Resolution of Facility Inspection Deficiencies
Severity: criticalThe sponsor must coordinate with the facility to resolve all inspection deficiencies, including providing the date(s) of the facility's response(s) to the FDA Form 483. The FDA may require CGMP reinspection and/or additional Pre-License Inspection (PLI) to confirm satisfactory resolution before approval.
Recommended response: Address all FDA Form 483 observations comprehensively, provide detailed responses, and prepare for potential CGMP and PLI reinspections to ensure manufacturing compliance.
Cited: Compliance Program CP 7356.002
Inadequate Safety Update and Data Presentation
Severity: criticalA comprehensive safety update is required, including: detailed description of significant changes/findings in the safety profile; incorporation of new safety data from clinical studies (same format as original BLA, combined tabulations, frequency comparisons); retabulation of reasons for premature study discontinuation; provision of case report forms and narrative summaries for deaths and serious adverse events; description of changes in common, less serious AEs; updated exposure information for clinical studies; and a summary of worldwide experience on product safety, including AEs, immunogenicity, and updated estimate of use in other countries.
Recommended response: Conduct a thorough review of all clinical and nonclinical safety data. Prepare a comprehensive safety update addressing all specific requests, ensuring consistent formatting, detailed narratives for serious events, and a global safety overview. All data must be accurately tabulated and compared with original submission data.
Resubmission of Proprietary Name
Severity: minorThe proposed proprietary name was found conditionally acceptable but must be resubmitted when all other application deficiencies identified in this letter have been addressed.
Recommended response: Resubmit the proprietary name proposal once all other substantive deficiencies, particularly safety and manufacturing, have been fully resolved and the application is otherwise adequate for approval.
Missing English Translations of Foreign Labeling
Severity: minorProvide English translations of current approved foreign labeling that has not been previously submitted.
Recommended response: Compile and submit English translations for all current approved foreign labeling that has not yet been provided to the agency.