[Survey on Patient Satisfaction with the Usability and Formulation of Budesonide Rectal Foam Following a Change in Head and Applicator Shape and Properties].

Budesonide Rectal Foam (BF) was introduced in 2017 and changed in November 2022 upon request, addressing the challenges encountered with liquid rectal formulations indicated for ulcerative colitis (UC). This formulation is an important agent in the treatment of rectal to sigmoid colon lesions in moderate UC. As the characteristics of the formulation of the rectal formulation are thought to influence patient satisfaction, a survey was conducted on the formulation and patient satisfaction among patients who used BF before and after the change. The survey spanned from January 2023 to May 2023. As the primary endpoint, the same patients were evaluated on the Visual Analogue Scale (VAS) for patient satisfaction. Significant variations in formulation usability and patient satisfaction were observed in 20 eligible patients before and after the change (p<0.05). Patient satisfaction with the formulation was strongly correlated with formulation usability, ease of pushing the head, and ease of insertion (r>0.7). The change in packaging was thought to improve the usability of the formulation and patient satisfaction. The formulation's usability and ease of insertion had a clear influence on satisfaction with the rectal formulation.

Ebeam Technology - Transfer Technology for Pre-Sterilized RTU Components.

With increased demand on sealed packed, pre-sterilized ready-to-use (RTU) components like Syringes & Vials, the ebeam technology is used as transfer technology with surface decontamination for transfer of the RTU in a GRADE A environment like an Isolator.

Prefilled Ophthalmic syringes - New Possibilities in Terminal Sterilization.

In a joint study carried out by Gerresheimer, Sterigenics and Früh, it could be shown that also NO2 is well suited to terminally sterilize prefilled ophthalmic syringes. In detail 5 topics were addressed: (1) Compare EtO vs. NO2 penetration into the filled syringe; (2) Analyze gas ingress though 4 different plunger stoppers including silicone oil free and standard rubber plungers; (3) Scrutinize gas ingress through 2 different cap designs based on different elastomer properties; (4) Investigate gas permeation through COP plastic barrels compared to glass; (5) Check if the Tyvek®-layer has an influence on either sterilization.Depending on the needs a suitable sterilization method, packaging and syringe type can be suggested to customers.

Case Study: Compatibility Testing of Pre-Filled Syringe Stopper Technology with Vaporized Hydrogen Peroxide Terminal Sterilization Process.

STERIS and W.L. GORE collaborated on a case study testing the compatibility of a new prefilled syringe plunger design with VHP terminal sterilization. VHP chamber conditions require deep vacuum pulsing, which may represent challenges to prefilled syringe container integrity. The growing industry trend toward VHP sterilization is driven by the FDA search for alternative sterilization methods to EO and the recent publication of a VHP specific process standard. The purpose of the study is to test and report compatibility of the new 0.5 mL GORE IMPROJECT plunger, a silicone free syringe solution for ophthalmic application, with VHP sterilization. Various challenges have been reported when using conventional, siliconized, prefilled syringe systems for intravitreal injections such as subvisible particles, inflammation, silicone floaters, and intraocular pressure increases. The GORE plunger eliminates the need for silicone oil as a lubricant on the plunger and barrel, while meeting strict container closure and terminal sterilization requirements of ophthalmic applications. This case study presents successful results of deep vacuum VHP terminal sterilization process compatibility with the GORE plunger design and material composition. Test results include primary container integrity, stopper off-gassing/ingress, and visual inspection. Principles of VHP vacuum sterilization process, test cycle configuration, and its main parameters are presented.

Basics of Compounding: Tips and Hints, Part 4: Lollipops/Lozenges, Gummy Bears, Patches, Flavoring/Coloring, Sweeteners, and Packaging.

This article represents the fourth in a series of articles on tips and hints of compounding. In this issue, we will discuss some tips and hints for the compounding of lollipops/lozenges, gummy bears, patches, flavoring/coloring, sweeteners, and packaging.

Sterile Basics of Compounding: Repackaging, Part 1.

This article on the topic of sterile and nonsterile repackaging is based on the content of United States Pharmacopeia 35-National Formulary 30 and how the respective official chapters of the publication relate to pharmacy compounding and practice. The article differentiates between commercial repackagers and pharmacists that repackage in their pharmacy for their patients. It also discusses the standards for packaging and the beyond-use dates that should be assigned.

Real-time visual intelligence for defect detection in pharmaceutical packaging.

Defect detection in pharmaceutical blister packages is the most challenging task to get an accurate result in detecting defects that arise in tablets while manufacturing. Conventional defect detection methods include human intervention to check the quality of tablets within the blister packages, which is inefficient, time-consuming, and increases labor costs. To mitigate this issue, the YOLO family is primarily used in many industries for real-time defect detection in continuous production. To enhance the feature extraction capability and reduce the computational overhead in a real-time environment, the CBS-YOLOv8 is proposed by enhancing the YOLOv8 model. In the proposed CBS-YOLOv8, coordinate attention is introduced to improve the feature extraction capability by capturing the spatial and cross-channel information and also maintaining the long-range dependencies. The BiFPN (weighted bi-directional feature pyramid network) is also introduced in YOLOv8 to enhance the feature fusion at each convolution layer to avoid more precise information loss. The model's efficiency is enhanced through the implementation of SimSPPF (simple spatial pyramid pooling fast), which reduces computational demands and model complexity, resulting in improved speed. A custom dataset containing defective tablet images is used to train the proposed model. The performance of the CBS-YOLOv8 model is then evaluated by comparing it with various other models. Experimental results on the custom dataset reveal that the CBS-YOLOv8 model achieves a mAP of 97.4% and an inference speed of 79.25 FPS, outperforming other models. The proposed model is also evaluated on SESOVERA-ST saline bottle fill level monitoring dataset achieved the mAP50 of 99.3%. This demonstrates that CBS-YOLOv8 provides an optimized inspection process, enabling prompt detection and correction of defects, thus bolstering quality assurance practices in manufacturing settings.

In-use stability of Rituximab and IVIG during intravenous infusion: Impact of peristaltic pump, IV bags, flow rate, and plastic syringes.

This study investigates the impact of intravenous (IV) infusion protocols on the stability of Intravenous Immunoglobulin G (IVIG) and Rituximab, with a particular focus on subvisible particle generation. Infusion set based on peristaltic movement (Medifusion DI-2000 pump) was compared to a gravity-based infusion system (Accu-Drip) at different flow rates. The impacts of different diluents (0.9 % saline and 5.0 % dextrose) and plastic syringes with or without silicone oil (SO) were also investigated. The results from the aforementioned particular case demonstrated that peristaltic pumps generated high levels of subvisible particles (prominently < 25 µm), exacerbated by increasing flow rates, specifically in formulations lacking surfactants. Other factors, such as diluent type and syringe composition, also increased the number of subvisible particles. Strategies that can help overcome these complications include surfactant addition as well as the use of SO-free syringes and a gravity infusion system, which aid in reducing particle formation and preserving antibody monomer during administration. Altogether, these findings highlight the importance of the careful selection of formulations and infusion protocols to minimize particle generation during IV infusion both for patients' safety and treatment efficacy.

Leftover of Amoxicillin Suspension After Use by Children in the Netherlands.

PURPOSE: In clinical practice, a discrepancy may exist between the prescribed amount of a drug and the commercially available pack sizes in the pharmacy, potentially contributing to drug waste. This study aimed-as an example of this phenomena-to quantify leftover of amoxicillin suspension prescribed to children, due to discrepancies between physician-prescribed and pharmacy-dispensed amounts. METHODS: We performed a retrospective cohort study including amoxicillin suspension dispensations for patients aged 0-12 years between 2017 and 2019 utilizing the Dutch PHARMO database. Leftover amount of amoxicillin was estimated by assessing the discrepancy between the prescribed and dispensed amounts. Extrapolated amoxicillin weight and economic spillage estimates for the Netherlands were determined. The impact of two theoretical interventions on leftover amount was assessed: (1) introducing vials with half the volume of the current 100 and 30 mL vials and (2) a combination of the first intervention with a maximum of 10% round-down by the dispensing pharmacy of the prescribed dose. RESULTS: We included 79 512 amoxicillin suspension dispensations for 62 252 patients. The mean leftover amount of amoxicillin suspension per dispensing was 27%. The yearly amount of amoxicillin leftover was 49.8 kg in the study cohort, equivalent to yearly 633 kg and €621 000 when extrapolated to the Netherlands. Employing the first theoretical intervention reduced the mean leftover per dispensing to 20%, reducing the yearly leftover to 31.6 kg amoxicillin in the study cohort, and to 400 kg and €400 000 extrapolated. The second theoretical intervention further reduced leftover to 17%, reducing the yearly leftover to 24.3 kg amoxicillin in the study cohort, and to 300 kg and €300 000 extrapolated. CONCLUSION: Approximately a quarter of amoxicillin suspension remains as leftover per dispensing. Applying different theoretical intervention shows the potential for a significant reduction of amoxicillin leftover.

Directional freezing and thawing of biologics in drug substance bottles.

Biological drug substance (DS) is typically stored frozen to increase stability. However, freezing and thawing (F/T) of DS can impact product quality and therefore F/T processes need to be controlled. Because active F/T systems for DS bottles are lacking, freezing is often performed uncontrolled in conventional freezers, and thawing at ambient temperature or using water baths. In this study, we evaluated a novel device for F/T of DS in bottles, which can be operated in conventional freezers, generating a directed air stream around bottles. We characterized the F/T geometry and process performance in comparison to passive F/T using temperature mapping and analysis of concentration gradients. The device was able to better control the F/T process by inducing directional bottom-up F/T. As a result, it reduced cryo-concentration during freezing as well as ice mound formation. However, freezing with the device was dependent on freezer performance, i.e. prolonged process times in a highly loaded freezer were accompanied by increased cryo-concentrations. Thawing was faster compared to without the device, but had no impact on concentration gradients and was slower compared to thawing in a water bath. High-performance freezers might be required to fully exploit the potential of directional freezing with this device and allow F/T process harmonization and scaling across sites.

Pharmaceutical residues in plastic tablet containers: Impacts on recycling and the environment.

High-density polyethylene tablet containers are potentially very suitable for recycling, but no data are publicly available on active pharmaceutical ingredients' (API) residues in empty containers and if they affect the recyclability of pharmaceutical packaging. Plastic tablet containers represented 15 % of pharmaceutical primary packages sold in Finland in 2020 and 2021, equalling 350 tons of plastic per year. We studied the residues of six APIs remaining or adsorbed inside plastic tablet containers. The effects of tablet coating and usage in dose-dispensing services versus households on the API residues, and rinsing water's ability to remove the residues were evaluated. Up to 940,000 µg/kg of carbamazepine was detected in a container of uncoated carbamazepine tablets. The residues from coated tablets containing the other five APIs were 2.4-6,100 µg/kg. Ten times higher paracetamol residues were obtained in containers from household use than from a dose-dispensing unit. Rinsing can remove most API residues, but it leads to environmental emissions. For example, rinsing water can double carbamazepine emissions from a Finnish wastewater treatment plant where plastic packaging waste effluents are processed. Considering the API concentrations, decreasing residues by rinsing and dilution with other plastic packaging waste, the residues of the studied APIs are not considered an obstacle to the recycling of plastic tablet containers. However, further research is needed on more toxic APIs and the fate of APIs in the plastics recycling process.

Investigating a Novel Two-Bag N-Acetylcysteine Regimen for Acetaminophen Toxicity.

BACKGROUND: Acetaminophen toxicity remains one of the most common causes of liver failure and is treated with a course of n-acetylcysteine (NAC). This exceptionally effective medication is traditionally administered using a complicated three-bag protocol that is prone to administration errors. OBJECTIVE: We aimed to assess whether switching to a novel two-bag protocol (150 mg/kg over 1 h followed by 150 mg/kg over 20 h) reduced administration errors while not increasing liver injury or anaphylactoid reactions. METHODS: This was a retrospective chart review of hospital encounters for patients with acetaminophen toxicity, comparing outcomes before and after the change from a three-bag protocol to a two-bag protocol at two affiliated institutions. The primary outcome was incidence of medication errors with secondary outcomes including acute liver injury (ALI) and incidence of non-anaphylactoid allergic reactions (NAAR). The study was approved by the health system's Institutional Review Board. RESULTS: 483 encounters were included for analysis (239 in the three-bag and 244 in the two-bag groups). NAAR were identified in 11 patients with no difference seen between groups. Similarly, no differences were seen in ALI. Medication administration errors were observed significantly less often in the two-bag group (OR 0.24) after adjusting for confounders. CONCLUSION: Transitioning to a novel two-bag NAC regimen decreased administration errors. This adds to the literature that two-bag NAC regimens are not only safe but also may have significant benefits over the traditional NAC protocol.

Modeling moisture change of packaged dry tablet dosage forms under consumer use condition.

A simple mathematical model based on product's moisture sorption isotherm and package's moisture transmission was developed to predict moisture content of dry solid tablets during consumers' use, which is useful for determination of in-use shelf life (ISL) or secondary shelf life. The moisture increase depending on amount of product remaining in the package was accounted for in the mass balance equation on the package. The model was first verified by literature data of desiccant canisters in a plastic bottle of high density polyethylene exposed to two environmental conditions (25 °C and 60% relative humidity (RH); 40 °C and 75% RH) simulating in-use of removing one canister each day. Then an experimental work was conducted on dry refresher candies in a polyethylene terephthalate bottle at 25 °C with two tablets taken out every day, which confirmed the model's capability to predict the product moisture content during in-use storage of 76% and 90% RH. Its use can provide science-based accurate determination of ISL, which may work as consumer guideline. The model is also expected to be helpful for recommending management scheme of whole product life.

Non-Destructive Analysis of Subvisible Particles with Mie-Scattering-Based Light Sheet Technology: System Development.

The characteristics of subvisible particles (SbVPs) are critical quality attributes of injectable and ophthalmic solutions in pharmaceutical manufacturing. However, current compendial SbVP testing methods, namely the light obstruction method and the microscopic particle count method, are destructive and wasteful of target samples. In this study, we present the development of a non-destructive SbVP analyzer aiming to analyze SbVPs directly in drug product (DP) containers while keeping the samples intact. Custom sample housings are developed and incorporated into the analyzer to reduce optical aberrations introduced by the curvature of typical pharmaceutical DP sample containers. The analyzer integrates a light-sheet microscope structure and models the side scattering event from a particle with Mie scattering theory with refractive indices as prior information. Equivalent spherical particle size under assigned refractive index values is estimated, and the particle concentration is determined based on the number of scattering events and the volume sampled by the light sheet. The resulting analyzer's capability and performance to non-destructively analyze SbVPs in DP containers were evaluated using a series of polystyrene bead suspensions in ISO 2R and 6R vials. Our results and analysis show the particle analyzer is capable of directly detecting SbVPs from intact DP containers, sorting SbVPs into commonly used size bins (e.g. ≥ 2 µm, ≥ 5 µm, ≥ 10 µm, and ≥ 25 µm), and reliably quantifying SbVPs in the concentration range of 4.6e2 to 5.0e5 particle/mL with a margin of ± 15 % error based on a 90 % confidence interval.

Development of an ELISA-based device to quantify antibody adsorption directly on medical plastic surfaces.

Monoclonal antibodies (mAbs) encounter numerous interfaces during manufacturing, storage, and administration. While protein adsorption at the solid/liquid interface has been widely explored on model surfaces, a key challenge remains - the detection of very small amounts of adsorbed mAb directly on real medical surfaces. This study introduces a novel ELISA-based device, ELIBAG, a new tool for measuring mAb adsorption on medical bags. The efficacy of this device was highlighted by successfully confirming the adsorption of an IgG1 on two medical bag types: a polypropylene IV administration bag and a low-density polyethylene pharmaceutical manufacturing bag. We also investigated IgG1 adsorption on plastic model surfaces, revealing a similar range of mAb bulk concentration for surface saturation on both model and bag surfaces. This innovative device, characterized by its high-throughput and rapid approach, paves the way for extensive investigations into therapeutic proteins, such as mAbs, adsorption on a variety of medical or pharmaceutical surfaces, diverse adsorption conditions, and the influence of excipients employed in mAb formulation, which could enhance the knowledge of mAb interactions with plastic surfaces throughout their lifecycle.

The silicone depletion in combination products induced by biologics.

Silicone oil (SO) migration into the drug product of combination products for biopharmaceuticals during storage is a common challenge. As the inner barrel surface is depleted of SO the extrusion forces can increase compromising the container functionality. In this context we investigated the impact of different formulations on the increase in gliding forces in a spray-on siliconized pre-filled syringe upon storage at 2-8 °C, 25 °C and 40 °C for up to 6 months. We tested the formulation factors such as surfactant type, pH, and ionic strength in the presence of one monoclonal antibody (mAb) as well as compared three mAbs in one formulation. After 1 month at 40 °C, the extrusion forces were significantly increased due to SO detachment dependent on the fill medium. The storage at 40 °C enhanced the SO migration process but it could also be observed at lower storage temperatures. Regarding the formulation factors the tendency for SO migration was predominantly dependent on the presence and type of surfactant. Interestingly, when varying the mAb molecules, one of the proteins showed a rather stabilizing effect on the SO layer resulting into higher container stability. In contrast to the formulation factors, those different stability outcomes could not be explained by interfacial tension (IFT) measurements at the SO interface. Further characterization of the mAb molecules regarding interfacial rheology and conformational stability were not adequately able to explain the observed difference. Solely a hydrophobicity ranking of the molecules correlated to the stability outcome. Further investigations are needed to clarify the role of the protein in the SO detachment process and to understand the cause for the stabilization. However, the study clearly demonstrated that the protein itself plays a critical role in the SO detachment process and underlined the importance to include verum for container stability.

[Greenhouse gas equivalents and water consumption of product sample packaging in dermatology]. / Treibhausgasäquivalente und Nutzwasserverbrauch durch dermatologische Produktprobenverpackungen.

BACKGROUND: Sampling refers to the free supply of small product samples. In this process, the packaging can be disproportionate to the contents leading to raw material consumption and, in the case of poor recyclability, environmental pollution. OBJECTIVE: In this article, calculations regarding the ratio between packaging and product weight for commonly used types of packaging (sachet, tube, jar) of dermatological product samples are presented. The usefulness of sampling is discussed considering environmental and economic criteria. MATERIAL AND METHODS: A total of 43 dermatological product samples from different manufacturers were manually weighed and classified. Packaging was disassembled into its structural components. The proportional weights or the weight of the bottle/tube body were calculated with database values for the respective material in terms of greenhouse gas equivalents (CO2eq) and freshwater consumption. Subsequently, a total sum for the impact of each packaging was formed. Only the material and manufacturing process were considered because there were no valid data available for transport, utilization, and end of life (EoL) impacts. RESULTS: The smallest and lightest product sample (1.24 g) generated ca. 15 g CO2eq and approximately 700 ml of freshwater consumption. The largest and heaviest product sample (37 g) generated 53 g CO2eq and 5.78 l of freshwater consumption. Assuming an annual distribution of 10 million units of the 43 product samples examined here, ca. 8000 t of CO2eq are produced by the packaging alone. Additionally, 880,000,000 l of water are used and approximately 2300 t of packaging waste are generated. DISCUSSION: Sampling shows an unfavorable ratio between CO2eq/water consumption and utility, especially in comparison to larger units of packaging. Millions of product samples are distributed annually in doctor's practices, hospitals and pharmacies, particularly in dermatology. The practice of sampling should be questioned both ecologically and economically.

A Case Study Demonstrating the Importance of Glass Vial Selection for Parenteral Pharmaceutical Products.

There are many factors to consider when selecting a container closure system for parenteral drug products to maintain their quality, efficacy, and safety. One aspect to consider for products stored in glass vials is the glass type. Although the glass vials in which most parenteral products are stored are classified as Type I by the United States Pharmacopoeia, Chapter <660>, not all glass vials that meet the glass performance characteristics of Type I are equivalent. In the study presented here, Type I glass vials from three suppliers of three different Type I glass vials (standard, delamination control, and coated) were investigated to evaluate the impact that each Type I glass vial had on the stability of a drug product under development. To evaluate this impact, a three-phase study was conducted in which the compatibility between the drug product and each vial was assessed through the measurement of the critical quality attributes of the product, extractable and leachable inorganic elements were analyzed for each vial, and finally a stability study under accelerated conditions was conducted for the drug product in the most compatible vial based on the aforementioned experiments. Results from this study demonstrated that there are, in fact, significant differences in glass vials regardless of their classification as Type I. In the study conducted here, delamination control Type I glass vials were found to be superior to both Standard Type I and coated Type I vials for the drug product under investigation.

Characterizing Extractables and Leachables Chemical Space to Support In Silico Toxicological Hazard Assessments.

This article describes the development of a representative dataset of extractables and leachables (E&L) from the combined Extractables and Leachables Safety Information Exchange (ELSIE) Consortium and the Product Quality Research Institute (PQRI) published datasets, representing a total of 783 chemicals. A chemical structure-based clustering of the combined dataset identified 142 distinct chemical classes with two or more chemicals across the combined dataset. The majority of these classes (105 chemical classes out of 142) contained chemicals from both datasets, whereas 8 classes contained only chemicals from the ELSIE dataset and 29 classes contain only chemicals from the PQRI dataset. This evaluation also identified classes containing chemicals that were flagged as potentially mutagenic as well as potent (strong or extreme) dermal sensitizers by in silico tools. The prevalence of alerting structures in the E&L datasets was approximately 9% (69 examples) for mutagens and 3% (25 examples) for potent sensitizers. This analysis showed that most (80%; 20 of 25) E&L predicted to be strong or extreme dermal sensitizers were also flagged as potential mutagens. Only two chemical classes, each containing three chemicals (alkyl bromides and isothiocyanates), were uniquely identified in the PQRI dataset and contained chemicals predicted to be potential mutagens and/or potent dermal sensitizers.

Development of an organic polymer monolith column for the nano liquid chromatography fast analysis of monoclonal antibody in infusion bags prepared in a hospital pharmacy.

Poly(butyl methacrylate-co-ethylene dimethacrylate) monolith was in situ prepared in a liquid chromatography capillary column with a 75 µm internal diameter. This monolith offered high permeability (5.3 ± 10-14 m2) and good peak capacity (140 for a 15 cm column length at 300 nl/min with a 20 min gradient time). This is exemplified by its separation ability in reversed mode for subunit analysis of monoclonal antibodies after IdeS digestion (middle-up analysis). The potential of this column was also illustrated for the fast analytical control of therapeutic monoclonal antibodies in standardized infusion bags prepared in advance in a pharmacy department. Linearity analysis revealed the column's capability for accurate quantification analysis of the different dose bandings (in mg) of monoclonal antibodies in <2 min. In addition, lifetime analysis data indicated that the column can be highly reproducible and has a long lifetime with stable and low back pressure. The variations observed on the peak shape and area between unstressed (intact) and stressed monoclonal antibodies indicated that our nano liquid chromatographic method was stability indicating. In addition, using a gradient elution mode, the presence of minor components in the infusion bags was visualized.