Human Participants (Promotion and Regulation) prepared by the Indian Council of Medical Research is put in the public domain for discussion and refinement, and is then tabled in the parliament on a priority basis. Such a law can provide mechanisms for legal remedy in the case of questionable and/or exploitative research.
The number of Ethics Committees (ECs) in the country is rising, but there is no clear estimation of the total numbers. The quality of conduct of ECs is often quite variable, and also there is no standardized training or orientation for members. Unless there is mandatory registration of ethics committees and an accreditationprocess, it would be difficult to ensure that ECs are optimally focusing on their core duty of protection of research participants. In a positive development, some ECs in India have voluntarily undergone accreditation through the Forum for Ethical Review Committees in the Asian and Western Pacific Region (FERCAP), and the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRP). Indian EC members who were surveyed in the past, also felt that there is a need for formal training of EC members in ethics, and networking of ECs. The Forum for Ethics Review Committees in India (FERCI), which recently conducted its first national conference, could serve as a platform to respond to these needs. E-groups and online discussion forums have also helped in providing avenues for sharing of experiences and updates. ECs also need to proactively engage researchers and conduct on-site monitoring of projects; this can help in identifying and addressing transgressions.
The role of mentorship is crucial in training research investigators. If the mentors demonstrate and require that trainees conduct research of a high standard, it can help a great deal in producing researchers for the future, who do not cut corners and believe strongly in scientific integrity.
Transparency is one of the core guiding principles in the ICMR Ethics Guidelines. Institutions and investigators need to put more information into the public domain: About the kind of research they are carrying out, the rationale for choosing a certain set of participants and the interventions, the standard of care in the research, ancillary care and post-trial obligations etc. While it might not be possible to always disclose proprietary information related to the intervention or some elements about the research, the relevant ethics committee should at least insist on full information being provided. Another area where enough attention is not often paid is the EC demanding to see the budget of the study, the details of any MoUs signed with the sponsors, as well as details of other sites (in a multi-site study).
Global attention is now being paid to the need for public engagement in science. There is a need to enhance the public understanding for research, and to develop a civic dialogue around what kind of research is necessary. This will help in creating widespread support for scientific endeavors. Mechanisms of communication being present between research participants and the communities they belong to, and between the researchers and ECs will help avoid misunderstandings developing due to a trust deficit. Scientists should also use the media at local and national levels to explain the rationale for the research which is being conducted, and how it relates to the health priorities in that context.

CONCLUSION

India, as an emerging economy needs to continue to promote a strong culture of research and development, including in the health sector. However, attention needs to be paid to ensuring that stringent quality checks are built in, and that investigators conduct research in an impeccable manner. Failure to do so will dent the credibility of the research enterprise, affecting not just investigators or institutions conducting research, but also those planning to do so.

Footnotes

Source of Support: Nil
Conflict of Interest: None declared.