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US FDA Inspections Resume in India

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India pharma

Sector outlook

Alok Dalal US FDA inspections resume in India


[email protected] History suggests most plants receive observations, but very few escalate
+91 22 6650 5063
Recent US FDA inspections for Lupin and Aurobindo may well result in resumption
of inspections in India, which have been on pause since the outbreak of the
pandemic last year. Products requiring pre-approval inspections, plants with
compliance issues and those supplying high-volume products to the US could be
of priority to the agency, in our view. Many leading Indian companies affected by
US FDA scrutiny over 2018-19 have completed remedial action and await re-
inspections. Stock-price movements for companies that receive inspection
observations tend to be volatile, with the initial reaction being negative. However,
21 September 2021 historical data suggests that very few observations escalate into adverse
outcomes, like a warning letter or import alert.
India Lupin and Aurobindo plants saw US FDA inspection recently
Healthcare  Over the last two months, the US FDA has inspected manufacturing plants of Lupin
(Goa) and Aurobindo (Unit 1). These plants were under a warning letter and an OAI
(Official Action Indicated, a quasi-warning letter) status for some time.
Key Indian plants awaiting US  The inspection for Aurobindo was conducted by the local team of US FDA in India,
FDA inspection:
whereas the inspection details for Lupin are awaited.
 In Aug-21, the US FDA had said that they had no plans to resume onsite foreign
Company Plant
inspections for operations that are not deemed “mission critical” during the Covid-19
Aurobindo Unit XI
public health emergency. Instead, it was relying on the expanded use of mutual
Biocon Bengaluru
recognition agreements as an alternative tool to boost on-the-ground inspections
Cadila Maraiya
Cipla Goa
along with desktop audits wherever possible.
Glenmark Baddi What will be the US FDA’s approach to inspections in India?
Ipca Ratlam  Our interaction with industry participants suggests the US FDA may prioritise pre-
Lupin Indore Unit II approval inspections (PAIs) for products with unmet medical needs in the US followed
Sun Pharma Halol by manufacturing plants with existing compliance issues, like a warning letter/import
Torrent Pharma Indrad, Dahej
alert or an OAI status.
 Manufacturing plants that are compliant with US FDA guidelines but supplying high
volumes to the US could be inspected next.
 Manufacturing plants supplying products to the US having no disruptions at the
moment may not be a priority for the US FDA initially.
Companies affected by US FDA scrutiny in 2019-19 await re-inspections
 A lot of Indian plants were affected by US FDA scrutiny in 2018-19. Examples of such
plants under our coverage are Aurobindo (3 plants including Unit 1), Cadila (Moraiya),
Cipla (Goa), Glenmark (Baddi), Lupin (4 plants including Goa), Sun Pharma (Halol), and
Torrent Pharma (2 plants). These plants have completed remedial work and are
awaiting inspections which has been delayed due to the pandemic
 We believe Lupin’s Indore Unit-2, Cadila’s Moraiya, Cipla’s Goa, Sun Pharma’s Halol
and Torrent Pharma’s Indrad/Dahej plants are important to drive US growth in
FY23/24 and timely inspection/clearance is important.
 Biocon’s plant in Bengaluru, from which it has filed biosimilar Bevacizumab (Avastin), is
also awaiting inspection. Timely approval and launch is important for Biocon before
competition catches up in the product.
Historical data suggests most plants receive observations, but very few escalate
 Stock-price movements for companies that receive inspection observations (listed in
Form 483 by the US FDA) tend to be volatile, with the initial reaction being negative.
 Historical data suggests ~80-85% of inspections globally result in observations, but
only 10-12% of those result in escalations, like OAI, warning letter or import alerts.
 While it is difficult to predict inspection outcomes, we are encouraged by the nature of
observations received by Indian companies over the last few years. These do not
involve data integrity issues, but are directed more towards manpower training,
production process and lab control practices which can be corrected over time.

www.clsa.com
CLSA and CL Securities Taiwan Co., Ltd. (“CLST”) do and seek to do business with companies covered in its research reports. As such,
investors should be aware that there may be conflicts of interest which could affect the objectivity of the report. Investors should consider
this report as only a single factor in making their investment decisions. For important disclosures please refer to page 5.
Prepared for: [email protected]
US FDA inspections resume in India India pharma

We would like to thank Evalueserve for its help in preparing our research reports. Akshay Chandak (Strategy and Oil & Gas), Ayush Gandhi (Strateg y), Dhaval
Parekh (Materials), Keshub Bhat (IT) and Zen Javeri (Power, Infra and Capital Goods) provide research support services t o CLSA.

Figure 1

Recent US FDA inspections of Indian plants


Date Company, Plant No of observations Status
US FDA inspections in India 19-Sep 2021 Lupin, Goa 7 Warning letter
have resumed 12-Aug 2021 Aurobindo, Unit 1 6 OAI
12-Mar 2021 Jubilant Generics 7 OAI
8-Feb 2021 Alembic Pharma, Karkhadi 5 New facility
Source: Companies, US FDA, CLSA, OAI is Official Action Indicated

Figure 2

Products requiring pre- What will be the US FDA’s approach to inspections in India?
approval inspections, plants
with compliance issues and
those supplying high- Pre-approval inspections for Plants with an import
volume products to the US products with unmet medical need alert/warning letter/OAI status
could be of priority to the
agency, in our view

US FDA's approach
to inspections

Products with adequate supplies to


Plants supplying high-volume
the US may not be a priority at this
products to the US
point

Source: CLSA

Figure 3

Clearance of plants is Key Indian plants awaiting US FDA re-inspections


critical for our coverage Company Plant Capability Last inspected Status
companies as Cadila Aurobindo Unit IX API Feb-19 OAI status
(Moraiya), Cipla (Goa), Unit XI API Feb-19 Warning letter
Glenmark (Baddi), Ipca
Biocon PAI for biosimilar
(three plants), Lupin Bengaluru Biologic products -
Bevacizumab
(four plants), Sun Pharma
Cadila Moraiya Formulations May-19 Warning letter
(Halol), Biocon (approval for
biosimilar Avastin) and Glenmark Baddi Formulations Apr-19 Warning letter
Torrent (two plants) are Ipca Ratlam API Jul-14 Import alert
seeing a drag Indore Formulations Oct-14 Import alert
Somerset, NJ Formulations Nov-20 OAI status
Lupin Mandideep (Unit 1) Formulations Dec-18 Warning letter
Pithampur (Unit 2) Formulations Jan-19 Warning letter
Sun Pharma Halol Formulations Dec-19 OAI status
Indrad Formulations & API Apr-19 Warning letter
Torrent
Dahej Formulations & API Mar-19 OAI status
Source: Companies, US FDA

Find CLSA research on Bloomberg, Thomson Reuters, FactSet and CapitalIQ - and profit from our evalu@tor proprietary database at clsa.com

21 September 2021 [email protected] 2


Prepared for: [email protected]
US FDA inspections resume in India India pharma

Figure 4

Issuance of warning letters Trend in warning letters by country


increased in 2019 before 100
the Covid pandemic (#) India China USA Others Total
resulted in inspection 90
stoppages 80
70
60
50
40
30
20
10
0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Source: US FDA, CLSA

Figure 5

Import alerts have been on Trend in import alert by country


a declining trend since 2017 60 (#) India China Total

50

40

30

20

10

0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Source: US FDA, CLSA

Figure 6

While 80-85% of plants Trend in plant classification by the US FDA


receive US FDA 140 (#) NAI OAI VAI
observations (Form 483),
only 10-12% escalate into 120
OAIs/warning letters
100

80

60

40

20

0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Source: US FDA, CLSA, NAI is No Action Indicated, OAI is Official Action Indicated and VAI is Voluntary Action
Indicated

21 September 2021 [email protected] 3


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US FDA inspections resume in India India pharma

Figure 7

Observations for Indian Trend in nature of observations for Indian companies


companies over the last few
% of observations Till 2010 2010 onwards
years have not pointed to
data integrity issues which 43
45
is an encouraging sign 40
40 More procedural in 36
35 nature
30
30
25
20 18
14 15
15
10
5 3

0
Building, equipment Organization and Production, process Records and reports
and packaging personnel and lab controls
Source: US FDA, CLSA

Figure 8

US FDA approach to a plant inspection

US FDA inspects facilities for pre-approval, compliance with cGMP or product specific compliance

Inspectional
Causes for observations Observations

Lack of Difference in Intentional Form 483


knowledge interpretation manipulation issued

US FDA follows an Response needs to be submitted


US FDA provides Level of scrutiny
open approach within 15 working days
time for gaining may become more
through granular; may result In the past, the US FDA
proper knowledge of
communication, in an immediate used to respond within
compliance and to Based on the
frequent follow up import alert if there 3-6 months to
adequately adhere responses given
to allow companies are severe data remedial action taken
with the compliance by firms
to develop better integrity or patient by companies but
requirements
compliance safety issues, it recently the timelines
mechanism could also lead to have got extended to
criminal 12-14 months
investigation or Warning letter
penalties

In a warning letter, there is no supply constraint


for existing products but no future approvals will
be granted from the said facility till issues are
- Import alert is issued based on the response given by a firm to the resolved
warning letter or failure to achieve prompt remedial action
- Repeat violations of observations made in the warning letter or
significant data integrity issues may lead to an import alert Import alert
- Import alerts follow warning letters within 2-4 months (average)
- Products from such facilities are not allowed to be sold in the US until Response needs to be submitted
all violations are corrected. No fresh approvals are granted. within 15 working days

Source: US FDA, CLSA

21 September 2021 [email protected] 4


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Important disclosures India pharma

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To change your report distribution requirements, please contact your CLSA sales representative or email us at [email protected].
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Companies mentioned
Alembic Pharma (N-R)
Aurobindo Pharma (ARBP IB - RS726.4 - O-PF)
Biocon (BIOS IB - RS367.1 - SELL)
Cadila Healthcare (CDH IB - RS550.1 - BUY)
Cipla (CIPLA IB - RS956.0 - BUY)
Glenmark Pharma (GNP IS - RS506.2 - SELL)
Ipca (IPCA IB - RS2,433.9 - O-PF)
Jubilant Generics (N-R)
Lupin (LPC IB - RS929.8 - SELL)
Sun Pharma (SUNP IB - RS764.5 - BUY)
Torrent Pharma (TRP IB - RS3,043.1 - BUY)

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be directly or indirectly related to the specific recommendation or views contained in this research report.

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