Celebrating 25 year anniversary in Regulatory Affairs

Press release celebrating 25 year anniversary in Regulatory Affairs. SPharm – Canada’s Drug Regulatory Experts.

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Myths of clinical trial and drug approval process in Canada

 

Myths of clinical trial and drug approval process in Canada

 

Canada has become an increasingly popular destination for clinical trials and drug approvals. Despite that, misconceptions persist about everything from approval time to the language used in the approval process. We have identified six of the more common myths about clinical trial applications and drug approval in Canada. Which ones have you believed?


Myth # 1: Obtaining approval for clinical trials takes more time in Canada than elsewhere.

Reality: You’ll receive your approval (No Objection Letter) — or rejection — in 30 days. Once a Clinical Trial Application (CTA) has been submitted, questions can be raised by Health Canada to which an answer (with or without commitment) needs to be provided within 2 days. Once the CTA review is complete, Health Canada notifies the sponsor if the application is found to be acceptable or not. If the CTA is acceptable, Health Canada issues a No Objection Letter (NOL) within the standard 30-day review period; this NOL needs to be received before moving forward with the trial and will be needed for investigational drug importation purpose.

Compare that to the U.S., where the FDA has 30 days to determine whether a clinical hold is necessary or if the clinical trial can start. There is no specific duration for a clinical hold in the U.S..  There is no such hold in Canada.

In most european countries in Europe the target review timeline is 60 days but it often takes more than that to obtain a decision at the national level. EMA is looking into applying  a centralized procedure that will have a longer review period than 60 days.

Myth #2: The requirements for a Clinical Trial Application in Canada are more onerous than elsewhere.

Reality: The content requirements are actually less onerous than in the U.S.  and in the EU. No non-clinical or clinical study reports are required to be submitted within the CTA in Canada. What is needed are the administrative documents plus key scientific documents on which Health Canada bases their review on: the protocol, the informed consent form and the investigator’s brochure, in addition to the standard chemistry and manufacturing data. The Clinical Trial Application is composed of three modules:

  • Module 1 – contains administrative and clinical information about the proposed trial
  • Module 2 – contains quality (chemistry and manufacturing) information about the drug
  • Module 3 – contains additional supporting quality information, when needed.

There can be delays in initiating Clinical Trials in Canada, as in other jurisdictions. For instance, there may be delays in obtaining Research Ethics Board reviews and approvals (a decision independent from Health Canada). Also, sponsors and CROs in North America can prioritize the U.S. sites ahead of Canadian sites for many reasons including patient population (see myth no. 3). Typically, for global studies it can take a few months to get a site up and running in Canada.

It is to note that there are efficient clinical trials start-up experts in Canada that helps with streamlining the study start-up processes in parallel or after the clinical trials application approval.

Myth #3: Because of its population size, recruitment and enrollment are difficult in Canada.

Reality: Enrollment — recruitment and retention — is no more of a challenge in Canada than elsewhere. In fact, the average time from trial set up to first patient visit is three months, with 98 percent of subjects enrolled within the planned study period, according to the Canadian Clinical Trials Coordinating Centre (CCTCC).  One reason for this success is that Canada’s universal healthcare system means coordinated access to patients and better patient data.

Moreover, Canadians are highly educated and interested in research:  More than 70 percent of the population has expressed interest in participating in clinical research, according to the CCTCC.

Finally, as one of the most diverse nations in the world, Canada provides researchers to a broad pool of potential subjects.

Myth #4: All study documents must be provided in English and French.

Reality: Either language is accepted; for regulatory submissions, English is used more often. There are two exceptions: Labels and informed consent forms must be in both languages. Of course, all patient materials for trials in Quebec must be translated into French.

Myth #5: Health Canada’s process for approving new drugs is excessively slow.

Reality: Health Canada have established submission review targets that are respected. Submissions to Health Canada are often delayed, but it has very little to do with the Health Canada process.

Research published in the Canadian Medical Association Journal in 2015, found that the submission of new drugs to Health Canada for approval is systematically delayed compared with submissions to regulatory agencies in the United States and the European Union. Over the years, it has been my experience also. Differences across jurisdictions in approval-processing times play a small role in the delays; differences in the timing of drug submissions are clearly an important factor.

Accessibility to new drugs in Canada is delayed primarily because of delays in submission to Health Canada by pharmaceutical companies and not because of a longer nor more complex approval-processing time at Health Canada.

Myth #6: Drug trials costs more in Canada.

Reality: Canada has the second lowest cost among G7 nations in the management, design and coordination of clinical trials. Only France is cheaper, according to the Canadian Clinical Trials Coordinating Centre. Canada has one of the most attractive tax environments for research and development compared to the U.S. and other G7 countries.

Myth #6.5: The Clinical Trial sponsor needs a Canadian presence.

Reality: The CTA must be signed by a scientific or medical officer residing in Canada. Generally, the regulatory agent or the CRO can sign on behalf of the sponsor.

 

How to Determine your Regulatory Affairs Needs

 

DETERMINING YOUR REGULATORY AFFAIRS NEEDS


Well-defined and appropriately supported needs increase the likelihood of successful submissions and market access. So how does one go about determining what those needs are or might be, especially when embarking in a health product development process at its initial stages? Also, are there different considerations for pharma, biotech, and investigator led trials?

The short answer is yes.

It takes experience to establish a good health product development strategy and to build trust and communication channels that clearly communicate its details. Get it right, and you can reduce possible errors, save time and money, and lessen the steep learning curves that are common at the start of a mandate.

Together we will look more closely at the considerations for starting to define needs as a whole whether you are Pharma, Biotech or an Academic institution. Let’s look at the unique needs for each:

PHARMA

As a pharma, you have regulatory professionals on board. In instances when in-house staff does not have the expertise required in a specific situation, you will need to hire for a specific need, an expert to work in collaboration with your team. (i.e. orphan drugs, oncology, products that can be considered for priority reviews or NOC with condition, literature-based dossiers, etc.). In instances when workload is very high, or during peaks of activity, external professionals will act as an extension of your team and alleviate congestion, avoid delays and ensure timelines are respected.

BIOTECH STARTUP

For a biotech, particularly start-ups, it is unlikely to have a regulatory expert on staff. Development is costlier with biology / biotech products which means that cost efficient health product development is key.  Considering the greater health product development costs for biotechnology companies, the impact of failures and errors is more significant.  As a biotech, one of the most significant impact that a regulatory professional’s expertise and regulatory intelligence will have is in streamlining the regulatory process. They will increase efficiency to save you time and money.

INVESTIGATOR DRIVEN CLINICAL TRIALS

It isn’t uncommon for investigator driven clinical trials to commence without at least an initial consultation with regulatory agencies. This typically happens when the investigators are unfamiliar with the characteristics and requirements of the regulatory process or don’t consider that the obligations apply equally to investigators as they do pharma and biotech start-ups. For some others, it’s seen as a viable cost-cutting measure until they see once in the trial that, had they had a regulatory professional to draw on in the planning stages, it would save more time, cost less money, and increase efficacy. The obligations are the same whether the sponsor is a manufacture or an investigator and it’s important that the clinical trial initiatives are developed in line with regulatory obligations and Good Clinical Practices (GCPs).  A regulatory affairs professional will be able to ensure the study starts off in observance of the applicable regulations and GCPs.

Also, all studies conducted with a health product have the potential to be included in a registration dossier, making having a regulatory professional involved from the moment you begin to think about planning a study is a significant advantage. An expert who can help plan the health product development efficiently, including clinical development, such that no investment is lost via suboptimal planning is particularly important.

HIRE EXPERTS EARLY

Whether you are a sponsor in pharma, a biotech, or an investigator, you will need regulatory support from inception to submission, and a good way to begin a needs assessment is with questions at the research planning stages that shape the thinking process; there are three in particular that are wise to consider at the start.

Best practices assert that the earlier a regulatory expert is brought on, the better the outcomes. A way to look at this is, bringing in a regulatory professional on for the first time at the submission stage, would be akin to hiring a boat maker after you’ve already built a boat and want help to put it in the water.

Hiring at the start to define needs and formulate a strategic regulatory plan produces three significant advantages:  

  1. Ensure the research is relevant and that it will address a medical need / allow for market access so that funds are not misspent.
  2. Establish a smooth relationship with Health Canada teams built on the positive reputation of the regulatory professional.
  3. Accelerate Health Canada’s confidence in the company developing the product because the person interfacing speaks the same language as the regulatory agency.

Deciding whether to hire for the entire process, or part of it.

Needs change and issues can arise because both the product development and regulatory landscape evolve. New laws and regulations, requirements, and even innovations have the potential to affect health product development strategies. Regulatory professionals understand this and work it into their strategic plan, making it possible to anticipate changes and overcome challenges should they arise.  The importance of being responsive to these events means that needing to find, hire and transfer knowledge (and all that this entails) would be wasteful of all resources as compared to having a team or dedicated professional involved (and informed) from the start.

Is it possible to use different professionals for different parts of the process?

Throughout every study there is a need for different skill sets and experience. A team (it can be a small one with proven experience) comprised of professionals with deep knowledge of specializations within the health product development and lifecycle management, not only will enable time to not be lost on learning about the project, but also consistency will be maintained in communications with regulatory authorities.

Still, if you opt to go the route of trying out different professionals for different parts of the process, keep in mind the importance of using a polyvalent expert to optimize information and reduce the time and money investment. It speaks directly to the costs associated to the project(s) learning phases. Subject matter expertise is a driving force in how well the development process unfolds because specialists are able to help you avoid and overcome concerns, changes, challenges or other issues along the way. Their work can help reduce overall cost, alleviate workload, and improve timelines.

To ensure that you’ve hired an excellent professional or firm, please read our post on the subject.

The more consistent the team, the lesser mistakes and errors are encountered. Adherence to regulatory requirements are best achieved with the guidance and support of a regulatory affairs professional. This has many benefits, including increasing the worth of the clinical study or development strategy by respecting regulatory paths, for future inclusion of studies/science in a registration dossier.

THE TAKEAWAY

Hire a professional early – very early, in fact, at the planning stage so that your needs can be delineated by an experienced professional who can established a plan that will allow the drug development strategy to be responsive to changes. Regulatory needs may change depending on whether you’re in pharma, biotech, or an independent investigator, consult with a regulatory expert before you begin to ensure that nothing is missing within your health product development strategy and / or your study design, in other words, you will want to make sure that your plans will build a boat that floats.

Canadian Drug Regulatory Glossary

Canadian Drug Regulatory Glossary

 

What’s with all these Acronyms and Definitions?

The pharmaceutical industry is complex. The terms, expressions, abbreviations and industry vernacular are also as complex and confusing. We have attempted to put some order within this process by providing a glossary of the most common abbreviations and terms used in the industry.

All acronyms have been organized alphabetically.


ADN – Annual Drug Notification
A Notification sent to Health Canada annually, before October, by a drug sponsor/manufacturer, confirming that all information previously supplied with regard to that drug is correct, in order to comply with section C.01.014.5 of the Food and Drug Regulations. The Annual Drug Notification Form (ADNF) is available to assist manufacturers in complying with the said regulations.

ADR – Adverse Drug Reaction
A noxious and unintended response to a drug, which occurs at doses normally used or tested for the diagnosis, treatment or prevention of a disease or the modification of an organic function. It includes lack of efficacy.

AE – Adverse Event
Any adverse occurrence in the health of a clinical trial subject who is administered a drug, that may or may not be caused by the administration of the drug, and includes an adverse drug reaction.

ANDS – Abbreviated New Drug Submission
Regulatory dossier that needs to be submitted and approved by Health Canada for a manufacturer to be granted authorizations to sell (Marketing Authorization) a generic drug on the Canadian market. This dossier typically requires a Bioequivalence study or a physico-chemical comparison (or both) against the Canadian Reference Product (innovator) plus a complete Chemistry and Manufacturing (Quality) package. Some exceptions can apply.

AR – Adverse Reaction
A noxious and unintended response to a marketed health product and includes Adverse Drug Reaction as defined in the Food and Drug Regulations and Adverse Reaction as defined in the Natural Health Products Regulations. In the later regulations, AR means a noxious and unintended response to a natural health product that occurs at any dose used or tested for the diagnosis, treatment or prevention of a disease or for modifying an organic function.

BGTD – Biologic and Genetic Therapies Directorate
Canadian regulatory authority of biological drugs (products made from living sources) and radiopharmaceuticals (drugs that have radioactivity) for human use in Canada. It is one of Health Product and Food Branch Directorates. Before giving permission to sell these therapies, the directorate must see scientific evidence of it’s safety, effectiveness, and quality, as required by the Food and Drugs Act and Regulations.

CADTH – Canadian Agency for Drugs and Technologies in Health
An independent, not-for-profit organization responsible for providing health care decision-makers with objective evidence to help make informed decisions about the optimal use of health technologies, including: drugs, diagnostic tests, medical, dental, and surgical devices and procedures. In addition to evidence, we also provide advice, recommendations, and tools.

This agency was initially established in 1989 as the Canadian Coordinating Office for Health Technology Assessment (CCOHTA), CADTH adopted its new name in April 2006 to better reflect their broad activities.

CAP – Clinical Assessment Package
Document which needs to be prepared and submitted to Health Canada’ appropriate review Bureau along with a written request to obtain a Priority Review Status, in advance of the filing of New Drug Submission (NDS).

Category IV Product
Category IV Products makes reference to products that have Category IV Monographs, that are developed for drugs that have a well characterized safety and efficacy profile under specific conditions of use. A manufacturer may reference a Category IV Monograph in a drug submission when the product and its labelling are consistent with the information set out in the document. Products subject to Category IV Monographs, can obtain a DIN through a DINF application.

CBS – Canadian Blood Services
Canadian Blood Services was founded in 1998, based on recommendations from the Krever Report on the tainted blood scandal of the early 1990s. CBS is regulated as a biologics manufacturer by Health Canada and primarily funded by the provincial and territorial ministries of health. Canadian Blood Services is a not-for-profit charitable organization.

CIHI – Canadian Institute for Health Information
A Canadian health agency that collects and reports on clinical and non-clinical data.

CIOMS – Council for International Organization of Medical Sciences
The CIOMS refers essentially to the CIOMS I Form, which provides a standardised format for the reporting of suspected adverse reactions to any particular medical product, in Canada as well as worldwide.  The Council plays an important role in the current pharmacovigilance practice.

Common Drug Review (CDR)
National review process for non-oncology drugs that focuses on the cost effectiveness of a drug vs. current therapies. CDR issues a recommendation to the government drug plans (except Quebec – see INESSS) as to whether or a not a  drug should be publicly funded for patients who need access.

CT – Clinical Trial
An investigation with a drug for use in human subjects, intended to discover or verify the clinical, pharmacological or pharmacodynamic effects of the drug, identify any adverse events, study the absorption, distribution, metabolism and excretion of the drug, or ascertain the safety or efficacy of the drug.

CTA – Clinical Trial Application
Regulatory dossier that needs to be submitted to Health Canada and given a No Objection Letter (NOL) from Health Canada prior to the sponsor proceeding with a clinical trial with an investigational pharmaceutical, biological and radiopharmaceutical product in the Canadian population / patients. In the the context of clinical trial management activities, CTA can also mean Clinical Trial Agreement (which is the agreement between the clinical trial investigational sites/center and the sponsor, in order to conduct the aimed study).

CTA also means Clinical Trial Authorization, the equivalent to a Clinical Trial Application required in Europe (EMA). In the USA (FDA), IND (Investigational New Drug) is the equivalent of the Clinical Trial Application.

CTA-A/N – Clinical Trial Application – Amendment/Notification
CTA-A: Changes to the clinical trial protocol or quality dossier, after the original CTA submission, that will impact the safety of the subjects, will affect the analysis and the interpretation of the safety and efficacy of the drug(s) under investigation or, that may affect the quality or safety of the clinical trial drug supplies.  A 30-day review period applies before these changes can be implemented.

CTA-N:  Changes that do not meet the criteria for a CTA-A, which may be implemented immediately, but Health Canada must be informed in writing, within 15 calendar days of the day of the change.  

CTD – Common Technical Document
Globally harmonized Submission format that is accepted by many regions, in an effort to avoid the need to compile different registration dossiers for different regulatory authorities. The CTD format was adopted by Health Canada in 2003.

CTS – Clinical Trial Site
The location where clinical trial-related activities are conducted.

CTSIF – Clinical Trial Site Information Form
Form that is required to be completed and submitted to Health Canada by the sponsor or its representative for each clinical trial site, prior to commencement of the clinical trial or implementation of a Clinical Trial Application-Amendment, at that site.

DEL – Drug Establishment License
A Licence issued to a person in Canada allowing them to conduct licensable activities in a building which has been inspected and assessed as being in compliance with the requirements of the Food and Drug Regulations. Activities covered under a DEL are: fabrication, packaging, labelling, testing, importation, distribution or wholesaling. DEL applies for active pharmaceutical ingredients, finished dosage drugs or bulk process intermediates.

DIN – Drug Identification Number
An eight (8) digit numerical code assigned to each drug product approved under the Food and Drugs Act and Regulations (except for Schedule C drugs – radiopharmaceuticals). A DIN identifies the following product characteristics: manufacturer, brand name, medicinal ingredient(s), strength of medicinal ingredient(s), pharmaceutical form, route of administration.

DINA – Application for a DIN
When a product is not subject to Division 8 of the Food and Drug Regulations, the application is called a DIN submission.

Note: Under the provisions of section C.01.014 of the Food and Drug Regulations, no manufacturer shall sell a drug in dosage form unless a drug identification number (DIN) has been assigned for that drug and the assignment of the number has not been cancelled pursuant to section C.01.014.6. In the case of a new drug, a new drug submission filed pursuant to Division 8 of the Food and Drug Regulations is regarded as an application for a DIN.

A DINB is an Application for a DIN specific to a Biologic Product.

A DIND is an Application for a DIN specific to a Disinfectant Product.

A DINF is an Application for a DIN specific to a Category IV Product.

FDA – Food and Drug Act
An Act respecting food, drugs, cosmetics and therapeutic devices.

FDR – Food and Drug Regulations
The legislation that oversees and sets out requirements for the manufacture, packaging, labelling, storage, importation, distribution and sale of foods, and prescription and non-prescription drugs in Canada. Requirements for drug clinical trials are also set out in the regulations. Health Canada develops and enforces regulations under Government of Canada legislation. The Department consults with the Canadian public, industry and other interested parties in the development of laws that protect health and safety. They also prepare guidelines and policies in order to help interpret and clarify the legislation surrounding drugs and health products.The purpose of the legislation is to protect the health and safety of Canadians with respect to the sales of food and drug products.

GCP – Good Clinical Practice
Generally accepted clinical practices that are designed to ensure the protection of the rights, safety and well-being of clinical trial subjects and other persons, and the good clinical practices referred to in section C.05.010 of the Regulations.

GMP – Good Manufacturing Practices
The part of quality assurance ensuring that drugs are consistently produced and controlled in such a way to meet the quality standards appropriate to their intended use, as required by the marketing authorization. Part of the Health Products and Food Branch Inspectorate (Inspectorate) program is to conduct inspections of establishments that are involved in activities covered by the Establishment Licensing framework.

HC – Health Canada
Federal department responsible for helping Canadians maintain and improve their health, while respecting individual choices and circumstances.

HP – Health Product
Products regulated under the Food and Drugs Regulations (drugs) and the Natural Health Products Regulations (natural health products). Drugs include both prescription and non-prescription pharmaceuticals; biotechnology products and biologically-derived products such as vaccines, serums, and blood derived products; disinfectants; and radiopharmaceuticals.  

HPFB – Health Product and Food Branch
Health Canada Branch mandated to manage the health-related risks and benefits of health products and food by: 1) minimizing health risk factors to Canadians while maximizing the safety provided by the regulatory system for health products and food; 2) providing information to Canadians so they can make healthy, informed decisions about their health. The HPFB activities are carried out under various Directorates and Offices, including the Therapeutic Product Directorate, the Biologic and Genetic Therapies Directorate and the Marketed Health product Directorate.

HPFBI – Health Product and Food Branch Inspectorate
Part of the HPFBI program to conduct inspections of establishments that are involved in activities covered by the Establishment Licensing framework. These inspections are conducted to verify the compliance with GMP (Part C, Division 2 of the Food and Drugs Regulations) which is a requirement for the issuance of an establishment licence.

HQ – Héma Québec
Société à but non lucratif, Héma-Québec a été constituée en 1998, des longues suites du rapport final de la commission Krever, initié en raison du scandale du sang contaminé du au début des années 90.  En matière de sécurité de l’approvisionnement, Héma-Québec est une organisation nationale, pour le Québec, légiféré par Santé Canada comme fabricant de produits du sang (biologique).

HTA – Health Technology Assessment
The process followed to provide an evidenced based recommendation on whether a health technology merits being publically funded.

IB – Investigator’s Brochure
In respect of a drug, a document containing the nonclinical and clinical data on the drug that are described in section C.05.005(e) of the Regulations.

ICF – Informed Consent Form
A document that describes: The risks and anticipated benefits to his or her health arising from participation in the clinical trial; and all other aspects of the clinical trial that are necessary for that person to make the decision to participate in the clinical trial.

ICH – International Conference on Harmonization
International initiative to harmonize efficacy, safety and quality (chemistry and manufacturing) requirements globally for the registration of drugs (pharmaceuticals, biologicals, genetic therapies, …) for human use. This initiative include standard information organization for new drug registration applications.

INESSS – Institut national d’excellence en santé et en services sociaux
Quebec’s review process to evaluate therapeutic value and cost-effectiveness of oncology and non-oncology drugs. INESSS issues a recommendation to Quebec’s Minister of Health and Social Services as to whether or not a drug should be publicly funded for patients who need access

ITA – Investigational Testing Application
The equivalent of a CTA but for a Medical Device.

MAH – Marketing Authorization Holder
The entity that holds the Notice of Compliance, the Drug Identification Number (DIN), the Natural Product Number (NPN), the Homeopathic Medicine Number (DIN-HM), or the product licence.

MDLA – Medical device License Application
Equivalent of a CTA but for Investigating the efficacy and safety of a Medical Device.

MF – Master File
Formerly known as Drug Master File. Reference that provides information about specific processes or components used in the manufacturing, processing, or packaging of a drug. The MF is a useful vehicle for providing information to Health Canada, where that information is of a proprietary nature [i.e., confidential business information] and is not available to the manufacturer of the dosage form or to the sponsors of a drug submission or clinical trial application (also referred to as the applicants).

NAS – New Active Substance

  • Chemical or biological substance not previously authorized for sale in Canada as a drug;
  • Isomer, derivative or salt of a chemical substance previously authorized for sale as a drug in Canada, but differing in properties with regard to safety and efficacy;
  • Biological substance previously authorized for sale in Canada as a drug, but differing in molecular structure, nature of the source material or manufacturing process.

NC – Notifiable Change
Notifiable changes are Level II Changes and are classified either as:

Moderate Quality Changes (chemistry and manufacturing) which have a moderate potential to have an adverse effect on the identity, strength, quality, purity, or potency of the drug product as these factors may relate to the safety or effectiveness of the drug product. This level of change does not apply to Human Pharmaceuticals.

Risk Management Change (clinical) defined as a change to the label that has the potential to improve the management of risk to the population currently indicated for use of, or in any other way exposed to the drug. These changes are classified as either 90-day review changes (more urgent changes) or 120-day review changes.

NDS – New Drug Submission
Regulatory dossier that needs to be submitted and approved by Health Canada for a manufacturer to be granted authorizations to sell a new drug (i.e. pharmaceutical, biologic, vaccine, biotechnology product). This dossier typically requires complete Pre-clinical, Clinical and Chemistry and Manufacturing (Quality) package. Specific requirements may differ depending on the drug type, the pathology treated, the aimed patient population, amongst other elements.

NHP – Natural Health Product
A substance set out in Schedule 1 of the Natural Health Products Regulations or a combination of substances in which all the medicinal ingredients are substances set out in Schedule 1 of the Natural Health Products Regulations, a homeopathic medicine or a traditional medicine.

NOC – Notice of Compliance
Notification issued by Health Canada indicating that a manufacturer has complied with the requirements of the Food and Drug Regulations at the end of the review of an NDS, ANDS, S/NDS or S/ANDS.

NOC/c-QN – Notice of Compliance with Conditions Qualifying Notice
Notification issued by the Director of the responsible reviewing Bureau/Centre upon completion of a review, should a submission be determined to qualify for further consideration under the NOC/c policy. The NOC/c – QN will indicate that the submission qualifies for a NOC, under the NOC/c policy, as well as outline the additional clinical evidence to be provided in confirmatory studies, post-market surveillance responsibilities and any requirements related to advertising, labeling, or distribution. Submission review will cease upon issuance of the Qualifying Notice.

This applies to products that has promising evidence of clinical effectiveness with acceptable safety profile intended for the treatment, prevention or diagnosis of a serious, life-threatening or severely debilitating disease or condition for which there is no existing therapy available in Canada which possesses  a similar therapeutic profile or for which the new drug submission demonstrates a significant improvement in the benefit/risk profile over the available alternative product.

NOD – Notice of Deficiency
If deficiencies and/or significant omissions that preclude continuing the review are identified during the review of a submission, a NOD will be issued.

NOL – No Objection Letter
Letter emitted by Health Canada after the review of a Clinical Trial Application or a Notifiable Change, if the application is deemed acceptable to them. It confirms that a sponsor can proceed with its Clinical Trial in Canada or can implement the changes presented in the Notifiable Change.

NON – Notice of Non Compliance
Notice issued after the comprehensive review of a submission is complete, if the submission is deficient or incomplete in complying with the requirements outlined in the Food and Drugs Act and Regulations.

NSN – Not Satisfactory Notice
A notice issued by the Director of the responsible reviewing Bureau/Centre if deficiencies are identified during the review of a Clinical Trial Application, Clinical Trial Application-Amendment or Notifiable Change. The deficiencies will be specified and review of the submission will stop on the date of the Not Satisfactory Notice.

PAAB – Pharmaceutical Advertising Advisory Board
An independent and not-for-profit organization funded on a fee-for-service basis. It is the only regulator whose preclearance service is recognized by Health Canada for advertising directed to healthcare professionals. PAAB works to protect Canadians by ensuring that healthcare product advertising meets the regulatory, scientific, therapeutic, and ethical standards outlined in the Code of Advertising Acceptance. All PAAB approved materials bear the PAAB logo.

PBRER – Periodic Benefit Risk Evaluation Report
A pharmacovigilance document intended to provide a comprehensive, concise, and critical analysis of new or emerging information on the risks of the health product, and on its benefit in approved indications, to enable an appraisal of the product’s overall benefit-risk profile. The current ICH guidance ensures that PSURs for marketed drugs have the role of being periodic benefit-risk evaluation reports by covering: Safety evaluation, evaluation of all relevant available information accessible to sponsors/MAHs and benefit-risk evaluation.

pCPA – pan-Canadian Pharmaceutical Alliance
National mechanism designed to achieve greater value for government drug plans. pCPA negotiates with a drug company to determine both the cost and criteria under which governments will pay for a medication, concluding with a Letter of Intent to fund the drug.

PMPRB – Patented Medicine Price Review Board
A board that protects and informs Canadian consumers by ensuring that the prices of patented medicines sold in Canada are not excessive, and by reporting on pharmaceutical trends.

PR – Priority Review
A status granted by Health Canada to an NDS or an SNDS for a serious, life-threatening or severely debilitating disease of condition for which there is substantial evidence of clinical effectiveness that the drug provides: 1) effective treatment, prevention or diagnosis of a disease or condition for which no drug is presently marketed in Canada; or 2) a significant increase in efficacy and/or a significant decrease in risk such that the overall benefit/risk profile is improved over existing therapies, preventatives or diagnostic agents for a disease or condition that is not adequately managed by a drug marketed in Canada.

PSEAT-CTA – Protocol Safety and Efficacy Assessment Template – Clinical Trial Application
A protocol summary to be prepared and submitted within the CTA. The summary is expected to contain: protocol identification, background and rationale, trial objectives, study design and duration, total number of sites (including number of Canadian sites), investigators, sample size, patient population, inclusion & exclusion criteria, drug formulation, dosage regimen, washout period, screening & baseline evaluation, treatment & assessment visits, concomitant & rescue medication, risk management, withdrawal/discontinuation criteria, efficacy & safety variables and analysis, statistical analysis.

PSUR – Periodic Safety Update Report
Mechanism for summarizing interval safety data, and for conducting an overall safety evaluation. It is a tool for sponsors to conduct systematic analyses of safety data on a regular basis. In addition to covering ongoing safety issues, the PSUR should also include updates on emerging and/or urgent safety issues, and major signal detection and evaluation that are addressed in other documents.

QHCP – Qualified Health Care Professional
A person who is a member in good standing of a professional medical, nursing, pharmacists’ or other health care practitioner association and entitled to provide health care under the laws of the jurisdiction in which the person is located, and other individuals retained by the Marketing Authorization Holder who have the appropriate health care education and therapeutic expertise.

QI – Qualified Investigator
The person responsible to the sponsor for the conduct of the clinical trial at the clinical trial site, who is entitled to provide health care under the laws of the province where that clinical trial site is located.

QIU – Qualified Investigator Undertaking
The undertaking that must be completed by the qualified investigator responsible for the conduct of the clinical trial at the clinical site and retained by the clinical trial sponsor for a period of 25 years. This undertaking should not be submitted to Health Canada unless requested.

QOS – Quality Overall Summary
Summary template that follows the scope and the outline of the Quality Body of Data (of CTD Module 3.2). Specific QOS templates exists for Clinical Trial Applications Phases I, II & III; for Bioavailability studies and for DIN applications. The QOS for new chemical entities is presented below.

QOS-CE – Quality Overall Summary – Chemical Entities (CTA)
Summary template that follows the scope and the outline of the Quality Body of Data (of CTD Module 3.2). This template can be used by sponsors to summarize the Quality information for New Drug Submissions (NDSs) and Abbreviated New Drug Submissions (ANDSs) containing drug substances and their corresponding products of synthetic or semi-synthetic origin that are filed with Health Canada pursuant to Part C, Division 8 of the Food and Drug Regulations.

This would exclude submissions for Biotechnological/Biological (Schedule D) and Radiopharmaceutical (Schedule C) drugs. Nonetheless in reality, the referenced QOS-CE is used to summarize the Quality information for Schedule D New Drug Submissions (NDSs); sections of the template are then bonified with the requirements of the Schedule D NDS guidance. A Quality Information Summary (QIS) is available for radiopharmaceuticals, upon request from Health Canada.

REB – Research Ethics Board
A body that is not affiliated with the sponsor, mandated to approve the initiation of, and conduct periodic reviews of, biomedical research involving human subjects in order to ensure the protection of their rights, safety and well-being. The body needs at least five members, that are in majority Canadian citizens or permanent residents under the Immigration Act, and composed of both men and women. Additional criterias apply.

RMA – Risk Minimization Activity
Risk minimization activities are interventions intended to prevent or reduce the occurrence of adverse reactions associated with the exposure to a medicine, or to reduce their severity or impact on the patient should adverse reactions occur. These measures may include warnings in the label or minimization activities beyond routine, such as health care provider educational material.

RMP – Risk Management Plan
A document that describes a set of pharmacovigilance activities and interventions designed to identify, characterize, prevent or minimize risks related to drug products, and the assessment of the effectiveness of those interventions (adopted from the European Medicines Agency definition of a Risk Management System).

S/ANDS – Supplemental Abbreviated New Drug Submission
Same as for a S/NDS presented below but for generic products.

S/NDS – Supplemental New Drug Application
Submission required for Level I Quality or Safety & Efficacy (Clinical) Changes that have a substantial potential to have an adverse effect on the identity, strength, quality, purity, or potency of a drug product as these factors may relate to the safety or effectiveness of the drug product or a change to the label of a drug that has the potential to increase the exposure levels of the drug, either by expanding the population that is exposed, or by increasing individual exposure.

SAP – Special Access Programme
Programme that allows access to nonmarketed drugs for practitioners treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable. The SAP authorizes a manufacturer to sell a drug that cannot otherwise be sold or distributed in Canada. Drugs considered for release by the SAP include pharmaceutical, biologic, and radio-pharmaceutical products not approved for sale in Canada.

SADR – Serious Adverse Drug Reaction
An adverse drug reaction that requires in-patient hospitalization or prolongation of existing hospitalization, that causes congenital malformation, that results in persistent or significant disability or incapacity, that is life threatening or that results in death.

SAR – Serious Adverse Reaction
A noxious and unintended response to a natural health product that occurs at any dose and that requires in-patient hospitalization or a prolongation of existing hospitalization, that causes congenital malformation, that results in persistent or significant disability or incapacity, that is life threatening or that results in death.

SEO – Senior Executive Officer
The most senior person with policy and operational decision making authority within the sponsor, or is an official who has this delegated authority in respect of a clinical trial.  The SEO is responsible for providing an attestation with respect to the Clinical Trial Application/Amendment at the time of filing the CTA to Health Canada.

SUADR – Serious Unexpected Adverse Drug Reaction
A serious adverse drug reaction that is not identified in nature, severity or frequency in the risk information set out in the investigator’s brochure or on the label of the drug.

TPD – Therapeutic Products Directorate is Canada’s regulator of prescription drugs and medical devices for human use. Before giving permission to sell a product, the directorate must see scientific evidence of the product’s safety, effectiveness, and quality, as required by the Food and Drugs Act and Regulations.

YBPR – Yearly Biologic Product Report
A report that must be submitted annually by manufacturers of all Schedule D (Biologic) drugs in accordance with Guidance for Sponsors: Lot Release Program for Schedule D (Biologics) Drugs. The report contains production information on both drug substance and drug product lots, including test methods and results, reasons for any recalls and corrective action taken, as well as other pertinent post-market information.

 

How long does it take a life science product to be approved in Canada?

How long does it take a life science product to be approved in Canada?

 

WHAT ARE HEALTH CANADA’S TIMELINES TO PROVIDE AUTHORIZATION FOR A DRUG TO BE SOLD ON THE CANADIAN MARKET?

The Canadian review timeline for a New Drug Submission (NDS) is competitive. A standard review consists of a maximum of 10 days eCTD validation, followed by 45 days administrative screening where it is verified that the content is acceptable and that no key information is missing. Following the screening period, a 300-day scientific review of the quality, non-clinical and clinical data packages, applies. Therefore, a total of 355 review days applies, before a sponsor obtains a final review decision.

Should the NDS qualify for an accelerated review either under a Priority Review or a Notice of Compliance with condition, the review timelines are shorter.

 


 

For questions about the Canadian Drug Review & Regulatory approval process that is not covered in this section, please go ahead and contact us directly.