Singapore health authority warns on falsified liraglutide pens
Reported from the analysis, not from a warning notice.
TheCompound Journal
Reporting on incretins, compounding & the peptide supply chain
Stability
At low concentrations a measurable fraction of peptide can adsorb to glass and plastic surfaces, and the loss is largest exactly where it is least expected.
An in-use period is a specific piece of experimental work. It requires the actual formulation, at the actual reconstituted concentration, in the actual container, held at the intended storage temperature, sampled at intervals, and analysed by methods capable of detecting the relevant degradation products — which in practice means a chromatographic method for related substances and a size-based method for aggregates. The output is a period over which the material remains within specification. Numbers circulating in this trade are, in the Journal’s experience, borrowed from the labelling of marketed pens, which are different formulations in different containers with different preservative systems.
A lyophilisation cycle has three stages and the differences between them explain most of what can go wrong. Freezing solidifies the solution, converting bulk water into ice crystals and concentrating everything else into an interstitial amorphous phase. Primary drying holds the product below the temperature at which that amorphous phase would soften, reduces the chamber pressure, and sublimes the ice directly to vapour. Secondary drying raises the shelf temperature to desorb water that remains bound to the solid matrix.
The rate-limiting stage is primary drying, and it is the stage under commercial pressure, because sublimation is slow and freeze-dryer time is expensive. Raising the shelf temperature accelerates it and risks carrying the product above its collapse temperature; shortening it leaves ice in the cake, which then melts during secondary drying and produces a partially collapsed plug with elevated moisture.
Secondary drying is the stage most often truncated, and truncation is invisible in the finished appearance. A cake can look entirely correct and carry three or four per cent residual water because the final desorption step was cut by six hours. The only way to detect it is to measure the water, which is why residual moisture is a release test in regulated manufacture and why its absence from a certificate is a substantive omission rather than a formatting one.1
Backbone hydrolysis cleaves an amide bond outright and produces two fragments, each of which is a distinct chromatographic species and each of which is detectable by mass. It is generally slower than deamidation at ordinary storage conditions but becomes dominant at low pH and elevated temperature, which is one reason accelerated stability data for peptides extrapolates so poorly: the pathway that dominates at forty degrees may be irrelevant at five.
Certain positions are much more labile than others. Aspartate-proline and aspartate-glycine bonds hydrolyse relatively readily under acidic conditions. N-terminal glutamine can cyclise to pyroglutamate, losing ammonia. Peptides with an N-terminal sequence of the right geometry can form a diketopiperazine and shed the first two residues as a cyclic dipeptide, a route that is fast enough at neutral pH to matter for some sequences.
Racemisation at susceptible residues produces epimers that are chemically identical in composition and differ only in stereochemistry. They are among the hardest impurities to detect, requiring either a chiral method or a sufficiently discriminating reversed-phase separation, and they are essentially never reported. A vial can be nominally pure by every measurement on its certificate and contain a percentage of a diastereomer with unknown biological behaviour.
The aggregate arrives at the column, comes apart, and is recorded as monomer.
Callum Brathwaite, Analytical Chemistry CorrespondentA gel pack works by latent heat. Water absorbs roughly three hundred and thirty-four joules per gram in melting, and while any solid remains the pack holds close to zero degrees. Once it has melted through, it has only sensible heat capacity left, about four joules per gram per degree, and it warms with the payload. The useful cold budget of a pack is therefore almost entirely its mass multiplied by the latent heat, and the transit time it buys is that budget divided by the rate at which heat leaks through the insulation.
The leak rate is where the arithmetic becomes discouraging. A thin expanded-polystyrene pouch has a modest thermal resistance and a large surface-to-volume ratio at parcel scale. A single two-hundred-gram pack in such a pouch, against an ambient temperature in the high twenties, is spent in something on the order of a day and a half. Two packs roughly double it. A vacuum-insulated shipper with a phase-change material would hold for several days, costs an order of magnitude more, and is not what arrives in this trade.
The honest conclusion is not that shipments in this market are catastrophic. It is that the cold chain they advertise is real for about the first day and notional thereafter, and that the practical protection for a multi-day journey is the intrinsic robustness of a dried peptide rather than anything in the packaging. The compendial guidance on distributing temperature-sensitive product is written around qualified shippers, mapped lanes and documented handover points, none of which exists here.2
Phase-change packs hold a narrower band for longer than water ice and avoid the sub-zero shock a freshly frozen gel pack delivers to a vial in direct contact. They cost a little more, and several suppliers switched to them after readers of this department asked.
| Intended storage | Long-term condition | Intermediate | Accelerated |
|---|---|---|---|
| Room temperature | 25 °C / 60% RH, ≥12 months | 30 °C / 65% RH | 40 °C / 75% RH, 6 months |
| Room temperature, hot climatic zone | 30 °C / 65% RH, ≥12 months | not applicable | 40 °C / 75% RH, 6 months |
| Refrigerated | 5 °C ± 3 °C, ≥12 months | not applicable | 25 °C / 60% RH, 6 months |
| Frozen | −20 °C ± 5 °C, ≥12 months | not applicable | single-batch excursion study |
| Below −20 °C | case by case | not applicable | single-batch excursion study |
| Summarised from the harmonised guideline on stability testing of new drug substances and products. Frozen-storage products are not accelerated in the usual sense; the guidance substitutes a study of the effect of a short excursion above the intended condition, which is precisely the data a shipped research vial would need and does not have. | |||
In-use stability is established by a dedicated study: the finished product reconstituted as intended, at the intended concentration, in the intended container, stored at the intended temperature, sampled at intervals, and analysed by stability-indicating methods for related substances and by a size-based method for aggregates. The output is a period, and the period belongs to that formulation in that container and to nothing else.
The in-use periods circulating in this market are not derived that way. They are, in the Journal’s experience of tracing them, borrowed from the labelling of marketed pen presentations, which are different formulations at different concentrations with different preservative systems in different primary containers. Marketed in-use periods for the incretin pens run from four weeks to eight depending on product and storage condition, and none of those figures transfers to a reconstituted research vial by any argument we can construct.
What can be said generally is directional rather than numerical. Degradation in solution proceeds orders of magnitude faster than in the cake. Lower temperature helps substantially. Repeated warming and cooling of an opened vial is worse than steady storage. Preservative-containing diluent addresses microbial growth and does nothing about chemical degradation. And in the absence of a study on the actual product, any specific number quoted for an in-use period is an assumption wearing a specification’s clothes.
One further loss is routinely mistaken for degradation. Peptides adsorb to glass and polymer surfaces, and the relationship runs the awkward way: the more dilute the solution, the larger the proportion a given surface area removes.3
Sterile water for injection contains water and nothing else. It is sterile when the container is opened and it has no capacity to remain so, and it supports the growth of any organism introduced subsequently. It is the appropriate diluent for a single-use presentation and the wrong one for anything intended to be entered more than once.
Bacteriostatic water for injection contains benzyl alcohol at nine parts per thousand. Benzyl alcohol inhibits microbial growth, which is what makes a multiple-dose presentation coherent, and it is important to be exact about what that means: a preservative suppresses the proliferation of organisms introduced during use. It does not sterilise a contaminated solution, it does not act instantly, and its effectiveness against a given organism is established by a specific compendial test rather than assumed.
Two further points get lost. Benzyl alcohol is not universally compatible; it has been implicated in the aggregation of certain protein formulations, and compatibility with a given peptide is a question for data rather than for convention. And a preservative system has its own stability: preservative content declines over an in-use period, which is one of the attributes a proper in-use study measures. A diluent choice is therefore a formulation decision with chemical consequences, not a matter of preference between two clear liquids.4
Freezing a reconstituted vial to extend its life is a common inference and a poor one, for reasons that have nothing to do with temperature and everything to do with what happens during the phase change. As ice forms, solutes are excluded from the crystal lattice and concentrated into a shrinking unfrozen fraction. Local concentration, ionic strength and pH in that fraction can shift dramatically — buffer components crystallise at different points, and a phosphate buffer is notorious for a large pH excursion on freezing.
The ice-water interface is itself a denaturing surface, and interfacial area increases with the number of freeze-thaw cycles. Each cycle presents the peptide with a fresh opportunity to unfold at that interface and aggregate. This is why formulations intended for frozen storage contain cryoprotectants and why lyophilisation exists as a technique at all: the point of drying is to avoid keeping a peptide in a partially frozen aqueous system.
The Journal states the mechanism and declines the recommendation, as this department’s practice requires. What can be said without advising anybody is that freezing a reconstituted solution is a different chemical operation from freezing a dried cake, that its effects are formulation-dependent and not predictable from first principles, and that no in-use study we have seen in this market has examined it. A reader treating the freezer as a pause button is relying on an assumption nobody has tested for that product.
Adsorption to the container looks exactly like degradation and is not. At low working concentrations a real fraction of peptide can be lost to glass or plastic within hours, which is why a dilute solution behaves worse than a concentrated one prepared the same day.
The regulatory framework in this article is taken from the harmonised guidelines on stability testing and on biotechnological products, read in the original, and from the current compendial chapters on storage definitions, distribution of temperature-sensitive products and stability in dispensing practice. The degradation chemistry is drawn from the peptide and pharmaceutical sciences literature, and where a claim is a generalisation across sequences this piece says so, because sequence dependence is the rule rather than the exception.
The shipment data is ours. Nine parcels, ordered at catalogue prices as ordinary customers, with calibrated loggers placed inside the insulated payload and sampling at five-minute intervals. Eight complete traces and one truncated by a customs hold. We disclose that nine parcels is not a survey, that we did not control the packing operation, and that a single logger cannot characterise a payload with a thermal gradient across it.
Nothing in this department is a recommendation about storing, reconstituting or administering anything. The compounds discussed are sold for research use only and are not approved for human use in any jurisdiction. Corrections and disputes go to standards@compoundjournal.com; documents, traces and certificates readers would like examined go to letters@compoundjournal.com, and we do not identify the source of anything sent to us.
The finding the Journal least wanted and most trusts is that the transit excursions everybody worries about are probably not the largest exposure in this supply chain. A dried cake at low moisture tolerates a warm afternoon. A reconstituted vial in a refrigerator door for six weeks, with no in-use study behind the number that justified the six weeks, is a different proposition, and it attracts almost no attention at all.
Selected from correspondence received on this article. Writers are identified by initial, surname and city, verified before printing. Replies are from the desk that filed the piece or from the standards editor. Write to letters@compoundjournal.com.
Light exposure is trivially controllable and almost never controlled. A clear vial on a shelf near a window is running a photostability study nobody designed, and the effect is real for several residue types.
— L. Silveira, Belo Horizonte
Bacteriostatic diluent contains a preservative and is intended for multiple withdrawals; sterile water is not. That distinction is the one thing in this whole subject that a supplier could usefully print on the box, and I have never seen it printed. Research-use material is not approved for human use in any event, and the storage physics is the same either way.
— C. Aguirre, Rosario
The distinction is real and the reason for it is microbiological rather than chemical, which is why it belongs beside the sterility material rather than the degradation chemistry.
The most useful thing a supplier can publish is its packing specification: pack type, quantity, insulation, and the tested hold time at a stated ambient. It is a page of text and it would let a buyer reason about their own climate.
— G. Thorbjørnsen, Tromsø
A logger recording every five minutes and a logger recording hourly will produce different excursion findings on the same journey, because the short spike at the depot falls between readings. Sampling interval is a specification and it is almost never quoted with the logger data.
— H. Barreto, Recife
Documentation of the cold chain between the fill site and dispatch is the leg that is genuinely under the supplier’s control, and it is the one nobody asks about. Everything before the courier is theirs to describe.
— C. Ilesanmi, Ado-Ekiti
Reported from the analysis, not from a warning notice.
The result is unremarkable. What the report states alongside it is not.
Documentation practice is the only part of vendor quality a buyer can assess before purchase.
The denominator excludes solvent-front features and injection artefacts by convention. Conventions differ on where the front ends, and a fragment eluting early exists in one…
Documentation practice is the only part of vendor quality a buyer can assess before purchase.
Follow the resin, not the catalogue.