1
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Loaiza-Bonilla A, Page RD. Achieving white blood cell equity: are the safety profiles of biosimilar and reference pegfilgrastims comparable? Future Oncol 2024; 20:145-158. [PMID: 37609795 DOI: 10.2217/fon-2023-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Biosimilars can provide choices for patients and may provide cost savings; however, their uptake has been slow in the USA, in part due to limited knowledge. To provide additional confidence in US pegfilgrastim biosimilars, this narrative review compared the safety profiles of biosimilar pegfilgrastims, currently approved or filed for approval in the USA, with the EU- and US-approved reference pegfilgrastims. Headache and bone pain were common to biosimilars and reference products and occurred at a similar incidence. Clinical trial data on the safety profiles of biosimilar pegfilgrastims and reference products have demonstrated similarity and comparability, with no unexpected safety outcomes. Overall, the safety profiles of biosimilar pegfilgrastims and reference pegfilgrastims demonstrated a high degree of similarity and comparability.
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Affiliation(s)
| | - Ray D Page
- The Center for Cancer & Blood Disorders, Fort Worth, TX 76104, USA
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2
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Wang CY, Vouri SM, Park H, Heldermon CD, Brown JD. Comparative effectiveness of pegfilgrastim biosimilars vs originator for prevention of febrile neutropenia: A retrospective cohort study. J Manag Care Spec Pharm 2023; 29:119-127. [PMID: 36705287 PMCID: PMC10387906 DOI: 10.18553/jmcp.2023.29.2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND: Real-world evidence on the comparative effectiveness of pegfilgrastim biosimilars compared with the originator product is limited. OBJECTIVE: To compare the risk of febrile neutropenia (FN) among users of pegfilgrastim biosimilars (pegfilgrastim-jmdb and pegfilgrastim-cbqv) and the originator product. METHODS: A retrospective cohort study was conducted using 2019 IBM MarketScan databases to assess comparative effectiveness of pegfilgrastim originator and biosimilars for prevention of FN among patients receiving myelosuppressive chemotherapy. Patients with cancer, including breast, lung, colorectal, esophageal and gastric, pancreatic, prostate, ovarian, and non-Hodgkin lymphomas, initiating myelosuppressive chemotherapy courses were selected. We further selected patients who used pegfilgrastim originator and biosimilars within 3 days of chemotherapy completion. FN-associated hospitalizations were measured by International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. After 1:1 propensity score matching, we used equivalence (with a margin of 6%) hypothesis tests to compare FN-related hospitalization risk in the first cycle and across all cycles between biosimilars and originator users. RESULTS: A total of 2,045 patients were included, of which 445 (21.8%) used pegfilgrastim-jmdb, 636 (31.1%) used pegfilgrastim-cbqv, and 964 (47.1%) used pegfilgrastim originator. After matching, 13 out of 445 originator users and 17 out of 445 pegfilgrastim-jmdb users developed FN after the first chemotherapy cycle (risk difference was 0.9%; P < 0.001 for equivalence test indicating statistical equivalence). After matching, 14 out of 633 originator users and 16 out of 633 pegfilgrastim-cbqv users developed FN (risk difference was 0.32%; P < 0.001 for equivalence test indicating statistical equivalence). Results across all cycles (including the first cycle) were consistent with that in the first cycle. CONCLUSIONS: In this real-world study of patients with cancer receiving myelosuppressive chemotherapy, there was no difference in FN risk between patients receiving pegfilgrastim originator and biosimilars in the first cycle and across all cycles. These results add further to the current evidence on pegfilgrastim biosimilars and support wider adoption of pegfilgrastim biosimilars among payers, providers, and patients. Future studies assessing the tolerability, side effects, and other safety issues of pegfilgrastim biosimilars are needed.
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Affiliation(s)
- Ching-Yu Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.,Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.,Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.,Center for Drug Evaluation and Safety, University of Florida, Gainesville
| | - Coy D Heldermon
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville
| | - Joshua D Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.,Center for Drug Evaluation and Safety, University of Florida, Gainesville
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3
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Kondo Y, Tachi T, Sakakibara T, Kato J, Kato A, Mizuno T, Miyake Y, Teramachi H. Cost-effectiveness analysis of pegfilgrastim in patients with non-small cell lung cancer receiving ramucirumab plus docetaxel in Japan. Support Care Cancer 2022; 30:6775-6783. [PMID: 35524869 DOI: 10.1007/s00520-022-07102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The dose-limiting factor of ramucirumab plus docetaxel (RAM + DTX) in patients with non-small cell lung cancer (NSCLC) is febrile neutropenia (FN), which has a high incidence in Asians. This study aimed to evaluate the cost-effectiveness of pegfilgrastim (Peg-G) in patients with NSCLC receiving RAM + DTX in Japan. METHODS We simulated model patients treated with RAM + DTX in Japan and developed a decision-analytical model for patients receiving Peg-G prophylaxis or no primary prophylaxis. The expected cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER) of each treatment were calculated from the perspective of a Japanese healthcare payer. The willingness-to-pay (WTP) threshold was set at 45,867 United States dollars (USD) (5 million Japanese yen) per QALY gained. The probabilities, utility values, and other costs were obtained from published sources. Deterministic sensitivity analysis (DSA) and probabilistic analysis were conducted to evaluate the effect of each parameter and robustness of the base-case results. RESULTS The expected cost and QALYs were 20,275 USD and 0.701 for Peg-G prophylaxis and 17,493 USD and 0.672 for no primary prophylaxis, respectively. The ICER was calculated to be 97,519 USD per QALY gained. The results were most sensitive to FN risk with Peg-G. When FN risk with no primary prophylaxis exceeded 51% or the cost of Peg-G was less than 649 USD per injection, the ICER was below the WTP threshold. The probabilistic analysis revealed a 9.1% probability that the ICER was below the WTP threshold. CONCLUSION Peg-G is not cost-effective in patients with NSCLC receiving RAM + DTX in Japan.
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Affiliation(s)
- Yu Kondo
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan.
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan.
| | - Tomoya Tachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan
| | - Takayoshi Sakakibara
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Jun Kato
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Aki Kato
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Takahito Mizuno
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Yoshio Miyake
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan.
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Civoli F, Finck B, Tang H, Hodge J, O'Kelly H, Vexler V. Biosimilar Pegfilgrastim-cbqv Demonstrated Similar Immunogenicity to Pegfilgrastim in Healthy Subjects Across Three Randomized Clinical Studies. Adv Ther 2022; 39:1230-1246. [PMID: 35034311 PMCID: PMC8918144 DOI: 10.1007/s12325-021-02024-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
Introduction Biologic therapeutics can trigger immune responses in patients. As part of the totality of evidence that is required for regulatory approval of biosimilars, immunogenicity similarity must be assessed in the clinical programs. Pegfilgrastim-cbqv (UDENYCA®) is a pegfilgrastim biosimilar approved in the USA and European Union. This article demonstrates the similar immunogenicity of pegfilgrastim-cbqv compared with its reference product, pegfilgrastim (Neulasta®). Methods The immunogenicity of pegfilgrastim-cbqv was assessed in three clinical studies in healthy subjects (one specifically designed to evaluate immunogenicity similarity and two studies to assess pharmacokinetics and pharmacodynamics bioequivalence) using a tiered approach, in which plasma samples were tested for the presence of antidrug antibodies (ADAs) as well as ADA binding-specificity, titer and neutralizing activity. To assess the clinical impact of ADAs, pharmacokinetics, pharmacodynamics and safety profiles were compared between ADA-positive and -negative subjects. Results These studies demonstrated similar immunogenicity of pegfilgrastim-cbqv and pegfilgrastim. The small differences in ADA incidence between treatment groups observed in the immunogenicity study were driven by non-neutralizing, low-titer, polyethylene glycol (PEG)-reactive ADAs, which are commonly present in healthy subjects. No treatment-emergent neutralizing antibodies (NAbs) were detected in either treatment group, and there was no apparent impact of ADAs on pharmacokinetics, pharmacodynamics or safety. Conclusion Pegfilgrastim-cbqv has similar immunogenicity to pegfilgrastim. The presented immunogenicity, pharmacokinetics, pharmacodynamics and safety data support the overall demonstration of no clinically meaningful differences between pegfilgrastim-cbqv and pegfilgrastim. Clinical Trial Registration NCT02418104 (CHS-1701-04, April 2015), NCT02650973 (CHS-1701-05, February 2016) and NCT02385851 (CHS-1701-03, March 2015). Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02024-x.
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Affiliation(s)
- Francesca Civoli
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive Suite 600, Redwood City, CA, 94065, USA.
| | - Barbara Finck
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive Suite 600, Redwood City, CA, 94065, USA
| | - Helen Tang
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive Suite 600, Redwood City, CA, 94065, USA
| | - Jennifer Hodge
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive Suite 600, Redwood City, CA, 94065, USA
- Myovant Sciences Inc., Brisbane, CA, USA
| | - Hillary O'Kelly
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive Suite 600, Redwood City, CA, 94065, USA
| | - Vladimir Vexler
- Coherus BioSciences, Inc., 333 Twin Dolphin Drive Suite 600, Redwood City, CA, 94065, USA
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Yao HM, Jones SR, Morales S, Moosavi S, Zhang J, Freyman A, Ottery FD. Phase I/II study to assess the clinical pharmacology and safety of single ascending and multiple subcutaneous doses of PF-06881894 in women with non-distantly metastatic breast cancer. Cancer Chemother Pharmacol 2021; 88:1033-1048. [PMID: 34618197 PMCID: PMC8536579 DOI: 10.1007/s00280-021-04355-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the pharmacodynamics (PD), pharmacokinetics (PK), and safety of single and multiple doses of PF-06881894 (pegfilgrastim-apgf; Nyvepria™), a biosimilar to reference pegfilgrastim (Neulasta®), in women with non-distantly metastatic breast cancer. METHODS In Phase I (Cycle 0) of this Phase I/II study, the PD response (absolute neutrophil count [ANC]; CD34 + count), PK profile, and safety of a single 3- or 6-mg subcutaneous dose of PF-06881894 were assessed in chemotherapy-naïve patients before definitive breast surgery. In Phase II (Cycles 1-4), the PD response (duration of severe neutropenia [DSN, Cycle 1], ANC [Cycles 1 and 4]) and PK profile (Cycles 1 and 4) of single and multiple 6-mg doses of PF-06881894 concomitant with chemotherapy and after definitive breast surgery were assessed. RESULTS Twenty-five patients (mean age 59 years) were enrolled (Cycle 0, n = 12; Cycles 1-4, n = 13). In Cycle 0, PD responses and PK values were lower with 3-mg versus 6-mg PF-06881894. In Cycles 1 and 4, mean DSN was 0.667 days after single or multiple 6-mg doses of PF-06881894, respectively. In Cycle 4 versus Cycle 1, PD responses were more robust; PK values (mean area under the curve, maximum concentration) were lower; and clearance values were higher. The safety profile of PF-06881894 was similar to that for reference pegfilgrastim. CONCLUSION PF-06881894 as a single 3- or 6-mg dose prior to definitive surgery, or multiple 6-mg/cycle doses postoperatively, with/without myelosuppressive chemotherapy, was consistent with the clinical pharmacology and safety profile of reference pegfilgrastim. TRIAL REGISTRATION October 2017. ClinicalTrials.gov Identifier: NCT02650193. EudraCT Number: 2015-002057-35.
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Affiliation(s)
| | - Sarah Ruta Jones
- Clinical Development and Operations, Pfizer Inc, Collegeville, PA, USA
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Song F, Zheng X, Wang Y, Chow SC, Sun H. Innovative Design and Analysis for PK/PD Biosimilar Bridging Studies with Multiple References. AAPS J 2021; 24:3. [PMID: 34850298 DOI: 10.1208/s12248-021-00658-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022] Open
Abstract
When there are multiple reference products, (e.g., EU-approved product and US-licensed product), a pharmacokinetic/pharmacodynamic (PK/PD) bridging study is often conducted in order to bridge the clinical data from the original region (e.g., Europe) to the new region (e.g., USA) in support of the biosimilar regulatory submission in the new region. The purpose is to avoid duplicated clinical trials for clinical similarity between a proposed biosimilar product and the reference product in the new region provided that there is no ethnic concern in the two regions. In this article, some innovative statistical designs for PK/PD biosimilar bridging studies are proposed. Statistical model and methods under the proposed statistical designs are studied. Power analysis for sample size requirement based on Schuirmann's two one-sided tests procedure is also derived and compared to pairwise testing using simulation.
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Affiliation(s)
- Fuyu Song
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University, Beijing, China.,Center for Food and Drug Inspection, National Medical Products Administration, Beijing, China
| | - Xin Zheng
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Beijing, China
| | - Yujia Wang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Durham, NC, USA.
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Durham, NC, USA
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University, Beijing, China.
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7
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Abstract
In 1991, the U.S. Food & Drug Administration (FDA) approved rmetHuGCSF for human use. This recombinant methionyl human granulocyte colony-stimulating factor, or filgrastim, saw use in over 1 million patients in its first 5 years on the market. In 2002, the FDA approved a version of filgrastim with covalent linkage to a monomethoxypolyethylene glycol, increasing the molecular size and half-life to replace multiple days of dosing with a single injection. These medications remained standard of care for neutropenia until the Biologics Price Competition and Innovation Act of 2009 created an abbreviated pathway to licensure for biologic products. Practitioners now have their pick of numerous and expanding options for pegfilgrastim biosimilars.
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Affiliation(s)
- Christopher Selby
- Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy, Dallas, Texas
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8
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Gattu S, Wang J, Bellon A, Schelcher C, Nakov R, Arani R. Meta-analysis of Pharmacokinetic/Pharmacodynamic Results of 3 Phase 1 Studies with Biosimilar Pegfilgrastim. Clin Pharmacol Drug Dev 2021; 10:1130-1141. [PMID: 34350732 PMCID: PMC9290022 DOI: 10.1002/cpdd.1005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 06/28/2021] [Indexed: 12/11/2022]
Abstract
A meta‐analysis using data from 3 phase 1 studies evaluated the pharmacokinetics (PK) and pharmacodynamics (PD) of Sandoz biosimilar versus US‐ and EU‐reference pegfilgrastim. The studies included a single‐dose, double‐blind, 3‐arm, parallel‐group study (study 1); a single‐dose, double‐blind, 2‐way crossover study (study 2); and a single‐dose, double‐blind, 3‐way, 6‐sequence crossover study (study 3). Healthy male and female subjects were randomized to receive the proposed biosimilar (all studies), US‐reference biologic (studies 1 and 3), or EU‐reference biologic (studies 1, 2, and 3). For PK parameters (area under the serum concentration–time curve from time of dosing and extrapolated to infinity, area under the serum concentration–time curve from the time of dosing to the last measurable concentration, and maximum observed serum concentration) and PD parameters (absolute neutrophil count area under the effect curve from the time of dosing to the last measurable concentration and maximum measured absolute neutrophil count) geometric mean ratios and 90% confidence intervals (CIs) for treatment comparisons were calculated using the meta‐analysis approach with a fixed‐effects model. PK/PD biosimilarity was concluded if the 90%CIs were within the equivalence margins of 0.80 to 1.25. The 90%CIs for the geometric mean ratios for the PK/PD parameters were all within the equivalence margins. Safety and tolerability were similar between the proposed biosimilar and the US‐ and EU‐reference pegfilgrastim in healthy subjects. This meta‐analysis of 3 phase 1 studies supports PK/PD similarity of Sandoz biosimilar pegfilgrastim to US‐ and EU‐reference pegfilgrastim. No clinically meaningful differences in safety or tolerability were observed.
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Ghidini M, Indini A, Nigro O, Polito S, Rijavec E, Petrelli F, Tomasello G. Advances in the pharmacological management of neutropenia in solid tumors: the advent of biosimilars. Expert Opin Pharmacother 2021; 22:857-865. [PMID: 33579166 DOI: 10.1080/14656566.2021.1873950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Severe neutropenia and infections are potentially life-threatening complications of cytotoxic antineoplastic therapies and often require hospitalization with a severe economic impact. Furthermore, hematological toxicity frequently results in chemotherapy dose reductions and delays that could interfere with disease control.Areas covered: This review provides an overview of granulocyte colony-stimulating factors (G-CSFs) including pegylated molecules, as well as more recent biosimilar G-CSFs, focusing on the toxicity, pharmacokinetics, and efficacy of these compounds.Expert opinion: The administration of hematopoietic growth factors in primary and secondary prophylaxis of neutropenia is a standard supportive care measure. Recently, several biosimilars have been developed. The market for biosimilar agents seems to be increasing over time thanks to their similar effectiveness and safety, compared with their originators, but lower costs.
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Affiliation(s)
- Michele Ghidini
- Department of Internal Medicine, Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Indini
- Department of Internal Medicine, Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Olga Nigro
- Oncology Department, Medical Oncology, ASST Sette Laghi, Ospedale Di Circolo E Fondazione Macchi, Varese, Italy
| | - Simona Polito
- Department of Pharmaceutical Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Erika Rijavec
- Department of Internal Medicine, Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fausto Petrelli
- Department of Medical Sciences, Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Gianluca Tomasello
- Department of Internal Medicine, Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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10
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Becker PS, Griffiths EA, Alwan LM, Bachiashvili K, Brown A, Cool R, Curtin P, Dinner S, Gojo I, Hicks A, Kallam A, Kidwai WZ, Kloth DD, Kraut EH, Landsburg D, Lyman GH, Miller R, Mukherjee S, Patel S, Perez LE, Poust A, Rampal R, Rosovsky R, Roy V, Rugo HS, Shayani S, Vasu S, Wadleigh M, Westbrook K, Westervelt P, Burns J, Keller J, Pluchino LA. NCCN Guidelines Insights: Hematopoietic Growth Factors, Version 1.2020. J Natl Compr Canc Netw 2021; 18:12-22. [PMID: 31910384 DOI: 10.6004/jnccn.2020.0002] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of febrile neutropenia (FN) is an integral part of supportive care for patients undergoing cancer treatment. The NCCN Guidelines for Hematopoietic Growth Factors provide suggestions for appropriate evaluation, risk determination, prophylaxis, and management of FN. These NCCN Guidelines are intended to guide clinicians in the appropriate use of growth factors for select patients undergoing treatment of nonmyeloid malignancies. These NCCN Guidelines Insights highlight important updates to the NCCN Guidelines regarding the incorporation of newly FDA-approved granulocyte-colony stimulating factor biosimilars for the prevention and treatment of FN.
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Affiliation(s)
| | | | - Laura M Alwan
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Anna Brown
- University of Michigan Rogel Cancer Center
| | - Rita Cool
- The University of Texas MD Anderson Cancer Center
| | | | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ivana Gojo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Eric H Kraut
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Sudipto Mukherjee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Shiven Patel
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Peter Westervelt
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; and
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Grigoletto A, Tedeschini T, Canato E, Pasut G. The evolution of polymer conjugation and drug targeting for the delivery of proteins and bioactive molecules. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2020; 13:e1689. [PMID: 33314717 DOI: 10.1002/wnan.1689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Polymer conjugation can be considered one of the leading approaches within the vast field of nanotechnology-based drug delivery systems. In fact, such technology can be exploited for delivering an active molecule, such as a small drug, a protein, or genetic material, or it can be applied to other drug delivery systems as a strategy to improve their in vivo behavior or pharmacokinetic activities such as prolonging the half-life of a drug, conferring stealth properties, providing external stimuli responsiveness, and so on. If on the one hand, polymer conjugation with biotech drug is considered the linchpin of the protein delivery field boasting several products in clinical use, on the other, despite dedicated research, conjugation with low molecular weight drugs has not yet achieved the milestone of the first clinical approval. Some of the primary reasons for this debacle are the difficulties connected to achieving selective targeting to diseased tissue, organs, or cells, which is the main goal not only of polymer conjugation but of all delivery systems of small drugs. In light of the need to achieve better drug targeting, researchers are striving to identify more sophisticated, biocompatible delivery approaches and to open new horizons for drug targeting methodologies leading to successful clinical applications. This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease Toxicology and Regulatory Issues in Nanomedicine > Regulatory and Policy Issues in Nanomedicine.
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Affiliation(s)
- Antonella Grigoletto
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Tommaso Tedeschini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Elena Canato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Gianfranco Pasut
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
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12
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Blayney DW, Zhang Q, Feng J, Zhao Y, Bondarenko I, Vynnychenko I, Kovalenko N, Nair S, Ibrahim E, Udovista DP, Mohanlal R, Ogenstad S, Ette E, Du L, Huang L, Shi YK. Efficacy of Plinabulin vs Pegfilgrastim for Prevention of Chemotherapy-Induced Neutropenia in Adults With Non-Small Cell Lung Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol 2020; 6:e204429. [PMID: 32970104 DOI: 10.1001/jamaoncol.2020.4429] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Plinabulin is a novel, non-granulocyte colony-stimulating factor (GCSF) small molecule with both anticancer and neutropenia-prevention effects. Objective To assess the efficacy and safety of plinabulin compared with pegfilgrastim for the prevention of chemotherapy-induced neutropenia following docetaxel chemotherapy in patients with non-small lung cancer. Design, Setting, and Participants This was a randomized, open-label, phase 2 clinical trial of 4 treatment arms that was conducted in 19 cancer treatment centers in the United States, China, Russia, and Ukraine. Participants were adult patients with non-small cell lung cancer whose cancer had progressed after platinum-based chemotherapy. Data were collected from April 2017 through March 2018 and analyzed from August 2019 through February 2020. Interventions All patients received docetaxel 75 mg/m2 on day 1 and were randomly assigned to 1 of 3 doses of plinabulin (5, 10, or 20 mg/m2) on day 1 or to pegfilgrastim 6 mg on day 2. Patients were treated every 21 days for 4 chemotherapy cycles. Main Outcomes and Measures The primary end point was the determination of the recommended phase 3 dose of plinabulin based on the days of severe neutropenia during chemotherapy cycle 1. Daily complete blood cell counts and absolute neutrophil counts were drawn during times of anticipated neutropenia during cycle 1. Results Of the 55 patients randomized and evaluated, the mean (SD) age was 61.3 (10.2) years, and 38 (69.1%) were men. With each escalation of the plinabulin dose, the incidence of any grade of neutropenia decreased. There were no significant differences in mean (SD) days of severe neutropenia among those treated with pegfilgrastim (0.15 [0.38] days) when dosed at day 2 vs plinabulin 20 mg/m2 (0.36 [0.93] days; P = .76) when dosed at day 1, and no safety signals were detected. Conclusions and Relevance Single dose-per-cycle plinabulin has a similar neutropenia protection benefit as pegfilgrastim. Plinabulin 40 mg fixed dose, which is pharmacologically equivalent to 20 mg/m2, will be compared with pegfilgrastim 6 mg in the phase 3 portion of this trial. Noninferior days of severe neutropenia will be the primary end point, and bone pain reduction, thrombocytopenia reduction, and quality of life maintenance will be secondary end points. Trial Registration ClinicalTrials.gov Identifier: NCT03102606.
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Affiliation(s)
| | - Qingyuan Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Jifeng Feng
- Department of Medical Oncology, Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yanqiu Zhao
- Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Igor Bondarenko
- Dnipropetrovsk Medical Academy, Ukraine. Dnepropetrovsk, Ukraine
| | - Ihor Vynnychenko
- Sumy Regional Clinical Oncology Dispensary, Sumy State University, Sumy, Ukraine
| | | | - Santosh Nair
- Mid Florida Hematology and Oncology Center, Orange City
| | - Emad Ibrahim
- Redlands Community Hospital, Redlands, California
| | | | | | | | - Ene Ette
- Anoixis Corporation, Natick, Massachusetts
| | - Lihua Du
- Wanchun Bulin Pharmaceuticals Limited, Dalian, China
| | - Lan Huang
- BeyondSpring Pharmaceuticals, New York, New York
| | - Yuan-Kai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
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13
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Finck B, Tang H, Civoli F, Hodge J, O'Kelly H, Vexler V. Pharmacokinetic and Pharmacodynamic Equivalence of Pegfilgrastim-cbqv and Pegfilgrastim in Healthy Subjects. Adv Ther 2020; 37:4291-4307. [PMID: 32789809 DOI: 10.1007/s12325-020-01459-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pegfilgrastim-cbqv was developed as a biosimilar of pegfilgrastim, a pegylated form of recombinant human granulocyte colony-stimulating factor approved for decreasing febrile neutropenia-associated infection in patients receiving myelosuppressive drugs. This multicenter, randomized, single-blind, partial-reference-replicated, three-sequence crossover study assessed pharmacokinetic and pharmacodynamic bioequivalence of pegfilgrastim-cbqv and pegfilgrastim in healthy subjects. METHODS One hundred twenty-two subjects were randomized to one of three treatment sequences; each included one dose of pegfilgrastim-cbqv and two doses of pegfilgrastim separated by ≥ 28 days. The primary pharmacokinetic end points were area under the curve (AUC) from 0 to infinity (AUC0-∞) and maximum concentration (Cmax). The primary pharmacodynamic end points were maximum absolute neutrophil count (ANCmax) and ANC AUC from time 0 to the last measurable observation (ANC AUC0-last). Pharmacokinetic and pharmacodynamic bioequivalences were demonstrated if the 90% CI for the geometric mean ratio (GMR) of pegfilgrastim-cbqv to pegfilgrastim was within 80-125% for the primary end points. RESULTS Pharmacokinetic bioequivalence criteria were met for Cmax (GMR 105.0; 90% CI 95.5-115.4) and AUC0-∞ (GMR 97.5; 90% CI 88.6-107.2). Pharmacodynamic bioequivalence criteria were met for ANCmax (GMR 99.6; 90% CI 96.2-103.2) and ANC AUC0-last (GMR 96.7; 90% CI 92.2-101.4). Adverse events occurred in 76.0%, 76.6%, and 73.1% of subjects for pegfilgrastim-cbqv, first pegfilgrastim, and second pegfilgrastim dosing periods across treatment sequences, respectively. Investigators found no drug-related serious adverse events. CONCLUSION This study established pharmacokinetic and pharmacodynamic bioequivalence of pegfilgrastim-cbqv to pegfilgrastim. The treatments displayed similar safety profiles, including immunogenicity, with no unexpected safety findings. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov, NCT02650973, February 2016.
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Affiliation(s)
| | - Helen Tang
- Coherus BioSciences, Redwood City, CA, USA
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PF-06881894, a Proposed Biosimilar to Pegfilgrastim, Versus US-Licensed and EU-Approved Pegfilgrastim Reference Products (Neulasta ®): Pharmacodynamics, Pharmacokinetics, Immunogenicity, and Safety of Single or Multiple Subcutaneous Doses in Healthy Volunteers. Adv Ther 2020; 37:3370-3391. [PMID: 32524499 PMCID: PMC7467414 DOI: 10.1007/s12325-020-01387-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 11/29/2022]
Abstract
Introduction PF-06881894 is a proposed biosimilar to pegfilgrastim
(Neulasta®). This study evaluated the
pharmacodynamic/pharmacokinetic (PD/PK) equivalence, immunogenicity, and safety of
PF-06881894 vs pegfilgrastim reference products (US- and
EU-Neulasta®) in healthy volunteers. Methods A phase 1, open-label, randomized, crossover study was conducted to
assess the pharmacologic equivalence and safety of a single 6-mg dose of PF-06881894,
pegfilgrastim-US, and pegfilgrastim-EU. The primary PD endpoints were area under the
effect-versus-time curve for absolute neutrophil count (ANC) from dose administration
to 288 h postdose, and maximum observed ANC value among subjects confirmed negative
for anti-pegfilgrastim antibodies. Primary PK variables included area under the serum
pegfilgrastim-versus-time curve from the time of dose administration to time infinity
and maximum observed serum pegfilgrastim concentration. A second phase 1, open-label,
randomized (1:1), parallel-group, non-inferiority study was conducted to assess the
immunogenicity and safety of multiple 6-mg doses of PF-06881894 versus
pegfilgrastim-US. The primary endpoint for the immunogenicity study was the
proportion of subjects with both negative baseline and confirmed positive postdose
anti-pegfilgrastim antibodies at any time during the study. Results Across the single- and multiple-dose studies (N = 153 and N = 420 treated
subjects, respectively), demographics for age (18–65 years), male gender (n = 264/573), and white race (n = 423/573) were similar. Three-way PD/PK equivalence of PF-06881894,
pegfilgrastim-US, and pegfilgrastim-EU was demonstrated with the primary PD endpoints
and primary PK variables being completely contained within the predefined 90%
confidence interval acceptance limits (80–125%). The non-inferiority of PF-06881894
versus pegfilgrastim-US in terms of immunogenicity was established according to the
prespecified non-inferiority margin (≤10%). Overall, there were no clinically
meaningful differences in safety profiles among or between study groups. Conclusions Single-dose PF-06881894 demonstrated PD/PK equivalence and comparable
safety with US- and EU-pegfilgrastim reference products. Multiple-dose PF-06881894
demonstrated immunogenicity non-inferiority to pegfilgrastim-US with comparable
safety. Both studies contributed to the totality of evidence supporting
biosimilarity. Trial Registration ClinicalTrials.gov identifiers: NCT02629289 (C1221001); NCT03273842
(C1221005). Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01387-x) contains supplementary material, which is available to authorized
users.
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15
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Hu C, Ji B, Hu X, Yang C, Sun W, Zhao X, Li L, Li X, Zhang L. Pharmacokinetics and Pharmacodynamics of Two Formulations of Pegylated Recombinant Human Granulocyte Colony-Stimulating Factor in Healthy Chinese Subjects: An Open-Label, Randomized, Parallel-Design Bioavailability Study. Clin Pharmacol Drug Dev 2020; 10:291-298. [PMID: 32567217 DOI: 10.1002/cpdd.819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/05/2020] [Indexed: 11/11/2022]
Abstract
Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF, pegfilgrastim) is a long-acting derivative of recombinant human granulocyte colony-stimulating factor with limited renal clearance and a longer half-life. It is used for the prevention of febrile neutropenia, owing to its capacity to promote neutrophil recovery. In this study, the pharmacokinetics, pharmacodynamics, safety, and immunogenicity of 2 formulations of PEG-rhG-CSF were evaluated in healthy Chinese subjects. Twenty-four male subjects who received a single dose of subcutaneous PEG-rhG-CSF 100 µg/kg were randomized to either treatment A (3 mg/mL) or treatment B (1 mg/mL). Noncompartmental pharmacokinetic parameters of PEG-rhG-CSF were derived from serum concentration-time data. In addition, absolute neutrophil count (ANC) as a pharmacodynamic maker, immunogenicity through antidrug antibody testing, and safety were evaluated. The mean area under the concentration-time curve from time zero to the last quantifiable concentration (AUC0-t ) and the mean maximum concentration (Cmax ) of PEG-rhG-CSF after treatment A were 5070 ng·h/mL and 125 ng/mL, respectively; these values were comparable to those measured after treatment B (5340 ng·h/mL and 123 ng/mL, respectively). The mean value of area under the △ANC (baseline-adjusted ANC)-time curve and the maximum △ANC values were 4380 × 109 h/L and 33.1 × 109 /L, respectively, in the treatment A group, and 5170 × 109 h/L and 38.6 × 109 /L, respectively, in the treatment B group. The pharmacokinetic and pharmacodynamic profiles were similar for the 2 PEG-rhG-CSF formulations following a single dose of 100 µg/kg. The safety and immunogenicity profiles were also similar, with no significant differences. The dose adjustment of PEG-rhG-CSF was not considered necessary for formulation transformation.
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Affiliation(s)
- Chaoying Hu
- Department of Pharmacy, Phase I Clinical Trial Center, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Bingxin Ji
- Department of Hematology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China.,Medical Affair Office, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xiao Hu
- Department of Pharmacy, Phase I Clinical Trial Center, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Cuicui Yang
- Department of Pharmacy, Phase I Clinical Trial Center, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Wanling Sun
- Department of Hematology, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xiaowei Zhao
- Department of Pharmacy, Phase I Clinical Trial Center, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lin Li
- Department of Pharmacy, Phase I Clinical Trial Center, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xiaoying Li
- Medical Affair Office, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lan Zhang
- Department of Pharmacy, Phase I Clinical Trial Center, Xuanwu Hospital of Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
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16
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Bellon A, Wang J, Skerjanec A, Velinova M, Dickerson D, Sabet A, Ngo L, O'Reilly T, Tomek C, Schussler S, Schier-Mumzhiu S, Gattu S, Koch SD, Schelcher C, Dobreva M, Boldea A, Nakov R, Otto GP. A large multicentre, randomized, double-blind, cross-over study in healthy volunteers to compare pharmacokinetics, pharmacodynamics and safety of a pegfilgrastim biosimilar with its US- and EU-reference biologics. Br J Clin Pharmacol 2020; 86:1139-1149. [PMID: 32022282 PMCID: PMC7256126 DOI: 10.1111/bcp.14226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 12/25/2022] Open
Abstract
Aims Recombinant PEGylated human granulocyte colony‐stimulating factor (pegfilgrastim) is indicated for the reduction of chemotherapy‐induced neutropenia and prevention of febrile neutropenia. Biosimilar pegfilgrastim is expected to reduce the financial burden of this complication of chemotherapy. The aim of this study was to demonstrate biosimilarity between Sandoz biosimilar pegfilgrastim and its US‐ and EU‐approved reference biologics. Methods Phase I, randomized, double‐blind, single‐dose, 3‐period, 6‐sequence cross‐over, multicentre study to evaluate the pharmacokinetics, pharmacodynamics, safety and immunogenicity of Sandoz biosimilar pegfilgrastim with US‐ and EU‐references in healthy adults. Results Pharmacokinetic and pharmacodynamic similarity was demonstrated between the 3 biologics, as the 90% confidence interval for all primary pharmacokinetic and pharmacodynamic endpoint comparisons were contained within the predefined similarity margins of 0.80–1.25. Safety, immunogenicity and tolerability were also similar. Conclusions Sandoz biosimilar pegfilgrastim demonstrated pharmacokinetic and pharmacodynamic similarity to both US‐ and EU‐reference biologics. No meaningful differences in safety, local tolerability and immunogenicity were identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anca Boldea
- Sandoz Pharma Services Romania SRL, Novartis, Bucharest, Romania
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17
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Brekkan A, Lopez-Lazaro L, Plan EL, Nyberg J, Kankanwadi S, Karlsson MO. Sensitivity of Pegfilgrastim Pharmacokinetic and Pharmacodynamic Parameters to Product Differences in Similarity Studies. AAPS JOURNAL 2019; 21:85. [PMID: 31286293 PMCID: PMC6614128 DOI: 10.1208/s12248-019-0349-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/30/2019] [Indexed: 11/30/2022]
Abstract
In this work, a previously developed pegfilgrastim (PG) population pharmacokinetic-pharmacodynamic (PKPD) model was used to evaluate potential factors of importance in the assessment of PG PK and PD similarity. Absolute neutrophil count (ANC) was the modelled PD variable. A two-way cross-over study was simulated where a reference PG and a potentially biosimilar test product were administered to healthy volunteers. Differences in delivered dose amounts or potency between the products were simulated. A different baseline absolute neutrophil count (ANC) was also considered. Additionally, the power to conclude PK or PD similarity based on areas under the PG concentration-time curve (AUC) and ANC-time curve (AUEC) were calculated. Delivered dose differences between the products led to a greater than dose proportional differences in AUC but not in AUEC, respectively. A 10% dose difference from a 6 mg dose resulted in 51% and 7% differences in AUC and AUEC, respectively. These differences were more pronounced with low baseline ANC. Potency differences up to 50% were not associated with large differences in either AUCs or AUECs. The power to conclude PK similarity was affected by the simulated dose difference; with a 4% dose difference from 6 mg the power was approximately 29% with 250 subjects. The power to conclude PD similarity was high for all delivered dose differences and sample sizes.
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Affiliation(s)
- Ari Brekkan
- Pharmetheus, Uppsala, Sweden.,Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Mats O Karlsson
- Pharmetheus, Uppsala, Sweden. .,Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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18
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Wang YMC, Strauss DG, Huang SM. Use of pharmacodynamic/response biomarkers for therapeutic biologics regulatory submissions. Biomark Med 2019; 13:805-809. [PMID: 31210051 DOI: 10.2217/bmm-2019-0197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Yow-Ming C Wang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation & Research, Food & Drug Administration, Silver Spring, MD 20993, USA
| | - David G Strauss
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation & Research, Food & Drug Administration, Silver Spring, MD 20993, USA
| | - Shiew Mei Huang
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation & Research, Food & Drug Administration, Silver Spring, MD 20993, USA
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19
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Waller CF, Ranganna GM, Pennella EJ, Blakeley C, Bronchud MH, Mattano LA, Berzoy O, Voitko N, Shparyk Y, Lytvyn I, Rusyn A, Popov V, Láng I, Beckmann K, Sharma R, Baczkowski M, Kothekar M, Barve A. Randomized phase 3 efficacy and safety trial of proposed pegfilgrastim biosimilar MYL-1401H in the prophylactic treatment of chemotherapy-induced neutropenia. Ann Hematol 2019; 98:1217-1224. [PMID: 30824956 PMCID: PMC6469669 DOI: 10.1007/s00277-019-03639-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/10/2019] [Indexed: 12/17/2022]
Abstract
Pegfilgrastim is indicated for reducing the duration of neutropenia and incidence of febrile neutropenia in patients receiving cytotoxic chemotherapy. Here, safety and efficacy of MYL-1401H, a proposed pegfilgrastim biosimilar, were investigated as prophylaxis for chemotherapy-induced neutropenia. This was a phase 3, multicenter, randomized, double-blind, parallel-group equivalence trial of MYL-1401H vs European Union–sourced reference pegfilgrastim. Patients with newly diagnosed stage II/III breast cancer eligible to receive (neo) adjuvant chemotherapy with docetaxel/doxorubicin/cyclophosphamide every 3 weeks for 6 cycles were enrolled and randomized 2:1 to 6 mg of MYL-1401H or reference pegfilgrastim 24 h (+ 2-h window after the first 24 h) after the end of chemotherapy. The primary efficacy endpoint was the duration of severe neutropenia in cycle 1 (i.e., days with absolute neutrophil count (ANC) < 0.5 × 109/L). Mean (standard deviation (SD)) duration of severe neutropenia in MYL-1401H and reference pegfilgrastim groups was 1.2 days (0.93) and 1.2 days (1.10), respectively. The 95% CI for least squares mean difference (− 0.285, 0.298) was within the predefined equivalence range of ± 1 day. Secondary endpoints, including grade ≥ 3 neutropenia (frequency, 91% and 82% for MYL-1401H and reference pegfilgrastim, respectively), time to ANC nadir (mean (SD), 6.2 (0.98) and 6.3 (1.57) days), and duration of post-nadir recovery (mean (SD), 1.9 (0.85) and 1.7 (0.91) days) were comparable. Overall safety profiles of the study drugs were comparable. MYL-1401H demonstrated equivalent efficacy and similar safety to reference pegfilgrastim and may be an equivalent option for reducing incidence of neutropenia. (ClinicalTrials.gov, NCT02467868; EudraCT, 2014-002324-27).
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Affiliation(s)
- Cornelius F Waller
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg and Faculty of Medicine, University of Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.
| | - Gopinath M Ranganna
- Global Clinical Research & Development, Mylan, Prestige Tech Park Platina-3, 7th to 12th Floor, Kadubesanahalli, Bangalore, 560103, India
| | - Eduardo J Pennella
- Global Clinical Research, Mylan, 1000 Mylan Boulevard, Canonsburg, PA, 15317, USA
| | - Christopher Blakeley
- Medical and Scientific Affairs, Worldwide Clinical Trials, 172 Tottenham Court Road, Fitzrovia, London, W1T 7DL, UK
| | - Miguel H Bronchud
- GenesisCare Corachan Institute of Oncology, Buïgas 19, 08017, Barcelona, Spain
| | - Leonard A Mattano
- HARP Pharma Consulting, LLC, 184 Masons Island Road, Mystic, CT, 06355, USA
| | - Oleksandr Berzoy
- Mammalogy Center, Odessa Regional Hospital, Akademika Zabolotnogo Str. 26, Odessa, 65025, Ukraine
| | - Nataliia Voitko
- Chemotherapy II, Kyiv City Clinical Oncological Centre, Kyiv, Street, Verkhovyna, 69, Kiev, 03115, Ukraine
| | - Yaroslav Shparyk
- Department of Chemotherapy, Lviv State Regional Treatment and Diagnostics Oncology Center, Lviv Street, Pekarskaya, 69, Lviv, 79010, Ukraine
| | - Iryna Lytvyn
- Department of Chemotherapy, Dnipropetrovsk Regional Clinical Oncology Center, Kosmicheskaja Street, 21, Dnepropetrovsk, 49100, Ukraine
| | - Andriy Rusyn
- Department of Chemotherapy, Transkarpathian Regional University Oncology Clinic, Narodna Square, 3, Uzhgorod, 88000, Ukraine
| | - Vasil Popov
- Department of Medical Oncology and Palliative Care, SHATOD Dr. Marko Аntonov Markov, Varna EOOD, SHOP "Tsar Osvoboditel" Boulevard 100000, 9000, Varna, Bulgaria
| | - István Láng
- Department of Medical Oncology and Clinical Pharmacology B, National Institute of Oncology Országos Onkológiai Intézet, Budapest Ráth György u. 7-9, Budapest, 1122, Hungary
| | - Katrin Beckmann
- Global Clinical Operations, Mylan Healthcare GmbH, Freundallee 9A, 30173, Hannover, Germany
| | - Rajiv Sharma
- Global Product Safety and Risk Management, Mylan, Building 4 Trident Place, Mosquito Way, Hatfield, AL10 9UL, UK
| | - Mark Baczkowski
- Product Safety and Risk Management, Mylan, 781 Chestnut Ridge Road, Morgantown, WV, 26505, USA
| | - Mudgal Kothekar
- Clinical Development, Biocon Research Ltd, 131, Jigani Road, RK Twp, Bommasandra Industrial Area, Bangalore, Karnataka, 560099, India
| | - Abhijit Barve
- Global Clinical Research, Mylan, 1000 Mylan Boulevard, Canonsburg, PA, 15317, USA
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Affiliation(s)
- Sheridan M Hoy
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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