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Combination products are medical devices that combine two or more different types of medical products (e.g., a drug-device combination or a biologic-device combination) into a single entity. These products present unique challenges in terms of design, development, and regulatory approval due to the integration of different technologies and functionalities. Therefore, it is crucial to use appropriate techniques to evaluate combination product’s safety, efficacy, and overall performance.

The FDA's Center for Devices and Radiological Health (CDRH) and the Center for Drug Evaluation and Research (CDER) developed the "Guidance for Industry and FDA Staff - Considering Whether an FDA-Regulated Product Involves the Application of Nanotechnology" to help manufacturers evaluate combination products containing nanomaterials. While this guidance specifically addresses nanotechnology, many of the concepts and principles apply more broadly to evaluating combination products.

What are the three main categories of combination products?

Combination products are categorized into three main types based on their primary mode of action.

1.Drug-Device Combination Products: These products combine a drug and a medical device into one single entity. The drug and device components work together to achieve the intended therapeutic effect. An example of this type of combination product is an auto-injector that contains a drug and a delivery device.

2. Biologic-Device Combination Products:These products combine a biological product (such as a vaccine, cellular therapy, or tissue product) with a medical device. The device is integral to the administration or use of the biological product. An example of this type of combination product is a pre-filled syringe containing a biological medication.

3. Drug-Biologic Combination Products: These products combine a drug and a biological product. This category is less common than the others, but it involves combining a drug with a biologically sourced material. An example of this type of combination product is a drug formulated with a growth factor derived from human tissues.

Combination Products Quality Control Techniques

Microcurrent HVLD technology

MicroCurrent High Voltage Leak Detection (HVLD mc) is a non-destructive container closure integrity testing method that has been proven to be significantly more effective in identifying leaks in various types of parenteral and pharmaceutical applications. It may be used to check for leaks in nonporous, rigid, or flexible packaging as well as packaging that contains liquids. Tests for high voltage leak detection are carried out using electrical conductivity and resistance theories. This method operates by transmitting high voltage, low current impulses through sample packages. When there is a leak, the electrical resistance of the sample falls, causing an increase in current. HVLD technology depends on the "flow" of current, compared to conventional leak detection methods that depend on the movement of gas or liquid.

MicroCurrent HVLD Applications

• Vials
• Ampoules
• Cartridges
• Pre-filled Syringes
• BFS

Helium Leak testing

Helium leak detection is a method for finding leaks in a variety of sealed or enclosed systems by utilizing helium as a "tracer" gas. It is a CCI technique used to evaluate the integrity of critical injectable or parenteral products. Since helium is non-toxic, non-flammable, and non-condensable, helium gas is a great option for tracer gas. Helium is present in the atmosphere in amounts of little more than 5 ppm, making minor leaks easy to pass through. Helium is also more readily available and less expensive than other tracer gases, available in a variety of cylinder sizes. The test is performed by attaching the test component to the leak detector, which is then filled with helium gas. Helium escapes from the test components when there is a leak, and this partial pressure is measured, with the results shown on the meter.

Benefits of Helium Leak Testing

• Practical and sensitive flow-based leak test method,
• Enables the discovery of extremely small microleaks.
• Detects leaks with sensitivity level as low as 1x10-10 mbar L/sec.
• Helium is a non-explosive, non-toxic and non-destructive tracer gas.
• Applicable across package design, failure analysis, packaging line setup and validation.
• A faster test cycle reduces cost and total processing time.

The specific techniques and requirements for evaluating combination products may vary depending on the nature of the product (e.g., drug-device vs. biologic-device) and the intended use. Manufacturers are encouraged to engage in early communication with regulatory authorities to clarify the requirements and expectations for their combination product. Additionally, seeking the expertise of professionals with experience in evaluating combination products can be beneficial throughout the development and approval processes.