81_FR_44742 81 FR 44611 - Use of Public Human Genetic Variant Databases To Support Clinical Validity for Next Generation Sequencing-Based In Vitro Diagnostics; Draft Guidance for Stakeholders and Food and Drug Administration Staff; Availability

81 FR 44611 - Use of Public Human Genetic Variant Databases To Support Clinical Validity for Next Generation Sequencing-Based In Vitro Diagnostics; Draft Guidance for Stakeholders and Food and Drug Administration Staff; Availability

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 81, Issue 131 (July 8, 2016)

Page Range44611-44614
FR Document2016-16200

The Food and Drug Administration (FDA or Agency) is announcing the availability of the draft guidance entitled ``Use of Public Human Genetic Variant Databases to Support Clinical Validity for Next Generation Sequencing (NGS)-Based In Vitro Diagnostics.'' This draft guidance document describes how publicly accessible databases of human genetic variants can serve as sources of valid scientific evidence to support the clinical validity of genotype-phenotype relationships in FDA's regulatory review of next generation sequencing (NGS)-based tests. This draft guidance further outlines the process by which administrators of genetic variant databases could voluntarily apply to FDA for recognition, and how FDA would review such applications and periodically reevaluate recognized databases. This draft guidance is not final nor is it in effect at this time.

Federal Register, Volume 81 Issue 131 (Friday, July 8, 2016)
[Federal Register Volume 81, Number 131 (Friday, July 8, 2016)]
[Notices]
[Pages 44611-44614]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-16200]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2016-D-1233]


Use of Public Human Genetic Variant Databases To Support Clinical 
Validity for Next Generation Sequencing-Based In Vitro Diagnostics; 
Draft Guidance for Stakeholders and Food and Drug Administration Staff; 
Availability

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice of availability.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA or Agency) is announcing 
the availability of the draft guidance entitled ``Use of Public Human 
Genetic Variant Databases to Support Clinical Validity for Next 
Generation Sequencing (NGS)-Based In Vitro Diagnostics.'' This draft 
guidance document describes how publicly accessible databases of human 
genetic variants can serve as sources of valid scientific evidence to 
support the clinical validity of genotype-phenotype relationships in 
FDA's regulatory review of next generation sequencing (NGS)-based 
tests. This draft guidance further outlines the process by which 
administrators of genetic variant databases could voluntarily apply to 
FDA for recognition, and how FDA would review such applications and 
periodically reevaluate recognized databases. This draft guidance is 
not final nor is it in effect at this time.

DATES: Although you can comment on any guidance at any time (see 21 CFR 
10.115(g)(5)), to ensure that the Agency considers your comment of this 
draft guidance before it begins work on the final version of the 
guidance, submit either electronic or written comments on the draft 
guidance by October 6, 2016.

ADDRESSES: You may submit comments as follows:

Electronic Submissions

    Submit electronic comments in the following way:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments. Comments submitted 
electronically, including attachments, to http://www.regulations.gov 
will be posted to the docket unchanged. Because your comment will be 
made public, you are solely responsible for ensuring that your comment 
does not include any confidential information that you or a third party 
may not wish to be posted, such as medical information, your or anyone 
else's Social Security number, or confidential business information, 
such as a manufacturing process. Please note that if you include your 
name, contact information, or other information that identifies you in 
the body of your comments, that information will be posted on http://www.regulations.gov.
     If you want to submit a comment with confidential 
information that you do not wish to be made available to the public, 
submit the comment as a written/paper submission and in the manner 
detailed (see ``Written/Paper Submissions'' and ``Instructions'').

[[Page 44612]]

Written/Paper Submissions

    Submit written/paper submissions as follows:
     Mail/Hand delivery/Courier (for written/paper 
submissions): Division of Dockets Management (HFA-305), Food and Drug 
Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.
     For written/paper comments submitted to the Division of 
Dockets Management, FDA will post your comment, as well as any 
attachments, except for information submitted, marked and identified, 
as confidential, if submitted as detailed in ``Instructions.''
    Instructions: All submissions received must include the Docket No. 
FDA-2016-D-1233 for ``Use of Public Human Genetic Variant Databases to 
Support Clinical Validity for Next Generation Sequencing (NGS)-Based In 
Vitro Diagnostics.'' Received comments will be placed in the docket 
and, except for those submitted as ``Confidential Submissions,'' 
publicly viewable at http://www.regulations.gov or at the Division of 
Dockets Management between 9 a.m. and 4 p.m., Monday through Friday.
     Confidential Submissions--To submit a comment with 
confidential information that you do not wish to be made publicly 
available, submit your comments only as a written/paper submission. You 
should submit two copies total. One copy will include the information 
you claim to be confidential with a heading or cover note that states 
``THIS DOCUMENT CONTAINS CONFIDENTIAL INFORMATION.'' The Agency will 
review this copy, including the claimed confidential information, in 
its consideration of comments. The second copy, which will have the 
claimed confidential information redacted/blacked out, will be 
available for public viewing and posted on http://www.regulations.gov. 
Submit both copies to the Division of Dockets Management. If you do not 
wish your name and contact information to be made publicly available, 
you can provide this information on the cover sheet and not in the body 
of your comments and you must identify this information as 
``confidential.'' Any information marked as ``confidential'' will not 
be disclosed except in accordance with 21 CFR 10.20 and other 
applicable disclosure law. For more information about FDA's posting of 
comments to public dockets, see 80 FR 56469, September 18, 2015, or 
access the information at: http://www.fda.gov/regulatoryinformation/dockets/default.htm.
    Docket: For access to the docket to read background documents or 
the electronic and written/paper comments received, go to http://www.regulations.gov and insert the docket number, 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.
    An electronic copy of the guidance document is available for 
download from the Internet. See the SUPPLEMENTARY INFORMATION section 
for information on electronic access to the guidance. Submit written 
requests for a single hard copy of the draft guidance document entitled 
``Use of Public Human Genetic Variant Databases to Support Clinical 
Validity for Next Generation Sequencing (NGS)-Based In Vitro 
Diagnostics'' to the Office of the Center Director, Guidance and Policy 
Development, Center for Devices and Radiological Health, Food and Drug 
Administration, 10903 New Hampshire Ave., Bldg. 66, Rm. 5431, Silver 
Spring, MD 20993-0002; or the Office of Communication, Outreach, and 
Development, Center for Biologics Evaluation and Research, Food and 
Drug Administration, 10903 New Hampshire Ave., Bldg. 71, Rm. 3128, 
Silver Spring, MD 20993-0002. Send one self-addressed adhesive label to 
assist that office in processing your request.

FOR FURTHER INFORMATION CONTACT: Personalized Medicine Staff, Center 
for Devices and Radiological Health, Food and Drug Administration, 
10903 New Hampshire Ave., Bldg. 66, Rm. 4546, Silver Spring, MD 20993-
0002, 301-796-7561, pmi@fda.hhs.gov; or Stephen Ripley, Center for 
Biologics Evaluation and Research, Food and Drug Administration, 10903 
New Hampshire Ave., Bldg. 71, Rm. 7301, Silver Spring, MD 20993-0002, 
240-402-7911.

SUPPLEMENTARY INFORMATION: 

I. Background

    This draft guidance document describes one part of FDA's effort to 
create a flexible regulatory approach to the oversight of NGS-based 
tests as part of the White House's Precision Medicine Initiative (PMI). 
FDA held two workshops on this issue: ``Use of Databases for 
Establishing the Clinical Relevance of Human Genetic Variants'' on 
November 13, 2015, and ``Patient and Medical Professional Perspectives 
on the Return of Genetic Test Results'' on March 2, 2016. The goal of 
this effort is to help ensure patients receive accurate and meaningful 
results, while promoting innovation in test development. This draft 
guidance document describes how publicly accessible databases of human 
genetic variants can serve as sources of valid scientific evidence to 
support the clinical validity of genotype-phenotype relationships in 
FDA's regulatory review of NGS-based tests. FDA is also issuing a draft 
guidance entitled ``Use of Standards in FDA Regulatory Oversight of 
Next Generation Sequencing (NGS)-Based In Vitro Diagnostics (IVDs) Used 
for Diagnosing Germline Diseases'' which is being released concurrently 
elsewhere in this issue of the Federal Register.
    NGS can enable rapid, broad, and deep sequencing of a portion of a 
gene, entire exome(s), or a whole genome and may be used clinically for 
a variety of diagnostic purposes, including risk prediction, diagnosis, 
and treatment selection for a disease or condition. The rapid adoption 
of NGS-based tests in both research and clinical practice is leading to 
identification of an increasing number of genetic variants (e.g., 
pathogenic, benign, and of unknown significance), including rare 
variants that may be unique to a single individual or family. This 
draft guidance document describes FDA's considerations in determining 
whether a genetic variant database is a source of valid scientific 
evidence that could support the clinical validity of an NGS-based test. 
This draft guidance further outlines the process by which 
administrators of genetic variant databases could voluntarily apply to 
FDA for recognition, and how FDA would review such applications and 
periodically reevaluate recognized databases.

II. Significance of Guidance

    This draft guidance is being issued consistent with FDA's good 
guidance practices regulation (21 CFR 10.115). The draft guidance, when 
finalized, will represent the current thinking of FDA on ``Use of 
Public Human Genetic Variant Databases to Support Clinical Validity for 
Next Generation Sequencing (NGS)-Based In Vitro Diagnostics.'' It does 
not establish any rights for any person and is not binding on FDA or 
the public. You can use an alternative approach if it satisfies the 
requirements of the applicable statutes and regulations.

III. Electronic Access

    Persons interested in obtaining a copy of the draft guidance may do 
so by downloading an electronic copy from the Internet. A search 
capability for all Center for Devices and Radiological

[[Page 44613]]

Health guidance documents is available at http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/default.htm and for Center for Biologics Evaluation and Research 
guidance documents is available at http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm. Guidance documents are also available at http://www.regulations.gov. Persons unable to download an electronic copy of 
``Use of Public Human Genetic Variant Databases to Support Clinical 
Validity for Next Generation Sequencing (NGS)-Based In Vitro 
Diagnostics'' may send an email request to CDRH-Guidance@fda.hhs.gov to 
receive an electronic copy of the document. Please use the document 
number 16008 to identify the guidance you are requesting.

IV. Paperwork Reduction Act of 1995

    Under the Paperwork Reduction Act of 1995 (the PRA) (44 U.S.C. 
3501-3520), Federal Agencies must obtain approval from the Office of 
Management and Budget (OMB) for each collection of information they 
conduct or sponsor. ``Collection of information'' is defined in 44 
U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes Agency requests or 
requirements that members of the public submit reports, keep records, 
or provide information to a third party. Section 3506(c)(2)(A) of the 
PRA (44 U.S.C. 3506(c)(2)(A)) requires Federal Agencies to provide a 
60-day notice in the Federal Register concerning each proposed 
collection of information before submitting the collection to OMB for 
approval. To comply with this requirement, FDA is publishing notice of 
the proposed collection of information set forth in this document.
    With respect to the following collection of information, FDA 
invites comments on these topics: (1) Whether the proposed collection 
of information is necessary for the proper performance of FDA's 
functions, including whether the information will have practical 
utility; (2) the accuracy of FDA's estimate of the burden of the 
proposed collection of information, including the validity of the 
methodology and assumptions used; (3) ways to enhance the quality, 
utility, and clarity of the information to be collected; and (4) ways 
to minimize the burden of the collection of information on respondents, 
including through the use of automated collection techniques, when 
appropriate, and other forms of information technology.

Use of Public Human Genetic Variant Databases To Support Clinical 
Validity for Next Generation Sequencing (NGS)-Based In Vitro 
Diagnostics OMB Control Number 0910--NEW

    The draft guidance document ``Use of Public Human Genetic Variant 
Databases to Support Clinical Validity for Next Generation Sequencing 
(NGS)-Based In Vitro Diagnostics'' describes FDA's considerations in 
determining whether a genetic variant database is a source of valid 
scientific evidence that could support the clinical validity of an NGS-
based test. This draft guidance further outlines the process by which 
administrators \1\ of genetic variant databases could voluntarily apply 
to FDA for recognition, and how FDA would review such applications and 
periodically reevaluate recognized databases. The draft guidance also 
recommends that, at the time of recognition, the database administrator 
make information regarding policies, procedures, and conflicts of 
interest publicly available and accessible on the genetic variant 
database's Web site.
---------------------------------------------------------------------------

    \1\ FDA acknowledges that many databases may not use the term 
``administrator'' or may have a committee of individuals that 
oversee the database. Therefore, for the purpose of this guidance, a 
genetic variant database administrator is the entity or entities 
that oversee database operations.
---------------------------------------------------------------------------

    Based on our experience and the nature of the information, we 
estimate that it will take an average of 80 hours to complete and 
submit an application for recognition. We estimate that maintenance of 
recognition activities will take approximately one-fourth of that time 
(20 hours) annually. We estimate that it will take approximately 1 hour 
to post the information on the Web site.
    Respondents are administrators of genetic databases. Our estimate 
of five respondents per year is based on the current number of 
databases that may meet FDA recommendations for recognition and seek 
such recognition.
    FDA estimates the burden of this collection of information as 
follows:

                                                     Table 1--Estimated Annual Reporting Burden \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         Number of
                              Activity                                  Number of      responses per     Total annual    Average burden    Total hours
                                                                       respondents       respondent       responses       per response
--------------------------------------------------------------------------------------------------------------------------------------------------------
Application for recognition of genetic database....................               5                1                5               80              400
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with this collection of information.


                                                   Table 2--Estimated Annual Recordkeeping Burden \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         Number of                       Average burden
                              Activity                                  Number of       records per      Total annual         per          Total hours
                                                                      recordkeepers     recordkeeper       records       recordkeeping
--------------------------------------------------------------------------------------------------------------------------------------------------------
Maintenance of recognition activities..............................               5                1                5               20              100
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with this collection of information.


[[Page 44614]]


                                               Table 3--Estimated Annual Third-Party Disclosure Burden \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         Number of
                              Activity                                  Number of     disclosures per    Total annual    Average burden    Total hours
                                                                       respondents       respondent      disclosures     per disclosure
--------------------------------------------------------------------------------------------------------------------------------------------------------
Public disclosure of policies, procedures, and conflicts of                       5                1                5                1                5
 interest..........................................................
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with this collection of information.

    This draft guidance also refers to previously approved collections 
of information. These collections of information are subject to review 
by the OMB under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-
3520). The collections of information in the guidance document 
``Requests for Feedback on Medical Device Submissions: The Pre-
Submission Program and Meetings with Food and Drug Administration 
Staff'' have been approved under OMB control number 0910-0756. The 
collections of information regarding premarket submissions have been 
approved as follows: The collections of information in 21 CFR part 807, 
subpart E, have been approved under OMB control number 0910-0120; and 
the collections of information in 21 CFR part 814, subparts A through 
E, have been approved under OMB control number 0910-0231.

V. Other Issues for Consideration

    The Agency invites comments on the draft guidance document entitled 
``Use of Public Human Genetic Variant Databases to Support Clinical 
Validity for Next Generation Sequencing (NGS)-Based In Vitro 
Diagnostics,'' in general, and on the following questions, in 
particular:
    1. Should the quality recommendations outlined in the guidance 
apply equally to databases of somatic variants and to germline 
variants?
    2. While this document applies to NGS-based tests, FDA expects that 
it may also be relevant to genetic tests that use other technologies 
(e.g., polymerase chain reaction, Sanger sequencing, etc.). Are any 
additional considerations necessary to support the use of these 
databases in the premarket review of tests using technologies other 
than NGS, should FDA decide to apply this approach more broadly in the 
future?
    3. FDA recognizes that the evidence linking specific variants to 
diseases or conditions will change over time, and as such, assertions 
about those variants may also change. If an assertion regarding a 
variant changes over time, how should FDA assess what regulatory 
actions may be appropriate with respect to in IVDs supported by such 
assertions? How often should FDA conduct ongoing review of an FDA-
recognized database?
    4. FDA notes that databases may have ``discordant calls'' with 
other databases, where the assertions for a variant in each database 
vary. While FDA believes that these discordant calls often arise 
because one database has information the other does not and our 
proposed policy will mitigate these issues over time; what, if any, 
action should FDA take when it learns about discordant calls between 
two databases with respect to database recognition or IVDs supported by 
such calls in FDA-recognized databases?
    5. FDA has requested information regarding conflicts of interest 
for curators and personnel of databases seeking FDA recognition. FDA 
acknowledges that many personnel involved with variant curation and 
interpretation may have some connection to NGS test developers. What 
type of information should FDA collect and what policies should it 
implement to mitigate such potential conflicts of interest in FDA-
recognized databases?

    Dated: July 5, 2016.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2016-16200 Filed 7-7-16; 8:45 am]
 BILLING CODE 4164-01-P



                                                                                      Federal Register / Vol. 81, No. 131 / Friday, July 8, 2016 / Notices                                           44611

                                                    requirement, CMS is publishing this                      profits and Not-for-profit institutions);             announcing the availability of the draft
                                                    notice.                                                  Number of Respondents: 310; Total                     guidance entitled ‘‘Use of Public Human
                                                                                                             Annual Responses: 310; Total Annual                   Genetic Variant Databases to Support
                                                    Information Collection
                                                                                                             Hours: 10,941. (For policy questions                  Clinical Validity for Next Generation
                                                       1. Type of Information Collection                     regarding this collection contact                     Sequencing (NGS)-Based In Vitro
                                                    Request: Revision of a currently                         Marcella Watts at 410–786–5724.)                      Diagnostics.’’ This draft guidance
                                                    approved collection; Title of                              3. Type of Information Collection                   document describes how publicly
                                                    Information Collection: Solicitation for                 Request: Extension of a currently                     accessible databases of human genetic
                                                    Applications for Medicare Prescription                   approved collection; Title of                         variants can serve as sources of valid
                                                    Drug Plan 2018 Contracts; Use: Coverage                  Information Collection: Financial                     scientific evidence to support the
                                                    for the prescription drug benefit is                     Statement of Debtor; Use: Section                     clinical validity of genotype-phenotype
                                                    provided through contracted                              1893(f)(1)) of the Social Security Act                relationships in FDA’s regulatory review
                                                    prescription drug (PD) plans or through                  and 42 CFR 401.607 provides the                       of next generation sequencing (NGS)-
                                                    Medicare Advantage (MA) plans that                       authority for collection of this
                                                    offer integrated prescription drug and                                                                         based tests. This draft guidance further
                                                                                                             information. Section 42 CFR 405.607
                                                    health care coverage (MA–PD plans).                                                                            outlines the process by which
                                                                                                             requires that, CMS recover amounts of
                                                    Cost Plans that are regulated under                                                                            administrators of genetic variant
                                                                                                             claims due from debtors including
                                                    section 1876 of the Social Security Act,                 interest where appropriate by direct                  databases could voluntarily apply to
                                                    and Employer Group Waiver Plans may                      collections in lump sums or in                        FDA for recognition, and how FDA
                                                    also provide a part D benefit.                           installments. In addition, the DOJ Final              would review such applications and
                                                    Organizations wishing to provide                         Rule, the Federal Claims Collection                   periodically reevaluate recognized
                                                    services under the Prescription Drug                     Standards, which was published as 32                  databases. This draft guidance is not
                                                    Benefit Program must complete an                         CFR parts 900–904, on November 22,                    final nor is it in effect at this time.
                                                    application, negotiate rates, and receive                2000, in the Federal Register, section 32             DATES:  Although you can comment on
                                                    final approval from CMS. Existing part                   CFR 900.1 stipulates that, standards for              any guidance at any time (see 21 CFR
                                                    D Sponsors may also expand their                         Federal agency use in the administrative              10.115(g)(5)), to ensure that the Agency
                                                    contracted service area by completing                    collection, offset, compromise, and the               considers your comment of this draft
                                                    the Service Area Expansion application.                  suspension or termination of collection               guidance before it begins work on the
                                                    Form Number: CMS–10137 (OMB                              activity. Section 32 CFR 901.8(a) states              final version of the guidance, submit
                                                    control number: 0938–0936); Frequency:                   that, Agencies should obtain financial                either electronic or written comments
                                                    Yearly; Affected Public: Private sector                  statements from debtors who represent
                                                    (Business or other For-profits and Not-                                                                        on the draft guidance by October 6,
                                                                                                             that they are unable to pay the debt in               2016.
                                                    for-profit institutions); Number of                      one lump sum. Form Number: CMS–379
                                                    Respondents: 463; Total Annual                           (OMB control number: 0938–0270);                      ADDRESSES:       You may submit comments
                                                    Responses: 160; Total Annual Hours:                      Frequency: Yearly; Affected Public:                   as follows:
                                                    1,565. (For policy questions regarding                   Private sector (Business or other for-
                                                    this collection contact Arianne                          profits); Number of Respondents: 500;                 Electronic Submissions
                                                    Spaccarelli at 410–786–5715.)                            Total Annual Responses: 500; Total
                                                       2. Type of Information Collection                                                                             Submit electronic comments in the
                                                                                                             Annual Hours: 1,000. (For policy
                                                    Request: Revision of a currently                                                                               following way:
                                                                                                             questions regarding this collection
                                                    approved collection; Title of                            contact Anita Crosier at 410–786–0217.)                 • Federal eRulemaking Portal: http://
                                                    Information Collection: Applications for                                                                       www.regulations.gov. Follow the
                                                    part C Medicare Advantage, 1876 Cost                        Dated: July 5, 2016.
                                                                                                                                                                   instructions for submitting comments.
                                                    Plans, and Employer Group Waiver                         William N. Parham, III,
                                                                                                                                                                   Comments submitted electronically,
                                                    Plans to Provide part C Benefits; Use:                   Director, Paperwork Reduction Staff, Office
                                                                                                                                                                   including attachments, to http://
                                                    This information collection includes the                 of Strategic Operations and Regulatory
                                                                                                             Affairs.                                              www.regulations.gov will be posted to
                                                    process for organizations wishing to                                                                           the docket unchanged. Because your
                                                    provide healthcare services under MA                     [FR Doc. 2016–16220 Filed 7–7–16; 8:45 am]
                                                                                                                                                                   comment will be made public, you are
                                                    and/or MA–PD plans must complete an                      BILLING CODE 4120–01–P
                                                                                                                                                                   solely responsible for ensuring that your
                                                    application annually, file a bid, and                                                                          comment does not include any
                                                    receive final approval from CMS. The                                                                           confidential information that you or a
                                                    application process has two options for                  DEPARTMENT OF HEALTH AND
                                                                                                             HUMAN SERVICES                                        third party may not wish to be posted,
                                                    applicants that include: Request for new
                                                                                                                                                                   such as medical information, your or
                                                    MA product or request for expanding
                                                                                                             Food and Drug Administration                          anyone else’s Social Security number, or
                                                    the service area of an existing product.
                                                                                                                                                                   confidential business information, such
                                                    This collection process is the only                      [Docket No. FDA–2016–D–1233]
                                                    mechanism for MA and/or MA–PD                                                                                  as a manufacturing process. Please note
                                                    organizations to complete the required                   Use of Public Human Genetic Variant                   that if you include your name, contact
                                                    application process. CMS utilizes the                    Databases To Support Clinical Validity                information, or other information that
                                                    application process as the means to                      for Next Generation Sequencing-Based                  identifies you in the body of your
                                                    review, assess and determine if                          In Vitro Diagnostics; Draft Guidance                  comments, that information will be
asabaliauskas on DSK3SPTVN1PROD with NOTICES




                                                    applicants are compliant with the                        for Stakeholders and Food and Drug                    posted on http://www.regulations.gov.
                                                    current requirements for participation in                Administration Staff; Availability                      • If you want to submit a comment
                                                    the Medicare Advantage program and to                    AGENCY:    Food and Drug Administration,              with confidential information that you
                                                    make a decision related to contract                      HHS.                                                  do not wish to be made available to the
                                                    award. Form Number: CMS–10237                            ACTION:   Notice of availability.                     public, submit the comment as a
                                                    (OMB control number: 0938–0935);                                                                               written/paper submission and in the
                                                    Frequency: Yearly; Affected Public:                      SUMMARY: The Food and Drug                            manner detailed (see ‘‘Written/Paper
                                                    Private sector (Business or other For-                   Administration (FDA or Agency) is                     Submissions’’ and ‘‘Instructions’’).


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                                                    44612                             Federal Register / Vol. 81, No. 131 / Friday, July 8, 2016 / Notices

                                                    Written/Paper Submissions                                   Docket: For access to the docket to                promoting innovation in test
                                                                                                             read background documents or the                      development. This draft guidance
                                                       Submit written/paper submissions as                   electronic and written/paper comments                 document describes how publicly
                                                    follows:                                                 received, go to http://                               accessible databases of human genetic
                                                       • Mail/Hand delivery/Courier (for                     www.regulations.gov and insert the                    variants can serve as sources of valid
                                                    written/paper submissions): Division of                  docket number, found in brackets in the               scientific evidence to support the
                                                    Dockets Management (HFA–305), Food                       heading of this document, into the                    clinical validity of genotype-phenotype
                                                    and Drug Administration, 5630 Fishers                    ‘‘Search’’ box and follow the prompts                 relationships in FDA’s regulatory review
                                                    Lane, Rm. 1061, Rockville, MD 20852.                     and/or go to the Division of Dockets                  of NGS-based tests. FDA is also issuing
                                                       • For written/paper comments                          Management, 5630 Fishers Lane, Rm.                    a draft guidance entitled ‘‘Use of
                                                    submitted to the Division of Dockets                     1061, Rockville, MD 20852.                            Standards in FDA Regulatory Oversight
                                                    Management, FDA will post your                              An electronic copy of the guidance                 of Next Generation Sequencing (NGS)-
                                                    comment, as well as any attachments,                     document is available for download                    Based In Vitro Diagnostics (IVDs) Used
                                                    except for information submitted,                        from the Internet. See the                            for Diagnosing Germline Diseases’’
                                                    marked and identified, as confidential,                  SUPPLEMENTARY INFORMATION section for                 which is being released concurrently
                                                    if submitted as detailed in                              information on electronic access to the               elsewhere in this issue of the Federal
                                                    ‘‘Instructions.’’                                        guidance. Submit written requests for a               Register.
                                                       Instructions: All submissions received                single hard copy of the draft guidance                   NGS can enable rapid, broad, and
                                                    must include the Docket No. FDA–                         document entitled ‘‘Use of Public                     deep sequencing of a portion of a gene,
                                                    2016–D–1233 for ‘‘Use of Public Human                    Human Genetic Variant Databases to                    entire exome(s), or a whole genome and
                                                    Genetic Variant Databases to Support                     Support Clinical Validity for Next                    may be used clinically for a variety of
                                                    Clinical Validity for Next Generation                    Generation Sequencing (NGS)-Based In                  diagnostic purposes, including risk
                                                    Sequencing (NGS)-Based In Vitro                          Vitro Diagnostics’’ to the Office of the              prediction, diagnosis, and treatment
                                                    Diagnostics.’’ Received comments will                    Center Director, Guidance and Policy                  selection for a disease or condition. The
                                                    be placed in the docket and, except for                  Development, Center for Devices and                   rapid adoption of NGS-based tests in
                                                    those submitted as ‘‘Confidential                        Radiological Health, Food and Drug                    both research and clinical practice is
                                                    Submissions,’’ publicly viewable at                      Administration, 10903 New Hampshire                   leading to identification of an increasing
                                                    http://www.regulations.gov or at the                     Ave., Bldg. 66, Rm. 5431, Silver Spring,              number of genetic variants (e.g.,
                                                    Division of Dockets Management                           MD 20993–0002; or the Office of                       pathogenic, benign, and of unknown
                                                    between 9 a.m. and 4 p.m., Monday                        Communication, Outreach, and                          significance), including rare variants
                                                    through Friday.                                          Development, Center for Biologics                     that may be unique to a single
                                                                                                             Evaluation and Research, Food and                     individual or family. This draft
                                                       • Confidential Submissions—To                                                                               guidance document describes FDA’s
                                                    submit a comment with confidential                       Drug Administration, 10903 New
                                                                                                             Hampshire Ave., Bldg. 71, Rm. 3128,                   considerations in determining whether a
                                                    information that you do not wish to be                                                                         genetic variant database is a source of
                                                    made publicly available, submit your                     Silver Spring, MD 20993–0002. Send
                                                                                                             one self-addressed adhesive label to                  valid scientific evidence that could
                                                    comments only as a written/paper                                                                               support the clinical validity of an NGS-
                                                    submission. You should submit two                        assist that office in processing your
                                                                                                             request.                                              based test. This draft guidance further
                                                    copies total. One copy will include the                                                                        outlines the process by which
                                                    information you claim to be confidential                 FOR FURTHER INFORMATION CONTACT:                      administrators of genetic variant
                                                    with a heading or cover note that states                 Personalized Medicine Staff, Center for               databases could voluntarily apply to
                                                    ‘‘THIS DOCUMENT CONTAINS                                 Devices and Radiological Health, Food                 FDA for recognition, and how FDA
                                                    CONFIDENTIAL INFORMATION.’’ The                          and Drug Administration, 10903 New                    would review such applications and
                                                    Agency will review this copy, including                  Hampshire Ave., Bldg. 66, Rm. 4546,                   periodically reevaluate recognized
                                                    the claimed confidential information, in                 Silver Spring, MD 20993–0002, 301–                    databases.
                                                    its consideration of comments. The                       796–7561, pmi@fda.hhs.gov; or Stephen
                                                    second copy, which will have the                         Ripley, Center for Biologics Evaluation               II. Significance of Guidance
                                                    claimed confidential information                         and Research, Food and Drug                              This draft guidance is being issued
                                                    redacted/blacked out, will be available                  Administration, 10903 New Hampshire                   consistent with FDA’s good guidance
                                                    for public viewing and posted on http://                 Ave., Bldg. 71, Rm. 7301, Silver Spring,              practices regulation (21 CFR 10.115).
                                                    www.regulations.gov. Submit both                         MD 20993–0002, 240–402–7911.                          The draft guidance, when finalized, will
                                                    copies to the Division of Dockets                        SUPPLEMENTARY INFORMATION:                            represent the current thinking of FDA
                                                    Management. If you do not wish your                                                                            on ‘‘Use of Public Human Genetic
                                                    name and contact information to be                       I. Background
                                                                                                                                                                   Variant Databases to Support Clinical
                                                    made publicly available, you can                            This draft guidance document                       Validity for Next Generation Sequencing
                                                    provide this information on the cover                    describes one part of FDA’s effort to                 (NGS)-Based In Vitro Diagnostics.’’ It
                                                    sheet and not in the body of your                        create a flexible regulatory approach to              does not establish any rights for any
                                                    comments and you must identify this                      the oversight of NGS-based tests as part              person and is not binding on FDA or the
                                                    information as ‘‘confidential.’’ Any                     of the White House’s Precision                        public. You can use an alternative
                                                    information marked as ‘‘confidential’’                   Medicine Initiative (PMI). FDA held two               approach if it satisfies the requirements
                                                    will not be disclosed except in                          workshops on this issue: ‘‘Use of
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                                                                                                                                                                   of the applicable statutes and
                                                    accordance with 21 CFR 10.20 and other                   Databases for Establishing the Clinical               regulations.
                                                    applicable disclosure law. For more                      Relevance of Human Genetic Variants’’
                                                    information about FDA’s posting of                       on November 13, 2015, and ‘‘Patient and               III. Electronic Access
                                                    comments to public dockets, see 80 FR                    Medical Professional Perspectives on                     Persons interested in obtaining a copy
                                                    56469, September 18, 2015, or access                     the Return of Genetic Test Results’’ on               of the draft guidance may do so by
                                                    the information at: http://www.fda.gov/                  March 2, 2016. The goal of this effort is             downloading an electronic copy from
                                                    regulatoryinformation/dockets/                           to help ensure patients receive accurate              the Internet. A search capability for all
                                                    default.htm.                                             and meaningful results, while                         Center for Devices and Radiological


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                                                                                         Federal Register / Vol. 81, No. 131 / Friday, July 8, 2016 / Notices                                                      44613

                                                    Health guidance documents is available                       Agencies to provide a 60-day notice in                 Based In Vitro Diagnostics’’ describes
                                                    at http://www.fda.gov/MedicalDevices/                        the Federal Register concerning each                   FDA’s considerations in determining
                                                    DeviceRegulationandGuidance/                                 proposed collection of information                     whether a genetic variant database is a
                                                    GuidanceDocuments/default.htm and                            before submitting the collection to OMB                source of valid scientific evidence that
                                                    for Center for Biologics Evaluation and                      for approval. To comply with this                      could support the clinical validity of an
                                                    Research guidance documents is                               requirement, FDA is publishing notice                  NGS-based test. This draft guidance
                                                    available at http://www.fda.gov/                             of the proposed collection of                          further outlines the process by which
                                                    BiologicsBloodVaccines/Guidance                              information set forth in this document.                administrators 1 of genetic variant
                                                    ComplianceRegulatoryInformation/                                With respect to the following                       databases could voluntarily apply to
                                                    Guidances/default.htm. Guidance                              collection of information, FDA invites                 FDA for recognition, and how FDA
                                                    documents are also available at http://                      comments on these topics: (1) Whether                  would review such applications and
                                                    www.regulations.gov. Persons unable to                       the proposed collection of information                 periodically reevaluate recognized
                                                    download an electronic copy of ‘‘Use of                      is necessary for the proper performance                databases. The draft guidance also
                                                    Public Human Genetic Variant                                 of FDA’s functions, including whether                  recommends that, at the time of
                                                    Databases to Support Clinical Validity                       the information will have practical                    recognition, the database administrator
                                                    for Next Generation Sequencing (NGS)-                        utility; (2) the accuracy of FDA’s                     make information regarding policies,
                                                    Based In Vitro Diagnostics’’ may send                        estimate of the burden of the proposed                 procedures, and conflicts of interest
                                                    an email request to CDRH-Guidance@                           collection of information, including the               publicly available and accessible on the
                                                    fda.hhs.gov to receive an electronic                         validity of the methodology and                        genetic variant database’s Web site.
                                                    copy of the document. Please use the                         assumptions used; (3) ways to enhance                    Based on our experience and the
                                                    document number 16008 to identify the                        the quality, utility, and clarity of the               nature of the information, we estimate
                                                    guidance you are requesting.                                 information to be collected; and (4)                   that it will take an average of 80 hours
                                                                                                                 ways to minimize the burden of the                     to complete and submit an application
                                                    IV. Paperwork Reduction Act of 1995
                                                                                                                 collection of information on                           for recognition. We estimate that
                                                       Under the Paperwork Reduction Act                         respondents, including through the use                 maintenance of recognition activities
                                                    of 1995 (the PRA) (44 U.S.C. 3501–                           of automated collection techniques,                    will take approximately one-fourth of
                                                    3520), Federal Agencies must obtain                          when appropriate, and other forms of                   that time (20 hours) annually. We
                                                    approval from the Office of Management                       information technology.                                estimate that it will take approximately
                                                    and Budget (OMB) for each collection of                                                                             1 hour to post the information on the
                                                                                                                 Use of Public Human Genetic Variant
                                                    information they conduct or sponsor.                                                                                Web site.
                                                                                                                 Databases To Support Clinical Validity
                                                    ‘‘Collection of information’’ is defined                                                                              Respondents are administrators of
                                                                                                                 for Next Generation Sequencing (NGS)-
                                                    in 44 U.S.C. 3502(3) and 5 CFR                                                                                      genetic databases. Our estimate of five
                                                                                                                 Based In Vitro Diagnostics OMB Control
                                                    1320.3(c) and includes Agency requests                                                                              respondents per year is based on the
                                                                                                                 Number 0910—NEW
                                                    or requirements that members of the                                                                                 current number of databases that may
                                                    public submit reports, keep records, or                        The draft guidance document ‘‘Use of                 meet FDA recommendations for
                                                    provide information to a third party.                        Public Human Genetic Variant                           recognition and seek such recognition.
                                                    Section 3506(c)(2)(A) of the PRA (44                         Databases to Support Clinical Validity                   FDA estimates the burden of this
                                                    U.S.C. 3506(c)(2)(A)) requires Federal                       for Next Generation Sequencing (NGS)-                  collection of information as follows:

                                                                                                         TABLE 1—ESTIMATED ANNUAL REPORTING BURDEN 1
                                                                                                                                                    Number of                               Average
                                                                                                                                  Number of                            Total annual                              Total
                                                                                    Activity                                                      responses per                           burden per
                                                                                                                                 respondents                            responses                                hours
                                                                                                                                                    respondent                             response

                                                    Application for recognition of genetic database ..................                5                   1                 5                  80                  400
                                                       1   There are no capital costs or operating and maintenance costs associated with this collection of information.

                                                                                                   TABLE 2—ESTIMATED ANNUAL RECORDKEEPING BURDEN 1
                                                                                                                                                     Number of                              Average
                                                                                                                                  Number of                            Total annual                              Total
                                                                                    Activity                                                        records per                            burden per
                                                                                                                                recordkeepers                            records                                 hours
                                                                                                                                                   recordkeeper                          recordkeeping

                                                    Maintenance of recognition activities ...................................         5                   1                 5                  20                  100
                                                       1   There are no capital costs or operating and maintenance costs associated with this collection of information.
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                                                      1 FDA acknowledges that many databases may not             committee of individuals that oversee the database.    genetic variant database administrator is the entity
                                                    use the term ‘‘administrator’’ or may have a                 Therefore, for the purpose of this guidance, a         or entities that oversee database operations.



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                                                    44614                                        Federal Register / Vol. 81, No. 131 / Friday, July 8, 2016 / Notices

                                                                                                    TABLE 3—ESTIMATED ANNUAL THIRD-PARTY DISCLOSURE BURDEN 1
                                                                                                                                                                     Number of            Total            Average
                                                                                                                                                   Number of         disclosures
                                                                                           Activity                                                                                      annual           burden per        Total hours
                                                                                                                                                  respondents            per           disclosures        disclosure
                                                                                                                                                                     respondent

                                                    Public disclosure of policies, procedures, and conflicts of
                                                      interest ..............................................................................          5                   1                5                  1                  5
                                                       1   There are no capital costs or operating and maintenance costs associated with this collection of information.


                                                      This draft guidance also refers to                                      actions may be appropriate with respect                   SUMMARY:    The Food and Drug
                                                    previously approved collections of                                        to in IVDs supported by such assertions?                  Administration (FDA or Agency) is
                                                    information. These collections of                                         How often should FDA conduct ongoing                      announcing the availability of the draft
                                                    information are subject to review by the                                  review of an FDA-recognized database?                     guidance entitled ‘‘Use of Standards in
                                                    OMB under the Paperwork Reduction                                            4. FDA notes that databases may have                   FDA Regulatory Oversight of Next
                                                    Act of 1995 (44 U.S.C. 3501–3520). The                                    ‘‘discordant calls’’ with other databases,                Generation Sequencing (NGS)-Based In
                                                    collections of information in the                                         where the assertions for a variant in                     Vitro Diagnostics (IVDs) Used for
                                                    guidance document ‘‘Requests for                                          each database vary. While FDA believes                    Diagnosing Germline Diseases.’’ As part
                                                    Feedback on Medical Device                                                that these discordant calls often arise                   of the White House’s Precision
                                                    Submissions: The Pre-Submission                                           because one database has information                      Medicine Initiative (PMI),1 FDA is
                                                    Program and Meetings with Food and                                        the other does not and our proposed                       issuing this draft guidance to provide
                                                    Drug Administration Staff’’ have been                                     policy will mitigate these issues over                    FDA’s proposed approach on the
                                                    approved under OMB control number                                         time; what, if any, action should FDA                     content and possible use of standards in
                                                    0910–0756. The collections of                                             take when it learns about discordant                      providing oversight for targeted and
                                                    information regarding premarket                                           calls between two databases with                          whole exome human DNA sequencing
                                                    submissions have been approved as                                         respect to database recognition or IVDs                   (WES) NGS-based tests intended to aid
                                                    follows: The collections of information                                   supported by such calls in FDA-                           in the diagnosis of individuals with
                                                    in 21 CFR part 807, subpart E, have been                                  recognized databases?                                     suspected germline diseases or other
                                                    approved under OMB control number                                            5. FDA has requested information                       conditions. This document provides
                                                    0910–0120; and the collections of                                         regarding conflicts of interest for                       recommendations for designing,
                                                    information in 21 CFR part 814,                                           curators and personnel of databases                       developing, and validating NGS-based
                                                    subparts A through E, have been                                           seeking FDA recognition. FDA                              tests for germline diseases, and also
                                                    approved under OMB control number                                         acknowledges that many personnel                          discusses possible use of FDA-
                                                    0910–0231.                                                                involved with variant curation and                        recognized standards for regulatory
                                                                                                                              interpretation may have some                              oversight of these tests. These
                                                    V. Other Issues for Consideration
                                                                                                                              connection to NGS test developers.                        recommendations are based on FDA’s
                                                       The Agency invites comments on the                                     What type of information should FDA                       understanding of the tools and
                                                    draft guidance document entitled ‘‘Use                                    collect and what policies should it                       processes needed to run an NGS-based
                                                    of Public Human Genetic Variant                                           implement to mitigate such potential                      test along with the design and analytical
                                                    Databases to Support Clinical Validity                                    conflicts of interest in FDA-recognized                   validation considerations appropriate
                                                    for Next Generation Sequencing (NGS)-                                     databases?                                                for such tests. This draft guidance is not
                                                    Based In Vitro Diagnostics,’’ in general,                                   Dated: July 5, 2016.                                    final nor is it in effect at this time.
                                                    and on the following questions, in                                                                                                  DATES: Although you can comment on
                                                                                                                              Leslie Kux,
                                                    particular:                                                                                                                         any guidance at any time (see 21 CFR
                                                                                                                              Associate Commissioner for Policy.
                                                       1. Should the quality                                                                                                            10.115(g)(5)), to ensure that the Agency
                                                    recommendations outlined in the                                           [FR Doc. 2016–16200 Filed 7–7–16; 8:45 am]
                                                                                                                                                                                        considers your comment of this draft
                                                    guidance apply equally to databases of                                    BILLING CODE 4164–01–P
                                                                                                                                                                                        guidance before it begins work on the
                                                    somatic variants and to germline                                                                                                    final version of the guidance, submit
                                                    variants?                                                                                                                           either electronic or written comments
                                                       2. While this document applies to                                      DEPARTMENT OF HEALTH AND
                                                                                                                              HUMAN SERVICES                                            on the draft guidance by October 6,
                                                    NGS-based tests, FDA expects that it                                                                                                2016.
                                                    may also be relevant to genetic tests that                                Food and Drug Administration
                                                    use other technologies (e.g., polymerase                                                                                            ADDRESSES:       You may submit comments
                                                    chain reaction, Sanger sequencing, etc.).                                 [Docket No. FDA–2016–D–1270]                              as follows:
                                                    Are any additional considerations                                                                                                   Electronic Submissions
                                                    necessary to support the use of these                                     Use of Standards in the Food and Drug
                                                                                                                              Administration’s Regulatory Oversight                       Submit electronic comments in the
                                                    databases in the premarket review of
                                                                                                                              of Next Generation Sequencing-Based                       following way:
                                                    tests using technologies other than NGS,
                                                                                                                              In Vitro Diagnostics Used for                               • Federal eRulemaking Portal: http://
                                                    should FDA decide to apply this
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                                                                                                                              Diagnosing Germline Diseases; Draft                       www.regulations.gov. Follow the
                                                    approach more broadly in the future?
                                                                                                                              Guidance for Stakeholders and Food                        instructions for submitting comments.
                                                       3. FDA recognizes that the evidence
                                                                                                                              and Drug Administration Staff;                            Comments submitted electronically,
                                                    linking specific variants to diseases or
                                                                                                                              Availability                                              including attachments, to http://
                                                    conditions will change over time, and as
                                                                                                                                                                                        www.regulations.gov will be posted to
                                                    such, assertions about those variants                                     AGENCY:           Food and Drug Administration,
                                                    may also change. If an assertion                                          HHS.                                                       1 The Precision Medicine Initiative found on the
                                                    regarding a variant changes over time,                                                                                              White House’s Web site at: https://
                                                                                                                              ACTION:       Notice of availability.
                                                    how should FDA assess what regulatory                                                                                               www.whitehouse.gov/precision-medicine.



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Document Created: 2016-07-08 00:18:07
Document Modified: 2016-07-08 00:18:07
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice of availability.
DatesAlthough you can comment on any guidance at any time (see 21 CFR 10.115(g)(5)), to ensure that the Agency considers your comment of this draft guidance before it begins work on the final version of the guidance, submit either electronic or written comments on the draft guidance by October 6, 2016.
ContactPersonalized Medicine Staff, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 66, Rm. 4546, Silver Spring, MD 20993- 0002, 301-796-7561, [email protected]; or Stephen Ripley, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 71, Rm. 7301, Silver Spring, MD 20993-0002, 240-402-7911.
FR Citation81 FR 44611 

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