80_FR_10072 80 FR 10035 - Over-the-Counter Sunscreen Drug Products-Regulatory Status of Ecamsule

80 FR 10035 - Over-the-Counter Sunscreen Drug Products-Regulatory Status of Ecamsule

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 80, Issue 37 (February 25, 2015)

Page Range10035-10043
FR Document2015-03883

The Food and Drug Administration (FDA or the Agency) is issuing a proposed sunscreen order (proposed order) under the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Sunscreen Innovation Act (SIA). The proposed order announces FDA's tentative determination that ecamsule (also known as terephthalylidene dicamphor sulfonic acid) at concentrations up to 10 percent is not generally recognized as safe and effective (GRASE) and is misbranded when used in over-the-counter (OTC) sunscreen products because the currently available data are insufficient to classify it as GRASE and not misbranded, and additional information is needed to allow us to determine otherwise.

Federal Register, Volume 80 Issue 37 (Wednesday, February 25, 2015)
[Federal Register Volume 80, Number 37 (Wednesday, February 25, 2015)]
[Proposed Rules]
[Pages 10035-10043]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-03883]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

21 CFR Part 310

[Docket No. FDA-2008-N-0474]


Over-the-Counter Sunscreen Drug Products--Regulatory Status of 
Ecamsule

AGENCY: Food and Drug Administration, HHS.

ACTION: Proposed order; request for comments.

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SUMMARY: The Food and Drug Administration (FDA or the Agency) is 
issuing a proposed sunscreen order (proposed order) under the Federal 
Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the 
Sunscreen Innovation Act (SIA). The proposed order announces FDA's 
tentative determination that ecamsule (also known as terephthalylidene 
dicamphor sulfonic acid) at concentrations up to 10 percent is not 
generally recognized as safe and effective (GRASE) and is misbranded 
when used in over-the-counter (OTC) sunscreen products because the 
currently available data are insufficient to classify it as GRASE and 
not misbranded, and additional information is needed to allow us to 
determine otherwise.

DATES: Submit either electronic or written comments on this proposed 
order by April 13, 2015. Sponsors may submit written requests for a 
meeting with FDA to discuss this proposed order by March 27, 2015. See 
section VI for the proposed effective date of a final order based on 
this proposed order.

ADDRESSES: You may submit comments by any of the following methods:

Electronic Submissions

    Submit electronic comments in the following way:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.

Written Submissions

    Submit written submissions in the following ways:
     Mail/Hand delivery/Courier (for paper submissions): 
Division of Dockets Management (HFA-305), Food and Drug Administration, 
5630 Fishers Lane, rm. 1061, Rockville, MD 20852.
    Instructions: All submissions received must clearly identify the 
specific active ingredient (ecamsule) and the Docket No. FDA-2008-N-
1474 for this

[[Page 10036]]

rulemaking. All comments received may be posted without change to 
http://www.regulations.gov, including any personal information 
provided. For additional information on submitting comments, see the 
``Comments'' heading of the SUPPLEMENTARY INFORMATION section of this 
document.
    Docket: For access to the docket to read background documents or 
comments received, go to http://www.regulations.gov and insert the 
docket numbers, found in brackets in the heading of this document, into 
the ``Search'' box and follow the prompts and/or go to the Division of 
Dockets Management, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.
    Submit requests for a meeting with FDA to discuss this proposed 
order to Kristen Hardin (see FOR FURTHER INFORMATION CONTACT).

FOR FURTHER INFORMATION CONTACT: Kristen Hardin, Division of 
Nonprescription Drug Products, Center for Drug Evaluation and Research, 
Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 22, Rm. 
5491, Silver Spring, MD 20993-0002, 240-402-4246.

SUPPLEMENTARY INFORMATION: 

I. Regulatory Background

A. Regulatory and Statutory Framework

    The data and information addressed in this proposed order were 
originally submitted for review under FDA's Time and Extent Application 
(TEA) regulation, Sec.  330.14 (21 CFR 330.14), a process that has 
since been supplemented with new statutory procedures established in 
the SIA (Pub. L. 113-195), enacted November 26, 2014. The discussion 
that follows briefly describes and compares the TEA and SIA processes 
as they apply to the regulatory status of ecamsule.
    The TEA regulation established a process through which a sponsor 
could request that an active ingredient or other OTC condition,\1\ 
particularly one not previously marketed in the United States, be added 
to an OTC drug monograph to enable compliant OTC drug products 
containing the condition to be marketed in the United States without an 
approved new drug application (NDA) or abbreviated new drug application 
(ANDA). Because this proposed order specifically addresses an OTC 
sunscreen active ingredient (ecamsule), the remainder of this 
discussion will refer only to ``active ingredients.''
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    \1\ For purposes of OTC drug regulation, a ``condition'' is 
defined as an active ingredient or botanical drug substance (or a 
combination of active ingredients or botanical drug substances), 
dosage form, dosage strength, or route of administration marketed 
for a specific OTC use, with specific exclusions (see Sec.  
330.14(a)(2)). This document will refer simply to new ``active 
ingredients,'' since that is the condition under consideration.
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    Critical steps in a proceeding under the TEA regulation include the 
following: (1) FDA's determination that an active ingredient had been 
marketed for the proposed OTC use for a material time and to a material 
extent (eligibility determination), and public call for submission of 
safety and efficacy data, followed by; (2) review of safety and 
efficacy data submitted by the sponsor or other interested parties; and 
(3) FDA's initial determination that the data show the active 
ingredient to be either GRASE or not GRASE for OTC use under the 
applicable monograph conditions (including any new conditions rising 
from FDA's review) (GRASE determination). Under the TEA regulation, 
FDA's GRASE determinations are effectuated through notice and comment 
rulemaking to amend or establish the appropriate monograph.
    The TEA process in FDA regulations was supplemented by Congress's 
enactment of the SIA. Among other amendments it makes to the FD&C Act, 
the SIA creates new procedures specifically for reviewing the safety 
and effectiveness of nonprescription sunscreen active ingredients, 
including those, such as ecamsule, that were the subject of pending TEA 
proceedings at the time the SIA was enacted. Like the TEA regulation, 
the SIA calls for an initial eligibility determination phase for 
nonprescription sunscreen active ingredients, followed by submissions 
of safety and efficacy data and a GRASE determination phase. However, 
the SIA requires FDA to make proposed and final GRASE determinations 
for nonprescription sunscreen active ingredients in the form of 
administrative orders rather than the multistep public rulemaking 
required by the TEA regulation, and establishes strict timelines for 
the necessary administrative actions.
    Among other requirements, no later than 90 days after the SIA was 
enacted (i.e., no later than February 24, 2015), FDA must publish a 
proposed sunscreen order in the Federal Register for any 
nonprescription sunscreen active ingredient, including ecamsule, for 
which, on the date of enactment, an eligibility determination had been 
issued under the TEA regulation and submissions of safety and efficacy 
data received, and for which a TEA feedback letter had not yet been 
issued (section 586C(b)(4) of the FD&C Act (21 U.S.C. 360fff-3(b)(4)), 
as amended by the SIA). Other provisions of the SIA that are not 
discussed in this proposed order address procedures applicable to other 
pending and future sunscreen active ingredient GRASE determinations, 
pending and future GRASE determinations for OTC products other than 
sunscreens, issuance of specified guidances and reports, and completion 
of pending sunscreen rulemakings, among others.
    A proposed sunscreen order under the SIA is an order containing 
FDA's tentative determination proposing that a nonprescription 
sunscreen active ingredient or combination of ingredients: (1) Is GRASE 
and is not misbranded when marketed in accordance with the proposed 
order; (2) is not GRASE and is misbranded; or (3) is not GRASE and is 
misbranded because the data are insufficient to classify the active 
ingredient or combination of ingredients as GRASE and not misbranded, 
and additional information is necessary to allow FDA to determine 
otherwise (section 586(7) of the FD&C Act, as amended by the SIA). 
Publication of a proposed sunscreen order triggers several timelines 
under the SIA, including a 45-day public comment period, and a 30-day 
period in which a sponsor may request a meeting with FDA to discuss the 
proposed order.

B. FDA's Review of Ecamsule

    L'Oreal asked FDA to include ecamsule in concentrations up to 10 
percent as an active ingredient in the OTC sunscreen monograph in a TEA 
submitted September 19, 2007. FDA announced on September 12, 2008, that 
ecamsule had been found eligible in concentrations up to 10 percent to 
be considered for inclusion in the OTC sunscreen monograph (21 CFR part 
352, currently stayed), and requested submissions of safety and 
effectiveness data to support a GRASE determination for the requested 
OTC use (73 FR 53029). L'Oreal submitted safety and efficacy data on 
ecamsule to the designated docket (FDA-2008-N-0474) on November 14, 
2008 (ecamsule data submission). At the time the SIA was enacted, FDA 
had not issued a TEA feedback letter or otherwise responded to that 
submission.
    In accordance with new section 586C(b)(4) of the FD&C Act as 
amended by the SIA, we are issuing this notice as a proposed order for 
ecamsule. Based on our review of the ecamsule data submission, we have 
made a tentative determination that ecamsule is not GRASE for OTC 
sunscreen use and is misbranded because the data are insufficient to 
classify it as GRASE and not misbranded, and additional

[[Page 10037]]

information is necessary to allow us to determine otherwise. The 
remainder of this proposed sunscreen order describes our review of 
safety and efficacy data, identifies additional data needed to 
demonstrate that ecamsule is GRASE for the requested use, and explains 
our rationale for specific conclusions and data requirements.
    This proposed order will be open for public comment (see DATES). 
The sponsor may request a meeting with FDA to discuss this proposed 
order (see DATES). We also invite the sponsor to submit additional 
safety and/or efficacy data to inform our further consideration, as 
publication of a final sunscreen order for ecamsule under the SIA will 
be contingent on receipt of such information. (See section 
586C(b)(9)(ii) of the FD&C Act.) We specifically encourage the sponsor 
to discuss any proposed study protocols with us before performing the 
studies.

II. Safety Data Considerations for OTC Sunscreen Products Containing 
Ecamsule

    In evaluating the safety of a proposed monograph active ingredient, 
FDA applies the following regulatory standard: Safety means a low 
incidence of adverse reactions or significant side effects under 
adequate directions for use and warnings against unsafe use as well as 
low potential for harm which may result from abuse under conditions of 
widespread availability. Proof of safety shall consist of adequate 
tests by methods reasonably applicable to show the drug is safe under 
the prescribed, recommended, or suggested conditions of use. This proof 
shall include results of significant human experience during marketing. 
General recognition of safety shall ordinarily be based upon published 
studies which may be corroborated by unpublished studies and other data 
(Sec.  330.10(a)(4)(i) (21 CFR 330.10(a)(4)(i))).
    FDA's OTC drug regulations generally identify the types of 
information that may be submitted as evidence that an active ingredient 
or other OTC drug condition is safe, as part of the consideration of 
whether an active ingredient or other condition is GRASE (Sec.  
330.10(a)(2)). For convenience, this order uses the term ``generally 
recognized as safe (GRAS)'' to refer to that aspect of the GRASE 
determination. To apply the general OTC safety standard to each 
potential new condition, FDA uses its scientific expertise to determine 
what constitutes ``adequate tests by methods reasonably applicable to 
show the drug is safe under the prescribed, recommended, or suggested 
conditions of use.'' In assessing what specific testing or other data 
are needed to adequately demonstrate the safety of ecamsule for use in 
sunscreen, FDA considers the circumstances under which OTC sunscreen 
products that could contain ecamsule would be used by consumers.
    When used as directed with other sun protection measures, broad 
spectrum OTC sunscreen products with a sun protection factor (SPF) 
value of 15 or higher strongly benefit the public health by decreasing 
the risk of skin cancer and premature skin aging associated with solar 
ultraviolet (UV) radiation, as well as by helping to prevent sunburn. 
(Sunscreens with lower SPF values, or without broad spectrum 
protection, also help prevent sunburn.) When used as directed by the 
required labeling, all OTC sunscreen products are applied liberally to 
the skin and reapplied frequently throughout the day (Sec.  201.327(e) 
(21 CFR 201.327(e))). Because the effects of UV exposure are 
cumulative, to obtain the maximum benefit, users of broad spectrum 
sunscreens with an SPF value of 15 or higher are directed to use such 
products regularly--on a routine basis (id.). Given these conditions of 
use, our safety evaluation of an OTC sunscreen active ingredient such 
as ecamsule must consider both short-term safety concerns (such as skin 
sensitization/irritation and photosafety) and potential concerns 
related to long-term sunscreen use, including potential systemic 
exposure via dermal absorption.
    The purpose of the safety testing described in this section II is 
to establish whether an OTC sunscreen product containing ecamsule and 
otherwise marketed under the conditions described in a final sunscreen 
order and in accordance with all requirements applicable to 
nonprescription drugs would be GRAS for use as labeled. To demonstrate 
that these requirements are met for ecamsule, initial safety testing 
should be performed using ecamsule as the sole active ingredient up to 
the highest concentration for which marketing status is sought and 
eligibility has been established: 10 percent. If initial testing 
suggests a particular safety concern associated with ecamsule (e.g., a 
hormonal activity), FDA may request additional studies to address that 
concern.

A. Human Safety Data

1. Human Irritation, Sensitization, and Photosafety Studies
    Studies of skin irritation, sensitization, and photosafety are 
standard elements in the safety evaluation of topical drug products 
that, like ecamsule-containing sunscreens, are applied to the skin 
repeatedly over long periods of time. FDA recommends separate studies 
for skin irritation and sensitization. Skin irritation studies should 
generally include at least 30 evaluable subjects and should evaluate 
the test formulation (i.e., ecamsule in an appropriate test vehicle), 
the vehicle alone, and both negative and positive controls. Skin 
sensitization studies generally should include at least 200 subjects 
and should evaluate the test formulation containing ecamsule, the 
vehicle, and a negative control. For both irritation and sensitization 
studies, test site applications should be randomized and the test 
observer blinded to the identities of the test formulations.
    FDA recommends that photosafety evaluation generally involve 
studies of skin photoirritation (phototoxicity) and skin 
photosensitization (photoallergenicity). General principles for 
designing and conducting photosafety studies are described in FDA 
guidance (Ref. 1). Photosafety studies, like sensitization and 
irritation studies, should be conducted using ecamsule 10 percent in an 
appropriate test vehicle, the vehicle alone, and a negative control. In 
addition, phototoxicity studies should include at least 30 evaluable 
subjects and photoallerginicity studies should include at least 45 
evaluable subjects.
Data Available for Ecamsule: Human Irritation, Sensitization, and 
Photosafety Studies
    We received information regarding 26 non-U.S. human dermal safety 
studies evaluating formulations containing up to approximately 4 
percent ecamsule with one or more other additional active ingredients 
(Note 1). These studies exposed a total of approximately 1,500 adults 
to formulations containing ecamsule. Reports of 21 of these studies 
were complete: 2 of these studies assessed primary cutaneous 
irritation, 7 assessed cumulative irritation and sensitization 
potential, 9 assessed phototoxicity potential, and 3 assessed 
photosensitizing potential. However, the information provided in the 21 
complete study reports does not meet FDA's current standards to support 
the human dermal safety of ecamsule at any concentration. All of these 
studies assessed formulations containing more than one active 
ingredient and therefore provide only limited insight into the safety 
of ecamsule. Furthermore, the formulations used in these studies 
included ecamsule only in concentrations of between 0.33 percent and 
3.96 percent, and therefore would

[[Page 10038]]

not support a determination that ecamsule is GRAS at concentrations 
between 3.96 percent and 10.0 percent as found eligible for review and 
requested for GRASE evaluation by L'Oreal. Other deficiencies noted 
included:
     Failure to provide individual skin reaction scores to 
negative controls in all studies.
     Failure to enroll a sufficient number of subjects in the 
sensitization, phototoxicity, and photoallergenicity studies.
     Although the cumulative irritation studies enrolled an 
adequate number of evaluable subjects, there was a failure to indicate 
whether positive controls were used, and only three study reports 
indicated a negative control was used.
     Failure to indicate whether or not investigators in the 
primary cutaneous irritation, phototoxicity, and photoallergenicity 
studies were blinded to patch applications.
     Failure to indicate whether the phototoxicity and 
photoallergenicity studies included vehicle controls.
    The ecamsule data submission also included reports for 14 studies 
exposing a total of over 500 children primarily between 3 and 12 years 
of age to sunscreen formulations containing ecamsule in concentrations 
of 1.5 percent to 9 percent, with 1 or more other additional active 
ingredients (Note 2). Numerous dermatologic reactions were reported; 
however, none were considered serious.
    Three human safety-related literature citations listed in the 
submission were limited to studies describing photoallergic reactions 
to combination sunscreen products formulated both with and without 
ecamsule (Note 3). One publication described a single case of 
photoallergy to an ecamsule-containing sunscreen product (Ref. 2). A 
second publication was a review that summarized published and 
unpublished data from a single center's experience with patch and 
photopatch testing in a consecutive series of 402 patients who 
presented to a photobiology unit from 1981 to 1996 with suspected 
clinical photosensitivity (Ref. 3). The authors did not observe allergy 
or photoallergy to 1 percent ecamsule, but experience with ecamsule was 
limited in this study because it was included in the sunscreen series 
beginning in 1995, towards the end of the 15-year study period. The 
third publication was a case report describing no photoallergy to an 
ecamsule-containing combination sunscreen drug product in a 71-year-old 
male patient with persistent photocontact allergy to other UV filters 
(Ref. 4). A literature search conducted by FDA did not identify 
additional publications regarding the human dermal safety of ecamsule 
in concentrations up to 10 percent for use as an OTC sunscreen.
    FDA concludes that the data submitted are not sufficient to assess 
the dermal safety of ecamsule in concentrations up to 10 percent and 
specifically its potential to cause irritation, sensitization, 
photoirritation, or photoallergenicity. Submission of data from human 
irritation, sensitization, and photosafety studies that meet FDA 
standards (see section II.A.1) is recommended to demonstrate that an 
OTC sunscreen product containing up to 10 percent ecamsule is not an 
irritant, sensitizer, photosensitizer, or photoirritant.
2. Human Dermal Pharmacokinetic (Bioavailability) Studies
    Because sunscreens are topically applied, another important safety 
consideration for ecamsule for use in sunscreens is whether dermal 
application may result in skin penetration and systemic exposure to 
ecamsule, and if so, to what extent. A well-designed and -conducted 
human dermal pharmacokinetic study can be expected to detect and 
quantify the presence of ecamsule and/or any metabolites in blood or 
other bodily fluids that may have a bearing on safety, using recognized 
parameters such as bioavailability percentage, maximum plasma 
concentration (Cmax), time to maximum plasma concentration (Tmax), 
total area under the plasma concentration versus time curve (AUC), 
half-life, clearance, and volume of distribution. This information can 
help identify potential safety concerns and help determine whether an 
adequate safety margin for sunscreens containing ecamsule exists. FDA 
recommends that the pharmacokinetic studies performed on ecamsule also 
collect additional safety-related data from regularly scheduled 
physical examinations, collection of vital signs, and other measures, 
which may help capture adverse skin events or other potential safety 
signals. To ensure that maximum penetration of ecamsule has taken place 
and chances of it being detected are optimal, studies should continue 
until steady state is reached.
    General information and recommendations on the design and conduct 
of human pharmacokinetic studies can be found in FDA guidance (Ref. 5). 
To support a GRAS determination for ecamsule (up to 10 percent), such a 
study should be conducted under maximal use conditions using ecamsule 
up to 10 percent in various vehicles, including vehicles that would be 
expected to enhance absorption. We encourage study sponsors to consult 
with us before conducting pharmacokinetic studies, because the 
properties of ecamsule bear on the optimal design.
Data Available for Ecamsule: Human Dermal Pharmacokinetic 
(Bioavailability) Studies
    Human dermal pharmacokinetic studies for ecamsule were submitted in 
response to our call for data. We reviewed one in vitro study that 
evaluated the potential for dermal penetration of topically applied 
ecamsule from human skin samples (Note 4). Because this study was not 
designed to detect or quantify ecamsule in the blood or other body 
fluids, it provides no useful information about systemic exposure. One 
urinary excretion study conducted with a 4.95 percent ecamsule test 
formulation suggested minimal systemic absorption in seven male 
volunteers dosed over an extensive body surface area for a total of 5 
days (Note 5). A study in which radiolabeled 2 percent ecamsule was 
topically applied to the forearms of five male volunteers and retained 
for 4 hours detected a minimal level of radiation above background in 
urine after dosing but radiation levels above background were not 
detected in blood (Note 6). Although this study suggests that ecamsule 
is minimally absorbed following dermal application, the study 
formulation contained ecamsule at a concentration much lower than the 
requested 10 percent maximum and only a small number of subjects were 
dosed over a limited surface area. The last human dermal 
pharmacokinetic study assessed the absorption of 3 percent ecamsule 
from a formulation containing a total of four active ingredients (Note 
7). The formulation was applied to an extensive body surface area of 
six male subjects twice daily for 8 days. Results showed that there 
were quantifiable plasma concentrations of ecamsule at several time 
points, suggesting that ecamsule is absorbed via dermal application. 
None of the submitted human dermal pharmacokinetic studies assessed an 
adequate number of subjects, or tested ecamsule at the maximum 
requested concentration of 10 percent.
    Our literature search found no additional publications regarding 
human pharmacokinetics of ecamsule. Accordingly, we request data from 
human pharmacokinetic studies to assess the potential for and the 
extent of systemic absorption. These studies should be performed under 
expected

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maximal use conditions with the proposed maximum concentration, as 
discussed previously in this section, in a sufficiently large study 
population to control for both gender and age.
3. Human Safety Data To Establish Adverse Event Profile
    An evaluation of safety information from adverse event reports and 
other safety-related information derived from commercial marketing 
experience of sunscreen products containing ecamsule, as well as from 
other sources, is a critical aspect of FDA's safety review for 
ecamsule. The TEA regulation under which the original request for 
ecamsule was submitted specifically calls for submission of information 
on all serious adverse drug experiences, as defined in 21 CFR 
310.305(a) and 314.80(a), from each country where the active ingredient 
or other condition has been or is currently marketed as either a 
prescription or an OTC drug; in addition, it calls for submission of 
all data generally specified in Sec.  330.10(a)(2), which includes 
documented case reports and identification of expected or frequently 
reported side effects (Sec.  330.14(f)(1) and (f)(2)). To evaluate 
ecamsule, FDA continues to seek individual adverse drug experience 
reports, a summary of all serious adverse drug experiences, and 
expected or frequently reported side effects of the condition (id.). To 
assist in the Agency's safety evaluation of ecamsule, FDA emphasizes 
its need for the following data:
     A summary of all available reported adverse events 
potentially associated with ecamsule;
     All available documented case reports of serious side 
effects;
     Any available safety information from studies of the 
safety and effectiveness of ecamsule in humans; and
     Relevant medical literature describing adverse events 
associated with ecamsule. Submissions of adverse event data should also 
include a description of how each country's system identifies and 
collects adverse events, unless this information has been previously 
submitted as part of ecamsule's TEA package.
    Although we recognize that adverse event data from foreign 
marketing experience may reflect patterns of use and regulatory 
reporting requirements that differ from those in the United States, we 
nonetheless consider such information to be strongly relevant both to 
our overall GRASE assessment of ecamsule for use in sunscreens and to 
our consideration of potential product labeling. FDA recognizes that 
such information may not be available from all countries; where that is 
the case, please provide a written explanation for the lack of data. 
Overall, we seek sufficient data to characterize ecamsule's adverse 
event profile.\2\
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    \2\ See 67 FR 3060 at 3069 (January 23, 2002) (agreeing that the 
absence of an adverse experience reporting system in a foreign 
country for drugs or cosmetics does not necessarily mean that a 
condition cannot be GRAS/E. The GRAS/E determination will be based 
on the overall quality of the data and information presented to 
substantiate safety and effectiveness).
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Ecamsule: Human Safety Data To Establish Adverse Event Profile
    The submission describes the marketing history of ecamsule and 
provides eight case report forms (Form FDA 3500A) that have been 
submitted to FDA's MedWatch program in association with marketed 
sunscreen products containing ecamsule in combination with other active 
ingredients (Note 8). Our review of the FDA Adverse Event Reporting 
System (FAERS) identified one additional case report associated with 
such a sunscreen product. These case reports describe serious allergic 
reactions such as redness, swelling and urticaria, breathing 
difficulties, and anaphylaxis. The role, if any, of ecamsule in these 
cases cannot be fully assessed due in part to the presence of multiple 
active ingredients in the associated sunscreen products. To support the 
evaluation of the safety of ecamsule for use in OTC sunscreens, we 
request that the sponsor either supplement the information already 
submitted with adverse event or other safety-related data derived from 
commercial marketing experience, or explain why such information cannot 
be provided.

B. Nonclinical (Animal) Studies

    Another important element of FDA's GRAS review of ecamsule for use 
in sunscreens is an assessment of data from nonclinical (animal) 
studies that characterize the potential long-term dermal and systemic 
effects of exposure to ecamsule. Even if the bioavailability data 
discussed in section II.A.2 suggest that dermal application is unlikely 
to result in skin penetration and systemic exposure to ecamsule, FDA 
still considers data on the effects of systemic exposure to be an 
important aspect of our safety evaluation of ecamsule. A determination 
that ecamsule up to 10 percent is GRASE for use in sunscreens would 
permit its use in as-yet-unknown product formulations, which might in 
turn alter the skin penetration of the active ingredient. Therefore, an 
understanding of the effects of ecamsule, were systemic exposure to 
occur, is critical to determine whether and how regulatory parameters 
can be defined to assure that all conforming ecamsule-containing 
sunscreens would be GRASE as labeled.
    FDA recommends animal testing of the potential long-term dermal and 
systemic effects of exposure to ecamsule because these effects cannot 
be easily assessed from previous human use. Taken together, the 
carcinogenicity studies, developmental and reproductive toxicity 
studies, and toxicokinetic studies described in sections II.B.1 through 
II.B.3 should provide the information needed to characterize both the 
potential dermal and systemic toxic effects and the levels of exposure 
at which they occur. These data, when viewed in the context of human 
exposure data, can be used to determine a margin of safety for use of 
ecamsule in OTC sunscreens.
Data Available for Ecamsule: Nonclinical (Animal) Studies Generally
    The ecamsule submission included reports of the following types of 
nonclinical safety studies:

 Single-dose toxicity studies
    [cir] Oral toxicity (rat, mouse) (Note 9)
    [cir] Dermal toxicity (rat, mouse) (Note 10)
    [cir] Intravenous toxicity (rat, mouse) (Note 11)
    [cir] Mucosal and skin irritation (rabbit) (Note 12)
    [cir] Skin irritation and sensitization (guinea pig) (Note 13)
    [cir] Photoirritation and photosensitization (guinea pig) (Note 14)
 Repeat-dose toxicity studies
    [cir] 4-week bridging dermal (mouse) (Note 15)
    [cir] 13-week dermal (mouse) (Note 16)
    [cir] 9-month dermal (minipig) (Note 17)
 Genotoxicity and mutagenicity assays
    [cir] Ames test (Salmonella typhimurium, Escherichia coli) (Note 
18)
    [cir] Chromosomal aberration assay (Chinese hamster ovary (CHO 
cells)) (Note 19)
    [cir] Micronucleus test (rat) (Note 20)
    [cir] Photomutagenicity (E. coli) (Note 21)
    [cir] HPRT test (CHO cells) (Note 22)
    [cir] Photochromosomal aberration assay (CHO cells) (Note 23)
 Reproductive and developmental toxicity studies
    [cir] Fertility and early embryonic development, oral (rat) (Note 
24)
    [cir] Pre/postnatal development, oral (rat) (Note 25)
    [cir] Embryotoxicity/teratogenicity, dermal (rabbit) (Note 26)

[[Page 10040]]

    [cir] Embryofetal development/teratogenicity, oral (rat) (Note 27)
    [cir] Embryofetal development/teratogenicity, oral (rabbit) (Note 
28)
 Carcinogenicity and photocarcinogenicity
    [cir] 104 weeks dermal carcinogenicity (mouse) (Note 29)
    [cir] 12 months photocarcinogenicity (mouse) (Note 30)
 Pharmacokinetics
    [cir] Pharmacokinetic study, oral (rat) (Note 31)
    [cir] Pharmacokinetic study, dermal (mouse, rat) (Note 32)
    [cir] Microsome metabolism (interspecies, in vitro) (Note 33)
    [cir] Excretion, oral and dermal (rat) (Note 34)

    The submission includes summary reports of nonclinical studies that 
are of the types FDA requests as a basis for evaluating whether 
ecamsule is GRAS for use in sunscreen (chronic toxicity, 
carcinogenicity, reproductive and developmental toxicity, and 
toxicokinetics). However, the submission did not provide the full 
reports and full comprehensive data sets that would be needed for an 
adequate review of the data for these studies. Because the summary data 
provided can support only tentative conclusions about these studies, 
full final study reports and data sets need to be made available to 
support a final GRASE determination.
    Additional discussion of study findings and data gaps are provided 
in the following subsections.
1. Carcinogenicity Studies: Dermal and Systemic
    FDA guidance recommends that carcinogenicity studies be performed 
for any pharmaceutical that is expected to be clinically used 
continuously or ``repeatedly in an intermittent manner'' for a total of 
6 months of exposure (Refs. 6, 7, and 8). Because the proposed use of 
ecamsule in OTC sunscreens falls within this category, these studies 
should be conducted to help establish that ecamsule is GRAS for its 
proposed use. Carcinogenicity studies assist in characterizing 
potential dermal and systemic risks by identifying the type of toxicity 
observed, the level of exposure at which toxicity occurs, and the 
highest level of exposure at which no adverse effects occur (i.e., 
NOAEL). The NOAEL would then be used in determining the safety margin 
for human exposure to sunscreens containing ecamsule.
    Systemic carcinogenicity studies can also help to identify other 
systemic or organ toxicities that may be associated with ecamsule, such 
as hormonal effects. For example, the effect of persistent disruption 
of particular endocrine gland systems (e.g., hypothalamic-pituitary-
adrenal axis), if any, can be captured by these assays.
Data Available for Ecamsule: Genotoxicity Studies
    The ecamsule submission included some information regarding 
genotoxicity studies. Based on the reviewable genotoxicity data 
included in the ecamsule data submission, ecamsule appears to be 
negative for causing genotoxic activity under the conditions studied 
(Notes 35 through 43). As we believe that data from the recommended 
systemic carcinogenicity and developmental and reproductive toxicology 
(DART) studies will provide an adequate and appropriate measure of 
potential long-term effects of systemic or dermal exposure to ecamsule, 
we do not request further genotoxicity studies.
Data Available for Ecamsule: Carcinogenicity Studies
    We have reviewed study summaries for four dermal carcinogenicity 
and photocarcinogenicity studies, which appear to be negative (Notes 44 
through 47). However, full final study reports need to be made 
available to support a final GRASE determination. In addition, we did 
not receive any systemic carcinogenicity data, which are recommended to 
support the safety of long-term use of ecamsule. We request that the 
sponsor provide a systemic carcinogenicity study, as well as make 
available full final study reports for the previously conducted 
carcinogenicity studies that were submitted in a summarized form.
2. DART Studies (Ref. 9)
    FDA recommends conducting DART studies to evaluate the potential 
effects that exposure to ecamsule may have on developing offspring 
throughout gestation and postnatally until sexual maturation, as well 
as on the reproductive competence of sexually mature male and female 
animals. Gestational and neonatal stages of development may also be 
particularly sensitive to active ingredients with hormonal activity. 
For this reason, we recommend that these studies include assessments of 
endpoints such as vaginal patency, preputial separation, anogenital 
distance, and nipple retention, which can be incorporated into 
traditional DART study designs to assess potential hormonal effects of 
ecamsule on the developing offspring. We also recommend conducting 
behavioral assessments (e.g., mating behavior) of offspring, which may 
also detect neuroendocrine effects.
Data Available for Ecamsule: DART Studies
    We received study summaries for five developmental and reproductive 
toxicity assays (Notes 48 through 52), which appear to be negative for 
the potential to cause adverse developmental or reproductive effects. 
However, comprehensive data sets were not provided.
    We request that the sponsor make available full final study 
reports, including full comprehensive datasets, to support a final 
GRASE determination.
3. Toxicokinetics (Ref. 10)
    We recommend conducting animal toxicokinetic studies because they 
provide an important bridge between toxic levels seen in animal studies 
and potential human exposure. Data from these studies can be correlated 
to potential human exposure via clinical dermal pharmacokinetic study 
findings. Toxicokinetic data could be collected as part of animal 
studies being conducted to assess one or more of the safety parameters 
described previously.
Data Available for Ecamsule: Toxicokinetics
    We reviewed single-dose pharmacokinetic studies conducted in animal 
models which showed that systemic exposure was achieved under the 
conditions of the conducted studies (Notes 53 and 54). However, we did 
not receive any pharmacokinetic data reflecting drug levels following 
long-term exposure, which are usually collected from repeat toxicity 
studies such as chronic (systemic or dermal) studies. We recommend that 
a time course toxicokinetic study be conducted following repeat-dose 
exposure (via the oral and dermal routes) to evaluate the steady-state 
exposure level of ecamsule. Data obtained from this study could be used 
to compare drug levels in animals to those in humans under maximal 
exposure conditions to establish a margin of safety for human exposure.

III. Effectiveness Data Considerations for OTC Sunscreen Products 
Containing Ecamsule

    FDA's evaluation of the effectiveness of active ingredients under 
consideration for inclusion in an OTC drug monograph is governed by the 
following regulatory standard: Effectiveness means a reasonable 
expectation that, in a significant proportion of the target population, 
the pharmacological effect of the drug, when used under adequate 
directions

[[Page 10041]]

for use and warnings against unsafe use, will provide clinically 
significant relief of the type claimed. Proof of efficacy shall consist 
of controlled clinical investigations as defined in 21 CFR 314.126(b). 
Investigations may be corroborated by partially controlled or 
uncontrolled studies, documented clinical studies by qualified experts, 
and reports of significant human experience during marketing. Isolated 
case reports, random experience, and reports lacking the details that 
permit scientific evaluation will not be considered. General 
recognition of effectiveness shall ordinarily be based upon published 
studies which may be corroborated by unpublished studies and other data 
(Sec.  330.10(a)(4)(ii)). For convenience, this order uses the term 
``generally recognized as effective'' (GRAE) when referring to this 
aspect of the GRASE determination.
    To evaluate the efficacy of ecamsule for use in OTC sunscreen 
products, FDA requests evidence from at least two adequate and well-
controlled SPF studies showing that ecamsule effectively prevents 
sunburn. To determine that ecamsule is GRAE for use in OTC sunscreens 
at concentrations in a range with the proposed maximum strength of 10 
percent as requested, two adequate and well-controlled SPF studies of 
ecamsule at a lower concentration should be conducted according to 
established standards.\3\ These SPF studies should demonstrate that the 
selected concentration (below 10 percent) provides an SPF of 2 or more.
---------------------------------------------------------------------------

    \3\ The upper bound of any concentration of ecamsule ultimately 
established in the OTC sunscreen monograph will be governed by the 
safety data, as well as by efficacy.
---------------------------------------------------------------------------

    The current standard procedure for SPF testing is described in 
FDA's regulations in Sec.  201.327(i).\4\ Further SPF tests for 
ecamsule should be performed as described in these regulations, using a 
test formulation containing ecamsule as the only active ingredient to 
identify its contribution to the overall SPF test results. (See the 
following subsection Data Available for Ecamsule: Effectiveness for 
further discussion of submitted SPF tests.) The study should also 
include a vehicle control arm to rule out any contribution the vehicle 
may have on the SPF test results. Finally, as described in Sec.  
201.327(i), an SPF standard formulation comparator arm should be 
another component of the study design.
---------------------------------------------------------------------------

    \4\ Although the SPF testing procedure is used primarily for 
final formulation testing of finished products marketed without 
approved NDAs, under the sunscreen monograph, it is equally 
applicable for determining whether or not a sunscreen active 
ingredient is GRAE.
---------------------------------------------------------------------------

    Although current sunscreen testing and labeling regulations also 
specify a ``broad spectrum'' testing procedure to support related 
labeling claims for certain OTC sunscreen products marketed without 
approved new drug applications that contain specific ingredients 
included in the OTC sunscreen monograph, those additional claims are 
permitted, but not required, for these products (Sec.  201.327(c)(2) 
and (j)). Under current regulations, sunscreen active ingredients need 
only be effective for the labeled indication of sunburn prevention, for 
which the SPF test can provide sufficient evidence. Consistent with 
this approach, we here do not request broad spectrum testing for 
ecamsule. Broad spectrum protection is often, although not always, the 
result of the combined contribution of multiple active ingredients in a 
final sunscreen formulation. Thus, under the current regulations 
applicable to other sunscreens, the determination of whether an 
individual sunscreen product may be labeled as broad spectrum and bear 
the related additional claims is made on a product-specific basis, 
applying standard testing methods set forth in those regulations. If 
ecamsule is established to be GRASE for use in nonprescription 
sunscreens (based in part on the efficacy data requested here), the 
final sunscreen order can likewise address broad-spectrum testing and 
related labeling conditions for final sunscreen formulations containing 
ecamsule.

Data Available for Ecamsule: Effectiveness

    Study reports were submitted for two studies that assessed SPF of 
formulations containing ecamsule, at a concentration of either 2 
percent or 3 percent (Notes 55 and 56, respectively), in combination 
with other active ingredients. Neither of these studies provides a 
direct evaluation of the efficacy of ecamsule alone. These studies were 
not adequately designed to provide evidence of efficacy on which to 
base a GRAE determination for ecamsule. No adequately designed studies 
of ecamsule efficacy were identified in our search of the published 
literature. To support the finding that ecamsule is GRAE when used at 
concentrations up to 10 percent, we request submission of data from two 
adequate and well-controlled SPF studies conducted according to 
established standards to demonstrate that the lowest selected 
concentration provides an SPF of 2 or more. Because no study has been 
identified that assesses the effectiveness of ecamsule at a 
concentration of 10 percent, it is recommended that such a study be 
conducted and submitted.

IV. Summary of Current Data Gaps for Ecamsule

    Based on our review of the available safety and efficacy data as 
discussed previously, we request the types of data listed in this 
section of the proposed order, at minimum, for us to reverse our 
tentative determination that ecamsule is not GRASE and is misbranded 
because the data are insufficient to classify ecamsule as GRASE and not 
misbranded, and additional data are necessary to allow us to determine 
otherwise. Note that, in some cases, as discussed in section II of this 
proposed order, the ecamsule data submission provided some information 
from nonclinical studies of the type FDA requests as part of the basis 
for a GRAS determination, but only in summary form. Were complete study 
data generally available from these previously conducted studies, they 
might address several aspects of our GRASE consideration. If data from 
these previously conducted studies are not made available, further 
studies of those types would be needed to support a finding that 
ecamsule is GRASE for use in sunscreens. Further, as summarized in the 
following subsections, some additional studies of other types are 
needed. For additional information about the purpose and design of 
studies recommended to address present data gaps, please refer to the 
earlier sections of this proposed order referenced in parentheses. We 
welcome discussions on the design of any of the studies prior to their 
commencement. We request the following types of data:

 Safety Data (see section II)

A. Human Clinical Studies

    1. Skin irritation/sensitization, and photosafety (see section 
II.A.1)
    2. Human dermal pharmacokinetic (bioavailability) studies (see 
section II.A.2)

B. Human Safety Data To Establish Adverse Event Profile (see Section 
II.A.3)

    1. A summary and analysis of all available reported adverse events 
potentially associated with ecamsule
    2. A summary and analysis of all available documented case reports 
of serious side effects
    3. A summary and analysis of any available safety information from 
studies of the safety and effectiveness of sunscreen products 
containing ecamsule in humans

[[Page 10042]]

    4. A summary and analysis of relevant medical literature describing 
adverse events associated with ecamsule
    Alternatively, the results of a literature search that found no 
reports of adverse events may be provided. In that case, detailed 
information on how the search was conducted should be provided.

C. Nonclinical (Animal) Studies

    Full study reports will be needed for the following studies:
    1. Systemic and dermal carcinogenicity (see section II.B.1)
    2. Reproductive and developmental toxicity studies (see section 
II.B.2)
    3. Toxicokinetics (see section II.B.3)
 Effectiveness Data (see section III)
    For concentrations of ecamsule up to 10 percent to be found to be 
GRASE for use in nonprescription sunscreen products as requested, at 
least two SPF studies showing effectiveness of a selected concentration 
lower than 10 percent should be conducted. An efficacy study of 
ecamsule at 10 percent is also recommended.

V. Administrative Procedures

    A copy of this proposed order will be filed in the Division of 
Dockets Management in Docket No. FDA-2008-N-0474. To inform FDA's 
evaluation of whether this ingredient is GRASE and not misbranded for 
use in sunscreen products, we encourage the sponsor and other 
interested parties to submit additional data regarding the safety and 
effectiveness of this ingredient for use as an OTC sunscreen product. 
We also encourage the sponsor and other interested parties to notify us 
in writing of their intent to submit additional data. However, as noted 
previously, because the data submitted to date are not sufficient to 
support a determination that ecamsule is GRASE for use as an active 
ingredient in OTC sunscreen drug products, at present, OTC sunscreen 
products containing ecamsule may not be marketed without approval of an 
NDA or ANDA (see section 586C(e)(1)(A) of the FD&C Act, as amended by 
the SIA). Data submissions relating to this proposed order should be 
submitted to Docket No. FDA-2008-N-0474 at the Division of Dockets 
Management (see ADDRESSES). In addition, you can submit the data 
through the Federal eRulemaking Portal at http://www.regulations.gov. 
Follow the instructions for submitting comments.
    Section 586C(b)(7) of the FD&C Act, as amended by the SIA, provides 
that the sponsor may, within 30 days of publication of a proposed order 
(see DATES), submit a request to FDA for a meeting to discuss the 
proposed order. Submit meeting requests electronically to http://www.regulations.gov or in writing to the Division of Dockets Management 
(see ADDRESSES), identified with the active ingredient name ecamsule, 
Docket No. FDA-2008-N-0474, and the heading ``Sponsor Meeting 
Request.'' To facilitate your request, please also send a copy to 
Kristen Hardin (see FOR FURTHER INFORMATION CONTACT).

VI. Proposed Effective Date

    FDA proposes that any final administrative order based on this 
proposal become effective on the date of publication of the final order 
in the Federal Register.

VII. Comments

    Similarly, section 586C(b)(6) of the FD&C Act, as amended by the 
SIA, establishes that a proposed sunscreen order shall provide 45 days 
for public comment. Interested persons wishing to comment on this 
proposed order may submit either electronic comments to http://www.regulations.gov or written comments to the Division of Dockets 
Management (see ADDRESSES). It is only necessary to send one set of 
comments. Identify comments with the active ingredient name (ecamsule) 
and the docket number found in brackets in the heading of this proposed 
order. Received comments on this proposed order may be seen in the 
Division of Dockets Management between 9 a.m. and 4 p.m., Monday 
through Friday, and will be posted to the docket at http://www.regulations.gov.

VIII. Notes

    1. FDA-2008-N-0474-0012 and FDA-2008-N-0474-0013, Volumes 6 and 
7, dated November 14, 2008.
    2. FDA-2008-N-0474-0015 and FDA-2008-N-0474-0016, Volumes 9 and 
10, dated November 14, 2008.
    3. FDA-2008-N-0474-0007, Volume 1, dated November 14, 2008, FDA-
2008-N-0474-0006, TEA submission.
    4. FDA-2008-N-0474-0008, Volume 2, Study no. 16039/G2347.
    5. FDA-2008-N-0474-0014, Volume 8, Study no. V3156.
    6. FDA-2008-N-0474-0014, Volume 8, Study no. V99.1203.
    7. FDA-2008-N-0474-0014, Volume 8, Study no. CG.03.SRE.2607.
    8. FDA-2008-N-0474-0007, Volume 1, dated November 14, 2008.
    9. FDA-2008-N-0474-0009, Volume 3, Study no. 3667-109/309, Study 
no. 1.CG.03.SRE.12160.
    10. FDA-2008-N-0474-0009, Volume 3, Study no. 4222-109/310, 
Study no. 1.CG.03.SRE.12156.
    11. FDA-2008-N-0474-0009, Volume 3, Study no. 1.CG.03.SRE.12158, 
Study no. 1.CG.03.SRE.12157.
    12. FDA-2008-N-0474-0009, Volume 3, Study no. 712332, Volume 4, 
Study no. 712320.
    13. FDA-2008-N-0474-0010, Volume 4, Study no. 802410, Study no. 
3697-109/313.
    14. FDA-2008-N-0474-0010, Volume 4, Study no. 1.CG.03.SRE.12163, 
Study no. 1.CG.03.SRE.12164.
    15. FDA-2008-N-0474-0010, Volume 4, Study no. RDA.03.SRE.12268.
    16. FDA-2008-N-0474-0009, Volume 3, Study no. 93/LOL/007/0971.
    17. FDA-2008-N-0474-0009, Volume 3, Study no. 1.CG.03.SRE.12183.
    18. FDA-2008-N-0474-0011, Volume 5, Study no. G185-109/314.
    19. FDA-2008-N-0474-0011, Volume 5, Study no. G220-109/381, 
Study no. G220-109/381A, Study no. 12174MIC, Study no. 413/52-D6172.
    20. FDA-2008-N-0474-0011, Volume 5, Study no. 12639MAR.
    21. FDA-2008-N-0474-0011, Volume 5, Study no. EU1REBRP.031.
    22. FDA-2008-N-0474-0011, Volume 5, Study no. LRL 170/921503.
    23. FDA-2008-N-0474-0011, Volume 5, Study no. ICHUREBRP.031.
    24. FDA-2008-N-0474-0010, Volume 4, Study no. 1.CG.03.SRE.12181.
    25. FDA-2008-N-0474-0011, Volume 5, Study no. 1.CG.03.SRE.12182.
    26. FDA-2008-N-0474-0011, Volume 5, Study no. 10297 RSL.
    27. FDA-2008-N-0474-0010, Volume 4, Study no. 1412 RMR/064.89.
    28. FDA-2008-N-0474-0011, Volume 5, RCC Project 682874.
    29. FDA-2008-N-0474-0010, Volume 4, Study no. 95/LOL/008/1217, 
Study no. LOL/011/980150.
    30. FDA-2008-N-0474-0010, Volume 4, Study no. C-1012-001, Study 
no. RDS.03.SRE.12215.
    31. FDA-2008-N-0474-0009, Volume 3, Study no. 10225PAR, Study 
no. 1.CG.03.SRE.12269/RDS.03.SRE.12269.
    32. FDA-2008-N-0474-0009, Volume 3, Study no. 10507 PAS, Study 
no. RDS.03.SRE 12268, Study no. RDS.03.SRE.12269/1.CG.03.SRE.12269.
    33. FDA-2008-N-0474-0009, Volume 3, Study no. 2.CG.03.SRE.11029.
    34. FDA-2008-N-0474-0009, Volume 3, Study no. 1.CG.03.SRE.12270.
    35. FDA-2008-N-0474-0011, Volume 5, Study no. G185-109/314.
    36. FDA-2008-N-0474-0011, Volume 5, Study no. G220-109/381.
    37. FDA-2008-N-0474-0011, Volume 5, Study no. G220-109/381A.
    38. FDA-2008-N-0474-0011, Volume 5, Study no. 12174MIC.
    39. FDA-2008-N-0474-0011, Volume 5, Study no. 413/52-D6172.
    40. FDA-2008-N-0474-0011, Volume 5, Study no. 12639MAR.
    41. FDA-2008-N-0474-0011, Volume 5, Study no. EU1REBRP.031.
    42. FDA-2008-N-0474-0011, Volume 5, Study no. LRL 170/921503.
    43. FDA-2008-N-0474-0011, Volume 5, Study no. ICHUREBRP.031.

[[Page 10043]]

    44. FDA-2008-N-0474-0010, Volume 4, Study no. 95/LOL/008/1217.
    45. FDA-2008-N-0474-0010, Volume 4, Study no. LOL/011/980150.
    46. FDA-2008-N-0474-0010, Volume 4, Study no. C-1012-001.
    47. FDA-2008-N-0474-0010, Volume 4, Study no. RDS.03.SRE.12215.
    48. FDA-2008-N-0474-1000, Volume 4, Study no. 1.CG.03.SRE.12181.
    49. FDA-2008-N-0474-0011, Volume 5, Study no. 1.CG.03.SRE.12182, 
Study no. 1412 RMR/064.89.
    50. FDA-2008-N-0474-0011, Volume 5, RCC Project 682874.
    51. FDA-2008-N-0474-0011, Volume 5, RCC Project 682874.
    52. FDA-2008-N-0474-0011, Volume 5, Study no. 1.CG.03.SRE.12182.
    53. FDA-2008-N-0474-0009, Volume 3, Study no. 10225PAR.
    54. FDA-2008-N-0474-0009, Volume 3, Study no. 1.CG.03.SRE.12269/
RDS.03.SRE.12269.
    55. FDA-2008-N-0474-0017, Volume 11, Study no. PEN.810.02.
    56. FDA-2008-N-0474-0017, Volume 11, Study no. PEN.810.06.

IX. References

    The following references have been placed on display in the 
Division of Dockets Management (see ADDRESSES) and may be seen by 
interested persons between 9 a.m. and 4 p.m., Monday through Friday, 
and are available electronically at http://www.regulations.gov. (FDA 
has verified the Web site addresses in this reference section, but FDA 
is not responsible for any subsequent changes to the Web sites after 
this document publishes in the Federal Register.)

    1. FDA, Guidance for Industry, ``Photosafety Testing,'' May 2003 
(available at http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm079252.pdf).
    2. Leonard, F., B. Kalis, H. Adamski, et al., ``The New Standard 
Battery of Photopatch Test in France.'' Nouvelles Dermatologiques, 
vol. 15, pp. 343-348, 1996.
    3. Schauder, S., and H. Ippen, ``Contact and Photocontact 
Sensitivity to Sunscreens. Review of a 15-Year Experience and of the 
Literature.'' Contact Dermatitis, vol. 37(5), pp. 221-232, 1997.
    4. Schmidt, T., J. Ring, and D. Abeck, ``Photoallergic Contact 
Dermatitis Due to Combined UVB (4-Methylbenzylidene Camphor/Octyl 
Methoxycinnamate) and UVA (Benzophenone-3/Butyl 
Methoxydibenzoylmethane) Absorber Sensitization.'' Dermatology, vol. 
196(3), pp. 354-357, 1998.
    5. FDA, Guidance for Industry, ``Guideline for the Format and 
Content of the Human Pharmacokinetics and Bioavailability Section of 
an Application,'' February 1987 (available at http://www.fda.gov/downloads/drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm072112.pdf).
    6. International Conference on Harmonization (ICH), Guidance for 
Industry, ``The Need for Long-Term Rodent Carcinogenicity Studies of 
Pharmaceuticals S1A,'' March 1996 (available at http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidance/UCM074911.pdf).
    7. ICH, Guidance for Industry, ``S1B Testing for Carcinogenicity 
of Pharmaceuticals,'' July 1997 (available at http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM074916.pdf).
    8. ICH, ``S1C(R2) Dose Selection for Carcinogenicity Studies'' 
(Revision 1), September 2008 (available at http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM074919.pdf).
    9. ICH Harmonized Tripartite Guideline for Industry, ``Detection 
of Toxicity to Reproduction for Medicinal Products & Toxicity to 
Male Fertility S5(R2),'' 2005 (available at http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Safety/S5_R2/Step4/S5_R2__Guideline.pdf).
    10. ICH, Guideline for Industry, ``Toxicokinetics: The 
Assessment of Systemic Exposure in Toxicity Studies S3A,'' March 
1995 (available at http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM074937.pdf).


    Dated: February 20, 2015.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2015-03883 Filed 2-24-15; 8:45 am]
BILLING CODE 4164-01-P



                                                                          Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules                                         10035

                                                      9. Ma, R., et al., ‘‘UV Filters With                         Endocrine Disrupters: Developmental              DEPARTMENT OF HEALTH AND
                                                           Antagonistic Action at Androgen                         Exposure of Rats to 4-Methylbenzylidene          HUMAN SERVICES
                                                           Receptors in the MDA–kb2 Cell                           Camphor.’’ Toxicology and Applied
                                                           Transcriptional-Activation Assay.’’                     Pharmacology, vol. 218(2), pp. 152–165,          Food and Drug Administration
                                                           Toxicological Sciences, vol. 74(1), pp.                 2007.
                                                           43–50, 2003.                                       22. Maerkel, K., et al., ‘‘Sex- and Region-
                                                      10. Mueller, S.O., et al., ‘‘Activation of                   Specific Alterations of Progesterone             21 CFR Part 310
                                                           Estrogen Receptor Alpha and ERbeta by                   Receptor mRNA Levels and Estrogen
                                                                                                                                                                    [Docket No. FDA–2008–N–0474]
                                                           4-Methylbenzylidene-Camphor in                          Sensitivity in Rat Brain Following
                                                           Human and Rat Cells: Comparison With                    Developmental Exposure to the
                                                                                                                   Estrogenic UV Filter 4-
                                                                                                                                                                    Over-the-Counter Sunscreen Drug
                                                           Phyto- and Xenoestrogens.’’ Toxicology
                                                           Letters, vol. 142(1–2), pp. 89–101, 2003.               Methylbenzylidene Camphor.’’                     Products—Regulatory Status of
                                                      11. Schlumpf, M., et al., ‘‘Estrogenic Activity              Environmental Toxicology and                     Ecamsule
                                                           and Estrogen Receptor Beta Binding of                   Pharmacology, vol. 19(3), pp. 761–765,
                                                                                                                   2005.                                            AGENCY:    Food and Drug Administration,
                                                           the UV Filter 3-Benzylidene Camphor.
                                                           Comparison With 4-Methylbenzylidene                23. Schlumpf, M., et al., ‘‘In Vitro and In           HHS.
                                                           Camphor.’’ Toxicology, vol. 199(2–3), pp.               Vivo Estrogenicity of UV Screens.’’                    Proposed order; request for
                                                                                                                                                                    ACTION:
                                                           109–120, 2004.                                          Environmental Health Perspectives, vol.          comments.
                                                      12. Schmutzler, C., et al., ‘‘Endocrine                      109(3), pp. 239–244, 2001. Erratum in:
                                                           Disruptors and the Thyroid Gland—A                      Environmental Health Perspectives, vol.          SUMMARY:   The Food and Drug
                                                           Combined In Vitro and In Vivo Analysis                  109(11), p. A517, 2001.                          Administration (FDA or the Agency) is
                                                           of Potential New Biomarkers.’’                     24. Schlumpf, M., et al., ‘‘Estrogenic Activity
                                                                                                                                                                    issuing a proposed sunscreen order
                                                           Environmental Health Perspectives, vol.                 and Estrogen Receptor Beta Binding of
                                                                                                                   the UV Filter 3-Benzylidene Camphor.             (proposed order) under the Federal
                                                           115 (Supplement 1), pp. 77–83, 2007.
                                                                                                                   Comparison With 4-Methylbenzylidene              Food, Drug, and Cosmetic Act (the
                                                      13. Schreurs, R., et al., ‘‘Estrogenic Activity
                                                           of UV Filters Determined by an In Vitro                 Camphor.’’ Toxicology, vol. 199(2–3), pp.        FD&C Act), as amended by the
                                                           Reporter Gene Assay and an In Vivo                      109–120, 2004.                                   Sunscreen Innovation Act (SIA). The
                                                           Transgenic Zebrafish Assay.’’ Archives of          25. Schlumpf, M., et al. ‘‘Endocrine Activity         proposed order announces FDA’s
                                                           Toxicology, vol. 76, pp. 257–261, 2002.                 and Developmental Toxicity of Cosmetic           tentative determination that ecamsule
                                                      14. Seidlová-Wuttke, D., et al., ‘‘Comparison               UV Filters—An Update.’’ Toxicology,              (also known as terephthalylidene
                                                           of Effects of Estradiol With Those of                   vol. 205(1–2), pp. 113–122, 2004.
                                                                                                              26. International Conference on                       dicamphor sulfonic acid) at
                                                           Octylmethoxycinnamate and 4-                                                                             concentrations up to 10 percent is not
                                                                                                                   Harmonization (ICH), Guidance for
                                                           Methylbenzylidene Camphor on Fat                                                                         generally recognized as safe and
                                                                                                                   Industry, ‘‘The Need for Long Term
                                                           Tissue, Lipids and Pituitary Hormones.’’
                                                                                                                   Rodent Carcinogenicity Studies of                effective (GRASE) and is misbranded
                                                           Toxicology and Applied Pharmacology,
                                                                                                                   Pharmaceuticals S1A,’’ March 1996                when used in over-the-counter (OTC)
                                                           vol. 214(1), pp. 1–7, 2006.                             (available at http://www.fda.gov/
                                                      15. S<eborg, T., et al., ‘‘Risk Assessment of                                                                 sunscreen products because the
                                                                                                                   downloads/Drugs/GuidanceCompliance               currently available data are insufficient
                                                           Topically Applied Products.’’                           RegulatoryInformation/Guidance/
                                                           Toxicology, vol. 236(1–2), pp. 140–148,                 UCM074911.pdf).
                                                                                                                                                                    to classify it as GRASE and not
                                                           2007.                                              27. ICH, Guidance for Industry, ‘‘S1B Testing         misbranded, and additional information
                                                      16. Tinwell, H., et al., ‘‘Confirmation of                   for Carcinogenicity of Pharmaceuticals,’’        is needed to allow us to determine
                                                           Uterotrophic Activity of 3-(4-                          July 1997 (available at http://                  otherwise.
                                                           Methylbenzylidine) Camphor in the                       www.fda.gov/downloads/Drugs/
                                                           Immature Rat.’’ Environmental Health                    GuidanceComplianceRegulatory
                                                                                                                                                                    DATES: Submit either electronic or
                                                           Perspectives, vol. 110(5), pp. 533–536,                 Information/Guidances/                           written comments on this proposed
                                                           2002.                                                   UCM074916.pdf).                                  order by April 13, 2015. Sponsors may
                                                      17. Durrer, S., et al., ‘‘Estrogen Sensitivity of       28. ICH, ‘‘S1C(R2) Dose Selection for                 submit written requests for a meeting
                                                           Target Genes and Expression of Nuclear                  Carcinogenicity Studies of                       with FDA to discuss this proposed order
                                                           Receptor Co-Regulators in Rat Prostate                  Pharmaceuticals SIC(R2)’’ (Revision 1),          by March 27, 2015. See section VI for
                                                           After Pre- and Postnatal Exposure to the                September 2008 (available at http://             the proposed effective date of a final
                                                           Ultraviolet Filter 4-Methylbenzylidene                  www.fda.gov/downloads/Drugs/
                                                           Camphor.’’ Environmental Health                                                                          order based on this proposed order.
                                                                                                                   GuidanceComplianceRegulatory
                                                           Perspectives, vol. 115 (Supplement 1),                  Information/Guidances/                           ADDRESSES: You may submit comments
                                                           pp. 42–50, 2007.                                        UCM074919.pdf).                                  by any of the following methods:
                                                      18. Durrer, S., et al., ‘‘Estrogen Target Gene          29. ICH Harmonized Tripartite Guideline for
                                                           Regulation and Coactivator Expression in                Industry, ‘‘Detection of Toxicity to             Electronic Submissions
                                                           Rat Uterus After Developmental                          Reproduction for Medicinal Products &              Submit electronic comments in the
                                                           Exposure to the Ultraviolet Filter 4-                   Toxicity to Male Fertility S5(R2),’’ 2005        following way:
                                                           Methylbenzylidene Camphor.’’                            (available at http://www.ich.org/
                                                                                                                   fileadmin/Public_Web_Site/ICH_                     • Federal eRulemaking Portal: http://
                                                           Endocrinology, vol. 146(5), pp. 2130–
                                                           2139, 2005.                                             Products/Guidelines/Safety/S5_R2/                www.regulations.gov. Follow the
                                                      19. Faass, O., et al., ‘‘Female Sexual                       Step4/S5_R2__Guideline.pdf).                     instructions for submitting comments.
                                                           Behavior, Estrous Cycle and Gene                   30. ICH, Guideline for Industry,
                                                                                                                   ‘‘Toxicokinetics: The Assessment of
                                                                                                                                                                    Written Submissions
                                                           Expression in Sexually Dimorphic Brain
                                                           Regions After Pre- and Postnatal                        Systemic Exposure in Toxicity Studies              Submit written submissions in the
                                                           Exposure to Endocrine Active UV                         S3A,’’ March 1995 (available at http://          following ways:
wreier-aviles on DSK5TPTVN1PROD with PROPOSALS




                                                           Filters.’’ Neurotoxicology, vol. 30(2), pp.             www.fda.gov/downloads/Drugs/                       • Mail/Hand delivery/Courier (for
                                                           249–260, 2009.                                          GuidanceComplianceRegulatory
                                                                                                                   Information/Guidances/
                                                                                                                                                                    paper submissions): Division of Dockets
                                                      20. Hofkamp, L., et al., ‘‘Region-Specific                                                                    Management (HFA–305), Food and Drug
                                                           Growth Effects in the Developing Rat                    UCM074937.pdf).
                                                                                                                                                                    Administration, 5630 Fishers Lane, rm.
                                                           Prostate Following Fetal Exposure to                 Dated: February 20, 2015.
                                                           Estrogenic Ultraviolet Filters.’’                                                                        1061, Rockville, MD 20852.
                                                                                                              Leslie Kux,                                             Instructions: All submissions received
                                                           Environmental Health Perspectives, vol.
                                                           116(7), pp. 867–872, 2008.                         Associate Commissioner for Policy.                    must clearly identify the specific active
                                                      21. Maerkel, K., et al., ‘‘Sexually Dimorphic           [FR Doc. 2015–03884 Filed 2–24–15; 8:45 am]           ingredient (ecamsule) and the Docket
                                                           Gene Regulation in Brain as a Target for           BILLING CODE 4164–01–P                                No. FDA–2008–N–1474 for this


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                                                      10036                Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules

                                                      rulemaking. All comments received may                    OTC sunscreen active ingredient                      discussed in this proposed order
                                                      be posted without change to http://                      (ecamsule), the remainder of this                    address procedures applicable to other
                                                      www.regulations.gov, including any                       discussion will refer only to ‘‘active               pending and future sunscreen active
                                                      personal information provided. For                       ingredients.’’                                       ingredient GRASE determinations,
                                                      additional information on submitting                        Critical steps in a proceeding under              pending and future GRASE
                                                      comments, see the ‘‘Comments’’ heading                   the TEA regulation include the                       determinations for OTC products other
                                                      of the SUPPLEMENTARY INFORMATION                         following: (1) FDA’s determination that              than sunscreens, issuance of specified
                                                      section of this document.                                an active ingredient had been marketed               guidances and reports, and completion
                                                         Docket: For access to the docket to                   for the proposed OTC use for a material              of pending sunscreen rulemakings,
                                                      read background documents or                             time and to a material extent (eligibility           among others.
                                                      comments received, go to http://                         determination), and public call for                     A proposed sunscreen order under the
                                                      www.regulations.gov and insert the                       submission of safety and efficacy data,              SIA is an order containing FDA’s
                                                      docket numbers, found in brackets in                     followed by; (2) review of safety and                tentative determination proposing that a
                                                      the heading of this document, into the                   efficacy data submitted by the sponsor               nonprescription sunscreen active
                                                      ‘‘Search’’ box and follow the prompts                    or other interested parties; and (3)                 ingredient or combination of
                                                      and/or go to the Division of Dockets                     FDA’s initial determination that the data            ingredients: (1) Is GRASE and is not
                                                      Management, 5630 Fishers Lane, Rm.                       show the active ingredient to be either              misbranded when marketed in
                                                      1061, Rockville, MD 20852.                               GRASE or not GRASE for OTC use                       accordance with the proposed order; (2)
                                                         Submit requests for a meeting with                    under the applicable monograph                       is not GRASE and is misbranded; or (3)
                                                      FDA to discuss this proposed order to                    conditions (including any new                        is not GRASE and is misbranded
                                                      Kristen Hardin (see FOR FURTHER                          conditions rising from FDA’s review)                 because the data are insufficient to
                                                      INFORMATION CONTACT).                                    (GRASE determination). Under the TEA                 classify the active ingredient or
                                                      FOR FURTHER INFORMATION CONTACT:                         regulation, FDA’s GRASE                              combination of ingredients as GRASE
                                                      Kristen Hardin, Division of                              determinations are effectuated through               and not misbranded, and additional
                                                      Nonprescription Drug Products, Center                    notice and comment rulemaking to                     information is necessary to allow FDA
                                                      for Drug Evaluation and Research, Food                   amend or establish the appropriate                   to determine otherwise (section 586(7)
                                                      and Drug Administration, 10903 New                       monograph.                                           of the FD&C Act, as amended by the
                                                      Hampshire Ave., Bldg. 22, Rm. 5491,                         The TEA process in FDA regulations                SIA). Publication of a proposed
                                                      Silver Spring, MD 20993–0002, 240–                       was supplemented by Congress’s                       sunscreen order triggers several
                                                      402–4246.                                                enactment of the SIA. Among other                    timelines under the SIA, including a 45-
                                                      SUPPLEMENTARY INFORMATION:                               amendments it makes to the FD&C Act,                 day public comment period, and a 30-
                                                                                                               the SIA creates new procedures                       day period in which a sponsor may
                                                      I. Regulatory Background                                 specifically for reviewing the safety and            request a meeting with FDA to discuss
                                                      A. Regulatory and Statutory Framework                    effectiveness of nonprescription                     the proposed order.
                                                                                                               sunscreen active ingredients, including
                                                        The data and information addressed                     those, such as ecamsule, that were the               B. FDA’s Review of Ecamsule
                                                      in this proposed order were originally                   subject of pending TEA proceedings at                   L’Oreal asked FDA to include
                                                      submitted for review under FDA’s Time                    the time the SIA was enacted. Like the               ecamsule in concentrations up to 10
                                                      and Extent Application (TEA)                             TEA regulation, the SIA calls for an                 percent as an active ingredient in the
                                                      regulation, § 330.14 (21 CFR 330.14), a                  initial eligibility determination phase              OTC sunscreen monograph in a TEA
                                                      process that has since been                              for nonprescription sunscreen active                 submitted September 19, 2007. FDA
                                                      supplemented with new statutory                          ingredients, followed by submissions of              announced on September 12, 2008, that
                                                      procedures established in the SIA (Pub.                  safety and efficacy data and a GRASE                 ecamsule had been found eligible in
                                                      L. 113–195), enacted November 26,                        determination phase. However, the SIA                concentrations up to 10 percent to be
                                                      2014. The discussion that follows                        requires FDA to make proposed and                    considered for inclusion in the OTC
                                                      briefly describes and compares the TEA                   final GRASE determinations for                       sunscreen monograph (21 CFR part 352,
                                                      and SIA processes as they apply to the                   nonprescription sunscreen active                     currently stayed), and requested
                                                      regulatory status of ecamsule.                           ingredients in the form of administrative            submissions of safety and effectiveness
                                                        The TEA regulation established a                                                                            data to support a GRASE determination
                                                                                                               orders rather than the multistep public
                                                      process through which a sponsor could                                                                         for the requested OTC use (73 FR
                                                                                                               rulemaking required by the TEA
                                                      request that an active ingredient or other                                                                    53029). L’Oreal submitted safety and
                                                                                                               regulation, and establishes strict
                                                      OTC condition,1 particularly one not                                                                          efficacy data on ecamsule to the
                                                                                                               timelines for the necessary
                                                      previously marketed in the United                                                                             designated docket (FDA–2008–N–0474)
                                                                                                               administrative actions.
                                                      States, be added to an OTC drug                             Among other requirements, no later                on November 14, 2008 (ecamsule data
                                                      monograph to enable compliant OTC                        than 90 days after the SIA was enacted               submission). At the time the SIA was
                                                      drug products containing the condition                   (i.e., no later than February 24, 2015),             enacted, FDA had not issued a TEA
                                                      to be marketed in the United States                      FDA must publish a proposed sunscreen                feedback letter or otherwise responded
                                                      without an approved new drug                             order in the Federal Register for any                to that submission.
                                                      application (NDA) or abbreviated new                     nonprescription sunscreen active                        In accordance with new section
                                                      drug application (ANDA). Because this                    ingredient, including ecamsule, for                  586C(b)(4) of the FD&C Act as amended
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                                                      proposed order specifically addresses an                 which, on the date of enactment, an                  by the SIA, we are issuing this notice as
                                                         1 For purposes of OTC drug regulation, a
                                                                                                               eligibility determination had been                   a proposed order for ecamsule. Based on
                                                      ‘‘condition’’ is defined as an active ingredient or
                                                                                                               issued under the TEA regulation and                  our review of the ecamsule data
                                                      botanical drug substance (or a combination of active     submissions of safety and efficacy data              submission, we have made a tentative
                                                      ingredients or botanical drug substances), dosage        received, and for which a TEA feedback               determination that ecamsule is not
                                                      form, dosage strength, or route of administration        letter had not yet been issued (section              GRASE for OTC sunscreen use and is
                                                      marketed for a specific OTC use, with specific
                                                      exclusions (see § 330.14(a)(2)). This document will
                                                                                                               586C(b)(4) of the FD&C Act (21 U.S.C.                misbranded because the data are
                                                      refer simply to new ‘‘active ingredients,’’ since that   360fff-3(b)(4)), as amended by the SIA).             insufficient to classify it as GRASE and
                                                      is the condition under consideration.                    Other provisions of the SIA that are not             not misbranded, and additional


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                                                                          Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules                                          10037

                                                      information is necessary to allow us to                 assessing what specific testing or other              evaluation of topical drug products that,
                                                      determine otherwise. The remainder of                   data are needed to adequately                         like ecamsule-containing sunscreens,
                                                      this proposed sunscreen order describes                 demonstrate the safety of ecamsule for                are applied to the skin repeatedly over
                                                      our review of safety and efficacy data,                 use in sunscreen, FDA considers the                   long periods of time. FDA recommends
                                                      identifies additional data needed to                    circumstances under which OTC                         separate studies for skin irritation and
                                                      demonstrate that ecamsule is GRASE for                  sunscreen products that could contain                 sensitization. Skin irritation studies
                                                      the requested use, and explains our                     ecamsule would be used by consumers.                  should generally include at least 30
                                                      rationale for specific conclusions and                     When used as directed with other sun               evaluable subjects and should evaluate
                                                      data requirements.                                      protection measures, broad spectrum                   the test formulation (i.e., ecamsule in an
                                                        This proposed order will be open for                  OTC sunscreen products with a sun                     appropriate test vehicle), the vehicle
                                                      public comment (see DATES). The                         protection factor (SPF) value of 15 or                alone, and both negative and positive
                                                      sponsor may request a meeting with                      higher strongly benefit the public health             controls. Skin sensitization studies
                                                      FDA to discuss this proposed order (see                 by decreasing the risk of skin cancer and             generally should include at least 200
                                                      DATES). We also invite the sponsor to                   premature skin aging associated with                  subjects and should evaluate the test
                                                      submit additional safety and/or efficacy                solar ultraviolet (UV) radiation, as well             formulation containing ecamsule, the
                                                      data to inform our further consideration,               as by helping to prevent sunburn.                     vehicle, and a negative control. For both
                                                      as publication of a final sunscreen order               (Sunscreens with lower SPF values, or                 irritation and sensitization studies, test
                                                      for ecamsule under the SIA will be                      without broad spectrum protection, also               site applications should be randomized
                                                      contingent on receipt of such                           help prevent sunburn.) When used as                   and the test observer blinded to the
                                                      information. (See section 586C(b)(9)(ii)                directed by the required labeling, all                identities of the test formulations.
                                                      of the FD&C Act.) We specifically                       OTC sunscreen products are applied                       FDA recommends that photosafety
                                                      encourage the sponsor to discuss any                    liberally to the skin and reapplied                   evaluation generally involve studies of
                                                      proposed study protocols with us before                 frequently throughout the day                         skin photoirritation (phototoxicity) and
                                                      performing the studies.                                 (§ 201.327(e) (21 CFR 201.327(e))).                   skin photosensitization
                                                                                                              Because the effects of UV exposure are                (photoallergenicity). General principles
                                                      II. Safety Data Considerations for OTC
                                                                                                              cumulative, to obtain the maximum                     for designing and conducting
                                                      Sunscreen Products Containing
                                                                                                              benefit, users of broad spectrum                      photosafety studies are described in
                                                      Ecamsule
                                                                                                              sunscreens with an SPF value of 15 or                 FDA guidance (Ref. 1). Photosafety
                                                         In evaluating the safety of a proposed               higher are directed to use such products              studies, like sensitization and irritation
                                                      monograph active ingredient, FDA                                                                              studies, should be conducted using
                                                                                                              regularly—on a routine basis (id.). Given
                                                      applies the following regulatory                                                                              ecamsule 10 percent in an appropriate
                                                                                                              these conditions of use, our safety
                                                      standard: Safety means a low incidence                                                                        test vehicle, the vehicle alone, and a
                                                                                                              evaluation of an OTC sunscreen active
                                                      of adverse reactions or significant side                                                                      negative control. In addition,
                                                                                                              ingredient such as ecamsule must
                                                      effects under adequate directions for use                                                                     phototoxicity studies should include at
                                                                                                              consider both short-term safety concerns
                                                      and warnings against unsafe use as well                                                                       least 30 evaluable subjects and
                                                                                                              (such as skin sensitization/irritation and
                                                      as low potential for harm which may                                                                           photoallerginicity studies should
                                                                                                              photosafety) and potential concerns
                                                      result from abuse under conditions of                                                                         include at least 45 evaluable subjects.
                                                                                                              related to long-term sunscreen use,
                                                      widespread availability. Proof of safety
                                                                                                              including potential systemic exposure                 Data Available for Ecamsule: Human
                                                      shall consist of adequate tests by
                                                      methods reasonably applicable to show                   via dermal absorption.                                Irritation, Sensitization, and Photosafety
                                                                                                                 The purpose of the safety testing                  Studies
                                                      the drug is safe under the prescribed,
                                                                                                              described in this section II is to
                                                      recommended, or suggested conditions                                                                             We received information regarding 26
                                                                                                              establish whether an OTC sunscreen
                                                      of use. This proof shall include results                                                                      non-U.S. human dermal safety studies
                                                                                                              product containing ecamsule and
                                                      of significant human experience during                                                                        evaluating formulations containing up
                                                                                                              otherwise marketed under the
                                                      marketing. General recognition of safety                                                                      to approximately 4 percent ecamsule
                                                                                                              conditions described in a final                       with one or more other additional active
                                                      shall ordinarily be based upon
                                                      published studies which may be                          sunscreen order and in accordance with                ingredients (Note 1). These studies
                                                      corroborated by unpublished studies                     all requirements applicable to                        exposed a total of approximately 1,500
                                                      and other data (§ 330.10(a)(4)(i) (21 CFR               nonprescription drugs would be GRAS                   adults to formulations containing
                                                      330.10(a)(4)(i))).                                      for use as labeled. To demonstrate that               ecamsule. Reports of 21 of these studies
                                                         FDA’s OTC drug regulations generally                 these requirements are met for                        were complete: 2 of these studies
                                                      identify the types of information that                  ecamsule, initial safety testing should be            assessed primary cutaneous irritation, 7
                                                      may be submitted as evidence that an                    performed using ecamsule as the sole                  assessed cumulative irritation and
                                                      active ingredient or other OTC drug                     active ingredient up to the highest                   sensitization potential, 9 assessed
                                                      condition is safe, as part of the                       concentration for which marketing                     phototoxicity potential, and 3 assessed
                                                      consideration of whether an active                      status is sought and eligibility has been             photosensitizing potential. However, the
                                                      ingredient or other condition is GRASE                  established: 10 percent. If initial testing           information provided in the 21
                                                      (§ 330.10(a)(2)). For convenience, this                 suggests a particular safety concern                  complete study reports does not meet
                                                      order uses the term ‘‘generally                         associated with ecamsule (e.g., a                     FDA’s current standards to support the
                                                      recognized as safe (GRAS)’’ to refer to                 hormonal activity), FDA may request                   human dermal safety of ecamsule at any
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                                                      that aspect of the GRASE determination.                 additional studies to address that                    concentration. All of these studies
                                                      To apply the general OTC safety                         concern.                                              assessed formulations containing more
                                                      standard to each potential new                          A. Human Safety Data                                  than one active ingredient and therefore
                                                      condition, FDA uses its scientific                                                                            provide only limited insight into the
                                                      expertise to determine what constitutes                 1. Human Irritation, Sensitization, and               safety of ecamsule. Furthermore, the
                                                      ‘‘adequate tests by methods reasonably                  Photosafety Studies                                   formulations used in these studies
                                                      applicable to show the drug is safe                        Studies of skin irritation,                        included ecamsule only in
                                                      under the prescribed, recommended, or                   sensitization, and photosafety are                    concentrations of between 0.33 percent
                                                      suggested conditions of use.’’ In                       standard elements in the safety                       and 3.96 percent, and therefore would


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                                                      10038               Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules

                                                      not support a determination that                        by FDA did not identify additional                    percent in various vehicles, including
                                                      ecamsule is GRAS at concentrations                      publications regarding the human                      vehicles that would be expected to
                                                      between 3.96 percent and 10.0 percent                   dermal safety of ecamsule in                          enhance absorption. We encourage
                                                      as found eligible for review and                        concentrations up to 10 percent for use               study sponsors to consult with us before
                                                      requested for GRASE evaluation by                       as an OTC sunscreen.                                  conducting pharmacokinetic studies,
                                                      L’Oreal. Other deficiencies noted                          FDA concludes that the data                        because the properties of ecamsule bear
                                                      included:                                               submitted are not sufficient to assess the            on the optimal design.
                                                         • Failure to provide individual skin                 dermal safety of ecamsule in
                                                      reaction scores to negative controls in                 concentrations up to 10 percent and                   Data Available for Ecamsule: Human
                                                      all studies.                                            specifically its potential to cause                   Dermal Pharmacokinetic
                                                         • Failure to enroll a sufficient number              irritation, sensitization, photoirritation,           (Bioavailability) Studies
                                                      of subjects in the sensitization,                       or photoallergenicity. Submission of                    Human dermal pharmacokinetic
                                                      phototoxicity, and photoallergenicity                   data from human irritation,                           studies for ecamsule were submitted in
                                                      studies.                                                sensitization, and photosafety studies                response to our call for data. We
                                                         • Although the cumulative irritation                 that meet FDA standards (see section                  reviewed one in vitro study that
                                                      studies enrolled an adequate number of                  II.A.1) is recommended to demonstrate                 evaluated the potential for dermal
                                                      evaluable subjects, there was a failure to              that an OTC sunscreen product                         penetration of topically applied
                                                      indicate whether positive controls were                 containing up to 10 percent ecamsule is               ecamsule from human skin samples
                                                      used, and only three study reports                      not an irritant, sensitizer,                          (Note 4). Because this study was not
                                                      indicated a negative control was used.                  photosensitizer, or photoirritant.                    designed to detect or quantify ecamsule
                                                         • Failure to indicate whether or not                                                                       in the blood or other body fluids, it
                                                      investigators in the primary cutaneous                  2. Human Dermal Pharmacokinetic                       provides no useful information about
                                                      irritation, phototoxicity, and                          (Bioavailability) Studies                             systemic exposure. One urinary
                                                      photoallergenicity studies were blinded                    Because sunscreens are topically                   excretion study conducted with a 4.95
                                                      to patch applications.                                  applied, another important safety                     percent ecamsule test formulation
                                                         • Failure to indicate whether the                    consideration for ecamsule for use in                 suggested minimal systemic absorption
                                                      phototoxicity and photoallergenicity                    sunscreens is whether dermal                          in seven male volunteers dosed over an
                                                      studies included vehicle controls.                      application may result in skin                        extensive body surface area for a total of
                                                         The ecamsule data submission also                    penetration and systemic exposure to                  5 days (Note 5). A study in which
                                                      included reports for 14 studies exposing                ecamsule, and if so, to what extent. A                radiolabeled 2 percent ecamsule was
                                                      a total of over 500 children primarily                  well-designed and -conducted human                    topically applied to the forearms of five
                                                      between 3 and 12 years of age to                        dermal pharmacokinetic study can be                   male volunteers and retained for 4 hours
                                                      sunscreen formulations containing                       expected to detect and quantify the                   detected a minimal level of radiation
                                                      ecamsule in concentrations of 1.5                       presence of ecamsule and/or any                       above background in urine after dosing
                                                      percent to 9 percent, with 1 or more                    metabolites in blood or other bodily                  but radiation levels above background
                                                      other additional active ingredients (Note               fluids that may have a bearing on safety,             were not detected in blood (Note 6).
                                                      2). Numerous dermatologic reactions                     using recognized parameters such as                   Although this study suggests that
                                                      were reported; however, none were                       bioavailability percentage, maximum                   ecamsule is minimally absorbed
                                                      considered serious.                                     plasma concentration (Cmax), time to                  following dermal application, the study
                                                         Three human safety-related literature                maximum plasma concentration (Tmax),                  formulation contained ecamsule at a
                                                      citations listed in the submission were                 total area under the plasma                           concentration much lower than the
                                                      limited to studies describing                           concentration versus time curve (AUC),                requested 10 percent maximum and
                                                      photoallergic reactions to combination                  half-life, clearance, and volume of                   only a small number of subjects were
                                                      sunscreen products formulated both                      distribution. This information can help               dosed over a limited surface area. The
                                                      with and without ecamsule (Note 3).                     identify potential safety concerns and                last human dermal pharmacokinetic
                                                      One publication described a single case                 help determine whether an adequate                    study assessed the absorption of 3
                                                      of photoallergy to an ecamsule-                         safety margin for sunscreens containing               percent ecamsule from a formulation
                                                      containing sunscreen product (Ref. 2). A                ecamsule exists. FDA recommends that                  containing a total of four active
                                                      second publication was a review that                    the pharmacokinetic studies performed                 ingredients (Note 7). The formulation
                                                      summarized published and unpublished                    on ecamsule also collect additional                   was applied to an extensive body
                                                      data from a single center’s experience                  safety-related data from regularly                    surface area of six male subjects twice
                                                      with patch and photopatch testing in a                  scheduled physical examinations,                      daily for 8 days. Results showed that
                                                      consecutive series of 402 patients who                  collection of vital signs, and other                  there were quantifiable plasma
                                                      presented to a photobiology unit from                   measures, which may help capture                      concentrations of ecamsule at several
                                                      1981 to 1996 with suspected clinical                    adverse skin events or other potential                time points, suggesting that ecamsule is
                                                      photosensitivity (Ref. 3). The authors                  safety signals. To ensure that maximum                absorbed via dermal application. None
                                                      did not observe allergy or photoallergy                 penetration of ecamsule has taken place               of the submitted human dermal
                                                      to 1 percent ecamsule, but experience                   and chances of it being detected are                  pharmacokinetic studies assessed an
                                                      with ecamsule was limited in this study                 optimal, studies should continue until                adequate number of subjects, or tested
                                                      because it was included in the                          steady state is reached.                              ecamsule at the maximum requested
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                                                      sunscreen series beginning in 1995,                        General information and                            concentration of 10 percent.
                                                      towards the end of the 15-year study                    recommendations on the design and                       Our literature search found no
                                                      period. The third publication was a case                conduct of human pharmacokinetic                      additional publications regarding
                                                      report describing no photoallergy to an                 studies can be found in FDA guidance                  human pharmacokinetics of ecamsule.
                                                      ecamsule-containing combination                         (Ref. 5). To support a GRAS                           Accordingly, we request data from
                                                      sunscreen drug product in a 71-year-old                 determination for ecamsule (up to 10                  human pharmacokinetic studies to
                                                      male patient with persistent                            percent), such a study should be                      assess the potential for and the extent of
                                                      photocontact allergy to other UV filters                conducted under maximal use                           systemic absorption. These studies
                                                      (Ref. 4). A literature search conducted                 conditions using ecamsule up to 10                    should be performed under expected


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                                                                          Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules                                         10039

                                                      maximal use conditions with the                         information may not be available from                 ecamsule, were systemic exposure to
                                                      proposed maximum concentration, as                      all countries; where that is the case,                occur, is critical to determine whether
                                                      discussed previously in this section, in                please provide a written explanation for              and how regulatory parameters can be
                                                      a sufficiently large study population to                the lack of data. Overall, we seek                    defined to assure that all conforming
                                                      control for both gender and age.                        sufficient data to characterize                       ecamsule-containing sunscreens would
                                                      3. Human Safety Data To Establish                       ecamsule’s adverse event profile.2                    be GRASE as labeled.
                                                                                                                                                                      FDA recommends animal testing of
                                                      Adverse Event Profile                                   Ecamsule: Human Safety Data To
                                                                                                                                                                    the potential long-term dermal and
                                                         An evaluation of safety information                  Establish Adverse Event Profile
                                                                                                                                                                    systemic effects of exposure to ecamsule
                                                      from adverse event reports and other                       The submission describes the                       because these effects cannot be easily
                                                      safety-related information derived from                 marketing history of ecamsule and                     assessed from previous human use.
                                                      commercial marketing experience of                      provides eight case report forms (Form                Taken together, the carcinogenicity
                                                      sunscreen products containing                           FDA 3500A) that have been submitted                   studies, developmental and
                                                      ecamsule, as well as from other sources,                to FDA’s MedWatch program in                          reproductive toxicity studies, and
                                                      is a critical aspect of FDA’s safety                    association with marketed sunscreen                   toxicokinetic studies described in
                                                      review for ecamsule. The TEA                            products containing ecamsule in                       sections II.B.1 through II.B.3 should
                                                      regulation under which the original                     combination with other active                         provide the information needed to
                                                      request for ecamsule was submitted                      ingredients (Note 8). Our review of the               characterize both the potential dermal
                                                      specifically calls for submission of                    FDA Adverse Event Reporting System                    and systemic toxic effects and the levels
                                                      information on all serious adverse drug                 (FAERS) identified one additional case                of exposure at which they occur. These
                                                      experiences, as defined in 21 CFR                       report associated with such a sunscreen               data, when viewed in the context of
                                                      310.305(a) and 314.80(a), from each                     product. These case reports describe                  human exposure data, can be used to
                                                      country where the active ingredient or                  serious allergic reactions such as                    determine a margin of safety for use of
                                                      other condition has been or is currently                redness, swelling and urticaria,                      ecamsule in OTC sunscreens.
                                                      marketed as either a prescription or an                 breathing difficulties, and anaphylaxis.
                                                      OTC drug; in addition, it calls for                     The role, if any, of ecamsule in these                Data Available for Ecamsule:
                                                      submission of all data generally                        cases cannot be fully assessed due in                 Nonclinical (Animal) Studies Generally
                                                      specified in § 330.10(a)(2), which                      part to the presence of multiple active                 The ecamsule submission included
                                                      includes documented case reports and                    ingredients in the associated sunscreen               reports of the following types of
                                                      identification of expected or frequently                products. To support the evaluation of                nonclinical safety studies:
                                                      reported side effects (§ 330.14(f)(1) and               the safety of ecamsule for use in OTC                 • Single-dose toxicity studies
                                                      (f)(2)). To evaluate ecamsule, FDA                      sunscreens, we request that the sponsor                 Æ Oral toxicity (rat, mouse) (Note 9)
                                                      continues to seek individual adverse                    either supplement the information                       Æ Dermal toxicity (rat, mouse) (Note
                                                      drug experience reports, a summary of                   already submitted with adverse event or                   10)
                                                      all serious adverse drug experiences,                   other safety-related data derived from                  Æ Intravenous toxicity (rat, mouse)
                                                      and expected or frequently reported side                commercial marketing experience, or                       (Note 11)
                                                      effects of the condition (id.). To assist in            explain why such information cannot be                  Æ Mucosal and skin irritation (rabbit)
                                                      the Agency’s safety evaluation of                       provided.                                                 (Note 12)
                                                      ecamsule, FDA emphasizes its need for                                                                           Æ Skin irritation and sensitization
                                                      the following data:                                     B. Nonclinical (Animal) Studies
                                                                                                                                                                        (guinea pig) (Note 13)
                                                         • A summary of all available reported                  Another important element of FDA’s                    Æ Photoirritation and
                                                      adverse events potentially associated                   GRAS review of ecamsule for use in                        photosensitization (guinea pig)
                                                      with ecamsule;                                          sunscreens is an assessment of data                       (Note 14)
                                                         • All available documented case                      from nonclinical (animal) studies that                • Repeat-dose toxicity studies
                                                      reports of serious side effects;                        characterize the potential long-term                    Æ 4-week bridging dermal (mouse)
                                                         • Any available safety information                   dermal and systemic effects of exposure                   (Note 15)
                                                      from studies of the safety and                          to ecamsule. Even if the bioavailability                Æ 13-week dermal (mouse) (Note 16)
                                                      effectiveness of ecamsule in humans;                    data discussed in section II.A.2 suggest                Æ 9-month dermal (minipig) (Note 17)
                                                      and                                                     that dermal application is unlikely to                • Genotoxicity and mutagenicity assays
                                                         • Relevant medical literature                        result in skin penetration and systemic                 Æ Ames test (Salmonella
                                                      describing adverse events associated                    exposure to ecamsule, FDA still                           typhimurium, Escherichia coli)
                                                      with ecamsule. Submissions of adverse                   considers data on the effects of systemic                 (Note 18)
                                                      event data should also include a                        exposure to be an important aspect of                   Æ Chromosomal aberration assay
                                                      description of how each country’s                       our safety evaluation of ecamsule. A                      (Chinese hamster ovary (CHO cells))
                                                      system identifies and collects adverse                  determination that ecamsule up to 10                      (Note 19)
                                                      events, unless this information has been                percent is GRASE for use in sunscreens                  Æ Micronucleus test (rat) (Note 20)
                                                      previously submitted as part of                         would permit its use in as-yet-unknown                  Æ Photomutagenicity (E. coli) (Note
                                                      ecamsule’s TEA package.                                 product formulations, which might in                      21)
                                                         Although we recognize that adverse                                                                           Æ HPRT test (CHO cells) (Note 22)
                                                                                                              turn alter the skin penetration of the
                                                      event data from foreign marketing                                                                               Æ Photochromosomal aberration assay
                                                                                                              active ingredient. Therefore, an
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                                                      experience may reflect patterns of use                                                                            (CHO cells) (Note 23)
                                                                                                              understanding of the effects of
                                                      and regulatory reporting requirements                                                                         • Reproductive and developmental
                                                      that differ from those in the United                      2 See 67 FR 3060 at 3069 (January 23, 2002)           toxicity studies
                                                      States, we nonetheless consider such                    (agreeing that the absence of an adverse experience     Æ Fertility and early embryonic
                                                      information to be strongly relevant both                reporting system in a foreign country for drugs or        development, oral (rat) (Note 24)
                                                      to our overall GRASE assessment of                      cosmetics does not necessarily mean that a              Æ Pre/postnatal development, oral
                                                                                                              condition cannot be GRAS/E. The GRAS/E
                                                      ecamsule for use in sunscreens and to                   determination will be based on the overall quality
                                                                                                                                                                        (rat) (Note 25)
                                                      our consideration of potential product                  of the data and information presented to                Æ Embryotoxicity/teratogenicity,
                                                      labeling. FDA recognizes that such                      substantiate safety and effectiveness).                   dermal (rabbit) (Note 26)


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                                                      10040               Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules

                                                         Æ Embryofetal development/                           effects. For example, the effect of                   behavior) of offspring, which may also
                                                           teratogenicity, oral (rat) (Note 27)               persistent disruption of particular                   detect neuroendocrine effects.
                                                         Æ Embryofetal development/                           endocrine gland systems (e.g.,
                                                           teratogenicity, oral (rabbit) (Note                                                                      Data Available for Ecamsule: DART
                                                                                                              hypothalamic-pituitary-adrenal axis), if
                                                           28)                                                                                                      Studies
                                                                                                              any, can be captured by these assays.
                                                      • Carcinogenicity and                                                                                           We received study summaries for five
                                                         photocarcinogenicity                                 Data Available for Ecamsule:                          developmental and reproductive
                                                         Æ 104 weeks dermal carcinogenicity                   Genotoxicity Studies                                  toxicity assays (Notes 48 through 52),
                                                           (mouse) (Note 29)                                    The ecamsule submission included                    which appear to be negative for the
                                                         Æ 12 months photocarcinogenicity                     some information regarding genotoxicity               potential to cause adverse
                                                           (mouse) (Note 30)                                  studies. Based on the reviewable                      developmental or reproductive effects.
                                                      • Pharmacokinetics                                      genotoxicity data included in the                     However, comprehensive data sets were
                                                         Æ Pharmacokinetic study, oral (rat)                                                                        not provided.
                                                                                                              ecamsule data submission, ecamsule
                                                           (Note 31)                                                                                                  We request that the sponsor make
                                                         Æ Pharmacokinetic study, dermal                      appears to be negative for causing
                                                                                                              genotoxic activity under the conditions               available full final study reports,
                                                           (mouse, rat) (Note 32)                                                                                   including full comprehensive datasets,
                                                         Æ Microsome metabolism                               studied (Notes 35 through 43). As we
                                                                                                              believe that data from the recommended                to support a final GRASE determination.
                                                           (interspecies, in vitro) (Note 33)
                                                         Æ Excretion, oral and dermal (rat)                   systemic carcinogenicity and                          3. Toxicokinetics (Ref. 10)
                                                           (Note 34)                                          developmental and reproductive
                                                                                                                                                                       We recommend conducting animal
                                                         The submission includes summary                      toxicology (DART) studies will provide
                                                                                                                                                                    toxicokinetic studies because they
                                                      reports of nonclinical studies that are of              an adequate and appropriate measure of
                                                                                                                                                                    provide an important bridge between
                                                      the types FDA requests as a basis for                   potential long-term effects of systemic
                                                                                                                                                                    toxic levels seen in animal studies and
                                                      evaluating whether ecamsule is GRAS                     or dermal exposure to ecamsule, we do
                                                                                                                                                                    potential human exposure. Data from
                                                      for use in sunscreen (chronic toxicity,                 not request further genotoxicity studies.
                                                                                                                                                                    these studies can be correlated to
                                                      carcinogenicity, reproductive and                       Data Available for Ecamsule:                          potential human exposure via clinical
                                                      developmental toxicity, and                             Carcinogenicity Studies                               dermal pharmacokinetic study findings.
                                                      toxicokinetics). However, the                                                                                 Toxicokinetic data could be collected as
                                                      submission did not provide the full                        We have reviewed study summaries                   part of animal studies being conducted
                                                      reports and full comprehensive data sets                for four dermal carcinogenicity and                   to assess one or more of the safety
                                                      that would be needed for an adequate                    photocarcinogenicity studies, which                   parameters described previously.
                                                      review of the data for these studies.                   appear to be negative (Notes 44 through
                                                                                                              47). However, full final study reports                Data Available for Ecamsule:
                                                      Because the summary data provided can
                                                                                                              need to be made available to support a                Toxicokinetics
                                                      support only tentative conclusions
                                                      about these studies, full final study                   final GRASE determination. In addition,                 We reviewed single-dose
                                                      reports and data sets need to be made                   we did not receive any systemic                       pharmacokinetic studies conducted in
                                                      available to support a final GRASE                      carcinogenicity data, which are                       animal models which showed that
                                                      determination.                                          recommended to support the safety of                  systemic exposure was achieved under
                                                         Additional discussion of study                       long-term use of ecamsule. We request                 the conditions of the conducted studies
                                                      findings and data gaps are provided in                  that the sponsor provide a systemic                   (Notes 53 and 54). However, we did not
                                                      the following subsections.                              carcinogenicity study, as well as make                receive any pharmacokinetic data
                                                                                                              available full final study reports for the            reflecting drug levels following long-
                                                      1. Carcinogenicity Studies: Dermal and                  previously conducted carcinogenicity                  term exposure, which are usually
                                                      Systemic                                                studies that were submitted in a                      collected from repeat toxicity studies
                                                         FDA guidance recommends that                         summarized form.                                      such as chronic (systemic or dermal)
                                                      carcinogenicity studies be performed for                2. DART Studies (Ref. 9)                              studies. We recommend that a time
                                                      any pharmaceutical that is expected to                                                                        course toxicokinetic study be conducted
                                                      be clinically used continuously or                        FDA recommends conducting DART                      following repeat-dose exposure (via the
                                                      ‘‘repeatedly in an intermittent manner’’                studies to evaluate the potential effects             oral and dermal routes) to evaluate the
                                                      for a total of 6 months of exposure (Refs.              that exposure to ecamsule may have on                 steady-state exposure level of ecamsule.
                                                      6, 7, and 8). Because the proposed use                  developing offspring throughout                       Data obtained from this study could be
                                                      of ecamsule in OTC sunscreens falls                     gestation and postnatally until sexual                used to compare drug levels in animals
                                                      within this category, these studies                     maturation, as well as on the                         to those in humans under maximal
                                                      should be conducted to help establish                   reproductive competence of sexually                   exposure conditions to establish a
                                                      that ecamsule is GRAS for its proposed                  mature male and female animals.                       margin of safety for human exposure.
                                                      use. Carcinogenicity studies assist in                  Gestational and neonatal stages of
                                                      characterizing potential dermal and                     development may also be particularly                  III. Effectiveness Data Considerations
                                                      systemic risks by identifying the type of               sensitive to active ingredients with                  for OTC Sunscreen Products Containing
                                                      toxicity observed, the level of exposure                hormonal activity. For this reason, we                Ecamsule
                                                      at which toxicity occurs, and the highest               recommend that these studies include                     FDA’s evaluation of the effectiveness
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                                                      level of exposure at which no adverse                   assessments of endpoints such as                      of active ingredients under
                                                      effects occur (i.e., NOAEL). The NOAEL                  vaginal patency, preputial separation,                consideration for inclusion in an OTC
                                                      would then be used in determining the                   anogenital distance, and nipple                       drug monograph is governed by the
                                                      safety margin for human exposure to                     retention, which can be incorporated                  following regulatory standard:
                                                      sunscreens containing ecamsule.                         into traditional DART study designs to                Effectiveness means a reasonable
                                                         Systemic carcinogenicity studies can                 assess potential hormonal effects of                  expectation that, in a significant
                                                      also help to identify other systemic or                 ecamsule on the developing offspring.                 proportion of the target population, the
                                                      organ toxicities that may be associated                 We also recommend conducting                          pharmacological effect of the drug,
                                                      with ecamsule, such as hormonal                         behavioral assessments (e.g., mating                  when used under adequate directions


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                                                                          Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules                                           10041

                                                      for use and warnings against unsafe use,                arm should be another component of the                assesses the effectiveness of ecamsule at
                                                      will provide clinically significant relief              study design.                                         a concentration of 10 percent, it is
                                                      of the type claimed. Proof of efficacy                     Although current sunscreen testing                 recommended that such a study be
                                                      shall consist of controlled clinical                    and labeling regulations also specify a               conducted and submitted.
                                                      investigations as defined in 21 CFR                     ‘‘broad spectrum’’ testing procedure to
                                                                                                              support related labeling claims for                   IV. Summary of Current Data Gaps for
                                                      314.126(b). Investigations may be                                                                             Ecamsule
                                                      corroborated by partially controlled or                 certain OTC sunscreen products
                                                      uncontrolled studies, documented                        marketed without approved new drug                       Based on our review of the available
                                                      clinical studies by qualified experts, and              applications that contain specific                    safety and efficacy data as discussed
                                                      reports of significant human experience                 ingredients included in the OTC                       previously, we request the types of data
                                                      during marketing. Isolated case reports,                sunscreen monograph, those additional                 listed in this section of the proposed
                                                      random experience, and reports lacking                  claims are permitted, but not required,               order, at minimum, for us to reverse our
                                                      the details that permit scientific                      for these products (§ 201.327(c)(2) and               tentative determination that ecamsule is
                                                      evaluation will not be considered.                      (j)). Under current regulations,                      not GRASE and is misbranded because
                                                      General recognition of effectiveness                    sunscreen active ingredients need only                the data are insufficient to classify
                                                      shall ordinarily be based upon                          be effective for the labeled indication of            ecamsule as GRASE and not
                                                      published studies which may be                          sunburn prevention, for which the SPF                 misbranded, and additional data are
                                                      corroborated by unpublished studies                     test can provide sufficient evidence.                 necessary to allow us to determine
                                                      and other data (§ 330.10(a)(4)(ii)). For                Consistent with this approach, we here                otherwise. Note that, in some cases, as
                                                      convenience, this order uses the term                   do not request broad spectrum testing                 discussed in section II of this proposed
                                                      ‘‘generally recognized as effective’’                   for ecamsule. Broad spectrum protection               order, the ecamsule data submission
                                                      (GRAE) when referring to this aspect of                 is often, although not always, the result             provided some information from
                                                      the GRASE determination.                                of the combined contribution of                       nonclinical studies of the type FDA
                                                                                                              multiple active ingredients in a final                requests as part of the basis for a GRAS
                                                         To evaluate the efficacy of ecamsule                 sunscreen formulation. Thus, under the                determination, but only in summary
                                                      for use in OTC sunscreen products, FDA                  current regulations applicable to other               form. Were complete study data
                                                      requests evidence from at least two                     sunscreens, the determination of                      generally available from these
                                                      adequate and well-controlled SPF                        whether an individual sunscreen                       previously conducted studies, they
                                                      studies showing that ecamsule                           product may be labeled as broad                       might address several aspects of our
                                                      effectively prevents sunburn. To                        spectrum and bear the related additional              GRASE consideration. If data from these
                                                      determine that ecamsule is GRAE for                     claims is made on a product-specific                  previously conducted studies are not
                                                      use in OTC sunscreens at concentrations                 basis, applying standard testing                      made available, further studies of those
                                                      in a range with the proposed maximum                    methods set forth in those regulations.               types would be needed to support a
                                                      strength of 10 percent as requested, two                If ecamsule is established to be GRASE                finding that ecamsule is GRASE for use
                                                      adequate and well-controlled SPF                        for use in nonprescription sunscreens                 in sunscreens. Further, as summarized
                                                      studies of ecamsule at a lower                          (based in part on the efficacy data                   in the following subsections, some
                                                      concentration should be conducted                       requested here), the final sunscreen                  additional studies of other types are
                                                      according to established standards.3                    order can likewise address broad-                     needed. For additional information
                                                      These SPF studies should demonstrate                    spectrum testing and related labeling                 about the purpose and design of studies
                                                      that the selected concentration (below                  conditions for final sunscreen                        recommended to address present data
                                                      10 percent) provides an SPF of 2 or                     formulations containing ecamsule.                     gaps, please refer to the earlier sections
                                                      more.                                                                                                         of this proposed order referenced in
                                                                                                              Data Available for Ecamsule:
                                                         The current standard procedure for                   Effectiveness                                         parentheses. We welcome discussions
                                                      SPF testing is described in FDA’s                                                                             on the design of any of the studies prior
                                                                                                                 Study reports were submitted for two               to their commencement. We request the
                                                      regulations in § 201.327(i).4 Further SPF
                                                                                                              studies that assessed SPF of                          following types of data:
                                                      tests for ecamsule should be performed
                                                                                                              formulations containing ecamsule, at a
                                                      as described in these regulations, using                                                                      • Safety Data (see section II)
                                                                                                              concentration of either 2 percent or 3
                                                      a test formulation containing ecamsule
                                                                                                              percent (Notes 55 and 56, respectively),              A. Human Clinical Studies
                                                      as the only active ingredient to identify
                                                                                                              in combination with other active                         1. Skin irritation/sensitization, and
                                                      its contribution to the overall SPF test
                                                                                                              ingredients. Neither of these studies                 photosafety (see section II.A.1)
                                                      results. (See the following subsection                  provides a direct evaluation of the
                                                      Data Available for Ecamsule:                                                                                     2. Human dermal pharmacokinetic
                                                                                                              efficacy of ecamsule alone. These                     (bioavailability) studies (see section
                                                      Effectiveness for further discussion of                 studies were not adequately designed to
                                                      submitted SPF tests.) The study should                                                                        II.A.2)
                                                                                                              provide evidence of efficacy on which
                                                      also include a vehicle control arm to                   to base a GRAE determination for                      B. Human Safety Data To Establish
                                                      rule out any contribution the vehicle                   ecamsule. No adequately designed                      Adverse Event Profile (see Section
                                                      may have on the SPF test results.                       studies of ecamsule efficacy were                     II.A.3)
                                                      Finally, as described in § 201.327(i), an               identified in our search of the published
                                                      SPF standard formulation comparator                                                                              1. A summary and analysis of all
                                                                                                              literature. To support the finding that               available reported adverse events
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                                                                                                              ecamsule is GRAE when used at                         potentially associated with ecamsule
                                                        3 The upper bound of any concentration of
                                                                                                              concentrations up to 10 percent, we                      2. A summary and analysis of all
                                                      ecamsule ultimately established in the OTC
                                                      sunscreen monograph will be governed by the             request submission of data from two                   available documented case reports of
                                                      safety data, as well as by efficacy.                    adequate and well-controlled SPF                      serious side effects
                                                        4 Although the SPF testing procedure is used          studies conducted according to                           3. A summary and analysis of any
                                                      primarily for final formulation testing of finished     established standards to demonstrate                  available safety information from
                                                      products marketed without approved NDAs, under
                                                      the sunscreen monograph, it is equally applicable
                                                                                                              that the lowest selected concentration                studies of the safety and effectiveness of
                                                      for determining whether or not a sunscreen active       provides an SPF of 2 or more. Because                 sunscreen products containing ecamsule
                                                      ingredient is GRAE.                                     no study has been identified that                     in humans


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                                                      10042               Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules

                                                         4. A summary and analysis of relevant                meeting to discuss the proposed order.                  11. FDA–2008–N–0474–0009, Volume 3,
                                                      medical literature describing adverse                   Submit meeting requests electronically                Study no. 1.CG.03.SRE.12158, Study no.
                                                      events associated with ecamsule                         to http://www.regulations.gov or in                   1.CG.03.SRE.12157.
                                                         Alternatively, the results of a                                                                              12. FDA–2008–N–0474–0009, Volume 3,
                                                                                                              writing to the Division of Dockets
                                                                                                                                                                    Study no. 712332, Volume 4, Study no.
                                                      literature search that found no reports of              Management (see ADDRESSES), identified                712320.
                                                      adverse events may be provided. In that                 with the active ingredient name                         13. FDA–2008–N–0474–0010, Volume 4,
                                                      case, detailed information on how the                   ecamsule, Docket No. FDA–2008–N–                      Study no. 802410, Study no. 3697–109/313.
                                                      search was conducted should be                          0474, and the heading ‘‘Sponsor                         14. FDA–2008–N–0474–0010, Volume 4,
                                                      provided.                                               Meeting Request.’’ To facilitate your                 Study no. 1.CG.03.SRE.12163, Study no.
                                                                                                              request, please also send a copy to                   1.CG.03.SRE.12164.
                                                      C. Nonclinical (Animal) Studies                                                                                 15. FDA–2008–N–0474–0010, Volume 4,
                                                                                                              Kristen Hardin (see FOR FURTHER
                                                         Full study reports will be needed for                                                                      Study no. RDA.03.SRE.12268.
                                                                                                              INFORMATION CONTACT).
                                                      the following studies:                                                                                          16. FDA–2008–N–0474–0009, Volume 3,
                                                         1. Systemic and dermal                               VI. Proposed Effective Date                           Study no. 93/LOL/007/0971.
                                                                                                                                                                      17. FDA–2008–N–0474–0009, Volume 3,
                                                      carcinogenicity (see section II.B.1)
                                                                                                                FDA proposes that any final                         Study no. 1.CG.03.SRE.12183.
                                                         2. Reproductive and developmental                                                                            18. FDA–2008–N–0474–0011, Volume 5,
                                                      toxicity studies (see section II.B.2)                   administrative order based on this
                                                                                                              proposal become effective on the date of              Study no. G185–109/314.
                                                         3. Toxicokinetics (see section II.B.3)                                                                       19. FDA–2008–N–0474–0011, Volume 5,
                                                      • Effectiveness Data (see section III)                  publication of the final order in the                 Study no. G220–109/381, Study no. G220–
                                                         For concentrations of ecamsule up to                 Federal Register.                                     109/381A, Study no. 12174MIC, Study no.
                                                      10 percent to be found to be GRASE for                  VII. Comments                                         413/52–D6172.
                                                      use in nonprescription sunscreen                                                                                20. FDA–2008–N–0474–0011, Volume 5,
                                                      products as requested, at least two SPF                   Similarly, section 586C(b)(6) of the                Study no. 12639MAR.
                                                      studies showing effectiveness of a                      FD&C Act, as amended by the SIA,                        21. FDA–2008–N–0474–0011, Volume 5,
                                                      selected concentration lower than 10                                                                          Study no. EU1REBRP.031.
                                                                                                              establishes that a proposed sunscreen
                                                                                                                                                                      22. FDA–2008–N–0474–0011, Volume 5,
                                                      percent should be conducted. An                         order shall provide 45 days for public                Study no. LRL 170/921503.
                                                      efficacy study of ecamsule at 10 percent                comment. Interested persons wishing to                  23. FDA–2008–N–0474–0011, Volume 5,
                                                      is also recommended.                                    comment on this proposed order may                    Study no. ICHUREBRP.031.
                                                      V. Administrative Procedures                            submit either electronic comments to                    24. FDA–2008–N–0474–0010, Volume 4,
                                                                                                              http://www.regulations.gov or written                 Study no. 1.CG.03.SRE.12181.
                                                         A copy of this proposed order will be                comments to the Division of Dockets                     25. FDA–2008–N–0474–0011, Volume 5,
                                                      filed in the Division of Dockets                        Management (see ADDRESSES). It is only                Study no. 1.CG.03.SRE.12182.
                                                      Management in Docket No. FDA–2008–                      necessary to send one set of comments.                  26. FDA–2008–N–0474–0011, Volume 5,
                                                      N–0474. To inform FDA’s evaluation of                                                                         Study no. 10297 RSL.
                                                                                                              Identify comments with the active
                                                      whether this ingredient is GRASE and                                                                            27. FDA–2008–N–0474–0010, Volume 4,
                                                                                                              ingredient name (ecamsule) and the                    Study no. 1412 RMR/064.89.
                                                      not misbranded for use in sunscreen                     docket number found in brackets in the                  28. FDA–2008–N–0474–0011, Volume 5,
                                                      products, we encourage the sponsor and                  heading of this proposed order.                       RCC Project 682874.
                                                      other interested parties to submit                      Received comments on this proposed                      29. FDA–2008–N–0474–0010, Volume 4,
                                                      additional data regarding the safety and                order may be seen in the Division of                  Study no. 95/LOL/008/1217, Study no. LOL/
                                                      effectiveness of this ingredient for use as             Dockets Management between 9 a.m.                     011/980150.
                                                      an OTC sunscreen product. We also                       and 4 p.m., Monday through Friday, and                  30. FDA–2008–N–0474–0010, Volume 4,
                                                      encourage the sponsor and other                         will be posted to the docket at http://               Study no. C–1012–001, Study no.
                                                      interested parties to notify us in writing                                                                    RDS.03.SRE.12215.
                                                                                                              www.regulations.gov.
                                                      of their intent to submit additional data.                                                                      31. FDA–2008–N–0474–0009, Volume 3,
                                                      However, as noted previously, because                   VIII. Notes                                           Study no. 10225PAR, Study no.
                                                                                                                                                                    1.CG.03.SRE.12269/RDS.03.SRE.12269.
                                                      the data submitted to date are not                                                                              32. FDA–2008–N–0474–0009, Volume 3,
                                                      sufficient to support a determination                     1. FDA–2008–N–0474–0012 and FDA–
                                                                                                              2008–N–0474–0013, Volumes 6 and 7, dated              Study no. 10507 PAS, Study no. RDS.03.SRE
                                                      that ecamsule is GRASE for use as an                                                                          12268, Study no. RDS.03.SRE.12269/
                                                                                                              November 14, 2008.
                                                      active ingredient in OTC sunscreen drug                   2. FDA–2008–N–0474–0015 and FDA–                    1.CG.03.SRE.12269.
                                                      products, at present, OTC sunscreen                     2008–N–0474–0016, Volumes 9 and 10,                     33. FDA–2008–N–0474–0009, Volume 3,
                                                      products containing ecamsule may not                    dated November 14, 2008.                              Study no. 2.CG.03.SRE.11029.
                                                      be marketed without approval of an                        3. FDA–2008–N–0474–0007, Volume 1,                    34. FDA–2008–N–0474–0009, Volume 3,
                                                      NDA or ANDA (see section                                dated November 14, 2008, FDA–2008–N–                  Study no. 1.CG.03.SRE.12270.
                                                      586C(e)(1)(A) of the FD&C Act, as                                                                               35. FDA–2008–N–0474–0011, Volume 5,
                                                                                                              0474–0006, TEA submission.
                                                                                                                                                                    Study no. G185–109/314.
                                                      amended by the SIA). Data submissions                     4. FDA–2008–N–0474–0008, Volume 2,
                                                                                                                                                                      36. FDA–2008–N–0474–0011, Volume 5,
                                                      relating to this proposed order should                  Study no. 16039/G2347.
                                                                                                                                                                    Study no. G220–109/381.
                                                      be submitted to Docket No. FDA–2008–                      5. FDA–2008–N–0474–0014, Volume 8,                    37. FDA–2008–N–0474–0011, Volume 5,
                                                      N–0474 at the Division of Dockets                       Study no. V3156.                                      Study no. G220–109/381A.
                                                      Management (see ADDRESSES). In                            6. FDA–2008–N–0474–0014, Volume 8,                    38. FDA–2008–N–0474–0011, Volume 5,
                                                      addition, you can submit the data                       Study no. V99.1203.                                   Study no. 12174MIC.
wreier-aviles on DSK5TPTVN1PROD with PROPOSALS




                                                                                                                7. FDA–2008–N–0474–0014, Volume 8,                    39. FDA–2008–N–0474–0011, Volume 5,
                                                      through the Federal eRulemaking Portal
                                                                                                              Study no. CG.03.SRE.2607.                             Study no. 413/52–D6172.
                                                      at http://www.regulations.gov. Follow                     8. FDA–2008–N–0474–0007, Volume 1,
                                                      the instructions for submitting                                                                                 40. FDA–2008–N–0474–0011, Volume 5,
                                                                                                              dated November 14, 2008.                              Study no. 12639MAR.
                                                      comments.                                                 9. FDA–2008–N–0474–0009, Volume 3,                    41. FDA–2008–N–0474–0011, Volume 5,
                                                         Section 586C(b)(7) of the FD&C Act,                  Study no. 3667–109/309, Study no.                     Study no. EU1REBRP.031.
                                                      as amended by the SIA, provides that                    1.CG.03.SRE.12160.                                      42. FDA–2008–N–0474–0011, Volume 5,
                                                      the sponsor may, within 30 days of                        10. FDA–2008–N–0474–0009, Volume 3,                 Study no. LRL 170/921503.
                                                      publication of a proposed order (see                    Study no. 4222–109/310, Study no.                       43. FDA–2008–N–0474–0011, Volume 5,
                                                      DATES), submit a request to FDA for a                   1.CG.03.SRE.12156.                                    Study no. ICHUREBRP.031.



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                                                                          Federal Register / Vol. 80, No. 37 / Wednesday, February 25, 2015 / Proposed Rules                                                10043

                                                        44. FDA–2008–N–0474–0010, Volume 4,                   www.regulations.gov. (FDA has verified                Carcinogenicity Studies of Pharmaceuticals
                                                      Study no. 95/LOL/008/1217.                              the Web site addresses in this reference              S1A,’’ March 1996 (available at http://
                                                        45. FDA–2008–N–0474–0010, Volume 4,                   section, but FDA is not responsible for               www.fda.gov/downloads/Drugs/
                                                      Study no. LOL/011/980150.                               any subsequent changes to the Web sites               GuidanceComplianceRegulatoryInformation/
                                                        46. FDA–2008–N–0474–0010, Volume 4,                                                                         Guidance/UCM074911.pdf).
                                                      Study no. C–1012–001.
                                                                                                              after this document publishes in the
                                                                                                                                                                       7. ICH, Guidance for Industry, ‘‘S1B
                                                        47. FDA–2008–N–0474–0010, Volume 4,                   Federal Register.)                                    Testing for Carcinogenicity of
                                                      Study no. RDS.03.SRE.12215.                                1. FDA, Guidance for Industry,                     Pharmaceuticals,’’ July 1997 (available at
                                                        48. FDA–2008–N–0474–1000, Volume 4,                   ‘‘Photosafety Testing,’’ May 2003 (available at       http://www.fda.gov/downloads/Drugs/
                                                      Study no. 1.CG.03.SRE.12181.                            http://www.fda.gov/downloads/Drugs/                   GuidanceComplianceRegulatoryInformation/
                                                        49. FDA–2008–N–0474–0011, Volume 5,                   GuidanceComplianceRegulatoryInformation/              Guidances/UCM074916.pdf).
                                                      Study no. 1.CG.03.SRE.12182, Study no.                  Guidances/ucm079252.pdf).                                8. ICH, ‘‘S1C(R2) Dose Selection for
                                                      1412 RMR/064.89.                                           2. Leonard, F., B. Kalis, H. Adamski, et al.,      Carcinogenicity Studies’’ (Revision 1),
                                                        50. FDA–2008–N–0474–0011, Volume 5,                   ‘‘The New Standard Battery of Photopatch              September 2008 (available at http://
                                                      RCC Project 682874.                                     Test in France.’’ Nouvelles Dermatologiques,          www.fda.gov/downloads/Drugs/
                                                        51. FDA–2008–N–0474–0011, Volume 5,                   vol. 15, pp. 343–348, 1996.                           GuidanceComplianceRegulatoryInformation/
                                                      RCC Project 682874.                                        3. Schauder, S., and H. Ippen, ‘‘Contact
                                                                                                                                                                    Guidances/UCM074919.pdf).
                                                        52. FDA–2008–N–0474–0011, Volume 5,                   and Photocontact Sensitivity to Sunscreens.
                                                                                                                                                                       9. ICH Harmonized Tripartite Guideline for
                                                      Study no. 1.CG.03.SRE.12182.                            Review of a 15-Year Experience and of the
                                                                                                              Literature.’’ Contact Dermatitis, vol. 37(5),         Industry, ‘‘Detection of Toxicity to
                                                        53. FDA–2008–N–0474–0009, Volume 3,                                                                         Reproduction for Medicinal Products &
                                                      Study no. 10225PAR.                                     pp. 221–232, 1997.
                                                                                                                 4. Schmidt, T., J. Ring, and D. Abeck,             Toxicity to Male Fertility S5(R2),’’ 2005
                                                        54. FDA–2008–N–0474–0009, Volume 3,
                                                                                                              ‘‘Photoallergic Contact Dermatitis Due to             (available at http://www.ich.org/fileadmin/
                                                      Study no. 1.CG.03.SRE.12269/
                                                                                                              Combined UVB (4-Methylbenzylidene                     Public_Web_Site/ICH_Products/Guidelines/
                                                      RDS.03.SRE.12269.
                                                                                                              Camphor/Octyl Methoxycinnamate) and                   Safety/S5_R2/Step4/S5_R2__Guideline.pdf).
                                                        55. FDA–2008–N–0474–0017, Volume 11,
                                                                                                              UVA (Benzophenone-3/Butyl                                10. ICH, Guideline for Industry,
                                                      Study no. PEN.810.02.
                                                                                                              Methoxydibenzoylmethane) Absorber                     ‘‘Toxicokinetics: The Assessment of Systemic
                                                        56. FDA–2008–N–0474–0017, Volume 11,
                                                      Study no. PEN.810.06.                                   Sensitization.’’ Dermatology, vol. 196(3), pp.        Exposure in Toxicity Studies S3A,’’ March
                                                                                                              354–357, 1998.                                        1995 (available at http://www.fda.gov/
                                                                                                                 5. FDA, Guidance for Industry, ‘‘Guideline         downloads/Drugs/
                                                      IX. References                                          for the Format and Content of the Human               GuidanceComplianceRegulatoryInformation/
                                                        The following references have been                    Pharmacokinetics and Bioavailability Section          Guidances/UCM074937.pdf).
                                                      placed on display in the Division of                    of an Application,’’ February 1987 (available
                                                                                                              at http://www.fda.gov/downloads/drugs/                  Dated: February 20, 2015.
                                                      Dockets Management (see ADDRESSES)                      GuidanceComplianceRegulatoryInformation/
                                                      and may be seen by interested persons                                                                         Leslie Kux,
                                                                                                              Guidances/ucm072112.pdf).
                                                      between 9 a.m. and 4 p.m., Monday                                                                             Associate Commissioner for Policy.
                                                                                                                 6. International Conference on
                                                      through Friday, and are available                       Harmonization (ICH), Guidance for Industry,           [FR Doc. 2015–03883 Filed 2–24–15; 8:45 am]
                                                      electronically at http://                               ‘‘The Need for Long-Term Rodent                       BILLING CODE 4164–01–P
wreier-aviles on DSK5TPTVN1PROD with PROPOSALS




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Document Created: 2015-12-18 13:08:43
Document Modified: 2015-12-18 13:08:43
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionProposed Rules
ActionProposed order; request for comments.
DatesSubmit either electronic or written comments on this proposed order by April 13, 2015. Sponsors may submit written requests for a meeting with FDA to discuss this proposed order by March 27, 2015. See section VI for the proposed effective date of a final order based on this proposed order.
ContactKristen Hardin, Division of Nonprescription Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 22, Rm. 5491, Silver Spring, MD 20993-0002, 240-402-4246.
FR Citation80 FR 10035 

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