Determination That TEQUIN (Gatifloxacin) Was Withdrawn From Sale for Reasons of Safety or Effectiveness, 52357-52358 [E8-20938]
Download as PDF
Federal Register / Vol. 73, No. 175 / Tuesday, September 9, 2008 / Notices
scheduled for the meeting; or you may
contact the Board’s Web site at https://
www.federalreserve.gov for an electronic
announcement that not only lists
applications, but also indicates
procedural and other information about
the meeting.
Board of Governors of the Federal Reserve
System, September 5, 2008.
Robert deV. Frierson,
Deputy Secretary of the Board.
[FR Doc. E8–20989 Filed 9–5–08; 4:15 pm]
BILLING CODE 6210–01–S
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket Nos. FDA–2006–P–0081 (formerly
Docket No. 2006P–0178) and FDA–2005–P–
0369 (formerly Docket No. 2005P–0023)]
Determination That TEQUIN
(Gatifloxacin) Was Withdrawn From
Sale for Reasons of Safety or
Effectiveness
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
SUMMARY: The Food and Drug
Administration (FDA) has determined
that TEQUIN (gatifloxacin) Tablets,
Injection, and Oral Suspension, were
withdrawn from sale for reasons of
safety or effectiveness. This
determination means that FDA will not
accept or approve abbreviated new drug
applications (ANDAs) for gatifloxacin
oral tablets, injection, or oral suspension
that refer to any previously approved
dosage forms and strengths of TEQUIN
(gatifloxacin).
FOR FURTHER INFORMATION CONTACT:
Elena Cohen, Center for Drug Evaluation
and Research, Food and Drug
Administration, 10903 New Hampshire
Ave., Bldg. 51, rm. 6228, Silver Spring,
MD 20993–0002, 301–796–3602.
SUPPLEMENTARY INFORMATION: In 1984,
Congress enacted the Drug Price
Competition and Patent Term
Restoration Act of 1984 (Public Law 98–
417) (the 1984 amendments), which
authorized the approval of duplicate
versions of drug products under an
ANDA procedure. ANDA applicants
must, with certain exceptions, show that
the drug for which they are seeking
approval contains the same active
ingredient in the same strength and
dosage form as the ‘‘listed drug,’’ which
is a version of the drug that was
previously approved under a new drug
application (NDA). ANDA applicants do
not have to repeat the extensive clinical
testing otherwise necessary to gain
approval of an NDA. The only clinical
data required in an ANDA are data to
show that the drug that is the subject of
the ANDA is bioequivalent to the listed
drug.
The 1984 amendments include what
is now section 505(j)(7) of the Federal
52357
Food, Drug, and Cosmetic Act (the act)
(21 U.S.C. 355(j)(7)), which requires
FDA to publish a list of all approved
drugs. FDA publishes this list as part of
the ‘‘Approved Drug Products With
Therapeutic Equivalence Evaluations,’’
which is generally known as the
‘‘Orange Book.’’ Drugs are removed from
the list if the agency withdraws or
suspends approval of the drug’s NDA or
ANDA for reasons of safety or
effectiveness, or if FDA determines that
the listed drug was withdrawn from sale
for reasons of safety or effectiveness
(section 505(j)(7)(C) of the act; § 314.162
(21 CFR 314.162)).
FDA will not approve an ANDA if the
listed drug has been withdrawn from
sale for safety or effectiveness reasons
(section 505(j)(4)(I) of the act). Under
§ 314.161(a)(1) (21 CFR 314.161(a)(1)),
the agency must determine whether a
listed drug was withdrawn from sale for
reasons of safety or effectiveness before
an ANDA that refers to that listed drug
may be approved. A drug that has been
withdrawn from the market for safety or
effectiveness reasons is not a listed drug
(21 CFR 314.3(b)). FDA may not approve
an ANDA that does not refer to a listed
drug. FDA currently has pending one or
more ANDAs that refer to TEQUIN
(gatifloxacin).
Bristol-Myers Squibb Co. (BMS) is the
holder of three NDAs1 for TEQUIN
tablets, injection, and oral suspension as
listed in the following table:
TABLE 1.—APPROVED TEQUIN PRODUCTS
NDA No.
Active Ingredients
Strength
Dosage Form/Route
21–061
Gatifloxacin
200 milligrams (mg)
Tablet; oral
21–061
Gatifloxacin
400 mg
Tablet; oral
21–062
Gatifloxacin
Equivalent to 10 mg/milliliter (mL) (200 mg)
Injectable; injection
21–062
Gatifloxacin
400 mg/40 mL (10 mg/mL)
Injectable; injection
21–062
Gatifloxacin in dextrose 5% in
plastic container
200 mg/100 mL (2 mg/mL)
Injectable; injection
21–062
Gatifloxacin in dextrose 5% in
plastic container
400 mg/200mL (2 mg/mL)
Injectable; injection
21–678
Gatifloxacin
200 mg/5 mL
Suspension; oral
jlentini on PROD1PC65 with NOTICES
TEQUIN is an antibacterial drug
indicated for the treatment of infections
due to susceptible strains of designated
microorganisms in the following
conditions: Acute bacterial exacerbation
of chronic bronchitis; acute sinusitis;
1 On December 17, 1999, FDA approved NDAs
21–061 and 21–062 for community-acquired
pneumonia, acute bacterial exacerbation of chronic
bronchitis, acute bacterial sinusitis, uncomplicated
urinary tract infections, complicated urinary tract
infections, pyelonephritis, and uncomplicated
gonorrhea. The December 17, 1999, approval letter
also stated that indications for uncomplicated skin
and skin structure infections were approvable
pending the submission of certain postmarketing
data. For administrative purposes, the agency
assigned administrative NDAs 21–404 (TEQUIN
Tablets) and 21–405 (TEQUIN Injections) for the
treatment of uncomplicated skin and skin structure
infections. BMS provided a complete response, and
upon approval on October 17, 2002, NDAs 21–404
and 21–405 were retired by FDA. The approvals
and all other submissions for the treatment of
uncomplicated skin and skin structure infections
were incorporated in the original NDAs, 21–061
and 21–062. NDAs 21–404 and 21–405 are not
listed in the Orange Book, but can be found through
a search at Drugs@FDA.
VerDate Aug<31>2005
17:08 Sep 08, 2008
Jkt 214001
PO 00000
Frm 00097
Fmt 4703
Sfmt 4703
E:\FR\FM\09SEN1.SGM
09SEN1
52358
Federal Register / Vol. 73, No. 175 / Tuesday, September 9, 2008 / Notices
jlentini on PROD1PC65 with NOTICES
community-acquired pneumonia;
uncomplicated skin and skin structure
infections; uncomplicated and
complicated urinary tract infections;
pyelonephritis; uncomplicated urethral
and cervical gonorrhea; and acute,
uncomplicated rectal infections in
women.
In January 2003, FDA received revised
product labeling relating to several
approved supplements for TEQUIN
(gatifloxacin). This revised labeling
deleted references to TEQUIN injection,
10 milligrams/milliliter (mg/mL) (200
mg), indicating that this product was no
longer being marketed; therefore, the
product was moved from the
prescription drug product list to the
‘‘Discontinued Drug Product List’’
section of the Orange Book. In response
to a citizen petition from Apotex Corp.
(Docket No. FDA–2005–P–0369),2 FDA
stated, in the Federal Register of
February 3, 2006 (71 FR 5858), that
TEQUIN injection, 10 mg/mL (200 mg),
was not withdrawn for reasons of safety
and effectiveness.
On May 1, 2006, Public Citizen
Research Group submitted a citizen
petition (Docket No. FDA–2006–P–
0081),3 under 21 CFR 10.30, requesting
that FDA immediately ban TEQUIN
because of the increased risk of
dysglycemia (hypoglycemia, low blood
sugar, and hyperglycemia, high blood
sugar) in humans. Public Citizen states
that it reached its conclusion based on:
(1) The relatively high numbers and
rates of gatifloxacin-associated
dysglycemia adverse event reports
calculated from data collected by FDA’s
Adverse Event Reporting System (AERS)
and Health Canada’s Adverse Drug
Reaction Monitoring Program; (2) a
study by Park-Wyllie et al., published in
March 2006 in the New England Journal
of Medicine, that showed that patients
(diabetic and nondiabetic) receiving
gatifloxacin had approximately 17 times
the odds of having a hyperglycemic
episode and 4 times the odds of having
a hypoglycemic episode compared to
those taking macrolide antibiotics; and
(3) the relatively high numbers and rates
of gatifloxacin-associated dysglycemic
events in the manufacturer’s safety
studies in uninfected patients and other
studies in infected patients, including
clinical trials, cohort studies, case2 This citizen petition was originally assigned
docket number 2005P–0023/CP1. The number was
changed to FDA–2005–P–0369 as a result of FDA’s
transition to its new docketing system
(Regulations.gov) in January 2008.
3 This citizen petition was originally assigned
docket number 2006P–0178. The number was
changed to FDA–2006–P–0081 as a result of FDA’s
transition to its new docketing system
(Regulations.gov) in January 2008.
VerDate Aug<31>2005
17:08 Sep 08, 2008
Jkt 214001
control studies, postmarketing
surveillance studies, and case reports.
In June 2006, BMS announced that it
would no longer market TEQUIN. In
light of pending ANDAs and the citizen
petition, FDA examined whether all
TEQUIN products, including TEQUIN
(gatifloxacin) injection, 10 mg/mL (200
mg), were withdrawn from the market
for reasons of safety or effectiveness.
After considering the citizen petition
and reviewing agency records
concerning the drug product, analyses
of AERS reports, and relevant literature,
FDA has determined under § 314.161
that TEQUIN was withdrawn from sale
for reasons of safety or effectiveness.
Accordingly, the agency will remove all
TEQUIN products from the Orange Book
(§ 314.162). FDA will not accept or
approve ANDAs that refer to these drug
products.
Therefore, the agency has determined,
under § 314.161, that all dosage forms
and strengths of TEQUIN (gatifloxacin)
listed in the table of this document were
withdrawn from sale for reasons of
safety. TEQUIN (gatifloxacin) will be
removed from the list of drug products
published in the Orange Book. FDA will
not accept or approve ANDAs that refer
to any dosage form or strength of
TEQUIN (gatifloxacin).
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
who elect to declare conformity with
consensus standards to meet certain
requirements for medical devices.
DATES: Effective September 9, 2008.
Submit written or electronic comments
concerning this document at any time.
ADDRESSES: Submit written requests for
single copies of ‘‘Modifications to the
List of Recognized Standards,
Recognition List Number: 020’’ to the
Division of Small Manufacturers,
International and Consumer Assistance,
Center for Devices and Radiological
Health (CDRH) (HFZ–220), Food and
Drug Administration, 1350 Piccard Dr.,
Rockville, MD 20850. Send two selfaddressed adhesive labels to assist that
office in processing your requests, or fax
your request to 240–276–3151. Submit
written comments concerning this
document, or recommendations for
additional standards for recognition, to
the contact person (see FOR FURTHER
INFORMATION CONTACT). Submit
electronic comments to
standards@cdrh.fda.gov. This document
may also be accessed on FDA’s Internet
site at https://www.accessdata.fda.gov/
scripts/cdrh/cfdocs/cfTopic/
cdrhnew.cfm. See section VI of this
document for electronic access to the
searchable database for the current list
of FDA recognized consensus standards,
including Recognition List Number: 020
modifications and other standards
related information.
FOR FURTHER INFORMATION CONTACT:
Carol L. Herman, Center for Devices and
Radiological Health (HFZ–84), Food and
Drug Administration, 7520 Standish Pl.,
Rockville, MD 20855, 240–276–8714.
SUPPLEMENTARY INFORMATION:
Food and Drug Administration
I. Background
[Docket No. FDA–2004–N–0451] (formerly
FDA–2004–N–0226)
Section 204 of the Food and Drug
Administration Modernization Act of
1997 (FDAMA) (Public Law 105–115)
amended section 514 of the Federal
Food, Drug, and Cosmetic Act (the act)
(21 U.S.C. 360d). Amended section 514
allows FDA to recognize consensus
standards developed by international
and national organizations for use in
satisfying portions of device premarket
review submissions or other
requirements.
In a notice published in the Federal
Register of February 25, 1998 (63 FR
9561), FDA announced the availability
of a guidance entitled ‘‘Recognition and
Use of Consensus Standards.’’ The
document described how FDA would
implement its standard recognition
program and provided the initial list of
recognized standards.
Modifications to the initial list of
recognized standards, as published in
Dated: September 2, 2008.
Jeffrey Shuren,
Associate Commissioner for Policy and
Planning.
[FR Doc. E8–20938 Filed 9–8–08; 8:45 am]
BILLING CODE 4160–01–S
Food and Drug Administration
Modernization Act of 1997:
Modifications to the List of Recognized
Standards, Recognition List Number:
020
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
SUMMARY: The Food and Drug
Administration (FDA) is announcing a
publication containing modifications
the agency is making to the list of
standards FDA recognizes for use in
premarket reviews (FDA recognized
consensus standards). This publication,
entitled ‘‘Modifications to the List of
Recognized Standards, Recognition List
Number: 020’’ (Recognition List
Number: 020), will assist manufacturers
PO 00000
Frm 00098
Fmt 4703
Sfmt 4703
E:\FR\FM\09SEN1.SGM
09SEN1
Agencies
[Federal Register Volume 73, Number 175 (Tuesday, September 9, 2008)]
[Notices]
[Pages 52357-52358]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-20938]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
[Docket Nos. FDA-2006-P-0081 (formerly Docket No. 2006P-0178) and FDA-
2005-P-0369 (formerly Docket No. 2005P-0023)]
Determination That TEQUIN (Gatifloxacin) Was Withdrawn From Sale
for Reasons of Safety or Effectiveness
AGENCY: Food and Drug Administration, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Food and Drug Administration (FDA) has determined that
TEQUIN (gatifloxacin) Tablets, Injection, and Oral Suspension, were
withdrawn from sale for reasons of safety or effectiveness. This
determination means that FDA will not accept or approve abbreviated new
drug applications (ANDAs) for gatifloxacin oral tablets, injection, or
oral suspension that refer to any previously approved dosage forms and
strengths of TEQUIN (gatifloxacin).
FOR FURTHER INFORMATION CONTACT: Elena Cohen, Center for Drug
Evaluation and Research, Food and Drug Administration, 10903 New
Hampshire Ave., Bldg. 51, rm. 6228, Silver Spring, MD 20993-0002, 301-
796-3602.
SUPPLEMENTARY INFORMATION: In 1984, Congress enacted the Drug Price
Competition and Patent Term Restoration Act of 1984 (Public Law 98-417)
(the 1984 amendments), which authorized the approval of duplicate
versions of drug products under an ANDA procedure. ANDA applicants
must, with certain exceptions, show that the drug for which they are
seeking approval contains the same active ingredient in the same
strength and dosage form as the ``listed drug,'' which is a version of
the drug that was previously approved under a new drug application
(NDA). ANDA applicants do not have to repeat the extensive clinical
testing otherwise necessary to gain approval of an NDA. The only
clinical data required in an ANDA are data to show that the drug that
is the subject of the ANDA is bioequivalent to the listed drug.
The 1984 amendments include what is now section 505(j)(7) of the
Federal Food, Drug, and Cosmetic Act (the act) (21 U.S.C. 355(j)(7)),
which requires FDA to publish a list of all approved drugs. FDA
publishes this list as part of the ``Approved Drug Products With
Therapeutic Equivalence Evaluations,'' which is generally known as the
``Orange Book.'' Drugs are removed from the list if the agency
withdraws or suspends approval of the drug's NDA or ANDA for reasons of
safety or effectiveness, or if FDA determines that the listed drug was
withdrawn from sale for reasons of safety or effectiveness (section
505(j)(7)(C) of the act; Sec. 314.162 (21 CFR 314.162)).
FDA will not approve an ANDA if the listed drug has been withdrawn
from sale for safety or effectiveness reasons (section 505(j)(4)(I) of
the act). Under Sec. 314.161(a)(1) (21 CFR 314.161(a)(1)), the agency
must determine whether a listed drug was withdrawn from sale for
reasons of safety or effectiveness before an ANDA that refers to that
listed drug may be approved. A drug that has been withdrawn from the
market for safety or effectiveness reasons is not a listed drug (21 CFR
314.3(b)). FDA may not approve an ANDA that does not refer to a listed
drug. FDA currently has pending one or more ANDAs that refer to TEQUIN
(gatifloxacin).
Bristol-Myers Squibb Co. (BMS) is the holder of three NDAs\1\ for
TEQUIN tablets, injection, and oral suspension as listed in the
following table:
---------------------------------------------------------------------------
\1\ On December 17, 1999, FDA approved NDAs 21-061 and 21-062
for community-acquired pneumonia, acute bacterial exacerbation of
chronic bronchitis, acute bacterial sinusitis, uncomplicated urinary
tract infections, complicated urinary tract infections,
pyelonephritis, and uncomplicated gonorrhea. The December 17, 1999,
approval letter also stated that indications for uncomplicated skin
and skin structure infections were approvable pending the submission
of certain postmarketing data. For administrative purposes, the
agency assigned administrative NDAs 21-404 (TEQUIN Tablets) and 21-
405 (TEQUIN Injections) for the treatment of uncomplicated skin and
skin structure infections. BMS provided a complete response, and
upon approval on October 17, 2002, NDAs 21-404 and 21-405 were
retired by FDA. The approvals and all other submissions for the
treatment of uncomplicated skin and skin structure infections were
incorporated in the original NDAs, 21-061 and 21-062. NDAs 21-404
and 21-405 are not listed in the Orange Book, but can be found
through a search at Drugs@FDA.
Table 1.--Approved TEQUIN Products
------------------------------------------------------------------------
Active Dosage Form/
NDA No. Ingredients Strength Route
------------------------------------------------------------------------
21-061 Gatifloxacin 200 milligrams (mg) Tablet; oral
------------------------------------------------------------------------
21-061 Gatifloxacin 400 mg Tablet; oral
------------------------------------------------------------------------
21-062 Gatifloxacin Equivalent to 10 mg/ Injectable;
milliliter (mL) (200 injection
mg)
------------------------------------------------------------------------
21-062 Gatifloxacin 400 mg/40 mL (10 mg/ Injectable;
mL) injection
------------------------------------------------------------------------
21-062 Gatifloxacin in 200 mg/100 mL (2 mg/ Injectable;
dextrose 5% in mL) injection
plastic
container
------------------------------------------------------------------------
21-062 Gatifloxacin in 400 mg/200mL (2 mg/ Injectable;
dextrose 5% in mL) injection
plastic
container
------------------------------------------------------------------------
21-678 Gatifloxacin 200 mg/5 mL Suspension; oral
------------------------------------------------------------------------
TEQUIN is an antibacterial drug indicated for the treatment of
infections due to susceptible strains of designated microorganisms in
the following conditions: Acute bacterial exacerbation of chronic
bronchitis; acute sinusitis;
[[Page 52358]]
community-acquired pneumonia; uncomplicated skin and skin structure
infections; uncomplicated and complicated urinary tract infections;
pyelonephritis; uncomplicated urethral and cervical gonorrhea; and
acute, uncomplicated rectal infections in women.
In January 2003, FDA received revised product labeling relating to
several approved supplements for TEQUIN (gatifloxacin). This revised
labeling deleted references to TEQUIN injection, 10 milligrams/
milliliter (mg/mL) (200 mg), indicating that this product was no longer
being marketed; therefore, the product was moved from the prescription
drug product list to the ``Discontinued Drug Product List'' section of
the Orange Book. In response to a citizen petition from Apotex Corp.
(Docket No. FDA-2005-P-0369),\2\ FDA stated, in the Federal Register of
February 3, 2006 (71 FR 5858), that TEQUIN injection, 10 mg/mL (200
mg), was not withdrawn for reasons of safety and effectiveness.
---------------------------------------------------------------------------
\2\ This citizen petition was originally assigned docket number
2005P-0023/CP1. The number was changed to FDA-2005-P-0369 as a
result of FDA's transition to its new docketing system
(Regulations.gov) in January 2008.
---------------------------------------------------------------------------
On May 1, 2006, Public Citizen Research Group submitted a citizen
petition (Docket No. FDA-2006-P-0081),\3\ under 21 CFR 10.30,
requesting that FDA immediately ban TEQUIN because of the increased
risk of dysglycemia (hypoglycemia, low blood sugar, and hyperglycemia,
high blood sugar) in humans. Public Citizen states that it reached its
conclusion based on: (1) The relatively high numbers and rates of
gatifloxacin-associated dysglycemia adverse event reports calculated
from data collected by FDA's Adverse Event Reporting System (AERS) and
Health Canada's Adverse Drug Reaction Monitoring Program; (2) a study
by Park-Wyllie et al., published in March 2006 in the New England
Journal of Medicine, that showed that patients (diabetic and
nondiabetic) receiving gatifloxacin had approximately 17 times the odds
of having a hyperglycemic episode and 4 times the odds of having a
hypoglycemic episode compared to those taking macrolide antibiotics;
and (3) the relatively high numbers and rates of gatifloxacin-
associated dysglycemic events in the manufacturer's safety studies in
uninfected patients and other studies in infected patients, including
clinical trials, cohort studies, case-control studies, postmarketing
surveillance studies, and case reports.
---------------------------------------------------------------------------
\3\ This citizen petition was originally assigned docket number
2006P-0178. The number was changed to FDA-2006-P-0081 as a result of
FDA's transition to its new docketing system (Regulations.gov) in
January 2008.
---------------------------------------------------------------------------
In June 2006, BMS announced that it would no longer market TEQUIN.
In light of pending ANDAs and the citizen petition, FDA examined
whether all TEQUIN products, including TEQUIN (gatifloxacin) injection,
10 mg/mL (200 mg), were withdrawn from the market for reasons of safety
or effectiveness. After considering the citizen petition and reviewing
agency records concerning the drug product, analyses of AERS reports,
and relevant literature, FDA has determined under Sec. 314.161 that
TEQUIN was withdrawn from sale for reasons of safety or effectiveness.
Accordingly, the agency will remove all TEQUIN products from the Orange
Book (Sec. 314.162). FDA will not accept or approve ANDAs that refer
to these drug products.
Therefore, the agency has determined, under Sec. 314.161, that all
dosage forms and strengths of TEQUIN (gatifloxacin) listed in the table
of this document were withdrawn from sale for reasons of safety. TEQUIN
(gatifloxacin) will be removed from the list of drug products published
in the Orange Book. FDA will not accept or approve ANDAs that refer to
any dosage form or strength of TEQUIN (gatifloxacin).
Dated: September 2, 2008.
Jeffrey Shuren,
Associate Commissioner for Policy and Planning.
[FR Doc. E8-20938 Filed 9-8-08; 8:45 am]
BILLING CODE 4160-01-S