The importance of rheumatology biologic registries in Latin America

High cost drugs in Latin America: access and barriers

INTRODUCTION

Latin America comprises a large set of culturally diverse middle-income countries sharing an inequality gap and a rapidly ageing population. A better informed growing middle class adds to the pressure on fragmented health systems that strive to attain universal coverage. Cost containment becomes crucial for sustainability.

AREAS COVERED

Using "high cost" as free term, together with individual country names, a search was performed in Pubmed and Scopus databases for relevant documents centered on pharmaceutical products. References of selected articles were also reviewed.

EXPERT OPINION

In the region as elsewhere improving health information systems has been the starting point. Official health technology assessment agencies have been established in several countries, supporting decisions on best available evidence. A few centralized procurement and price regulation schemes using international reference pricing have been successful. Fast-track approval of generics and biosimilars, or establishing a separate funding source for high cost technologies are other options that, with varying degrees of success, have been. Since Latin America is characterized by its social, geographical and political diversity, each health system needs to recognize its individual priorities, learn from successful experiences elsewhere, and adapt possible alternative interventions to the different local contexts.

Barriers towards effective pharmacovigilance systems of biosimilars in rheumatology: A Latin American survey

Purpose

This review summarises the current status of regulatory guidelines for the approval of biosimilars in Latin America and highlights the main barriers to effective pharmacovigilance in this region. We also report results from a survey of Latin American rheumatologists assessing their understanding of prescribing biosimilars and the pharmacovigilance of these drugs.

Methods

We reviewed the current guidelines for the regulatory approval of biosimilars and barriers to effective pharmacovigilance in Latin American countries. Rheumatologists attending the II Pan‐American League of Rheumatology Associations PANLAR Review Course (Biosimilars update) in Lima, Peru were asked to complete a short survey to determine their knowledge of biosimilars.

Results

Many Latin American countries continue to lag behind Europe and the United States in establishing regulatory guidance and effective pharmacovigilance systems for biosimilars. Results from our survey also highlight a lack of awareness regarding the availability of biosimilars, their nomenclature, automatic substitution, and reporting adverse drug reactions because of these drugs.

Conclusions

The main barriers to effective pharmacovigilance in Latin America are the lack of consensus on the interchangeability of reference biologics and biosimilars, and the need for more suitably trained personnel to carry out effective postmarketing pharmacovigilance of biosimilars. Inconsistencies in biosimilar nomenclature make it difficult to adequately trace drugs and record adverse drug reactions associated with their use, creating a barrier to the global pharmacovigilance of biologics.

Objectives and methodology of BIOBADASER phase iii

OBJECTIVE

Describe the objectives, methods and results of the first year of the new version of the Spanish registry of adverse events involving biological therapies and synthetic drugs with an identifiable target in rheumatic diseases (BIOBADASER III).

METHODOLOGY

Multicenter prospective registry of patients with rheumatic inflammatory diseases being treated with biological drugs or synthetic drugs with an identifiable target in rheumatology departments in Spain. The main objective of BIOBADASER Phase III is the registry and analysis of adverse events; moreover, a secondary objective was added consisting of assessing the effectiveness by means of the registry of activity indexes. Patients in the registry are evaluated at least once every year and whenever they experience an adverse event or a change in treatment. The collection of data for phase iii began on 17 December 2015.

RESULTS

During the first year, 35 centers participated. The number of patients included in this new phase in December 2016 was 2,664. The mean age was 53.7 years and the median duration of treatment was 8.1 years. In all, 40.4% of the patients were diagnosed with rheumatoid arthritis. The most frequent adverse events were infections and infestations.

CONCLUSIONS

BIOBADASER Phase III has been launched to adapt to a changing pharmacological environment, with the introduction of biosimilars and small molecules in the treatment of rheumatic diseases. This new stage is adapted to the changes in the reporting of adverse events and now includes information related to activity scores.

Safety of biologic DMARDs in RA patients in real life: A systematic literature review and meta-analyses of biologic registers

OBJECTIVES

In daily practice, safety in rheumatoid arthritis (RA) patients receiving biological treatment is an important issue. Unlike randomized controlled trials, biologic registers provide long-term real life safety data. To identify all biologic registers worldwide, to extract and analyze data regarding safety in RA patients under biologics.

METHOD

Systematic review was performed independently by 2 rheumatologists using PUBMED, COCHRANE Library and EMBASE databases, up to December 2014. Worldwide biologic registers and related publications were identified. Data on safety issues in RA patients were extracted for meta-analyses. Random-effect meta-analyses were performed to estimate risk ratios (RRs) of mortality, cardiovascular events, cancer, including lymphoma and melanoma and serious infections between (1) biological and non-biological DMARD (cDMARD), (2) between biologics when data were available.

RESULTS

Forty-three biological registers were identified worldwide and 27 publications were included for safety meta-analyses on anti-TNFs. Compared to cDMARD, mortality and cardiovascular events were significantly decreased in patients treated with anti-TNFs: RR=0.60 [95% CI 0.38-0.94] and RR=0.62 [0.44-0.88], respectively. Anti-TNFs did not increase the risk of solid cancer in patients without or with prior malignancy (RR=0.84 [0.60-1.18] and RR=0.77 [0.29-2.03], respectively), lymphoma (RR=0.90 [0.62-1.31]) and melanoma (RR=1.17 [0.86-1.59]). As expected, serious infections were significantly increased during anti-TNF treatment (RR=1.48 [1.18-1.85]) compared to cDMARD. No significant difference was found between soluble receptor to TNF and monoclonal antibodies (RR=0.55 [0.22-1.35]).

CONCLUSIONS

By reducing dramatically chronic inflammation in RA patients, anti-TNFs decrease mortality, cardiovascular events without increase significantly the risk of cancer, compared to cDMARDs.

Epidemiological profile of colombian patients with rheumatoid arthritis in a specialized care clinic

INTRODUCTION

Few studies report the epidemiological profile of RA patients attending clinics for comprehensive care. We describe the clinical, socio-demographic characteristics and comorbidities of a cohort of patients with RA.

METHODS

Cross-sectional study in a cohort of patients according to ACR criteria/EULAR 2010 classification who have entered to the AR clinic since October 2012 until May 2014, referred from primary care. Frequencies for socio-demographic, comorbidity, state of disease activity, functional status, biomarkers and therapeutic modalities variables are described.

RESULTS

In total, 1652 patients were included with a mean age of 58 years and a duration of 9 years. Rheumatoid factor was positive in 80% and anti-citrullinated peptide antibody in 63% of patients. In total, 43.6% of patients had comorbidities: Hypertension (20.4%), osteoporosis (17.3%) and Sjögren's syndrome (10.4%). Fifty percent of the patients had moderate and high disease activity level measured by DAS-28 score, and the mean HAQ score was 0.64 (DS 1.12). Seventy three percent of patients were treated with oral disease modified anti rheumatic treatment and 63.6% of them were with methotrexate. 42.4% of the patients were treated with glucocorticoids (mean dose 6.3mg).

CONCLUSIONS

The epidemiological behavior of a group of RA patients is reported. The presence of comorbidities is significant affecting the risk of morbidity and mortality in these patients. The definition of the epidemiological profile of this population will allow the design of research questions to resolve outstanding problems in the clinical context of this pathology.