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Qneibi D, Ramacciotti E, Macedo AS, Caffaro RA, Agati LB, Siddiqui F, Kouta A, Hoppensteadt D, Fareed J, Carter CA. Comparative Studies on the Anticoagulant Profile of Branded Enoxaparin and a New Biosimilar Version. Clin Appl Thromb Hemost 2021; 26:1076029620960820. [PMID: 32996340 PMCID: PMC7533927 DOI: 10.1177/1076029620960820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Low molecular weight heparins (LMWH) represent depolymerized heparin prepared by various methods that exhibit differential, biochemical and pharmacological profiles. Enoxaparin is prepared by benzylation followed by alkaline depolymerization of porcine heparin. Upon the expiration of its patent, several biosimilar versions of enoxaparin have become available. Heparinox (Sodic enoxaparine; Cristália Produtos Químicos Farmacêuticos LTDA, Sao Paulo, Brazil) is a new biosimilar form of enoxaparin. We assessed the molecular weight and the biochemical profile of Heparinox and compared its properties to the original branded enoxaparin (Lovenox; Sanofi, Paris, France). Clotting profiles compared included activated clotting time, activated partial thromboplastin time (aPTT), and thrombin time (TT). Anti-protease assays included anti-factor Xa and anti-factor IIa activities. Thrombin generation was measured using a calibrated automated thrombogram and thrombokinetic profile included peak thrombin, lag time and area under the curve. USP potency was determined using commercially available assay kits. Molecular weight profiling was determined using high performance liquid chromatography. We determined that Heparinox and Lovenox were comparable in their molecular weight profile. Th anticoagulant profile of the branded and biosimilar version were also similar in the clot based aPTT and TT. Similarly, the anti-Xa and anti-IIa activities were comparable in the products. No differences were noted in the thrombin generation inhibitory profile of the branded and biosimilar versions of enoxaparin. Our studies suggest that Heparinox is bioequivalent to the original branded enoxaparin based upon in vitro tests however will require further in vivo studies in animal models and humans to determine their clinical bioequivalence.
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Affiliation(s)
- Dalia Qneibi
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Department of Pathology and Laboratory Medicines, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | | | | | | | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Ahmed Kouta
- Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Charles A Carter
- Department of Clinical Research, College of Pharmacy & Health Sciences, 2078Campbell University, Buies Creek, NC, USA
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Kariya S, Nakatani M, Maruyama T, Ono Y, Ueno Y, Komemushi A, Tanigawa N. Evaluation of the antithrombogenicity of poly-2-methoxyethylacrylate-coated catheters. J Vasc Access 2020; 23:117-122. [PMID: 33356882 DOI: 10.1177/1129729820983175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The blood compatibility of indwelling intravascular catheters is facilitated by the use of antithrombogenic materials. Heparin has typically been used for this purpose; however, since heparin-coated catheters are considered combination products, difficulties meeting the relevant Food and Drug Administration safety recommendations have disrupted commercialization. Other issues include coating durability and the occurrence of heparin-induced thrombocytopenia. Polymer coatings are a potential alternative; however, polymer antithrombogenicity in circulating human blood has yet to be demonstrated. The present study aimed to establish the ex vivo antithrombogenicity of a poly-2-methoxyethylacrylate (PMEA) polymer coating applied to a central venous catheter using an artificial human blood circulation system. METHODS The present study used an artificial human blood circulation system to conduct an ex vivo evaluation of the antithrombogenicity of poly-2-methoxyethylacrylate (PMEA)-coated catheters. Human blood samples obtained from volunteer donors were loaded into a circulation system fitted with either a PMEA-coated or uncoated catheter. After 3-h, the catheter was removed and examined using scanning electron microscopy. Protein adsorption on the catheter surface was investigated by shredding the catheter that had contacted the blood inside the circulation system and immersing the pieces in 1 mL of 0.5 N NaOH for 2 days. The amount of protein in the 0.5 N NaOH was determined according to the Lowry method. RESULTS Adherent fibrin, which forms a sheath on the catheter surface, was observed on uncoated, but not PMEA-coated catheters. Furthermore, the amount of protein adsorption was significantly less with PMEA-coated than uncoated catheters (p = 0.043). CONCLUSIONS The present findings demonstrated the antithrombogenicity of PMEA-coated catheters in circulating human blood.
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Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Miyuki Nakatani
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takuji Maruyama
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuyuki Ono
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yutaka Ueno
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
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Kariya S, Nakatani M, Ono Y, Maruyama T, Ueno Y, Komemushi A, Tanigawa N. Assessment of the Antithrombogenicity of a Poly-2-Methoxyethylacrylate-Coated Central Venous Port-Catheter System. Cardiovasc Intervent Radiol 2020; 43:775-780. [PMID: 32055927 DOI: 10.1007/s00270-020-02408-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the antithrombogenic effects of poly-2-methoxyethylacrylate (PMEA) coating applied to the internal surfaces of the port-catheter system to prevent thrombotic occlusion. MATERIALS AND METHODS PMEA coating was applied to the inner surfaces of the entire system, including the chamber, catheter, and connecting stem. PMEA-coated and uncoated port-catheter systems were each filled with fresh human blood for 1 or 3 h and then flushed with saline. Volumes of residual thrombi in the system and protein in the catheter were then compared. RESULTS Saline flushing of the PMEA-coated port-catheter system expelled all visually recognizable thrombi, leaving no unremovable adhesions. In contrast, the uncoated port showed thrombi adherent to the inner surfaces and incomplete expulsion with flushing. Mean (± standard deviation) residual thrombus mass was significantly lower in PMEA-coated port-catheter systems (20.5 ± 6.2 mg) than in uncoated systems (230.3 ± 92.5 mg; p < 0.01). Mean residual protein was likewise significantly lower in PMEA-coated systems (20.5 ± 6.2 mg) than in uncoated systems (230.3 ± 92.5 mg; p < 0.01). CONCLUSIONS PMEA coating on a central venous port-catheter system decreased accumulation and facilitated flushing of thrombi from the system by flushing, as compared with the uncoated system. PMEA-coated central venous port-catheter systems appear relatively antithrombotic compared to uncoated systems.
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Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
| | - Miyuki Nakatani
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Yasuyuki Ono
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Takuji Maruyama
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Yutaka Ueno
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
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Brouwers JRBJ, Roeters van Lennep JE, Beinema MJ. Biosimilars of low molecular weight heparins: Relevant background information for your drug formulary. Br J Clin Pharmacol 2019; 85:2479-2486. [PMID: 31378961 DOI: 10.1111/bcp.14081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 12/27/2022] Open
Abstract
Biosimilars of low molecular weight heparins (LMWHs) are more alike the originator than different branded LMWHs. The latter differ largely in molecular weight, anti-FXa/anti-FIIa ratio and antithrombin binding. The Food and Drug Administration and European Medicines Agency guidelines are sufficient for the clinical use of high quality LMWHs. However, the Food and Drug Administration guideline lacks the results of a phase I clinical trial in the approval process. Most information about biosimilars is available for enoxaparin given that many biosimilars of enoxaparin have received market access. The guidelines of many International Thrombosis Societies for LMWH biosimilars are too stringent, not updated and impractical for formulary uptake discussions. This review gives background information on critical factors for the formulary uptake process of LMWHs with special attention for the use of the System of Objectified Judgment Analysis/Infomatrix model.
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Affiliation(s)
- Jacobus R B J Brouwers
- Unit Pharmacotherapy -Epidemiology and -Economy, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Expertise Centre Pharmacotherapy in Old Persons, Oranjewoud, The Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine-subdivision Vascular Medicine, Erasmus Medical Center Rotterdam, The Netherlands
| | - Maarten J Beinema
- Anticoagualation Center, Deventer Hospital, Deventer, The Netherlands
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Antithrombin III-Binding Site Analysis of Low-Molecular-Weight Heparin Fractions. J Pharm Sci 2018; 107:1290-1295. [DOI: 10.1016/j.xphs.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
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Liu X, St. Ange K, Lin L, Zhang F, Chi L, Linhardt RJ. Top-down and bottom-up analysis of commercial enoxaparins. J Chromatogr A 2017; 1480:32-40. [DOI: 10.1016/j.chroma.2016.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/14/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
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Harenberg J, Walenga J, Torri G, Dahl OE, Drouet L, Fareed J. Update of the recommendations on biosimilar low-molecular-weight heparins from the Scientific Subcommittee on Control of Anticoagulation of the International Society on Thrombosis and Haemostasis. J Thromb Haemost 2013; 11:1421-5. [PMID: 23615078 DOI: 10.1111/jth.12269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Harenberg
- Clinical Pharmacology, Medical Faculty Mannheim, University of Heidelberg, Maybachstrasse 14, Heidelberg, Germany.
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Scientific considerations in the review and approval of generic enoxaparin in the United States. Nat Biotechnol 2013; 31:220-6. [DOI: 10.1038/nbt.2528] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 02/08/2013] [Indexed: 12/16/2022]
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Walenga JM, Jeske WP, Hoppensteadt D, Cunanan J, Khan H, Escalante V, Fareed J, Bakhos M. Comparative studies on branded enoxaparin and a US generic version of enoxaparin. Clin Appl Thromb Hemost 2012; 19:261-7. [PMID: 23091283 DOI: 10.1177/1076029612463427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Enoxaparin, a complex, biologically derived low-molecular-weight heparin, is approved for a range of clinical indications. This study was carried out to compare the potency profile and pharmacodynamic responses of branded enoxaparin (Lovenox; Sanofi, US) with a generic enoxaparin (enoxaparin sodium injection, USP). Five batches of each product were tested. Although the average molecular weight, anti-factor Xa, and anti-factor IIa potencies were similar for the two products, differences were observed in the in vitro thrombin generation and kinetics of clot formation (P = .01) and in the ex vivo pharmacodynamics regarding thrombin generation inhibition (P = .029), tissue factor pathway inhibitor release (P = .006), and inhibition of the active form of thrombin-activated fibrinolysis inhibitor (P = .023). These findings suggest that simple analytical characterization can establish good quality control in manufacturing, but they may not assure similarity in biological performance between the branded and the generic enoxaparin.
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Affiliation(s)
- Jeanine M Walenga
- Department of Thoracic & Cardiovascular Surgery, Loyola University Chicago, Maywood, IL 60153, USA.
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Li L, Zhang F, Zaia J, Linhardt RJ. Top-down approach for the direct characterization of low molecular weight heparins using LC-FT-MS. Anal Chem 2012; 84:8822-9. [PMID: 22985071 DOI: 10.1021/ac302232c] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Low molecular heparins (LMWHs) are structurally complex, heterogeneous, polydisperse, and highly negatively charged mixtures of polysaccharides. The direct characterization of LMWH is a major challenge for currently available analytical technologies. Electrospray ionization (ESI) liquid chromatography-mass spectrometry (LC-MS) is a powerful tool for the characterization complex biological samples in the fields of proteomics, metabolomics, and glycomics. LC-MS has been applied to the analysis of heparin oligosaccharides, separated by size exclusion, reversed phase ion-pairing chromatography, and chip-based amide hydrophilic interaction chromatography (HILIC). However, there have been limited applications of ESI-LC-MS for the direct characterization of intact LMWHs (top-down analysis) due to their structural complexity, low ionization efficiency, and sulfate loss. Here we present a simple and reliable HILIC-Fourier transform (FT)-ESI-MS platform to characterize and compare two currently marketed LMWH products using the top-down approach requiring no special sample preparation steps. This HILIC system relies on cross-linked diol rather than amide chemistry, affording highly resolved chromatographic separations using a relatively high percentage of acetonitrile in the mobile phase, resulting in stable and high efficiency ionization. Bioinformatics software (GlycReSoft 1.0) was used to automatically assign structures within 5-ppm mass accuracy.
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Affiliation(s)
- Lingyun Li
- Department of Chemistry and Chemical Biology, Rensselaer Polytechnic Institute, Troy, New York 12180-3590, United States
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