1
|
Aapro M, Krendyukov A, Höbel N, Gascon P. Treatment patterns and outcomes in patients with non-small cell lung cancer receiving biosimilar filgrastim for prophylaxis of chemotherapy-induced/febrile neutropaenia: Results from the MONITOR-GCSF study. Eur J Cancer Care (Engl) 2019; 28:e13034. [PMID: 30968997 PMCID: PMC9285596 DOI: 10.1111/ecc.13034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/08/2018] [Accepted: 01/17/2019] [Indexed: 12/16/2022]
Abstract
Objective Real‐world evidence data on the use of granulocyte colony‐stimulating factor (G‐CSF) in patients with non‐small cell lung cancer (NSCLC) are limited. MONITOR‐GCSF is a pan‐European, multicentre, prospective, non‐interventional study designed to describe patient characteristics, treatment patterns and clinical outcomes in patients receiving biosimilar filgrastim in the prophylaxis of chemotherapy‐induced neutropaenia (CIN) and febrile neutropaenia (FN). Methods In this subanalysis, patient characteristics, treatment patterns, and outcomes are described for 345 patients with stage 3 or 4 NSCLC, receiving up to six chemotherapy cycles. Patients were treated with biosimilar filgrastim as per their treating physician's best judgement. Results CIN (any grade) occurred in 13.6% of patients in Cycle 1 and in 36.5% of patients in all cycles. FN occurred in 1.4% of patients in Cycle 1 and in 5.2% of patients in all cycles. Grade 3–4 FN occurred in 1.2% of patients in Cycle 1 and in 3.8% of patients in all cycles. Conclusion Results show that in real‐life practice in patients with NSCLC, biosimilar filgrastim has similar effectiveness and safety to the known effectiveness and safety profile of reference filgrastim, supporting the use of biosimilar filgrastim for the real‐world treatment of neutropaenia in patients with NSCLC.
Collapse
Affiliation(s)
- Matti Aapro
- Cancer Center, Clinique de Genolier, Genolier, Switzerland
| | | | | | - Pere Gascon
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Ludwig H, Bokemeyer C, Aapro M, Boccadoro M, Gascón P, Denhaerynck K, Krendyukov A, Abraham I, MacDonald K. Chemotherapy-induced neutropenia/febrile neutropenia prophylaxis with biosimilar filgrastim in solid tumors versus hematological malignancies: MONITOR-GCSF study. Future Oncol 2019; 15:897-907. [DOI: 10.2217/fon-2018-0814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: This study aimed to report patterns of biosimilar filgrastim prophylaxis and outcomes of chemotherapy-induced neutropenia (CIN)/febrile neutropenia (FN) in patients with hematological malignancies or solid tumors. Patients & methods: MONITOR-GCSF is a real-world study of 1447 cancer patients receiving CIN/FN prophylaxis with biosimilar filgrastim (solid tumors: 77.2%; hematological malignancies: 22.8%). Results: Differences in prophylaxis intensity and day of initiation relative to guideline recommendations were observed. In hematology patients, higher rates of CIN and FN occurred at cycle level, and rate of FN was higher at patient level (9.1 vs 5.0% in solid tumor patients). Conclusion: Adequate GCSF support in hematology and solid tumor patients is important to prevent CIN/FN and related hospitalizations and chemotherapy disturbances.
Collapse
Affiliation(s)
- Heinz Ludwig
- Medizinische Abteilung I – Onkologie und Haematologie, Wilhelminenspital, Wienpäoh, Montleartstraße 37, 1160 Vienna, Austria
| | - Carsten Bokemeyer
- Department of Oncology, Hematology & BMT with Section of Pneumology Universitaetsklinikum Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Route du Muids 3, 1272 Genolier, Switzerland
| | - Mario Boccadoro
- Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S Giovanni Battista di Torino, Via Cherasco 15, 10126 Torino, Italy
| | - Pere Gascón
- Department of Hematology–Oncology, Division of Medical Oncology, Hospital Clínic de Barcelona, University of Barcelona, Carrer de Villarroel 170, 08036 Barcelona, Spain
| | - Kris Denhaerynck
- Matrix45, Tucson, 6159 West Sunset Road, Tucson, AZ 85743, USA
- Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Andriy Krendyukov
- Hematology and Oncology, Hexal AG, Industriestraße 25, 83607 Holzkirchen, Germany (formerly)
| | - Ivo Abraham
- Matrix45, Tucson, 6159 West Sunset Road, Tucson, AZ 85743, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- Center for Health Outcomes & PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Karen MacDonald
- Matrix45, Tucson, 6159 West Sunset Road, Tucson, AZ 85743, USA
| |
Collapse
|
3
|
Ludwig H, Gascón P, Bokemeyer C, Aapro M, Boccadoro M, Denhaerynck K, Krendyukov A, MacDonald K, Abraham I. Outcomes of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim (Zarzio®) initiated “same-day” (< 24 h), “per-guidelines” (24–72 h), and “late” (> 72 h): findings from the MONITOR-GCSF study. Support Care Cancer 2018; 27:2301-2312. [DOI: 10.1007/s00520-018-4513-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
|
4
|
Gascón P, Krendyukov A, Höbel N, Aapro M. MONITOR-GCSF DLBCL subanalysis: Treatment patterns/outcomes with biosimilar filgrastim for chemotherapy-induced/febrile neutropenia prophylaxis. Eur J Haematol 2017; 100:241-246. [DOI: 10.1111/ejh.13002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Pere Gascón
- Department of Hematology-Oncology; University of Barcelona; Barcelona Spain
| | | | - Nadja Höbel
- Sandoz Biopharmaceuticals/Hexal AG; Holzkirchen Germany
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie; Clinique de Genolier; Genolier Switzerland
| |
Collapse
|
5
|
McBride A, Balu S, Campbell K, Bikkina M, MacDonald K, Abraham I. Expanded access to cancer treatments from conversion to neutropenia prophylaxis with biosimilar filgrastim-sndz. Future Oncol 2017; 13:2285-2295. [DOI: 10.2217/fon-2017-0374] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: Biosimilar medicines offer significant cost-savings potential over their reference products, which can be re-allocated to provide access to other cancer treatments on a budget-neutral basis. Methods: Simulation study using cost data for the USA under consideration of several prophylaxis patterns. Results: Potential savings from conversion from reference filgrastim to biosimilar filgrastim-sndz are significant. These savings expand budget-neutral access to novel immunotherapies (obinutuzumab; pembrolizumab) or supportive care (filgrastim-sndz). Conclusion: The combination of biosimilar savings and expanded access increases the value of cancer care as the same supportive care is provided at lower cost, additional cancer care is enabled at no additional cost, and more patients will have access to cancer care.
Collapse
Affiliation(s)
- Ali McBride
- Department of Pharmacy, Banner University Medical Center, Tucson, AZ 85719, USA
- Department of Pharmacy, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | | | | | | | | | - Ivo Abraham
- Department of Pharmacy, University of Arizona Cancer Center, Tucson, AZ 85719, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
- Matrix45, Tucson, AZ 85743, USA
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA
- Department of Family & Community Medicine, College of Medicine – Tucson, University of Arizona, Tucson, AZ 85721, USA
| |
Collapse
|
6
|
Bokemeyer C, Gascón P, Aapro M, Ludwig H, Boccadoro M, Denhaerynck K, Gorray M, Krendyukov A, Abraham I, MacDonald K. Over- and under-prophylaxis for chemotherapy-induced (febrile) neutropenia relative to evidence-based guidelines is associated with differences in outcomes: findings from the MONITOR-GCSF study. Support Care Cancer 2017; 25:1819-1828. [PMID: 28111718 PMCID: PMC5403842 DOI: 10.1007/s00520-017-3572-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE In the MONITOR-GCSF study of chemotherapy-induced (febrile) neutropenia with biosimilar filgrastim, 56.6% of patients were prophylacted according to amended EORTC guidelines, but 17.4% were prophylacted below and 26.0% above guideline recommendations. METHODS MONITOR-GCSF is a prospective, observational study of 1447 evaluable patients from 140 cancers centers in 12 European countries treated with myelosuppressive chemotherapy for up to 6 cycles receiving biosimilar GCSF prophylaxis. Patients were classified as under-, correctly-, or over-prophylacted with GCSF relative to guideline recommendations based on their chemotherapy risk, individual risk factors, and type of GCSF prophylaxis (primary versus secondary). RESULTS Differences between under- (17.4%), correctly- (56.6%), or over-prophylacted (26.0%) groups were found in terms of patient risk factors (age, performance status, history of FN, comorbid conditions) as well as prophylaxis patterns (type of prophylaxis, day of GCSF initiation, and GCSF duration). Rates of chemotherapy-induced neutropenia (CIN) (all grades), FN, and CIN-related hospitalizations were consistently lower in over-prophylacted patients relative to under- and correctly-prophylacted patients. No differences were observed between under- and correctly-prophylacted patients except for CIN/FN-related chemotherapy disturbances. No GCSF safety differences were found between groups (except for headaches). CONCLUSIONS The real-world evidence provided by the MONITOR-GCSF study indicates that providing GCSF support may yield better CIN, FN, and CIN/FN-related hospitalization outcomes if patients are prophylacted at levels above guideline recommendations. Patients who are under-prophylacted are at higher risk for disturbances to their chemotherapy regimens. Our findings support the guideline recommendation that CIN/FN risk be assessed at the beginning of each chemotherapy cycle.
Collapse
Affiliation(s)
| | - Pere Gascón
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - Heinz Ludwig
- Medizinische Abteilung I - Onkologie und Haematologie, Wilhelminenspital, Wien, Austria
| | - Mario Boccadoro
- Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy
| | - Kris Denhaerynck
- Matrix45, 6159 W Sunset Rd, Tucson, AZ, 85743, USA
- Universitaet Basel, Basel, Switzerland
| | | | | | - Ivo Abraham
- Matrix45, 6159 W Sunset Rd, Tucson, AZ, 85743, USA.
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.
| | | |
Collapse
|
7
|
Affiliation(s)
- Jean Klastersky
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Lissandra Dal Lago
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
8
|
Aapro M, Bokemeyer C, Ludwig H, Gascón P, Boccadoro M, Denhaerynck K, Gorray M, Krendyukov A, MacDonald K, Abraham I. Chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim in elderly versus non-elderly cancer patients: Patterns, outcomes, and determinants (MONITOR-GCSF study). J Geriatr Oncol 2016; 8:86-95. [PMID: 27829539 DOI: 10.1016/j.jgo.2016.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/22/2016] [Accepted: 09/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myelotoxic chemotherapy is associated with chemotherapy-induced (febrile) neutropenia (CIN/FN). The MONITOR-GCSF study evaluated biosimilar filgrastim (Zarzio®) prophylaxis patterns, associated outcomes, and determinants. We performed stratified analyses comparing elderly and non-elderly patients. METHODS Comparative (elderly/non-elderly) analysis of demographics and clinical status, prophylaxis, associated CIN/FN outcomes (CIN grade 4 [CIN4], FN, CIN/FN-related hospitalizations and chemodisturbances, composite), and, per hierarchical modeling, determinants thereof evaluated at the patient- and cycle-level. RESULTS There were no significant differences between both cohorts in prophylaxis initiation/duration and associated outcomes, but proportionately more elderly patients were correctly-prophylacted and fewer over-prophylacted. Common determinants of poor CIN/FN outcomes included concomitant antibiotic prophylaxis, impaired performance status, and any grade CIN in a previous cycle, whereas common determinants of good outcomes included over-prophylaxis and prophylaxis initiation within 24-72h. In the elderly, female gender, liver/renal/cardiovascular disease, secondary prophylaxis, and under-prophylaxis were associated with poorer outcomes. In the non-elderly, CIN4 at baseline or in a prior cycle was associated with poorer CIN/FN outcomes, and higher biosimilar filgrastim dose and, perhaps counter-intuitively, under-prophylaxis with better outcomes. CONCLUSION Adequate GCSF support is essential for all patients, but especially for elderly patients with serious chronic disease, certainly, if concomitant antibiotic prophylaxis is indicated and if a CIN4 episode occurred in a prior cycle. The potential impact of impaired performance status, especially ECOG≥2 at chemotherapy start or a worsening to such during chemotherapy; under-prophylaxis, including inadequate secondary prophylaxis, should be considered in elderly patients. Timely GCSF initiation and over-prophylaxis is associated with lower rates of adverse CIN/FN events in elderly and non-elderly patients, and should be further evaluated in prospective randomized trials.
Collapse
Affiliation(s)
- Matti Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland.
| | | | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Wien, Austria
| | - Pere Gascón
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Mario Boccadoro
- Dipartimento di Oncologia e Ematologia, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy
| | - Kris Denhaerynck
- Matrix45, Tucson, AZ, USA; Universitaet Basel, Basel, Switzerland
| | | | | | | | - Ivo Abraham
- Matrix45, Tucson, AZ, USA; Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
9
|
Aapro M, Ludwig H, Bokemeyer C, Gascón P, Boccadoro M, Denhaerynck K, Krendyukov A, Gorray M, MacDonald K, Abraham I. Predictive modeling of the outcomes of chemotherapy-induced (febrile) neutropenia prophylaxis with biosimilar filgrastim (MONITOR-GCSF study). Ann Oncol 2016; 27:2039-2045. [PMID: 27793849 PMCID: PMC5091320 DOI: 10.1093/annonc/mdw309] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/18/2016] [Accepted: 07/26/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Risk models of chemotherapy-induced (CIN) and febrile neutropenia (FN) have to date focused on determinants measured at the start of chemotherapy. We extended this static approach with a dynamic approach of CIN/FN risk modeling at the start of each cycle. DESIGN We applied predictive modeling using multivariate logistic regression to identify determinants of CIN/FN episodes and related hospitalizations and chemotherapy disturbances (CIN/FN consequences) in analyses at the patient ('ever' during the whole period of chemotherapy) and cycle-level (during a given chemotherapy cycle). Statistical dependence of cycle data being 'nested' under patients was managed using generalized estimation equations. Predictive performance of each model was evaluated using bootstrapped c concordance statistics. RESULTS Static patient-level risk models of 'ever' experiencing CIN/FN adverse events and consequences during a planned chemotherapy regimen included predictors related to history, risk factors, and prophylaxis initiation and intensity. Dynamic cycle-level risk models of experiencing CIN/FN adverse events and consequences in an upcoming cycle included predictors related to history, risk factors, and prophylaxis initiation and intensity; as well as prophylaxis duration, CIN/FN in prior cycle, and treatment center characteristics. CONCLUSIONS These 'real-world evidence' models provide clinicians with the ability to anticipate CIN/FN adverse events and their consequences at the start of a chemotherapy line (static models); and, innovatively, to assess risk of CIN/FN adverse events and their consequences at the start of each cycle (dynamic models). This enables individualized patient treatment and is consistent with the EORTC recommendation to re-appraise CIN/FN risk at the start of each cycle. Prophylaxis intensity (under-, correctly-, or over-prophylacted relative to current EORTC guidelines) is a major determinant. Under-prophylaxis is clinically unsafe. Over-prophylaxis of patients administered chemotherapy with intermediate or low myelotoxicity levels may be beneficial, both in patients with and without risk factors, and must be validated in future studies.
Collapse
Affiliation(s)
- M Aapro
- Institut Multidisciplinaire d'Oncologie, Clinique de Genolier, Genolier, Switzerland
| | - H Ludwig
- Medizinische Abteilung I-Oncology and Hematology, Wilhelminenspital, Wien, Austria
| | - C Bokemeyer
- Department of Oncology, Universitaetsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - P Gascón
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Boccadoro
- Department of Oncology and Hematology, Azienda Ospedaliero Universitaria S. Giovanni Battista di Torino, Torino, Italy
| | - K Denhaerynck
- Matrix45, Tucson, AZ, USA
- Department of Statistics, Universitaet Basel, Basel, Switzerland
| | | | | | | | - I Abraham
- Matrix45, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
10
|
Khraishi M, Stead D, Lukas M, Scotte F, Schmid H. Biosimilars: A Multidisciplinary Perspective. Clin Ther 2016; 38:1238-49. [PMID: 26988243 DOI: 10.1016/j.clinthera.2016.02.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/05/2016] [Accepted: 02/22/2016] [Indexed: 12/30/2022]
Abstract
A biosimilar is an officially regulated and approved copy of an originator biologic therapy. Improved affordability and consequent wider patient access compared with biologics are a significant appeal of biosimilars. Regulatory guidelines for biosimilar development and approval are rigorous and undergoing constant refinement. The process of licensing approval for all biosimilars requires demonstration of comparability in quality, efficacy, and safety between the biosimilar and reference (originator) product, which is undertaken in a stepwise procedure of nonclinical and clinical evaluation. The approval of >20 biosimilars in Europe in several drug classes, including the first monoclonal antibody biosimilar, bears testimony to the increasing regulatory acceptance of these agents. In contrast, the clinical application of biosimilars remains underrecognized by physicians across therapy areas. Therefore, this article aims to provide a comprehensive review of the biosimilar development process and to provide multidisciplinary guidance on the potential therapeutic utility of biosimilars in clinical practice. Specifically, experts discuss clinical developments in the introduction of biosimilars across the disciplines of gastroenterology, nephrology, oncology, and rheumatology, and from a payer perspective, and also highlight a common need for ongoing pharmacovigilance, robust head-to-head clinical studies, and real-world data to establish the long-term risk-benefit profile of biosimilars. In conclusion, significant potential exists for biosimilars to revolutionize biologic therapy by widening patient access across therapy areas.
Collapse
Affiliation(s)
- Majed Khraishi
- Clinical Professor of Medicine (Rheumatology), Memorial University of Newfoundland, Canada.
| | - David Stead
- Recently retired Medicines Procurement Specialist Pharmacist NHS South West and past Chairman of Pharmaceutical Market Support Group
| | - Milan Lukas
- IBD Clinical and Research Center, And 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Florian Scotte
- Medical Oncology and Supportive Care in Cancer Unit Georges Pompidou European Hospital, Paris, France
| | - Holger Schmid
- Clinic and Policlinic IV, Section of Nephrology, Munich University Hospital, Campus Innenstadt, Munich, Germany
| |
Collapse
|
11
|
Treatment patterns and outcomes in the prophylaxis of chemotherapy-induced (febrile) neutropenia with biosimilar filgrastim (the MONITOR-GCSF study). Support Care Cancer 2015; 24:911-925. [DOI: 10.1007/s00520-015-2861-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/17/2015] [Indexed: 12/24/2022]
|
12
|
Model-Based Approach to Early Predict Prolonged High Grade Neutropenia in Carboplatin-Treated Patients and Guide G-CSF Prophylactic Treatment. Pharm Res 2014; 32:654-64. [DOI: 10.1007/s11095-014-1493-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/15/2014] [Indexed: 02/05/2023]
|
13
|
Gascón P, Tesch H, Verpoort K, Rosati MS, Salesi N, Agrawal S, Wilking N, Barker H, Muenzberg M, Turner M. Clinical experience with Zarzio® in Europe: what have we learned? Support Care Cancer 2013; 21:2925-32. [PMID: 23903799 PMCID: PMC3765845 DOI: 10.1007/s00520-013-1911-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/12/2013] [Indexed: 11/13/2022]
Abstract
Biosimilars are similar, but non-identical, versions of existing biological drugs for which patents have expired. Despite the rigorous approval process for biosimilars, concerns have been expressed about the efficacy and safety of these products in clinical practice. Biosimilars of filgrastim, based on the originator product Neupogen®, have been available since 2008 and are now in widespread clinical use in Europe and elsewhere. Three biosimilar G-CSFs have been approved based on a combination of physicochemical and biological protein characterisation, pharmacokinetic and pharmacodynamic assessment in healthy volunteers and efficacy and safety data in patients with cancer. To assess whether biosimilars are effective in the real-world clinical practice setting, a pooled analysis of five post-approval studies of biosimilar G-CSF (Zarzio®) that included 1,302 adult patients who received at least one cycle of chemotherapy with G-CSF support for the prevention of neutropenia was conducted. A total of 36 % of patients had a febrile neutropenia risk of >20 %, while 39.6 % had a risk of 10-20 % based on chemotherapy regimen. The occurrence of severe or febrile neutropenia was within the range of that observed in previous studies of originator G-CSF. In addition, the safety profile of Zarzio® was consistent with that reported for originator G-CSF and the known safety profile of G-CSF. Initial concerns about the use of biosimilars, at least with regard to biosimilar G-CSFs, appear to be unfounded. Adoption of cost-effective biosimilars should help reduce healthcare costs and improve patient access to biological treatments.
Collapse
Affiliation(s)
- Pere Gascón
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Calle Villarroel 170, 08036, Barcelona, Spain,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Abraham I, Sun D, Bagalagel A, Altyar A, Mohammed A, Tharmarajah S, MacDonald K. Biosimilars in 3D: definition, development and differentiation. Bioengineered 2013; 4:203-6. [PMID: 23714845 DOI: 10.4161/bioe.25067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Abraham I, Tharmarajah S, MacDonald K. Clinical safety of biosimilar recombinant human granulocyte colony-stimulating factors. Expert Opin Drug Saf 2013; 12:235-46. [PMID: 23419039 DOI: 10.1517/14740338.2013.770472] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION A 'biosimilar', or 'similar biological medicinal product', is a biologic agent that is similar in terms of quality, safety and efficacy to an authorized reference biological medicine. Since the expiration of the filgrastim patent in Europe, three agents have received marketing authorization from the EMA: Tevagrastim, Zarzio and Nivestim. Tevagrastim has also been approved as a biologic by the FDA as tbo-filgrastim. AREAS COVERED Using the EMA dossiers (all three agents), the FDA dossier (Tevagrastim), and journal publications, this article reviews clinical safety data for these products with emphasis on serious/severe adverse events and special consideration of immunogenicity, bone pain, splenomegaly, allergic reactions, acute respiratory distress syndrome and mortality. EXPERT OPINION All three agents have similar safety profiles. None were statistically higher on safety parameters to what is known about originator filgrastim (Neupogen). What is known about filgrastim in general regarding safety can be extended to biosimilar filgrastim. Safety profiles may become more differentiated once long-term product-specific safety data are available. Large-sample, long-term, observational studies of real-world practice will provide the heterogeneity and statistical power to demonstrate product-specific safety profiles. Current evidence indicates that statistically no one product is less and no one product is more safe.
Collapse
Affiliation(s)
- Ivo Abraham
- University of Arizona, College of Medicine, College of Pharmacy, Center for Health Outcomes and PharmacoEconomic Research, Department of Pharmacy Practice and Science, Department of Family and Community Medicine, 1295 N. Martin Ave., Tucson, AZ 85721, USA.
| | | | | |
Collapse
|
16
|
Follow-on biologics in oncology - the need for global and local regulations. Contemp Oncol (Pozn) 2013; 16:461-6. [PMID: 23788931 PMCID: PMC3687471 DOI: 10.5114/wo.2012.32475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/21/2012] [Accepted: 12/11/2012] [Indexed: 11/19/2022] Open
Abstract
The patent expiration for first-generation biological drugs has prompted the development of a new group of biopharmaceuticals – follow-on biologics. The extent of studies needed in the process of follow-on biologics approval is incomparably greater than in the case of generics but reduced in comparison to innovative biologics. The basis for the approval is to show the similarity sufficient to ensure the same quality, safety and efficacy as the reference medicine. In oncology, the most widely used among so far registered follow-on biologics are biosimilar granulocyte colony-stimulating factors, and in the hitherto clinical practice, there have been no concerns about their effectiveness and safety. It is expected that along with the patent expiry of next biologics, the number of follow-on biologics will increasingly grow, that implies the need to develop and implement specific regulations for this new class of medicine.
Collapse
|
17
|
What do prescribers think of biosimilars? Target Oncol 2012; 7 Suppl 1:S51-5. [PMID: 22258706 DOI: 10.1007/s11523-011-0193-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/02/2011] [Indexed: 10/14/2022]
Abstract
Until recently, prescribers had to deal with generics, considered to be simple molecules that are easy to copy. But as discussed in this paper, the biodisponibility of generics remains a source of uncertainty. And now there are biosimilars, limited for the time being in the cancer setting to granulocyte-colony stimulating factors (G-CSFs) and epoetins. Soon there will be biosimilar monoclonal antibodies with anticancer activity. Prescribers will ask, as they did for generics, if such drugs have the same activity as originators, if their safety profile is the same, if quality of the production process is guaranteed. Prescribers will want to know if their patients are indeed receiving the prescribed product, and not another. Finally prescribers will want to check that the lower cost of biosimilars will allow them to adhere to international guidelines. This should benefit patients and the community.
Collapse
|
18
|
|
19
|
Gascón P, Aapro M, Ludwig H, Rosencher N, Boccadoro M, Turner M, MacDonald K, Muenzberg M, Abraham I. Update on the MONITOR-GCSF study of biosimilar filgrastim to reduce the incidence of chemotherapy-induced febrile neutropenia in cancer patients: Protocol amendments. Crit Rev Oncol Hematol 2011; 77:198-200. [DOI: 10.1016/j.critrevonc.2011.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/13/2011] [Indexed: 11/27/2022] Open
|