Jill Wechsler
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The cherry blossoms bloomed in Washington last month, but it was not a cheery time for FDA—or pharma companies. Prospects
for a speedy Senate confirmation of Lester Crawford as the next FDA commissioner were put on hold by Senators demanding that
FDA first take action on the application for an OTC version of Duramed's "morning-after" contraceptive, Plan B (levonorgestrel).
As legislators accelerated efforts to shore up FDA's oversight of drug safety, agency officials showed their muscle by seizing
a massive quantity of drugs produced in Puerto Rico by GlaxoSmithKline (GSK), and forcing Pfizer to halt sales of its COX-2
inhibitor Bextra (valdecoxib). While many observers fear that the seizures and withdrawal actions signal a more risk-averse
stance at FDA, cynics regard these actions as just another swing of the regulatory pendulum. A decade ago, FDA was accused
of dragging its feet over new drug applications; now the agency is accused of moving so fast that it's letting unsafe and
insufficiently tested products onto the market. Meanwhile, despite the current focus on safety, legislators and others remain
oddly focused on opening the door to broader importation of drugs (see "Matters of Import").
Matters of Import
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On the Attack
Meanwhile, FDA has demonstrated that it already has the power and will to pull unsafe drugs off the market. At the annual
meeting of the Food and Drug Law Institute in April, Senator Mike Enzi (R-WY), chairman of the Senate Health, Education, Labor
and Pensions Committee, reported that he is working with ranking Democrat Edward Kennedy (D-MA) on a "comprehensive response"
to drug safety problems. They are evaluating recommendations made by FDA officials and other experts at committee hearings
this past February, including legislative proposals to establish a more independent drug safety oversight system.
Not coincidentally, FDA cracked down on GSK in March for failing to fully recall deficient lots of controlled release Paxil
(paroxetine) and the diabetes drug Avandamet (metformin) made in Puerto Rico. The seizure, which FDA says is the largest in
its history, aimed to send a message to manufacturers to pay attention to warning letters and citations for violating good
manufacturing practices.
The loss of these blockbuster products should cost GSK more than $1 billion in annual revenues for as long as the plant remains
shut down, and more if the feds seek disgorgement of past revenues and profits. Negotiations of a consent decree were rumored
at press time. This could involve a very long and costly process of overhauling the plant to meet manufacturing standards.
In addition to telling Pfizer to halt sales of Bextra, FDA required black-box warnings for Pfizer's other COX-2, Celebrex
(celecoxib), and for all prescription NSAIDs (non-steroidal anti-inflammatory drugs). Pfizer objected, but FDA's decision
may be a boost for Celebrex, which now appears no riskier than widely used painkillers.
FDA is allowing nonprescription NSAIDs to remain on the market, albeit with more warnings on labels, because the OTC versions
are used in low doses and generally for short periods.
Pfizer moved to shore up its position in pain relief by promising a long-term study comparing Celebrex's safety to other drugs',
and suggesting that it might even resume DTC advertising. The company acknowledged hopes to renew limited sales of Bextra,
despite speedy moves by trial lawyers to file new suits against the drug.
FDA's decision to halt Bextra sales went beyond the recommendations of its advisory committees, which in February voted by
a narrow margin to keep the drug on the market. Some Congressional critics praised FDA for taking an aggressive stance with
high-risk drugs—and for throwing the book at pharma marketers—but industry fears that the agency is tipping the delicate risk-benefit
balance for prescription drugs too much to the risk side.
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