Quality Risk Management Demystified at CMC Strategy Forum - ICH Q9 encourages companies to apply the concept of quality risk management. Easier said than done. - BioPharm International

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Quality Risk Management Demystified at CMC Strategy Forum
ICH Q9 encourages companies to apply the concept of quality risk management. Easier said than done.


BioPharm International
Volume 22, Issue 9

THE MEANING OF SEVERITY RANKINGS: HOW TO ASSESS POTENTIAL PATIENT HARM

Participants also struggled to understand the meaning of severity rankings. The ICH Q9 guideline instructs the industry to consider harm in terms of patients. For some examples, however, like the cell culture step discussed in the workshop, it is difficult to envision any problem—from contamination to aggregation—that wouldn't be resolved before the product reaches the patient. Some cited improper glycosylation, but others pointed out that for many products, particularly monoclonal antibodies, even carbohydrate structures would not necessarily affect product safety or efficacy.

The solution, many speakers said, is to use in-process product quality as a surrogate for patient harm when assigning severity rankings.

"The first time we piloted a risk assessment during our implementation of ICH Q9, we attempted to use a severity scoring criteria that included harm to patients, and the highest severity score included serious injury or death," said Weese. "That didn't work for upstream assessments begun in the middle of Phase 2, because in many cases, you just don't know how a potential failure in a unit operation might cause direct harm to a patient. But we can estimate the potential impact on product quality attributes." As a result, he said, they decided it made more sense to use the potential impact on a product quality attribute as a surrogate for potential harm to patients.

The connection to patient risk would be clearer, some said, if clinical staff participated in risk assessments. "We include clinical staff when evaluating the need for product recalls, so I would think companies could benefit from including clinical staff when assessing risks," said Kevin O'Donnell of the Irish Medicines Board. "Clinical staff do see things that we don't in terms of risk to patients."

A few people responded that clinical staff participate in an earlier stage in the process. "We get input from clinicians in an earlier step, when we are determining critical quality attributes," said Kathy Francissen of Genentech.

Others questioned whether any clinician could really be expected to predict the patient impact of a manufacturing change. "Unless you have a very strong event, you are not going to get a clear linkage, because of extreme number of variables involved," said Wassim Nashabeh of Genentech.

Steven Kozlowski of the US Food and Drug Administration's Center for Drug Evaluation and Research (CDER) asked if anyone has attempted to tackle this problem through data mining, using multivariate data analysis to compare clinical outcomes or adverse event reporting to product attributes, perhaps by linking those data to lot numbers. "If we did this, would we find clusters of data that would be useful?" he asked.

Stefanie Pluschkell of Pfizer said her company is trying to do just that. "It's complex, because the databases [of adverse events and product lots] are not always directly linked," she said, adding that it also can be difficult to determine which specific adverse events to look at, because they can be diverse. "But I am reasonably hopeful that this effort will be useful," she said.

SCIENTISTS AND SUBJECTIVITY

A number of participants also questioned the real value of risk-ranking scores, given their subjectivity. "Now may be the time to improve the science of our decision-making, to increase our confidence in the results of these risk assessment exercises," said O'Donnell of the Irish Medicines Board. "There are other disciplines, such as experimental psychology, that we should look at. Much research work has been carried out and that research can be helpful to us when we are carrying out quality risk management exercises."

"Subjectivity will not disappear, and we should not strive for that," cautioned Rohin Mhatre of Biogen Idec. "The whole process is very subjective, from deciding how many experiments to run, to which parameters to study. We should try to build a good rationale for our risk assessments, but not aim for objectivity."

Nancy Waites of the FDA's Center for Biologics (CBER) agreed. "We're all scientists and we don't like ambiguity," she said. "But you can't think of everything. You need to be comfortable with not knowing everything."

Terry Ocheltree of CDER also concurred. "I don't think anyone at FDA expects you to remove all subjectivity," he said. "What is important is to have the tools and use them correctly. But that's not to say that everyone must run risk assessments in the same way."

THE RIGHT TEAM AND THE RIGHT FACILITATOR

Various speakers stressed the importance of assembling the right team to conduct a risk assessment. "The scoring is as good as who is in the room," said Amgen's Weese, emphasizing the importance of including staff from all key departments. "Our rules say that if certain people are not present, we will not proceed," he added.

But don't underestimate the importance of a good facilitator, several people said. "It's not just a question of involving the right subject matter experts, but also about the competence of the facilitator," said Keith Webber of CDER.

In particular, managing the people and personalities involved can be tricky. "Often we will have one very outspoken person who dominates, especially if that person is an expert in the topic under discussion," said Weese. "We need to ensure we hear from everyone else."

Vince Hamner of Talecris agreed, adding that those who disagree don't always voice their views. "Sometimes you get someone who sits back and doesn't say anything, then suddenly speaks up at the end," he said.

A good facilitator, Weese added, can help the group reach decisions, particularly when doubt leads a group to score everything conservatively. "If every risk number is extremely high, we are not achieving anything," he said.

But many also pointed out that there are few people in the biotech industry trained in risk management. Some suggested turning to the medical devices industry, because medical device manufacturers have been conducting risk assessments for decades.


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