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Agboton C, Salameh J. Biosimilars in chronic inflammatory diseases: facts and remaining questions 5 years after their introduction in Europe. Expert Opin Biol Ther 2021; 22:157-167. [PMID: 34338115 DOI: 10.1080/14712598.2021.1963435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Five years after the launch of the first infliximab biosimilar, biologics have found their place in the treatment of chronic inflammatory conditions, but there are remaining questions. This is a review of the introduction of antibody biosimilars in Europe; the reasons for their success and how biosimilar hesitancy was quailed. AREAS COVERED We provide an overview of the concepts of biosimilarity, extrapolation, and interchangeability, using examples in rheumatology and gastroenterology for illustration. A review of the evidence collected from switching studies using robust designs is included. Remaining questions such as 'inter-switching' are also discussed. EXPERT OPINION Biosimilars have democratized access to powerful medicines. Efficacy and safety studies provided reassuring data, but knowledge gaps persist. The availability of so-called 'bio-betters' might open new avenues and change clinical practice.
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Affiliation(s)
- Christian Agboton
- Global medical affairs, Takeda Pharmaceuticals AG, Zürich, Switzerland
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Kowalski SC, Benavides JA, Roa PAB, Galarza-Maldonado C, Caballero-Uribe CV, Soriano ER, Pineda C, Azevedo VF, Avila-Pedretti G, Babini AM, Cachafeiro-Vilar A, Cifuentes-Alvarado M, Cohen SB, Díaz PE, Soto LD, Encalada C, Garro B, Sariego IAG, Guibert-Toledano M, Rodriguez VJK, Lopez MEL, Ortega AP, Russell AS, Santos-Moreno P, Terán IS, Vargas A, Vásquez G, Xavier RM, Firedman DXX, Mysler E, Kay J. PANLAR consensus statement on biosimilars. Clin Rheumatol 2019; 38:1485-1496. [DOI: 10.1007/s10067-019-04496-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 01/28/2023]
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Felix T, Jordan JB, Akers C, Patel B, Drago D. Current state of biologic pharmacovigilance in the European Union: improvements are needed. Expert Opin Drug Saf 2019; 18:231-240. [DOI: 10.1080/14740338.2019.1577818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Thomas Felix
- Global Regulatory and R&D Policy, Amgen Inc., Washington, DC, USA
| | - John B. Jordan
- Global Regulatory and R&D Policy, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Bina Patel
- Global Patient Safety, Amgen Ltd., Cambridge, UK
| | - Daniela Drago
- Regulatory Affairs, School of Medicine and Health Science, The George Washington University, Washington, DC, USA
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Calvo B, Martinez-Gorostiaga J, Echevarria E. The surge in biosimilars: considerations for effective pharmacovigilance and EU regulation. Ther Adv Drug Saf 2018; 9:601-608. [PMID: 30283628 DOI: 10.1177/2042098618790442] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/03/2018] [Indexed: 01/03/2023] Open
Abstract
The development of biosimilars is growing rapidly, especially in Europe. They are a cost-effective alternative to original biological medicines and can help improve patient access to these therapies. The European Medicines Agency (EMA) has been the first to issue scientific guidelines related to regulatory requirements for the approval of biosimilars. These guidelines have been being updated in line with advances in analytical techniques and growing experience in the clinical use of these drugs. Given the complex nature of biological medicines, they pose a greater potential risk of immunogenicity than nonbiological medicines, and hence warrant special consideration. The risk management plan for biopharmaceuticals (innovator and biosimilar drugs) should be based on strengthening ongoing pharmacovigilance activities, especially in the post-approval period. This paper addresses regulatory issues related to the approval of biosimilars in Europe associated with safety considerations linked to the development and use of these medicines. We also discuss the issues of immunogenicity, interchangeability and traceability of biological medicines.
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Affiliation(s)
- Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz 01008, Spain
| | - Javier Martinez-Gorostiaga
- Integrated Healthcare Organisation (OSI Araba), Basque Health Service (Osakidetza), Vitoria-Gasteiz, Spain
| | - Enrique Echevarria
- Physiology Department. University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain
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Uhlig T, Goll GL. Reviewing the evidence for biosimilars: key insights, lessons learned and future horizons. Rheumatology (Oxford) 2017; 56:iv49-iv62. [PMID: 28903542 PMCID: PMC5850213 DOI: 10.1093/rheumatology/kex276] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/12/2017] [Indexed: 12/28/2022] Open
Abstract
Biologic therapies have become central to the long-term management of many chronic diseases, including inflammatory rheumatic diseases. Over recent years, the development and licensing pathways for biosimilars have become more standardized, and several biosimilars have been made available for patients with inflammatory rheumatic diseases, such as RA. Pre-licensing requirements for biosimilars mandate the demonstration of comparability with reference products in terms of clinical activity, safety and immunogenicity, whereas post-marketing surveillance and risk minimization requirements are set in place to ensure that long-term, real-world safety data are collected to assess biosimilars in clinical practice. These measures should provide a foundation for physician confidence in biosimilars, which can be established further through clinical experience. Biosimilars may help to fill an unmet need by improving patient access to effective biologic treatments for chronic diseases. Greater access may result in additional clinical benefits, with appropriate use of biologic therapies according to treatment guidelines being associated with improved outcomes and the potential for reduced costs of care. Key challenges for the integration of biosimilars into everyday practice include questions about interchangeability, switching and automatic substitution. Several switching studies have shown that biosimilars can be used in place of reference products while maintaining efficacy and safety. Additional ongoing studies and registries may help to optimize the process of switching, and different funding models are examining the optimal mechanisms to ensure effective uptake of these new treatments.
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Affiliation(s)
- Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology
| | - Guro L. Goll
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Kobayashi T, Kamada I, Komura J, Toyoshima S, Ishii-Watabe A. Comparative study of the number of report and time-to-onset of the reported adverse event between the biosimilars and the originator of filgrastim. Pharmacoepidemiol Drug Saf 2017; 26:917-924. [PMID: 28612945 DOI: 10.1002/pds.4218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE The objective of this study is to specify the most reported adverse events as preferred terms (PTs) and to compare the reported adverse events about some properties including the number of report and time-to-onset (TTO) distribution of the originator of filgrastim Neupogen® and its biosimilars in Europe, using VigiBase®. METHODS We identified the biosimilar which was reported as the suspected drug in more than 100 individual case safety reports in Europe. Then, we specified the top ranking 10 PTs in the cases reported with Neupogen® or each biosimilar as the suspected drug. We also compared the TTO of the most reported PTs using the data about the onset date of the PT and the start date of filgrastim. We used Kolmogorov-Smirnov method to detect significant difference. RESULTS The total ICSR numbers with Neupogen® and 3 biosimilars, Zarzio®, Nivestim®, and Tevagrastim® were 1,301, 295, 156, and 127, respectively, in Europe. The most reported PTs with Neupogen® were bone pain, pyrexia, and dyspnoea. The TTO of bone pain and pyrexia with Zarzio® (N: 22 and 16, median: 1 and 0.5 days) were significantly shorter than those with Neupogen® (P < 0.01, N: 72 and 33, median: 3.5 and 3 days), respectively. The most reported PTs with biosimilars were drug ineffective and neutropenia. CONCLUSION The difference in the TTO was identified between originator filgrastim Neupogen and its biosimilar regarding some PTs, which may suggest the difference in their safety profile. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tetsu Kobayashi
- Division of Biological Chemistry and Biologicals, National Institute of Health Sciences, Tokyo, Japan
| | - Izumi Kamada
- Faculty of Pharmacy, Musashino University, Tokyo, Japan
| | - Junko Komura
- Office of Safety I, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | | | - Akiko Ishii-Watabe
- Division of Biological Chemistry and Biologicals, National Institute of Health Sciences, Tokyo, Japan
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Leporini C, Marrazzo G, Mumoli L, Esposito S, Gallelli L, Mangano G, Brancati G, De Francesco EA, Russo E, De Sarro G. Adverse drug reactions reporting in Calabria (Southern Italy) in the four-year period 2011-2014: impact of a regional pharmacovigilance project in light of the new European Legislation. Expert Opin Drug Saf 2017; 16:515-522. [DOI: 10.1080/14740338.2017.1316486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Christian Leporini
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giuseppina Marrazzo
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Laura Mumoli
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | | | - Luca Gallelli
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giovanna Mangano
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giacomino Brancati
- Department of Health and Health Politics, Calabria Region, Sector 3 Area 3 LEA, Department of health and health politics, Calabria, Italy
| | | | - Emilio Russo
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Science of Health, School of Medicine and Surgery, University of Catanzaro, Catanzaro, Italy
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Klein K, Scholl JHG, Vermeer NS, Broekmans AW, Van Puijenbroek EP, De Bruin ML, Stolk P. Traceability of Biologics in The Netherlands: An Analysis of Information-Recording Systems in Clinical Practice and Spontaneous ADR Reports. Drug Saf 2016; 39:185-92. [PMID: 26719190 PMCID: PMC4735237 DOI: 10.1007/s40264-015-0383-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction and Objective Pharmacovigilance requirements for biologics mandate that EU Member States shall ensure that any biologic that is the subject of a suspected adverse drug reaction (ADR) is identifiable by brand name and batch number. Recent studies showed that brand name identification is well established, whereas batch numbers are (still) poorly reported. We evaluated information-recording systems and practices in the Dutch hospital setting to identify determinants for brand name and batch number recording as well as success factors and bottlenecks for traceability. Methods We surveyed Dutch hospital pharmacists with an online questionnaire on systems and practices in hospitals for recording brand names and batch numbers. Additionally, we performed an analysis of the traceability of recombinant biologics in spontaneous ADR reports (received between 2009 and 2014) from the Netherlands Pharmacovigilance Centre Lareb. Results The survey showed that brand names are not routinely recorded in the clinical practice of Dutch hospitals, whereas batch numbers are poorly recorded. Seventy-six percent of the 1523 ADR reports for recombinant biologics had a traceable brand name whereas 5 % of these reports contained a batch number. The results suggest a possible relationship between the availability of brand and batch number information in clinical practice and the inclusion of this information in ADR reports for biologics. Conclusion The limited traceability of brand names and batch numbers in ADR reports may be primarily caused by the shortcomings in the recording of information in clinical practice. We recommend efforts to improve information-recording systems as a first step to improve the traceability of biologics in ADR reporting. Electronic supplementary material The online version of this article (doi:10.1007/s40264-015-0383-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kevin Klein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
- TI Pharma Escher, Leiden, The Netherlands.
- Exon Consultancy, Amsterdam, The Netherlands.
| | - Joep H G Scholl
- The Netherlands Pharmacovigilance Centre Lareb, Den Bosch, The Netherlands
| | - Niels S Vermeer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands
| | | | | | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands.
| | - Pieter Stolk
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- TI Pharma Escher, Leiden, The Netherlands
- Exon Consultancy, Amsterdam, The Netherlands
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Francescon S, Fornasier G, Baldo P. Biosimilar Oncology Drugs in Europe: Regulatory and Pharmacovigilance Considerations. Oncol Ther 2016; 4:173-182. [PMID: 28261647 PMCID: PMC5315076 DOI: 10.1007/s40487-016-0028-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Indexed: 11/12/2022] Open
Abstract
The introduction in clinical practice of pharmaceutical products known as biosimilars, as part of a more complex series of progress in the field of biological drugs, represents an excellent therapeutic resource. A biosimilar drug is a biological/biotechnological drug that is highly similar to an approved reference biologic product. Given their complexity, biosimilars require attention and a continued vigilance to ensure appropriate use, especially in cancer therapy. There is the urgent need, both at Italian and European levels, of clear and more comprehensive guidelines to elucidate the open questions. Probably, the acquisition of new data, obtained from larger samples of patients than those used in the pre-approval studies and with extremely variable clinical conditions, will allow clarifying the extent to which biosimilar drugs are similar in safety and efficacy to their biologic reference drug. The aims of this article are to provide health professionals with basic, but essential information about biosimilars, and to identify current critical points and future perspectives for clinical practice, cancer care, regulatory aspects, and pharmacovigilance.
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Affiliation(s)
- Sara Francescon
- Pharmacy Division, CRO National Cancer Institute, Aviano, Italy
| | | | - Paolo Baldo
- Pharmacy Division, CRO National Cancer Institute, Aviano, Italy
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Correale J, Chiquete E, Boyko A, Beran RG, Strauch JB, Milojevic S, Frider N. Clinical implications for substandard, nonproprietary medicines in multiple sclerosis: focus on fingolimod. Drug Des Devel Ther 2016; 10:2109-17. [PMID: 27418809 PMCID: PMC4933568 DOI: 10.2147/dddt.s106802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Both proprietary and nonproprietary medicines are expected to undergo rigorous preapproval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Nonproprietary (also known as copy, or generic) medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower the cost and, thus, increase patient access. If these medicines fail to meet quality standards, such as good manufacturing practice and bioequivalence (in humans), they are then defined as substandard copies and can pose serious risks to patients in terms of safety and efficacy. Potentially noncontrolled or different manufacturing process and excipients in nonproprietary medicines may result in poor batch-to-batch reproducibility (accurate and consistent quantity of each ingredient in each capsule/tablet) and lower quality. Substandard, nonproprietary copies of medicines that are immunomodulatory or immunosuppressive are of concern to patients due to their possible untoward safety and lack of efficacy events. This article reviews the potential risks associated with nonproprietary medicines that do not meet the regulatory requirements of the United States Food and Drug Administration, the European Medicines Agency, or the World Health Organization. The clinical implications for patients are described. This article focuses on nonproprietary medicines for multiple sclerosis, particularly fingolimod, that are not identical to proprietary versions and could thus fail to meet efficacy expectations or have different impact on the safety of patients with multiple sclerosis.
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Affiliation(s)
- Jorge Correale
- Department of Neurology, Raúl Carrea Institute for Neurological Research, Foundation for the Fight against Infant Neurological Illnesses (FLENI), Buenos Aires, Argentina
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Alexey Boyko
- Clinical and Research Center “MS and Other Demyelinating Diseases” at the Neuroclinical Hospital, Department of Neurology, Neurosurgery and Medical Genetics of the Pirogov Russian National Research Medical University, Moscow, Russia
| | - Roy G Beran
- South Western Clinical School, University of New South Wales, Liverpool
- Department of Neurology, Liverpool Hospital, Sydney, NSW
- School of Medicine, Griffith University, Southport, QLD, Australia
| | - Jorge Barahona Strauch
- Department of Neurology, Clínica Alemana de Santiago
- School of Medicine, Universidad del Desarrollo, Santiago, Chile
| | | | - Nadina Frider
- Novartis Latin America and Canada Region, Buenos Aires, Argentina
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Stergiopoulos S, Brown CA, Grampp G, Felix T, Getz KA. Identifying and Quantifying the Accuracy of Product Name Attribution of US-Sourced Adverse Event Reports in MedWatch of Somatropins and Insulins. Ther Innov Regul Sci 2015; 49:706-716. [PMID: 30227042 DOI: 10.1177/2168479015578156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND As of 2014, the US FDA was considering policy options to promote accurate attribution of adverse events for biosimilars. In order to assess the identification and traceability of biologics from multiple sources, Tufts University's Center for the Study of Drug Development conducted a study reviewing the current FDA Adverse Event Reporting System (FAERS) for reports related to insulin and growth hormone products. METHODS For this study, all primary suspect reports that were received by FAERS for human growth hormone (hGH) and human insulin between the fourth quarter of 2005 and the third quarter of 2013 were extracted and analyzed. RESULTS The rates of "accurate" brand (ie, identifiable) drug names were generally high, with a higher incidence for hGH drugs than for insulin drugs (92% of hGH primary suspect reports vs 84% of insulin primary suspect reports). Lot number completion rates were generally low, with a higher incidence for insulin drugs than for hGH drugs (37% of insulin primary suspect reports vs 13% of hGH primary suspect reports). There were 13.5% of insulin reports that could not be linked to manufacturers, while 7.5% of hGH reports could not be linked to a manufacturer. CONCLUSIONS The completion and accuracy rates of FAERS data on biologics observed in this study are consistent with those observed in earlier studies and suggest that traceability in adverse event reports can be improved through more consistent use of brand names or other product specific identifiers and through more frequent inclusion of lot numbers.
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Biosimilars: A consideration of the regulations in the United States and European union. Regul Toxicol Pharmacol 2015; 76:199-208. [PMID: 26732800 DOI: 10.1016/j.yrtph.2015.12.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Abstract
Biosimilars are defined as biological products that are highly similar to a reference product, notwithstanding minor differences in clinically inactive components. Biosimilars show no clinically meaningful differences in safety, purity, and potency of the product in comparison to the reference product. With the ever looming patent expiry of some major high cost biologics, biosimilar production is becoming ever more lucrative to companies. Europe (EU) set the precedent, followed by the United States (US) in early 2012, for the approval process for biosimilars. Therefore, the purpose of this paper is to explore the nature of the regulatory processes in the US and EU and to determine the requirements of each in the approval process of a biosimilar. The current Food and Drug Administration (FDA) and European Medicines Agency's (EMA) guidance documents for biosimilars were reviewed revealing a need for further clarifications, as well as specifically addressing Celltrion's and Sandoz's application for approval for the biosimilars infliximab and filgrastim, respectively. Currently, the FDA and EMA focus on comparability in terms of the clinical, pharmacokinetic (PK)/pharmacodynamic (PD), preclinical, biological activity, and physiochemical characterization results, as well as requiring a robust and consistent manufacturing process. Both the EU and US have prepared guidance documents for biosimilars that will result in biotherapeutics that are as safe and efficacious as the innovator product but the necessity exists to globally harmonize international nonproprietary naming nomenclature and clarify how the concept of pharmacovigilance, extrapolation, and interchangeability will be handled and regulated in the future.
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Abstract
The impending expiry of the patent on a number of leading biologic drugs has led to a surge in the development of 'biosimilar' or 'follow-on' products. However, in contrast to generic small-molecule medicines, biosimilars are not identical to their reference products. The differences and complexities surrounding both the molecular structure and the manufacturing process for biologics and biosimilars have resulted in a lack of clarity regarding the terms used in different parts of the world to define various aspects of development and utilization such as regulatory approval, pharmacovigilance, interchangeability and treatment-naivety. This makes quantitative evaluation of biosimilars a great challenge to both the scientific community and regulatory agencies. This manuscript attempts to clarify the terms used and address an important knowledge gap which is currently resulting in an increasing rush to position biosimilars for certain indications and patients in the absence of agreed upon definitions.
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Affiliation(s)
- Paul Declerck
- a a Department of Pharmaceutical and Pharmacological Sciences , KU Leuven, University of Leuven , Leuven , Belgium
| | - Håkan Mellstedt
- b b Cancer Centre Karolinska, Department of Oncology, Karolinska University Hospital Solna , Stockholm , Sweden
| | - Silvio Danese
- c c Istituto Clinico Humanitas - IRCCS in Gastroenterology , Milan , Italy
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Safety profile of biological medicines as compared with non-biologicals: an analysis of the italian spontaneous reporting system database. Drug Saf 2015; 37:961-70. [PMID: 25255847 DOI: 10.1007/s40264-014-0224-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Biologicals are important treatment options for various chronic diseases. After the introduction of the first biosimilars, animated debate arose in the scientific community about the actual benefit-risk profile of these drugs. In this context, a comparative safety evaluation of biologicals and biosimilars in clinical practice is warranted. METHODS We identified all suspected adverse drug reactions (ADRs) concerning biological/biosimilars (excluding vaccines, toxins, blood derivatives, and radio-pharmaceuticals), and further classified them into mechanistic classes. We described the frequency of biological/biosimilar class- and compound-specific ADRs by system organ class (SOC) and type of reporter. We also separately explored the traceability of biologicals and biosimilar-related ADR reports. RESULTS Overall 171,201 ADR reports were collected during the observation period; 9,601 (5.6 %) of these concerned biologicals. Biological-related reports were mainly issued by hospital-based physicians (78.7 %). Most of these reports involved monoclonal antibodies and fusion proteins (66.3 %). Reported ADRs were mainly 'skin and subcutaneous tissue disorders' (21 %), 'general and administration site disorders' (17 %), and 'gastrointestinal disorders' (13.6 %). In terms of traceability, 94.8 % of biological-related reports included an identifiable product name, whilst only 8.6 % indicated the corresponding batch number. Regarding biosimilars, 298 reports were identified, with a low proportion indicating drug ineffectiveness (10.1 %). CONCLUSIONS Most ADRs attributed to biologicals are 'skin and subcutaneous tissue disorders'. Anticancer monoclonal antibodies are most frequently associated with ADRs. A low proportion of ADR reports concern biosimilars.
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Foley M, Harris R, Rich E, Rapca A, Bergin M, Norman I, Van Hout MC. The availability of over-the-counter codeine medicines across the European Union. Public Health 2015. [PMID: 26215740 DOI: 10.1016/j.puhe.2015.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M Foley
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland.
| | - R Harris
- H.I. Weldricks Ltd, Doncaster, United Kingdom
| | - E Rich
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - A Rapca
- H.I. Weldricks Ltd, Doncaster, United Kingdom
| | - M Bergin
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - I Norman
- Kings College London, Florence Nightingale School of Nursing & Midwifery, London, United Kingdom
| | - M C Van Hout
- School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
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Abstract
PURPOSE OF REVIEW The goal is to review the most recent literature about biosimilars in inflammatory bowel disease (IBD), with emphasis on controversial regulatory issues. RECENT FINDINGS Although biosimilars have been in use in Europe since 2005, the recent approval of CT-P13 (Remsima, Inflectra), a biosimilar of the reference infliximab (Remicade), by the European Medicines Agency (EMA) and several regulatory agencies has become a widely discussed topic in IBD, rheumatology, and other areas. Biologics are the main drivers of cost in current IBD units, and biosimilars can reduce prices thus increasing the availability of this type of treatment. The guidelines for evaluation of biosimilars are considerably different from those of the reference biologics, regulatory agencies relying on detailed in-vitro studies for defining 'high similarity', and requiring many fewer clinical data. 'High similarity' is considered sufficient for clinical trials, as the new molecule is demonstrated so structurally similar to the reference one that no significant difference in efficacy or safety is expected. Two trials in ankylosing spondylitis and rheumatoid arthritis gave no evidence of real difference and provided the required pharmacokinetic and PD data. The main controversy remains in the 'extrapolation' of indications, accepted by EMA but not by Health Canada. Position statements from several scientific societies and some expert's reviews have expressed concerns to the concept of extrapolation without direct IBD clinical evidence, whereas EMA experts have published detailed reviews supporting extrapolation. SUMMARY Biosimilars in IBD are here to stay. New data are awaited to settle the controversy of extrapolation, but only the complex behavior of markets will show whether biosimilars fuel competition and extend access to biologics with significant cuts in drug costs.
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Morales-Ríos O, Jasso-Gutiérrez L, Garduño-Espinosa J, Olivar-López V, Muñoz-Hernández O. [Do pediatricians identify adverse drug reactions even when they do not report them?]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:106-111. [PMID: 29425989 DOI: 10.1016/j.bmhimx.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Spontaneous notification depends on the ability of pediatricians to identify adverse drug reactions (ADRs) along with their habit of reporting these incidents. During the years 2008 and 2009, the frequency of reports of ADRs to the Electronic Program of Pharmacovigilance (SISFAR) in the Hospital Infantil of Mexico Federico Gomez (HIMFG) was low (0.44% and 0.20%, respectively). Because of the above, the ability of pediatricians from the Emergency Department (ED) to identify ADRs using the clinical chart review was evaluated in 2010 in this study. METHODS A descriptive, observational, cross-sectional retrospective study was conducted in the ED from March 1 to August 31. ADRs were classified and quantified as "ADRs identified by pediatricians" when there was evidence in the clinical chart that pediatricians associated a clinical sign, symptom and laboratory value with an ADR. The numbers of notifications reported in SISFAR were quantified. Descriptive analysis was done using SPSS v.18. RESULTS Considering patients who were admitted to the ED, the frequency of ADRs was 21.8%. The frequency of ADRs identified by physicians in clinical charts was 86%. The pharmacist detected 14% of ADRs. The frequency of ADRs reported by physicians was 6.1%. CONCLUSIONS Although identification of ADRs in the clinical charts by pediatricians was high, it is possible that some ADRs were undetected. Because underreporting was very high, it is necessary to take actions to improve the reporting process.
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Affiliation(s)
- Olga Morales-Ríos
- Departamento de Evaluación y Análisis de Medicamentos. Hospital Infantil de México Federico Gómez, México D.F., México.
| | - Luis Jasso-Gutiérrez
- Departamento de Evaluación y Análisis de Medicamentos. Hospital Infantil de México Federico Gómez, México D.F., México
| | - Juan Garduño-Espinosa
- Subdirección de Investigación. Hospital Infantil de México Federico Gómez, México D.F., México
| | - Víctor Olivar-López
- Departamento de Urgencias. Hospital Infantil de México Federico Gómez, México D.F., México
| | - Onofre Muñoz-Hernández
- Dirección de Investigación. Hospital Infantil de México Federico Gómez, México D.F., México
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[Biosimilars: current reality, promising future?]. Med Clin (Barc) 2015; 145:18-20. [PMID: 25978924 DOI: 10.1016/j.medcli.2015.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/24/2015] [Indexed: 11/21/2022]
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Abstract
Biologics have revolutionized several areas of medical therapeutics, and dozens of them are used by millions of patients. Monoclonal antibodies are only one type of biologics, but more than 900 are now in different phases of development. These drugs are complex to make and not cheap. The market is constantly increasing, and several biosimilars (copies of biologics) are being used, while many are still waiting to become available to the public. Biosimilars are more complex than generics, and regulatory agencies have very stringent criteria for approval. In the IBD field, the biosimilar infliximab (Inflectra®, Remsima®) has been recently approved by the EMA, but not by Canadian authorities. The EMA has considered that 'high similarity' in preclinical studies together with clinical data from two trials in ankylosing spondylitis and rheumatoid arthritis warrant the 'extrapolation' for all approved indications for original infliximab (Remicade®), specifically Crohn's disease and ulcerative colitis. Canadian authorities have not accepted extrapolation, based on differences in glycosylation (fucosylation) that could be related to properties important in Crohn's disease. Most scientific societies do support the idea of asking for specific clinical trials before approval, although they acknowledge that following EMA, FDA, and WHO guidelines warrant safe products. Practical issues such as interchangeability and substitution remain unsolved, and it is very likely that there will be different solutions at the national level. Pharmacovigilance plans will be key for obtaining reliable data. Biosimilars are not better drugs, but can be clearly cheaper and may facilitate access to new treatments in many populations.
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Affiliation(s)
- Fernando Gomollón
- IBD Unit, Digestive Diseases Service, Hospital Clínico Universitario 'Lozano Blesa', IIS Aragón, CIBEREHD, Zaragoza, Spain
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Calvo B. Author’s Reply to Borg et al. Comment on: “EU’s New Pharmacovigilance Legislation: Considerations for Biosimilars”. Drug Saf 2013; 37:125-6. [DOI: 10.1007/s40264-013-0130-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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