VITROS CHEMISTRY PRODUCTS BARB REAGENT; CALIBRATOR KIT 26; FS CALIBRATOR 1; DAT PERFORMANCE VERIFIERS

{0} 1 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ASSAY ONLY TEMPLATE A. 510(k) Number: k062165 B. Purpose for Submission: New device C. Measurand: Barbiturates D. Type of Test: Qualitative and semi-quantitative enzyme immunoassay E. Applicant: Ortho-Clinical Diagnostics, Inc. F. Proprietary and Established Names: VITROS Chemistry Products BARB Reagent VITROS Chemistry Products Calibrator 26 VITROS Chemistry Products FS Calibrator 1 VITROS Chemistry Products DAT Performance Verifiers I, II, III, IV and V G. Regulatory Information: 1. Regulation section: 21 CFR 862.3150, Barbiturates test system 21 CFR 862.3200, Clinical Toxicology Calibrator 21 CFR 862.3180, Clinical Toxicology Control 2. Classification: Class II, (reagent, calibrator) Class I, reserved (control) 3. Product code: DIS, DLJ and DIF 4. Panel: Toxicology (91) {1} H. Intended Use: 1. Intended use(s): See Indications for use. 2. Indication(s) for use: VITROS Chemistry Products BARB Reagent: For in vitro diagnostic use only. VITROS Chemistry Products BARB Reagent is used on VITROS 5,1 FS Chemistry Systems for the semi-quantitative or qualitative determination of barbiturates (BARB) in human urine using a cutoff of 200 ng/mL or 300 ng/mL. Measurements obtained with the VITROS BARB method are used in the diagnosis and treatment of barbiturates use or overdose. The VITROS Chemistry Products BARB assay is intended for use by professional laboratory personnel. It provides only a preliminary test result. A more specific alternative chemical method must be used to confirm a result with this assay. Gas Chromatography/Mass Spectrometry (GC/MS) is the preferred confirmatory method. Clinical consideration and professional judgment should be applied to any drug-of-abuse test result, particularly when evaluating a preliminary positive result. VITROS Chemistry Products Calibrator Kit 26: For in vitro diagnostic use only. VITROSChemistry Products Calibrator Kit 26 is used to calibrate VITROS 5,1 FS Chemistry Systems for the qualitative or semi-quantitative measurement of drugs of abuse. VITROS Chemistry Products DAT Performance Verifiers I, II, III, IV &amp; V: For in vitro diagnostic use only. VITROS Chemistry Products DAT Performance Verifiers are assayed controls used to monitor performance of urine drugs of abuse screening assays on VITROS 5,1 FS Chemistry Systems. 3. Special conditions for use statement(s): For use by professional laboratory personnel. For in vitro diagnostic use only. 4. Special instrument requirements: Ortho-Clinical Diagnostics VITROS 5,1 FS Chemistry System I. Device Description: The VITROS Chemistry Products BARB Reagent consists of two dual chambered reagent packs containing two ready-to-use liquid reagents. The reactive ingredients in Reagent 1 include sheep polyclonal antibodies reactive to secobarbital, Glucose 6-phosphate and Nicotinamide adenine nucleotide (NAD). The other ingredients in Reagent 1 include inorganic salt, organic salt, inorganic polymer, protease inhibitor, surfactant and preservative. The reactive ingredients in Reagent 2 include secobarbital labeled with glucose-6-phosphate dehydrogenase. The other ingredients in Reagent 2 include buffers, organic salt, inorganic salt, proteins, protease inhibitors, biological material, surfactant and preservatives. VITROS Chemistry Products Calibrator Kit 26 is prepared from human urine to which drugs of abuse, {2} metabolites of drugs of abuse, organic salts, surfactants and preservative have been added. VITROS Chemistry Products FS Calibrator 1 is prepared from sodium chloride and processed water. These products are used to calibrate VITROS 5,1 FS Chemistry Systems for the qualitative and semi-quantitative measurement of barbiturates (BARB). VITROS DAT Performance Verifiers I, II, III, IV &amp; V are prepared from a human urine pool to which analytes, surfactant and preservative have been added. These are assayed controls used to monitor performance of VITROS BARB Reagent on VITROS 5,1 FS Chemistry Systems. The product labeling for the calibrator and controls contain warnings regarding the presence of human sourced materials and recommend the use of Universal Precautions when handling these products. ## J. Substantial Equivalence Information: 1. Predicate device name(s): Syva EMIT II Plus Barbiturate assay Bio-Rad Liquicheck Urine Toxicology Controls 2. Predicate 510(k) number(s): k993987 k022707 3. Comparison with predicate: | Similarities | | | | --- | --- | --- | | Item | Device | Predicate | | Intended Use | For use in the semi-quantitative or qualitative determination of barbiturates in human urine. | Same | | Reagent | Liquid, ready to use | Same | | Principle | Homogeneous enzyme immunoassay | Same | | Matrix | Urine | Same | | Antibody | Sheep polyclonal | Same | | Differences | | | | --- | --- | --- | | Item | Device | Predicate | | Instrumentation | VITROS 5,1 FS Chemistry Systems | Multiple automated clinical chemistry analyzers | | Calibrators | 6 levels | Qualitative: 3 levels Semi-quantitative: 5 levels | | Controls: Number of levels | 5 levels | Two levels | ## K. Standard/Guidance Document Referenced (if applicable): CSLI EP9-A2: Method Comparison and Bias Estimation Using Patient Samples {3} CLSI EP5-A: Evaluation of Precision Performance of Clinical Chemistry Devices CLSI EP6-A: Evaluation of the Linearity of Quantitative Measurement Procedures, A Statistical Approach CLSI EP7-P: Interference Testing in Clinical Chemistry CLSI EP17-A: Protocols for Demonstration, Verification and Evaluation of Limits of Detection and Quantitation CLSI EP12-A: User Protocols for Evaluation of Qualitative Test Performance ## L. Test Principle: The VITROS BARB assay is a homogenous immunoassay based on the competition between barbiturates in the treated urine sample and secobarbital labeled with the enzyme glucose-6-phosphate dehydrogenase (G6P-DH) for antibody binding sites. Enzyme activity decreases upon binding to the antibody, therefore the concentration of barbiturates in the urine sample is directly proportional to measured enzyme activity. Active enzyme converts oxidized nicotinamide adenine dinucleotide $(\mathrm{NAD}^{+})$ to NADH, resulting in an absorbance change that is measured spectrophotometrically. ## M. Performance Characteristics (if/when applicable): ### 1. Analytical performance: #### a. Precision/Reproducibility: Semi-quantitative precision was assessed with quality control materials on the VITROS 5,1 FS Chemistry System following CLSI Protocol EP5 and EP12. The samples were run in duplicate, twice a day for twenty-two days using two reagent lots and four instruments. Each run consisted of five control fluids to assess assay imprecision at approximately $\pm 25\%$ of the 200 and $300~\mathrm{ng/mL}$ cutoff concentrations. The results are presented in the table below. | Mean Conc. ng/mL | Within-Day SD | Within-Lab SD | Within-Lab %CV | No. Observations | | --- | --- | --- | --- | --- | | 143 | 6.8 | 10.3 | 7.2 | 86 | | 215 | 6.0 | 10.5 | 4.9 | 84 | | 240 | 6.2 | 11.5 | 4.8 | 86 | | 378 | 7.9 | 14.1 | 3.7 | 84 | | 632 | 12.8 | 20.5 | 3.2 | 86 | Qualitative imprecision was assessed using drug-spiked human urine pools with concentrations targeted at approximately $\pm 25\%$ of the 200 and $300~\mathrm{ng/mL}$ cutoff concentrations. The concentrations of the targeted test fluids were confirmed by GC/MS. The sponsor performed one to two runs per day with two replicates per run for 22 days using a single lot of reagent on one analyzer. The results are presented below: {4} | Cutoff ng/mL | Test Fluid Concentration ng/mL | No. Observations | Number of Correct Results | | --- | --- | --- | --- | | 200 | 143 | 86 | 86/86 | | 200 | 240 | 86 | 86/86 | | 300 | 215 | 84 | 84/84 | | 300 | 378 | 84 | 84/84 | b. Linearity/assay reportable range: The sponsor followed CLSI EP6-A: "Evaluation of the Linearity of Quantitative Analytical Methods; Approved Guideline" in determining the linear range of their device. Number of reagent lots: 3 Replicates of each solution: 3 Two urine pools were prepared with barbiturate concentrations at the low (0 ng/mL) and high (1000 ng/mL) end of the calibration range. The two pools were mixed to give 13 admixtures of intermediate barbiturate concentrations. Linearity was evaluated using three assay reagent lots and comparing the measured results against the expected results from 13 pooled samples. A linear regression was performed and the results indicated acceptable linearity across the concentration range tested (3 - 890 ng/mL). The claimed reportable range of the VITROS BARB assay is 60 - 800 ng/mL. c. Traceability, Stability, Expected values (controls, calibrators, or methods): The assigned values for the calibrators and controls are traceable to the Cerillant secobarbital standard catalogue S-005 and are verified by GC/MS. Real time and accelerated stability studies were conducted; protocols and acceptance criteria were described and found to be acceptable. These studies support the sponsor's stability claims for the following products: | Reagent | Storage | Stability* | | --- | --- | --- | | Unopened | 2-8°C | 12 months | | Opened | On board analyzer, system tu | ≤14 days | | Opened | On board analyzer, system tu | ≤30 minutes | | Calibrator | Storage | Stability* | | --- | --- | --- | | Unopened | ≤18°C | 8 months | | Opened | 2-8°C | 4 weeks | | Controls | Storage | Stability* | | --- | --- | --- | {5} | Controls | Storage | Stability* | | --- | --- | --- | | Unopened | 2-8°C | 6 months | | Opened | 2-8°C | 4 weeks | *NOTE: Real time stability studies are ongoing. d. Detection limit: The detection limit was determined according to protocol recommendations in CLSI EP-17 on three different lots of reagent and one instrument platform. The claimed lower limit for VITROS BARB assay is $60\mathrm{ng / mL}$ . e. Analytical specificity: The sponsor conducted interference studies following CLSI EP7-A2. The substances listed in the table below were determined not to interfere in the two secobarbital concentrations tested, 200 and $300\mathrm{ng / mL}$ , up to the concentrations shown: | Compound | Concentration Tested | | | --- | --- | --- | | | Conventional | SI | | Ammonia | 570 mg/dL | 334.6 μmol/L | | Ascorbic Acid | 500 mg/dL | 28.4 mmol/L | | Bilirubin | 26 mg/dL | 444.6 μmol/L | | Brompheniramine | 100,000 ng/mL | 313.2 μmol/L | | Calcium | 30 mg/dL | 7.5 mmol/L | | Ciprofloxacin | 100,000 ng/mL | 300.3 μmol/L | | Citric acid | 100 mg/dL | 5.2 mmol/L | | Cloxacillin | 100,000 ng/mL | 229.4μmol/L | | creatinine | 300 mg/dL | 26.5 mmol/L | | Desipramine | 100,000 ng/mL | 330.2 μmol/L | | dextromethorphan | 100,000 ng/mL | 368.5 μmol/L | | Dicyclomine | 100,000 ng/mL | 289.1 μmol/L | | Dipethylpropione | 100,000 ng/mL | 487.1 μmol/L | | Doxylamine | 100,000 ng/mL | 369.8 μmol/L | | Ethacrylic acid | 100,000 ng/mL | 329.9 μmol/L | | Ethanol | 780 mg/dL | 169.3 mmol/L | | Glucose | 4000 mg/dL | 222 mmol/L | | Hemoglobin | 500 mg/dL | 5 g/L | | Human IgG | 200 mg/dL | 2 g/L | | Human serum album | 200 mg/dL | 2 g/L | | Imipramine | 10 mg/dL | 357 μmol/L | | Indomethacin | 10 mg/dL | 280 μmol/L | {6} | Compound | Concentration Tested | | | --- | --- | --- | | | Conventional | SI | | Iron | 100 ug/dL | 18 μmol/L | | KCl | 1118 mg/dL | 150 mmol/L | | l-hyoscyamine | 10 mg/dL | 346 μmol/L | | Magnesium | 60 mg/dL | 24.7 mmol/L | | Meperidine | 10 mg/dL | 404 μmol/L | | Methoxyphenamine | 10 mg/dL | 558 μmol/L | | Metronidazole | 10 mg/dL | 584 μmol/L | | NaCl | 6000 mg/dL | 1027 mmol/L | | Nylidrine | 10 mg/dL | 334 μmol/L | | Ofloxacin | 10 mg/dL | 277 μmol/L | | Oxalic acid | 300 mg/dL | 24 mmol/L | | pH = 4 | | | | pH = 9 | | | | Phenytoloxamine | 10 mg/dL | 392 μmol/L | | Phenylbutazone | 10 mg/dL | 324 μmol/L | | Phosphate | 1420 mg/dL | 100 mmol/L | | Promethazine | 10 mg/dL | 312 μmol/L | | Propanolol | 10 mg/dL | 386 μmol/L | | Pyruvate | 100 mg/dL | 11 mmol/L | | Riboflavin | 2 mg/dL | 53 μmol/L | | Tolmetin/tolectin | 10 mg/dL | 389 μmol/L | | Trihexylphenidyl | 10 mg/dL | 296 μmol/L | | Trimethobenzamide | 10 mg/dL | 257 μmol/L | | Tripelannamine | 10 mg/dL | 392 μmol/L | | Triprolidine | 10 mg/dl | 359 μmol/L | | Tyramine | 10 mg/dL | 576 μmol/L | | Urea | 3000 mg/dL | 500 mmol/L | | Uric acid | 120 mg/dL | 7 mmol/L | The sponsor determined that a high specific gravity does not interfere with the assay by evaluating the primary causes of high specific gravity: high concentrations of NaCl, protein and glucose in urine. The specificity of VITROS BARB assay for common barbiturates and structurally similar compounds was determined by generating a dose response curve for each of the compounds and determining the approximate quantity of each compound that is equivalent in assay reactivity to a secobarbital 200 ng/mL and 300 ng/mL cutoff. {7} | Compound | Conc. equivalent to 200 ng/mL | Approx. % Cross-reactivity | Conc. equivalent to 300 ng/mL | Approx. % Cross-reactivity | | --- | --- | --- | --- | --- | | Alphenal | 100 | 200 | 230 | 130.2 | | Talbutal | 188 | 106.7 | 311 | 96.5 | | Secobarbital | 200 | 100 | 300 | 100 | | Aprobarbital | 219 | 91.4 | 415 | 72.3 | | Butabarbital | 238 | 84.2 | 472 | 63.5 | | Butalbital | 263 | 76.2 | 472 | 63.5 | | Pentobarbital | 281 | 71.1 | 472 | 63,5 | | Cyclopentobarbital | 350 | 57.1 | 611 | 49.1 | | Butobarbital | 375 | 53.3 | 864 | 34.7 | | Amobarbital | 450 | 44.4 | 922 | 32.6 | | Allobarbital | 563 | 35.6 | 1152 | 26.0 | | Phenobarbital | 1000 | 20 | 3456 | 8.7 | | Barbital | 1875 | 10.7 | 6106 | 4.9 | | 5-ethyl-5-(4-hydroxyphenyl) barbituric acid | 2250 | 8.9 | 9792 | 3.1 | | Thiopental | 6250 | 3.2 | 40320 | 0.7 | f. Assay cut-off: There is a description of the analytical performance of the device around the 200 ng/mL and 300 ng/mL cutoffs in section M.1.d. The test is designed to yield a positive result when the drug exceeds these cutoff concentrations in the urine sample. 2. Comparison studies: a. Method comparison with predicate device: A total of 102 human urine samples were assayed using the VITROS Chemistry Products BARB Reagent and GC/MS reference method. Percent agreement was evaluated at assay cutoff values of 200 ng/mL and 300ng/mL. {8} GC/MS Reference Method Comparison for BARB | | | Commercial Method | | | | %Agreement | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Cutoff Value (ng/mL) | | Low Negative | Near Cutoff Negative | Near Cutoff Positive | High Positive | %Agreement Negative | %Agreement Positive | %Agreement Overall | | 200 | | (<-50%) <100 ng/mL | (-50% to cutoff) 100-200 ng/mL | (cutoff to +50%) 200-300 ng/mL | (>+50%) >300 ng/mL | 68.4 | 100.0 | 82.4 | | | VITROS Positive | 0 | 18 | 18 | 27 | | | | | | VITROS Negative | 27 | 12 | 0 | 0 | | | | | 300 | | (<-50%) <150 ng/mL | (-50% to cutoff) 150-300 ng/mL | (cutoff to +50%) 300-450 ng/mL | (>+50%) >450 ng/mL | 73.3 | 100.0 | 80.4 | | | VITROS Positive | 1 | 19 | 11 | 16 | | | | | | VITROS Negative | 41 | 14 | 0 | 0 | | | | Summary of Discordant Samples: GC/MS | 200 ng/mL Cutoff | VITROS BARB Assay (ng/mL) | GC/MS Reference Method (ng/mL) | | --- | --- | --- | | | 203 | 369 phenobarbital | | | 208 | 408 phenobarbital | | | 203 | 434 phenobarbital | | | 204 | 451 phenobarbital | | | 212 | 496 phenobarbital | | | 201 | 520 phenobarbital | | | 203 | 663 phenobarbital | | | 213 | 803 phenobarbital | | | 376 | 119 butalbital | | | 352 | 170 butalbital | | | 276 | 177 butalbital | | | 286 | 185 butalbital | | | 327 | 215 butalbital | | | 305 | 221 butalbital | | | 369 | 224 butalbital | | | 351 | 236 butalbital | | | 341 | 248 butalbital | | 369 | 253 butalbital | | Summary of Discordant Samples: GC/MS | 300 ng/mL Cutoff | VITROS BARB Assay (ng/mL) | GC/MS Reference Method (ng/mL) | | --- | --- | --- | | | 376 | 119 butalbital | | | 352 | 170 butalbital | | | 327 | 215 butalbital | | | 305 | 221 butalbital | | | 369 | 224 butalbital | | | 351 | 236 butalbital | | | 341 | 248 butalbital | | | 369 | 253 butalbital | | | 334 | 308 butalbital | | | 381 | 322 butalbital | {9} A total of 102 unaltered human urine samples were assayed on the device and a commercially available immunoassay method for barbiturates. Percent agreement was evaluated at assay cutoff values of 200 and 300 ng/mL. To challenge performance at the 200 ng/mL cutoff value, 25 of the 102 samples tested had concentrations within +/- 50% of the cutoff value, 10 samples below the cutoff value and 15 above the cutoff value. To challenge performance at the 300 ng/mL cutoff value, 54 of the 102 samples tested had concentrations within +/- 50% of the cutoff value, 25 samples below the cutoff value and 29 above the cutoff value. Commercial Method Comparison for BARB | | | Commercial Method | | | | %Agreement | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Cutoff Value (ng/mL) | | Low Negative | Near Cutoff Negative | Near Cutoff Positive | High Positive | %Agreement Negative | %Agreement Positive | %Agreement Overall | | 200 | | (<-50%) <100 ng/mL | (-50% to cutoff) 100-200 ng/mL | (cutoff to +50%) 200-300 ng/mL | (>+50%) >300 ng/mL | 100.0 | 94.0 | 96.1 | | | VITROS Positive | 0 | 0 | 11 | 52 | | | | | | VITROS Negative | 25 | 10 | 4 | 9 | | | | | 300 | | (<-50%) <150 ng/mL | (-50% to cutoff) 150-300 ng/mL | (cutoff to +50%) 300-450 ng/mL | (>+50%) >450 ng/mL | 100.0 | 90.4 | 95.1 | | | VITROS Positive | 0 | 0 | 24 | 23 | | | | | | VITROS Negative | 25 | 25 | 5 | 0 | | | | b. Matrix comparison: Not applicable 3. Clinical studies: a. Clinical Sensitivity: Not applicable {10} b. Clinical specificity: Not applicable c. Other clinical supportive data (when a. and b. are not applicable): Not applicable 4. Clinical cut-off: Not applicable 5. Expected values/Reference range: Not applicable. N. Proposed Labeling: The labeling is sufficient and it satisfies the requirements of 21 CFR Part 809.10. O. Conclusion: The submitted information in this premarket notification is complete and supports a substantial equivalence decision. 11