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Mohd Sani N, Aziz Z, Kamarulzaman A. Use of Biosimilars: A Systematic Review of Published Position Statements and Recommendations from Health Organisations and Societies. BioDrugs 2024; 38:405-423. [PMID: 38472644 DOI: 10.1007/s40259-024-00649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Hesitation about using biosimilars still exists among healthcare professionals (HCPs), despite extensive experience with their use. Globally, several health organisations and societies from various specialties have issued biosimilar position statements to guide the use of biosimilars in their specialties. However, it is uncertain how similar or different their positions or recommendations are or whether these positions have evolved with the increased experience and availability of new evidence. OBJECTIVES The study aimed to describe and assess the recommendations of published position statements regarding several aspects of biosimilars across specialties and determine whether these positions have changed with the emergence of new evidence. METHODS We systematically searched for published position statements of biosimilars in online databases and included statements written in English. The search was from the inception of the databases until May 2023. Two reviewers independently extracted the data. Only position statements that included recommendations to guide the use of biosimilars in clinical practice and were issued by health organisations and societies, including expert panels, were included. We synthesised recommendations on five aspects: prescribing practice, extrapolation of indication, interchangeability, treatment initiation with biosimilars in biologic-naïve patients, and pharmacovigilance. RESULTS The review included 25 papers involving eight specialties, 16 of which were from European countries, 1 from an international organisation representing 49 countries, and 6 from various countries. The papers were published between 2009 and 2020, with 19 published between 2015 and 2020. Of the five aspects of biosimilars assessed, nearly half (11 of 25) of the papers at the time they were published did not base their positions on a scientific or evidence-based approach. Only 4 of the 25 position papers were identified as revisions of their previous papers. With increasing experience in biosimilars and the emergence of new evidence, about 60% (16 of 25) of the papers contained outdated recommendations, particularly on two aspects. They were extrapolations of indications and interchangeability (including switching). The recommendations for most papers for three other aspects were still appropriate. These were prescribing biosimilars by their brand name and active ingredient, initiating treatment with biosimilars in biologic-naïve patients, and monitoring the long-term safety of biosimilars through pharmacovigilance. For four of the revised papers, their position evolved from opposing indication extrapolation for biosimilars to accepting it, while the position of two papers shifted from not recommending biosimilar switching to permitting the practice. Meanwhile, most papers were against automatic substitution by pharmacists because the evidence for this practice was still limited. CONCLUSIONS Across specialties, the variability among the position statements is seen for extrapolation of indications for biosimilars and interchangeability (including switching). This requires a revision, considering the latest evidence and growing experience with the use of biosimilars in extrapolated indications and with switching.
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Affiliation(s)
- Noraisyah Mohd Sani
- Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
- National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | - Zoriah Aziz
- Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.
- Faculty of Pharmacy, MAHSA University, Jenjarom, Malaysia.
| | - Adeeba Kamarulzaman
- Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
- Monash University Malaysia, Subang Jaya, Malaysia
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Wetwittayakhlang P, Karkout K, Wongcha-Um A, Tselekouni P, Al-Jabri R, Afif W, Wild G, Bitton A, Bessissow T, Lakatos PL. Clinical efficacy and nocebo effect following non-medical biosimilar switch in patients with inflammatory bowel disease: A prospective observational study. Dig Liver Dis 2024; 56:35-42. [PMID: 37419726 DOI: 10.1016/j.dld.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/04/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND We aimed to evaluate clinical efficacy, biomarker activity, therapeutic drug monitoring (TDM), adverse events (AEs), and nocebo effect in inflammatory bowel disease (IBD) patients who underwent non-medical biosimilar switching. METHODS A prospective observational study of consecutive IBD patients who underwent biosimilar switch. Disease activity, biomarkers, TDM, and AEs, including the nocebo effect were captured 8 weeks before switch, at the time of switch (baseline),12 and 24 weeks after the switch. RESULTS 210 patients were included [81.4% had Crohn's disease (CD), the median age at inclusion: 42 years (IQR 29-61)]. There was no significant difference in the rates of clinical remission at week 8 before switch, baseline, week12, and 24 after switch: 89.0%,93.4%,86.3%,and 90.8%,p = 0.129. The biomarker remission rates were not significantly different; CRP:81.3%,74.7%,81.2%,73.0%,p = 0.343; fecal calprotectin: 78.3%,74.5%,71.7%,76.3%,p = 0.829. The rates of maintaining therapeutic levels (84.7%,83.9%,83.0%,85.3%,p = 0.597) and prevalence of positive anti-drug antibodies remained unchanged. Drug persistence at 12 week of switch was 97.1%, regardless of disease phenotype and originator. The nocebo effect was observed in 13.3%. The discontinuation rate was 4.8%. CONCLUSION Despite a significant number of early nocebo complaints within the first 6 months after the biosimilar switch, no significant changes were found in clinical efficacy, biomarkers, therapeutic drug level, or anti-drug antibodies.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Khaled Karkout
- Division of Internal Medicine McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada
| | - Arti Wongcha-Um
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Paraskevi Tselekouni
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Reem Al-Jabri
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Waqqas Afif
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Gary Wild
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; Department of Internal Medicine and Oncology, Semmelweis University, Budapest H-1085, Hungary.
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Hörbrand F, Schuch F, Bleß HH, Messinger D, Bretthauer B, Killian P. [PHARAO study: drug treatment of inflammatory rheumatic diseases : Guideline-conform treatment with biologics follows availability of biosimilars]. Z Rheumatol 2023; 82:787-797. [PMID: 36006471 PMCID: PMC10627965 DOI: 10.1007/s00393-022-01259-5] [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] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND With the introduction of tumor necrosis factor (TNF) alpha inhibitors, the treatment of inflammatory rheumatic diseases (IRD) has undergone a fundamental change. Several of the originally high-priced biologics are now accessible as lower cost biosimilars, removing a significant impediment to prescription. OBJECTIVE The present study investigated whether the availability of biosimilars is associated with an improvement in the care of IRD. Moreover, the subjective acceptance of biosimilars by physicians and patients was investigated and compared with objectifiable parameters. MATERIAL AND METHODS Pseudonymized claims data of the Bavarian Association of Statutory Health Insurance Physicians from 2014 to 2019 as well as a paper and pencil survey of patients and rheumatologists formed the data basis of the study. RESULTS During the observation period, the proportion of diagnosed patients receiving drug therapy increased from 38.5% to 43.2%. Also, the care changed in terms of the prescribed agents. Conventional drug therapy declined overall and, in particular, glucocorticoid prescriptions decreased from 39.3% in 2014 to 34.3% in 2019. At the same time, the proportion of targeted treatments increased from 12.3% to 20.4%. The median duration of basic treatment before first-time bDMARD use dropped from 3.15 years in 2014 to 2.17 years in 2019. CONCLUSION Over the observation period, in which three biosimilars entered the market, the care of patients with IRD improved both quantitatively and qualitatively. The market share of biosimilars increased in parallel with this development. With an overall high acceptance of biosimilars, the assessment of the disease course by physicians and patients indicates a slight subjectively perceived advantage of therapy with originals compared to biosimilars, which, however, is not confirmed when standardized scores are applied. A possible explanation for this might be a nocebo effect, which could be minimized by suitable communication strategies.
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Affiliation(s)
| | - Florian Schuch
- Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Deutschland
| | | | | | | | - Peter Killian
- Kassenärztliche Vereinigung Bayerns (KVB), München, Deutschland
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Yin Y, McDermott C, Lockhart C. Real-world switching and discontinuation outcomes of infliximab biosimilars in patients with rheumatoid arthritis: A scoping review. J Manag Care Spec Pharm 2023; 29:985-998. [PMID: 37610110 PMCID: PMC10508713 DOI: 10.18553/jmcp.2023.29.9.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND: Infliximab (IFX) was one of the first tumor necrosis factor inhibitors developed to treat rheumatoid arthritis (RA) and has transformed the treatment and management of many chronic inflammatory diseases. Large-scale studies in the real-world setting on the utilization patterns of IFX biosimilars are limited. OBJECTIVE: To conduct a scoping review of observational studies investigating the switching and discontinuation outcomes of the IFX biosimilars in patients with RA. METHODS: A comprehensive literature search was conducted in 3 databases (ie, PubMed, Embase, and Web of Science). This review identified observational studies that examined switching and/or discontinuation outcomes of IFX biosimilar products in adult patients with RA. Studies published in English between 2015 and 2020 were included. Studies that did not include either switching or discontinuation patterns of IFX biosimilars, had a pooled result for biologics, or were nonobservational were excluded. Extracted data were summarized using descriptive statistics. RESULTS: The initial literature search yielded 1,130 studies. With 244 duplicate articles removed and 779 excluded after title and abstract screening, the search resulted in 107 studies for full-text screening. 18 articles were included in this review. 13 countries were represented in the included studies, with most studies originating in a European country and only one article from the United States. Discontinuation rates of IFX biosimilars were reported by 14 studies and varied substantially from 8.3% to 87.0%. 4 studies (22%) directly compared discontinuation rates between IFX reference and biosimilar. Switching rates, similarly, had a great variance from 4% to 81.5%; only 4 articles described rates specifically in patients with RA. The most common causes of discontinuation were ineffectiveness and adverse effects. CONCLUSIONS: The growing market of biologic products necessitates more large-scale studies examining the real-world treatment patterns of these therapy options to provide reassurance to and build trust among patients and clinicians. Our findings suggest the inconclusiveness of current literature on the real-world implications of IFX biosimilars discontinuation and product switching. This review captures the heterogeneity in reported data and identifies areas for future research to provide clarity to the value of IFX biosimilars.
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Affiliation(s)
- Yue Yin
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - Cara McDermott
- Biologics and Biosimilars Collective Intelligence Consortium, Alexandria, VA
| | - Catherine Lockhart
- Biologics and Biosimilars Collective Intelligence Consortium, Alexandria, VA
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Pauline O, Robert M, Bernardeau C, Hlavaty A, Fusaroli M, Roustit M, Cracowski JL, Khouri C. Assessment of Reported Adverse Events After Interchanging Between TNF-α Inhibitor Biosimilars in the WHO Pharmacovigilance Database. BioDrugs 2023; 37:699-707. [PMID: 37278971 DOI: 10.1007/s40259-023-00603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Observational studies have shown that a significant proportion of patients interchanging between tumor necrosis factor-α inhibitor biosimilars withdraws from the new treatment because of adverse effects. We aim to analyze adverse events related to interchanging from tumor necrosis factor-α (TNF-α) inhibitor reference products to biosimilars and between biosimilars reported in the World Health Organization pharmacovigilance database. METHODS We extracted all cases reporting the Medical Dictionary for Regulatory Activities term "Product substitution issue (PT)" for TNF-α inhibitors. Then, we analyzed and categorized all adverse events reported in more than 1% of cases. We compared the adverse events reported according to reporter qualification, type of switch, and type of TNF-α inhibitor using Chi2 tests. We conducted a network analysis coupled with a clustering approach to identify syndromes of co-reported adverse events. RESULTS In the World Health Organization pharmacovigilance database, 2543 cases and 6807 adverse events related to TNF-α inhibitor interchangeability have been reported up to October 2022. Injection-site reactions were the most reported adverse events with 940 cases (37.0%), followed by modifications in drug effect in 607 cases (23.9%). Musculoskeletal, cutaneous, and gastrointestinal disorders linked to the underlying disease were reported in 505 (20.0%), 145 (5.7%), and 207 (8.1%) cases, respectively. Adverse events non-related to the underlying disease were nonspecific (n = 458, 18.0%), neurologic (n = 224, 8.8%), respiratory (n = 132, 5.2%), and psychological disorders (n = 64, 2.5%). Injection-site reactions and infection-related symptoms (e.g., nasopharyngitis, urinary tract infection, lower respiratory tract infection) were more reported by non-healthcare professionals while adverse events related to reduced clinical efficacy (e.g., drug ineffective, arthralgia, psoriasis) were more reported by healthcare professionals. The proportions of injection-site reactions were higher when switching between biosimilars of the same reference product, but the proportions of adverse events related to reduced clinical efficacy (e.g., psoriasis, arthritis, psoriatic arthropathy) were more reported when switching from a reference product. The main differences in the proportions of reported cases between adalimumab, infliximab, and etanercept were driven by symptoms related to the underlying targeted diseases, except for a higher reporting rate of injection-site pain with adalimumab. Adverse events evocative of hypersensitivity reactions were reported in 192 (7.6%) cases. Most of the network clusters concerned non-specific adverse events or were related to reduced clinical efficacy. CONCLUSIONS This analysis highlights the burden of patient-reported adverse events when interchanging between TNF-α inhibitor biosimilars, notably injection-site reactions, non-specific adverse events, and symptoms related to reduced clinical efficacy. Our study also highlights differences in reporting patterns between patients and healthcare professionals and depending on the type of switch. The results are limited by missing data, the lack of precision of the coded Medical Dictionary for Regulatory Activities terms, and by the variability of reporting rate of adverse events. Thus, incidence rates of adverse events cannot be inferred from these results.
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Affiliation(s)
- Orhon Pauline
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Marion Robert
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Claire Bernardeau
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Alex Hlavaty
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matthieu Roustit
- Grenoble Alpes University, HP2 Laboratory, Inserm U1300, Grenoble, France
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, CIC1406, Grenoble, France
| | - Jean-Luc Cracowski
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
- Grenoble Alpes University, HP2 Laboratory, Inserm U1300, Grenoble, France
| | - Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France.
- Grenoble Alpes University, HP2 Laboratory, Inserm U1300, Grenoble, France.
- Grenoble Alpes University, Inserm, CHU Grenoble Alpes, CIC1406, Grenoble, France.
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Kunkel A, Bingel U. [Placebo effects in analgesia : Influence of expectations on the efficacy and tolerability of analgesic treatment]. Schmerz 2023; 37:59-71. [PMID: 36637498 PMCID: PMC9889476 DOI: 10.1007/s00482-022-00685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 01/14/2023]
Abstract
Expectations of patients influence the perception and neuronal processing of acute and chronic pain and modulate the effectiveness of analgesic treatment. The expectation of treatment is not only the most important determinant of placebo analgesia. Expectations of treatment also influence the efficacy and tolerability of "active" pharmacological and non-pharmacological treatment of pain. Recent insights into the psychological and neurobiological mechanisms underlying the clinically relevant effects of treatment expectations enable and call for the systematic integration and modulation of treatment expectations into analgesic treatment concepts. Such a strategy promises to optimize analgesic treatment and to prevent or reduce the burden of unwanted side effects and the misuse of analgesics, particularly of opioids. This review highlights the current concepts, recent achievements and also challenges and key open research questions.
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Affiliation(s)
- Angelika Kunkel
- Klinik für Neurologie, Zentrum für translationale Neuro- und Verhaltenswissenschaften, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Ulrike Bingel
- Klinik für Neurologie, Zentrum für translationale Neuro- und Verhaltenswissenschaften, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Young-Xu Y, Melsheimer R, Emond B, Lefebvre P, DerSarkissian M, Lax A, Nguyen C, Bhak RH, Wu M, Lin I. Author's Response to Letter to the Editor - Re: Lin I, Melsheimer R, Bhak RH, et al. Impact of switching to infliximab biosimilars on treatment patterns among US veterans receiving innovator infliximab. Curr Med Res Opin. 2022;38(4):613-627. Curr Med Res Opin 2022; 38:2237-2240. [PMID: 36274636 DOI: 10.1080/03007995.2022.2139970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Yinong Young-Xu
- White River Junction VA Medical Center, White River Junction, VT, USA
| | | | - Bruno Emond
- Analysis Group, Inc, Montréal, Québec, Canada
| | | | | | - Angela Lax
- Analysis Group, Inc, Los Angeles, CA, USA
| | | | | | - Melody Wu
- Analysis Group, Inc, Los Angeles, CA, USA
| | - Iris Lin
- Analysis Group, Inc., Boston, MA, USA
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Exploring the Reasons Behind the Substantial Discontinuation Rate Among Patients Taking CT-P13 in a Large Tertiary Hospital in Western Switzerland: A Retrospective Cohort Study Using Routinely Collected Medical Data. Drugs Real World Outcomes 2022; 9:425-436. [PMID: 35590047 PMCID: PMC9392673 DOI: 10.1007/s40801-022-00299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND CT-P13 is an infliximab biosimilar that was granted market authorization in Switzerland in 2016. Despite the growing literature supporting the equivalence of CT-P13 compared with originator infliximab regarding the efficacy, safety, and immunogenicity and the undeniable cost-saving opportunities, CT-P13 remains widely underused in Switzerland. OBJECTIVE Leaving aside the phenomenon of a low initiation rate, this study aimed to explore the reasons behind the high discontinuation rate observed among the patients taking CT-P13 in a large tertiary hospital in Western Switzerland. METHODS We performed a retrospective cohort study using routinely collected data. Patients were eligible if they received originator infliximab or CT-P13 between September 2017 and December 2020. They were included if they had received at least two CT-P13 infusions during the same period. Patients were excluded if the follow-up was incomplete prior to or 6 months after their first CT-P13 infusion and if they had an oncological main diagnosis. Primary outcomes were the reasons for treatment discontinuation. RESULTS One hundred and fifty-six patients were included and classified into two groups: switchers who were treated with originator infliximab and were switched to CT-P13 (n = 85, 54%) and initiators who did not receive originator infliximab prior to CT-P13 treatment (n = 71, 46%). Included patients belonged to three different groups of diagnosis: gastroenterological (67, 43%), rheumatological (61, 39%), and immunological (28, 18%). Twenty-three (27%) switchers and 35 (49%) initiators discontinued CT-P13 after 12 months. Main reasons for CT-P13 discontinuation were lack of efficacy (n = 21, 36%) and secondary loss of response (n = 16, 28%); however, objective assessments were not available. Initiators' probability to discontinue CT-P13 at 12 months was significantly higher than switchers' (p < 0.01). CONCLUSIONS Lack of efficacy and secondary loss of response were the main reasons for the high CT-P13 discontinuation rate observed in a large tertiary hospital in Western Switzerland. Lack of active training and coordination among healthcare professionals and little education in patients may have exacerbated patients' subjective complaints and increased the CT-P13 discontinuation rate.
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Lin I, Melsheimer R, Bhak RH, Lefebvre P, DerSarkissian M, Emond B, Lax A, Nguyen C, Wu M, Young-Xu Y. Impact of switching to infliximab biosimilars on treatment patterns among US veterans receiving innovator infliximab. Curr Med Res Opin 2022; 38:613-627. [PMID: 35125053 DOI: 10.1080/03007995.2022.2037846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare treatment patterns of United States (US) veterans stable on innovator infliximab (IFX) who switched to an IFX biosimilar (switchers) or remained on innovator IFX (continuers). METHODS US Veterans Healthcare Administration data (01/2012-12/2019) were used to identify adults with rheumatoid arthritis (RA), psoriatic arthritis (PsA), plaque psoriasis (PsO), ankylosing spondylitis (AS), or Crohn's disease and ulcerative colitis (i.e. inflammatory bowel disease [IBD]), treated with innovator or biosimilar IFX. Index date was the first IFX biosimilar administration for switchers or a random innovator IFX administration for continuers. Patients were required to have ≥5 innovator IFX administrations during the 12 months pre-index (prevalent population). Patients with ≥12 months of observation prior to the first innovator IFX administration were analyzed as the primary population (incident population), and data were assessed from start of innovator IFX. Inverse probability of treatment weighting was used to balance baseline characteristics between cohorts. Treatment patterns were evaluated post-index; continuers were censored before switching to IFX biosimilar. Discontinuation was defined as switching to another biologic (including innovator IFX) or having ≥120 days between 2 consecutive index treatment records. RESULTS In the incident population, mean [median] duration of follow-up was 737 [796] days among switchers (N = 838) and 479 [337] days among continuers (N = 849). Compared to continuers, switchers were 2.88-times more likely to discontinue index therapy (hazard ratio [HR] = 2.88, p < .001) and 4.99-times more likely to switch to another innovator biologic (HR = 4.99, p < .001). Of 653 switchers switching to another innovator biologic, 594 (91.0%) switched back to innovator IFX. Results were similar among the prevalent population and RA and IBD subgroups. CONCLUSION Patients switching from innovator to biosimilar IFX were more likely to discontinue treatment and switch to another innovator biologic (notably back to innovator IFX) than those remaining on innovator IFX; however, reasons for discontinuation and switching are unknown.
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Affiliation(s)
- Iris Lin
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | | | | | | | - Bruno Emond
- Analysis Group, Inc, Montréal, Québec, Canada
| | - Angela Lax
- Analysis Group, Inc, Boston, Massachusetts, USA
| | | | - Melody Wu
- Analysis Group, Inc, Boston, Massachusetts, USA
| | - Yinong Young-Xu
- White River Junction VA Medical Center, White River Junction, VT, USA
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Demirkan FG, Ulu K, Öztürk K, Karadağ ŞG, Özdel S, Sönmez HE, Çakmak F, Demir F, Sözeri B, Aktay Ayaz N. Toward the integration of biosimilars into pediatric rheumatology: adalimumab ABP 501 experience of PeRA research group. Expert Opin Biol Ther 2021; 22:197-202. [PMID: 34730483 DOI: 10.1080/14712598.2021.2002296] [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
OBJECTIVES To review the real-life data, to provide an input to the literature concerning treatment of juvenile idiopathic arthritis (JIA) with adalimumab (ADL) biosimilar. METHOD This multi-centric retrospective study was conducted among children with JIA, followed up for at least 24-weeks from the initiation of ADL biosimilar (ABP 501) treatment. Adverse events and alterations in disease activity scores were figured out. RESULTS The median age of the group was 15.5 (5-18) years. JIA categories were oligoarticular (n =12), enthesitis-related (ERA) (n=24), psoriatic (PsA) (n=6), and polyarticular (n=4). Uveitis was detected at the initiation of the disease (n=3), during the disease course (n=5), or before the diagnosis (n=1). The first-line treatment preferences were ADL biosimilar (n=37) and etanercept (n=9). On the 6th month of ABP 501, 40 (86.9%) patients had achieved complete remission. Six patients (1 PsA, 1 polyarticular JIA, and 4 ERA) had ongoing active arthritis. Furthermore, all except one of the patients had remission of ophthalmologic findings. No life-threatening adverse events were observed. CONCLUSIONS ABP 501 has a gradual increase in prescription in pediatric rheumatology. Real-life data of the cohort announce that ADL biosimilar is a suitable and effective treatment option for patients with JIA in case of indication.
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Affiliation(s)
- Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul University, Istanbul School of Medicine, İstanbul, Turkey
| | - Kadir Ulu
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Istanbul Medeniyet University, School of Medicine, Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatric Rheumatology, University of Health Sciences, Bakırköy Dr. SadiKonuk Training and Research Hospital, İstanbul, Turkey
| | - Semanur Özdel
- Department of Pediatric Rheumatology, University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University, Kocaeli School of Medicine, Kocaeli, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul University, Istanbul School of Medicine, İstanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University, Istanbul School of Medicine, İstanbul, Turkey
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Mysler E, Azevedo VF, Danese S, Alvarez D, Iikuni N, Ingram B, Mueller M, Peyrin-Biroulet L. Biosimilar-to-Biosimilar Switching: What is the Rationale and Current Experience? Drugs 2021; 81:1859-1879. [PMID: 34705255 PMCID: PMC8578069 DOI: 10.1007/s40265-021-01610-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 01/15/2023]
Abstract
Over time, clinicians have become increasingly comfortable embracing the prescription of biosimilars-highly similar versions of innovator or reference biological agents-for their patients with inflammatory diseases. Although a switch from a reference product to a licensed biosimilar version (or vice versa) is a medical decision robustly supported by the stepwise accumulation of clinical trial evidence concerning comparable safety, immunogenicity, and efficacy between these products, a switch from one biosimilar to another biosimilar of the same reference product, or a cross-switch, is not. Similarity among biosimilars of a reference product is not a regulatory agency concern and therefore is unlikely to be investigated in randomized controlled trials in the foreseeable future. Yet in clinical practice, across a diverse range of patients, the option to cross-switch from one biosimilar to another can and does arise for valid reasons such as convenience or tolerability issues, or driven by third parties (e.g., payers). In the absence of clinical trial data, clinicians must attempt to objectively evaluate the emerging real-world cross-switching evidence within the context of what is known about the science underpinning a designation of biosimilar. That knowledge then needs to be integrated with what clinicians know about their patients and their disease on a case-by-case basis. This review aims to consolidate relevant emerging real-world data and other key information about biosimilar-to-biosimilar cross-switching for prescribing clinicians. In the absence of clear clinical guidelines addressing this topic at present, this review may serve to facilitate discretionary and educated treatment decision making.
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Affiliation(s)
- Eduardo Mysler
- Organización Médica de Investigación, Buenos Aires, Argentina.
| | - Valderilio Feijó Azevedo
- Rheumatology Unit, Department of Internal Medicine, Federal University of Paraná, Curitiba, PR, Brazil
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | | | | | | | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U1256 NGERE, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
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12
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Overbeek JA, Kuiper JG, Bakker M, van den Bemt BJFB, Herings RMC. Infliximab use in the Netherlands: Uptake and characteristics of originator and biosimilars over time. Br J Clin Pharmacol 2021; 88:1804-1810. [PMID: 34571570 DOI: 10.1111/bcp.15097] [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] [Received: 02/15/2021] [Revised: 06/24/2021] [Accepted: 09/19/2021] [Indexed: 01/11/2023] Open
Abstract
AIMS The objective of this retrospective cohort study was to provide an overview of the utilization of originator and biosimilar infliximab in the Netherlands. METHODS All infliximab dispensings were selected from the PHARMO In-patient Pharmacy Database from 2002-2018. Descriptive analyses were performed in order to characterise initiators and to describe switching patterns over time. RESULTS Overall, 3840 patients with 61 274 infliximab dispensings were identified. 2496 patients initiated an originator infliximab and 777 patients initiated a biosimilar infliximab. Overall, 57% of the patients was female and mean age was 43.2 years. Both originators and biosimilars were mostly prescribed by gastroenterologists, followed by internists and rheumatologists. After market authorisation of the first biosimilar, the proportion of new patients initiating the biosimilar increased from 39% in 2015 to 91% in 2018. Out of 704 patients eligible for switching 34% switched. Among switchers, the proportion of females was 60% and mean age at index was 45.1 years. Among nonswitchers, 55% were female and mean age was 39.8 years. The median time to switch was 1.7 years and switchers were most frequently initiated on infliximab by a rheumatologist (42%), while nonswitchers were most frequently initiated by a gastroenterologist (42%). CONCLUSION The results of this large population-based cohort show an increase in biosimilar initiation in daily clinical practice. The number of switchers remains relatively low as nonmedical switch is not encouraged in the Netherlands.
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Affiliation(s)
- Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marina Bakker
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.,Zilveren Kruis, Utrecht, Netherlands
| | - B J F Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.,Department of Epidemiology and Data Science, VU University Medical Center, Amsterdam, Netherlands
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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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14
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Switching to an Infliximab Biosimilar Was Safe and Effective in Dutch Sarcoidosis Patients. Cells 2021; 10:cells10020441. [PMID: 33669641 PMCID: PMC7922542 DOI: 10.3390/cells10020441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022] Open
Abstract
The effect of switching from originator infliximab to biosimilar infliximab in patients with sarcoidosis is unknown. The objective of this study is to investigate the effect of switching from Remicade® or Inflectra® to Flixabi® in patients with severe refractory sarcoidosis. This single center retrospective cohort study was performed at St Antonius Hospital Nieuwegein, The Netherlands. All patients diagnosed with severe refractory sarcoidosis receiving Remicade® or Inflectra® switched to Flixabi®. The primary outcome was infliximab discontinuation within 6 months of switching. Secondary endpoints included adverse events and loss of clinical, functional, or inflammatory response. Out of 86 patients who switched to Flixabi®, 79 patients had complete data. None of the 79 patients discontinued infliximab during the first 6 months after switching. Five patients reported an adverse event related to Flixabi® treatment. We found no change from baseline in FVC, FEV1, DLCOc, 6MWT, and infliximab trough levels 26 weeks after switching. An improvement in physical functioning of 7.3 ± 13.4 points (p = 0.002) with RAND/SF36 and in biomarker sIL-2R (−475.58 ± 1452.39; p = 0.005) was observed. Switching from originator infliximab Remicade® or biosimilar infliximab Inflectra® to biosimilar infliximab Flixabi® did not result in treatment discontinuation or loss of clinical/functional/inflammatory remission.
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15
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Pierik MJ, van der Meulen AE, Van der Linde K, Lutgens M, Kuijvenhoven JP, Akol H, Klompmaker IJ, Sikkens MSG, van Megen YJB, Stoop CM, Bloemsaat-Minekus JPJ, Dijkstra G. Switching From Reference Infliximab to Biosimilar CT-P13 Did Not Change Quality of Life in Stable Inflammatory Bowel Disease Patients. CROHN'S & COLITIS 360 2021; 4:otab001. [PMID: 36777418 PMCID: PMC9802295 DOI: 10.1093/crocol/otab001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 11/14/2022] Open
Abstract
Background Quality of life (QoL) data for patients with inflammatory bowel disease switched from the reference infliximab to biosimilar CT-P13 is lacking. This study aims to demonstrate noninferiority for QoL and efficacy after switching. Methods OoL and clinical efficacy were measured prior to and after 2, 4, and 6 CT-P13 infusions. Results One hundred seventy-eight patients were included. Noninferiority was established for QoL [ratio 97.95% (95% confidence interval 95.93 to 100.01)] and efficacy [difference -0.02 (95% confidence interval -0.68 to 0.64)]. Five patients reported 6 nonrelated, serious adverse events. Conclusions Switching from reference infliximab to CT-P13 did not affect the QoL or disease activity and was well tolerated.
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Affiliation(s)
- Marieke J Pierik
- Division of Gastroenterology and Hepatology, MUMC, Maastricht, The Netherlands
| | - Andrea E van der Meulen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Klaas Van der Linde
- Department of Gastroenterology and Hepatology, MCL, Leeuwarden, The Netherlands
| | - Maurice Lutgens
- Department of Gastroenterology and Hepatology, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Johan P Kuijvenhoven
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Halil Akol
- Department of Gastroenterology and Hepatology, MC De Veluwe, Apeldoorn, The Netherlands
| | - Ids J Klompmaker
- Department of Gastroenterology and Hepatology, Wilhelmina Ziekenhuis Assen, Assen, The Netherlands
| | - Michelle S G Sikkens
- Department of Gastroenterology-Hepatology, Dijklander Ziekenhuis, Enkhuizen, The Netherlands
| | | | - Corinne M Stoop
- Medical Department, Mundipharma Pharmaceuticals B.V., Leusden, The Netherlands
| | - Joanne P J Bloemsaat-Minekus
- Address correspondence to: Joanne P.J. Bloemsaat-Minekus, PhD, Mundipharma Pharmaceuticals B.V., Leusderend 24, 3832 RC Leusden, The Netherlands ()
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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16
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Sondermann W, Reinboldt-Jockenhöfer F, Dissemond J, Pfaar O, Bingel U, Schedlowski M. Effects of Patients' Expectation in Dermatology: Evidence from Experimental and Clinical Placebo Studies and Implications for Dermatologic Practice and Research. Dermatology 2021; 237:857-871. [PMID: 33498052 DOI: 10.1159/000513445] [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: 10/02/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
Patients' expectations towards the benefit of a treatment are key determinants of placebo responses and can affect the development and course of medical conditions and the efficacy and tolerability of active medical treatment. The mechanisms mediating these placebo and nocebo effects have been best described in the field of experimental pain and placebo analgesia. However, also in dermatology experimental and clinical studies demonstrate that various skin diseases such as inflammatory dermatoses and allergic reactions can be modulated by patients' expectations. Dermatologists should consider the important modulatory role of patients' expectations on the efficacy and tolerability of specific treatments and the key role of verbal information, patients' prior treatment experiences (associative learning), and the quality and quantity of doctor-patient communication in shaping treatment expectation. As a consequence, techniques aiming at maximizing patients' expectation effects should be implemented into daily clinical routine. By contrast, in clinical studies expectation effects should be maximally controlled and harmonized to improve the "assay sensitivity" to detect new compounds. Further translational studies, also in dermatoses that have not been investigated yet, are needed to better characterize the mechanisms underlying patients' expectation and to gain further insights into potential clinical implications of these effects in dermatologic conditions. Therefore, in this review, we provide a brief overview on the concept of expectation effects on treatment outcome in general, summarize what is already known about this topic for dermatologic diseases, and finally present the relevance of this topic in clinical dermatology.
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Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,
| | - Finja Reinboldt-Jockenhöfer
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
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17
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Hansen E, Zech N, Benson S. [Nocebo, informed consent and doctor-patient communication]. DER NERVENARZT 2020; 91:691-699. [PMID: 32728796 DOI: 10.1007/s00115-020-00963-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Negative previous experiences (conditioning), observational learning and expectations can trigger nocebo effects. They are responsible for a substantial proportion of the side effects of medical treatment, and are induced primarily by risk information for informed consent. This has been demonstrated in studies on patient groups with or without modified medical information. Drug trials in the field of neurology and psychiatry have regularly revealed side effects and drop-out also in placebo groups. The underlying neurobiological mechanisms were experimentally investigated especially for nocebo-induced hyperalgesia, whereby the specifically involved regions of the brain could be identified by functional imaging as well as changes in the dopamine, endorphin and cholecystokinin systems. Nocebo effects are specific, i.e. they are closely related to patient information and can induce or aggravate exactly the symptoms addressed. Nevertheless, informed consent is an essential part of doctor-patient communication; however, information on risks can be markedly less damaging when unnecessary repetitions are avoided, misunderstandings are recognized or resolved and several different options are given. In addition, risks should always be named together with positive aspects, such as the advantages of the appropriate treatment, the prophylactic measures applied or the early detection and treatment of developing side effects. The best protection against harm caused by information on risks is a trustful doctor-patient relationship. Poor knowledge of nocebo effects or lack of countermeasures constitute a serious threat to patients and according to the current state of knowledge could be rated as medical malpractice.
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Affiliation(s)
- E Hansen
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - N Zech
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - S Benson
- Institut für Medizinische Psychologie und Verhaltensbiologie, Universitätsklinikum Essen, Essen, 45122, Deutschland
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18
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Feagan BG, Marabani M, Wu JJ, Faccin F, Spronk C, Castañeda-Hernández G. The Challenges of Switching Therapies in an Evolving Multiple Biosimilars Landscape: A Narrative Review of Current Evidence. Adv Ther 2020; 37:4491-4518. [PMID: 32910420 PMCID: PMC7547992 DOI: 10.1007/s12325-020-01472-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Indexed: 02/06/2023]
Abstract
With the increasing availability of biosimilars, the practice of switching therapies for non-medical reasons between an originator biologic and an analogous biosimilar has become more common. The evidence to support this practice mostly comes from single-switch randomized controlled trials (RCTs) and real-world (RW) evidence studies. However, as more biosimilars of the same originator enter the market, multiple switching events between originators and biosimilars is becoming a reality, despite limited evidence to support the efficacy and safety of such practice. Some countries have established guidelines, policies, or laws related to interchangeability and/or automatic substitution, whereas others have left these practices unregulated or controlled by other components of the healthcare system. Collectively, guidelines on single non-medical switching are often vague, with even less focus given to multiple non-medical switching, leaving this practice mostly unregulated. This narrative review will first discuss the current regulatory perspectives on non-medical switching and challenges associated with switching therapies, particularly with the availability of multiple biosimilars. We will then review the current evidence from RCTs and RW studies in the light of three different multiple-switch scenarios currently taking place in clinical practice: switching between an originator and a single biosimilar, switching between biosimilars of the same originator, and the clinical practice of switching back to the originator (i.e., switchbacks) after a failure of the initial non-medical switch to the analogous biosimilar.
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Affiliation(s)
- Brian G Feagan
- Department of Medicine, Western University, Robarts Clinical Trials, St. Joseph's Health Care, London, ON, Canada.
| | - Mona Marabani
- Department of Medicine, Canterbury Hospital, Sydney, NSW, Australia
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
| | | | | | - Gilberto Castañeda-Hernández
- Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
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19
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20
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Kravvariti E, Kitas GD, Sfikakis PP. The role of the Nocebo effect in the use of biosimilars in routine rheumatology clinical practice. Mediterr J Rheumatol 2020; 30:63-68. [PMID: 32524080 PMCID: PMC7280873 DOI: 10.31138/mjr.30.1.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - George D Kitas
- Clinical Research Unit, Dudley Group NHS Foundation Trust, Dudley, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National & Kapodistrian University of Athens Medical School, Athens, Greece
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21
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Kumari A, Prasad DN, Kumar S, Singh RK. Clinical Benefits of Switching from Original Infliximab to its Biosimilar (CT-P13) as a Potential TNF-α Inhibitor. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2020; 000:1-9. [DOI: 10.14218/jerp.2020.00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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van Langenberg DR, Cheng RKY, Garg M. Outcomes of a drug shortage requiring switching in patients with ulcerative colitis. World J Gastrointest Pathophysiol 2020; 11:32-42. [PMID: 32318313 PMCID: PMC7156848 DOI: 10.4291/wjgp.v11.i2.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Drug shortages are common yet their impact on patient care and their commercial ramifications has not been adequately researched. In Australia a shortage of balsalazide (2012-2013) necessitated substitution with alternative 5-aminosalicylate (5-ASA) formulations for ulcerative colitis (UC).
AIM To assess and compare the clinical and commercial sequelae of non-medical switching from balsalazide to another 5-ASA and/or return to balsalazide once supply resumed.
METHODS A prospective cohort study of patients on balsalazide for mild-moderate UC was conducted where, strictly due to the national shortage (November 2012- January 2013), were switched to alternative 5-ASA and/or then returned to balsalazide once supply resumed. Clinical (Partial Mayo), endoscopic (Mayo score) activity, adverse effects (to alternative 5-ASA) and percentage market share (of continuous 5-ASA users) from baseline (i.e., time of switching due to shortage) through to five years were assessed.
RESULTS Of 31 patients switched due to the shortage, 12 (38.7%) resumed balsalazide immediately once supply resumed, 8 (25.8%) prompted by adverse effects to the alternative 5-ASA used. Three patients (9.7%) had documented symptomatic improvement, 15 (48.4%) were unchanged and 13 (41.9%) had symptomatic worsening vs baseline (P < 0.01), after switching to an alternative 5-ASA. At 3 and 5y post switch, overall 26/31 (83.9%) and 23/31 (74.2%) had remained continuously on any 5-ASA therapy respectively. Twelve (38.7%) and 11 (35.5%) patients remained on balsalazide continuously at three and five years respectively after drug supply returned, equating to a loss of market share (within 5-ASA class) of 45.2% and 38.7% respectively.
CONCLUSION This study of a balsalazide shortage in UC patients exemplifies the detrimental impact of a drug shortage on long term patient, disease and commercial outcomes.
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Affiliation(s)
- Daniel R van Langenberg
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria 3128, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria 3128, Australia
| | - Richard Kai-Yuan Cheng
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria 3128, Australia
- Department of Gastroenterology, Redcliffe Hospital, Redcliffe, Queensland 4020, Australia
| | - Mayur Garg
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria 3128, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria 3128, Australia
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria 3052, Australia
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23
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Dutcher SK, Eworuke E, Blum MD, Ball R. Using real-world data to evaluate biosimilar switching. Pharmacoepidemiol Drug Saf 2019; 29:814-816. [PMID: 31692176 DOI: 10.1002/pds.4899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah K Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Efe Eworuke
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Michael D Blum
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Robert Ball
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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24
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Annese V. Biosimilars in IBD: Similarity Breeds Contented Patients. Dig Dis Sci 2019; 64:1399-1400. [PMID: 30725297 DOI: 10.1007/s10620-019-05499-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Vito Annese
- Valiant Clinic & American Hospital, Dubai, UAE.
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25
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Edwards CJ, Hercogová J, Albrand H, Amiot A. Switching to biosimilars: current perspectives in immune-mediated inflammatory diseases. Expert Opin Biol Ther 2019; 19:1001-1014. [PMID: 31056970 DOI: 10.1080/14712598.2019.1610381] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The expiry of patents for biologics has led to the introduction of biosimilars for the treatment of immune-mediated inflammatory diseases (IMIDs). These treatment alternatives may allow earlier and wider access to appropriate therapy for patients without increasing the economic burden on health-care systems. Prescription of biosimilars to treatment-naïve patients is well accepted; however, additional considerations must be taken into account when switching clinically stable patients from reference products to biosimilars. Area covered: We discuss the current considerations related to switching from reference products to biosimilars from a physician and patient perspective. We review the clinical data and real-life experience on switching patients with IMIDs, present the position of the relevant medical societies, and discuss the importance of patient-physician communication and need for shared decision-making. Expert opinion: The introduction of biosimilars provides an opportunity to expand access to treatment for patients with IMIDs across Europe and support the financial sustainability of health-care systems. We anticipate that as the real-world evidence base grows, confirming the results of clinical trials, there will be a corresponding increase in physician and patient acceptance, not only to initiating treatment with a biosimilar, but also to switching medication from a reference product to a biosimilar.
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Affiliation(s)
- Christopher J Edwards
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Jana Hercogová
- Dermatology Department, 2nd Medical faculty, Charles University and Na Bulovce Hospital , Prague , Czech Republic
| | | | - Aurelian Amiot
- Department of Gastroenterology and EC2M3-EA7375 Unit, Assistance Publique-Hôpitaux de Paris, Paris Est Creteil University, Henri Mondor Hospital , Creteil , France
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Abstract
In this review, we explored different ways of controlling the placebo effects in clinical trials and described various factors that may increase/decrease the placebo effect in randomized placebo-controlled trials. These factors can be subdivided into four groups, and while not all factors are effective in every study and under all clinical conditions, they show on the whole that - even under the ideal condition of drug therapy, where blinded placebo provision is much easier and warranted than in, e.g., psychotherapy - many factors need to be controlled to ascertain that the goal of the clinical trials, fair assessment of superiority of the drug over placebo in placebo-controlled trials and fair assessment of non-inferiority of the drug compared to another drug in comparator trials, is reached. Ignorance towards the placebo effect, which was common in the past, is no longer acceptable; instead, it should be the goal of all therapeutic trials to minimize the placebo effect in clinical trials, while utilizing and maximizing it in clinical routine.
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Affiliation(s)
- Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy , University Hospital Tübingen, Tübingen, Germany.
| | - Sibylle Klosterhalfen
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy , University Hospital Tübingen, Tübingen, Germany
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