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Greenberg B, Giovannoni G. A place for biosimilars in the changing multiple sclerosis treatment landscape. Mult Scler Relat Disord 2023; 77:104841. [PMID: 37467536 DOI: 10.1016/j.msard.2023.104841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The treatment paradigm for multiple sclerosis (MS), particularly relapsing-remitting MS, is heavily reliant on biologic disease-modifying therapies (DMTs). However, the current cost of treatment acts as a significant barrier to access for patients. Over the next few years exclusivity periods for key biologic medicines used in MS are likely to end, opening the door for biosimilar medicines to enter the market. METHODS In this review, we discuss what biosimilar medicines are, and how the existing experience with biosimilar medicines across multiple therapy areas can inform the assimilation of biosimilar medicines into the MS treatment landscape in Europe and the US. RESULTS There is currently a lack of knowledge and awareness around the distinctions and similarities between small molecules, non-biological complex drugs, and biological medicines, as well as the different categories of follow-on successor medicines. These include biosimilar medicines that offer a matching efficacy and safety profile to the reference biologic. Understanding and recognition of the stringency of the approval pathways required for drug categories such as biosimilars are key in building confidence in treatment outcomes. For example, biosimilar medicines are sometimes perceived only as 'copies' of their reference biologic despite undergoing an extensive approval process requiring that no clinically meaningful differences are observed between the biosimilar medicine and the reference medicine. For MS, introduction of biosimilar medicines in the future will enable more people with MS to receive effective treatment, and also expand access to biologic DMTs in MS. Experiences from the use of biosimilars in multiple therapy areas have shown us that this can result in cost-saving benefits for a healthcare system. Introduction of biosimilar medicines in other therapy areas has also demonstrated the importance of appropriate, accurate education and information for their successful integration into clinical practice. CONCLUSION In order to realize optimized treatment outcomes in MS in coming years and to find the appropriate place for biosimilar medicines in the changing MS landscape, it is essential that clinicians and people with MS understand the fundamentals of biosimilars, their potential benefits and consistency of treatment provided by a biosimilar medicine, given the matching efficacy and safety profile to its reference medicine. As evidenced in other therapy areas, biosimilar medicines may reduce key barriers to access by providing a cost-effective alternative to the MS treatment arsenal, while providing the same treatment outcomes as reference biologics.
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Affiliation(s)
- Benjamin Greenberg
- Department of Neurology and Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom
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Altunan B, Ünal A, Efendi H, Köseoğlu M, Terzi M, Kotan D, Tamam Y, Boz C, Güler S, Turan ÖF, Altunrende B, Balcı FB, Turgut N, Akçalı A, Yildirim KA, Günal Dİ, Sunter G, Bingöl A. Use of follow-on fingolimod for multiple sclerosis: Analysis of effectiveness and patient reported outcomes in a real-world clinical setting. Mult Scler Relat Disord 2023; 77:104880. [PMID: 37459716 DOI: 10.1016/j.msard.2023.104880] [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: 05/03/2023] [Revised: 06/19/2023] [Accepted: 07/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Follow-on disease modifying therapies (FO-DMTs) do not always require Phase III studies. There are concerns that cheaper FO-DMTs are only used to reduce healthcare costs. However, the well-being of people with MS (pwMS) should be a priority. We aimed to evaluate the efficacy, safety and treatment satisfaction of one of the FO- Fingolimod (FTY) used in Turkey with the approval of Turkish Ministry of Health. METHODS PwMS under FTY were recruited from 13 centers and real-world data and answers of satisfaction and adherence statements of pwMS on FTY treatment were analyzed. RESULTS Data of 239 pwMS were obtained. The duration of FTY treatment was 2.5 ± 0.8 (1-4) years in pwMS who were included in the study and whose treatment continued for at least one year. Significant decreases in annual relapse rate (p < 0.001), Expanded Disability Status Scale (p < 0.001) and neuroimaging findings (p < 0.001) were observed. While 64% of the patients were satisfied and 71.5% were found to adherent with this FO-FTY. CONCLUSION This multicenter retrospective study found that the efficacy, safety and treatment adherence of a prescribed FO-FTY were consistent with the results of real-world studies. Studies including real-world data may provide guidance to address issues related to FO-FTY use.
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Affiliation(s)
- Bengü Altunan
- Department of Neurology, Faculty of Medicine, Tekirdag Namık Kemal University, Kampus street,.Süleymanpasa, Tekirdag 59100, Turkey
| | - Aysun Ünal
- Department of Neurology, Faculty of Medicine, Tekirdag Namık Kemal University, Kampus street,.Süleymanpasa, Tekirdag 59100, Turkey.
| | - Hüsnü Efendi
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | | | - Murat Terzi
- Department of Neurology, Ondokuz Mayıs University, Samsun, Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yusuf Tamam
- Department of Neurology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Cavit Boz
- Department of Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sibel Güler
- Department of Neurology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Ömer Faruk Turan
- Department of Neurology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Burcu Altunrende
- Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | | | - Nilda Turgut
- Department of Neurology, Faculty of Medicine, Tekirdag Namık Kemal University, Kampus street,.Süleymanpasa, Tekirdag 59100, Turkey
| | - Aylin Akçalı
- Department of Neurology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Dilek İnce Günal
- Department of Neurology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Gulin Sunter
- Department of Neurology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Schorr EM, Calabresi PA. Generic MS medications: Reducing costs without compromising safety. Mult Scler 2022; 28:2157-2159. [DOI: 10.1177/13524585221135129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emily M Schorr
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Brownlee WJ, Wolf C, Hartung HP, Dingermann T, Anshasi N, Clark RA, Trojano M, Selmaj K, Uitdehaag BM, Tur C, Wuerfel J, Dallmann G, Witte J, Sintzel M, Bobrovnikova O, Cohen JA. Use of follow-on disease-modifying treatments for multiple sclerosis: Consensus recommendations. Mult Scler 2022; 28:2177-2189. [PMID: 36000489 DOI: 10.1177/13524585221116269] [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]
Abstract
BACKGROUND As patents for multiple sclerosis (MS) therapies expire, follow-on disease-modifying treatments (FO-DMTs) become available at reduced cost. Concerns exist that cheaper FO-DMTs are used simply to reduce healthcare costs. However, the well-being of people with MS should take priority. OBJECTIVES To identify best practices for FO-DMT development and use by agreeing on principles and consensus statements through appraisal of published evidence. METHODS Following a systematic review, we formulated five overarching principles and 13 consensus statements. Principles and statements were voted on by a multidisciplinary panel from 17 European countries, Argentina, Canada and the United States. RESULTS All principles and statements were endorsed by >80% of panellists. In brief, FO-DMTs approved within highly regulated areas can be considered effective and safe as their reference products; FO-DMTs can be evaluated case by case and do not always require Phase III trials; long-term pharmacovigilance and transparency are needed; there is lack of evidence for multiple- and cross-switching among FO-DMTs; and education is needed to address remaining concerns. CONCLUSION Published data support the use of FO-DMTs in MS. The consensus may aid shared decision-making. While our consensus focused on Europe, the results may contribute to enhanced quality standards for FO-DMTs use elsewhere.
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Affiliation(s)
- Wallace J Brownlee
- Queen Square Multiple Sclerosis Centre, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Hans-Peter Hartung
- Department of Neurology, Heinrich Heine University Medical Faculty, Düsseldorf, Germany/Brain and Mind Center, Medical Faculty, The University of Sydney, Sydney, NSW, Australia/Department of Neurology, Medical University of Vienna, Vienna, Austria/Department of Neurology, Palacky University, Olomouc, Czech Republic
| | - Theo Dingermann
- Institute for Pharmaceutical Biology, Goethe University Frankfurt, Frankfurt, Germany
| | - Nadia Anshasi
- European Multiple Sclerosis Platform, Brussels, Belgium
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University 'Aldo Moro', Bari, Italy
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland/Center of Neurology, Lodz, Poland
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdam Neuroscience, Amsterdam MS Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain/Queen Square Multiple Sclerosis Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jens Wuerfel
- Medical Image Analysis Center (MIAC AG) and University of Basel, Basel, Switzerland/Department of Radiology, University Hospital Magdeburg, Magdeburg, Germany
| | | | | | | | | | - Jeffrey A Cohen
- Mellen Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Hecker M. Blood transcriptome profiling captures dysregulated pathways and response to treatment in neuroimmunological disease. EBioMedicine 2019; 49:2-3. [PMID: 31668881 PMCID: PMC6945196 DOI: 10.1016/j.ebiom.2019.10.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 01/14/2023] Open
Affiliation(s)
- Michael Hecker
- Rostock University Medical Center, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany.
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