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Bouguen G, Gossec L, Abitbol V, Senbel E, Bonnaud G, Roblin X, Bouhnik Y, Nancey S, Mathieu N, Filippi J, Vuitton L, Nahon S, Dellal A, Denis A, Foulley L, Habauzit C, Benkhalifa S, Marotte H. Patient Satisfaction and Experience with CT-P17 Following Transition from Reference Adalimumab or Another Adalimumab Biosimilar: Results from the Real-World YU-MATTER Study. BioDrugs 2024:10.1007/s40259-024-00681-2. [PMID: 39322802 DOI: 10.1007/s40259-024-00681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Biosimilars are cost-effective alternatives to reference products for patients with inflammatory bowel diseases (IBD) and chronic inflammatory rheumatic diseases (CIRD), but patient beliefs can affect adherence to the transition. This study aimed to explore patient experience and satisfaction after switching to CT-P17, a high-concentration (100 mg/mL), citrate-free adalimumab biosimilar. PATIENTS AND METHODS This observational, multicenter, prospective French study included adult patients with IBD or CIRD who switched to CT-P17 from reference adalimumab (R-ADA; 100 mg/mL) or a low-concentration adalimumab biosimilar (ADA-BioS; 50 mg/mL). Patients completed online questionnaires to assess treatment perceptions, satisfaction, and tolerance at study inclusion (under previous treatment) and over 3 months of CT-P17 treatment. The primary criterion was overall patient satisfaction, which was assessed with the question, "What is your global satisfaction with the CT-P17 injection?", using a 7-point Likert scale. Multivariate logistic regression analysis was performed to identify factors associated with increased treatment satisfaction after switching to CT-P17. RESULTS The total analysis population included 232 patients (IBD 72.0%, CIRD 28.0%). Median patient age was 57.0 years (interquartile range [IQR] 46.0-63.0), 50.4% were men, and median disease duration was 9 years (IQR 5-16). Approximately half of the cohort (51.2%) switched to CT-P17 from an ADA-BioS (including 19.4% from an ADA-BioS with citrate) and half (48.7%) from R-ADA. The proportion of patients who were satisfied with treatment was stable between baseline (under previous treatment) and 3 months (under CT-P17). More patients reported increased satisfaction after switching to CT-P17 from an ADA-BioS (22.7% vs 8.0% when switching from R-ADA; p = 0.002), or from an ADA-BioS containing citrate (28.9% vs 12.3% when switching from a citrate-free ADA-BioS; p = 0.008). Independent prognostic factors for increased satisfaction were previous treatment with an ADA-BioS (odds ratio [OR] 2.88 [95% confidence interval 1.17-7.08]; p = 0.021) and pain at the injection site under previous treatment (OR 1.26 [1.08-1.47]; p = 0.004). Significantly fewer patients reported pain, redness, itching, and hematoma after 3 months of CT-P17 treatment versus baseline (p < 0.001). CONCLUSIONS The majority of patients had stable or increased treatment satisfaction after switching from R-ADA or an ADA-BioS to CT-P17. In particular, switching to CT-P17 from a low-concentration ADA-BioS or an ADA-BioS containing citrate was associated with increased patient satisfaction. An improvement in overall tolerance with CT-P17 versus previous adalimumab treatment was also reported. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05427942, registered June 22, 2022.
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Affiliation(s)
- Guillaume Bouguen
- Rennes University Hospital, Rennes University, INSERM, CIC1414, NUMECAN (Nutrition Metabolism and Cancer) Institute, Rennes, France
| | - Laure Gossec
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin University Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Eric Senbel
- Medical practice, Marseille, France
- Department of Rheumatology, Ste Marguerite University Hospital, Marseille, France
| | | | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Yoram Bouhnik
- Institut des MICI, Paris IBD Center, Private Hospital Group of Ambroise Paré-Hartmann, Neuilly sur Seine, France
| | - Stéphane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon, Lyon-Sud Hospital, University Claude Bernard Lyon 1 and INSERM U1111, CIRI, Lyon, France
| | | | - Jérôme Filippi
- Gastroenterology, Saint-Jean Clinic, Cagnes-sur-Mer, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, UMR Right INSERM, Franche-Comté University, Besançon, France
| | - Stéphane Nahon
- Gastroenterology Unit, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Azeddine Dellal
- Department of Rheumatology, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Alice Denis
- Medical Affairs, Celltrion Healthcare France S.A.S., 9-15 rue Rouget de Lisle, 92130, Issy-les-Moulineaux, France
| | - Lucile Foulley
- Medical Affairs, Celltrion Healthcare France S.A.S., 9-15 rue Rouget de Lisle, 92130, Issy-les-Moulineaux, France
| | - Caroline Habauzit
- Medical Affairs, Celltrion Healthcare France S.A.S., 9-15 rue Rouget de Lisle, 92130, Issy-les-Moulineaux, France.
| | - Salim Benkhalifa
- Medical Affairs, Celltrion Healthcare France S.A.S., 9-15 rue Rouget de Lisle, 92130, Issy-les-Moulineaux, France
| | - Hubert Marotte
- Jean Monnet Saint-Etienne University, Saint-Etienne University Hospital, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, Saint-Etienne, France
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Medina A, Dragulin-Otto S, Cox E, Fuentes N, Wang Y, Flores K, Lent I, Glasser L, Kwok SC, Donegan S, Brown MN, Siapkara A. Drug Product Development and Case Studies for User Centric Pediatric Protein-Based Therapeutics. J Pharm Sci 2024:S0022-3549(24)00260-0. [PMID: 39173743 DOI: 10.1016/j.xphs.2024.07.014] [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: 05/14/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 08/24/2024]
Abstract
The user of a pediatric drug includes not only the patient, but also their caregiver and healthcare provider, including nurses, doctors, and pharmacists. Therefore, adopting a patient-centric approach that focuses on all users is critical for the development of pediatric drug products. This article outlines the quality target product profile parameters and a patient-centric approach for the development of pediatric proteinbased therapies. The use environment, formulation design, and preparation and in use stability considerations are described. An acceptability profile for the various routes of parenteral administration is described with a focus on pediatric age groups. Furthermore, a risk assessment approach is presented for the selection of excipients to be utilized in pediatric protein-based biopharmaceuticals. Several case studies are included which illustrate the selection of drug product parameters such as formulation, dose volume, and route of administration with the pediatric user in mind.
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Affiliation(s)
- Annette Medina
- Dosage Form Design and Development, Biopharmaceutical Development, AstraZeneca, Gaithersburg, MD, USA.
| | - Sonia Dragulin-Otto
- Dosage Form Design and Development, Biopharmaceutical Development, AstraZeneca, Gaithersburg, MD, USA
| | - Emily Cox
- Dosage Form Design and Development, Biopharmaceutical Development, AstraZeneca, Gaithersburg, MD, USA
| | - Nathalie Fuentes
- Dosage Form Design and Development, Biopharmaceutical Development, AstraZeneca, Gaithersburg, MD, USA
| | - Yujing Wang
- Dosage Form Design and Development, Biopharmaceutical Development, AstraZeneca, Cambridge, UK
| | - Katiria Flores
- Injectable Drug Product Development, Product Development and Clinical Supply, Alexion AstraZeneca Rare Disease, New Haven, CT, USA
| | - Ian Lent
- Dosage Form Design and Development, Biopharmaceutical Development, AstraZeneca, Gaithersburg, MD, USA
| | - Lisa Glasser
- US Medical Affairs, Vaccines and Immune Therapies, BioPharmaceutical Medical, AstraZeneca, Wilmington, DE, USA
| | - Stanley C Kwok
- Dosage Form Design and Development, Biopharmaceutical Development, AstraZeneca, Gaithersburg, MD, USA
| | | | - Mary N Brown
- Early Respiratory and Immunology (R&I) Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Boston, MA, USA
| | - Angeliki Siapkara
- CVRM Regulatory Affairs, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
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Zhang W, Xu Z, Shu Y, Shu S, Zhang Q. Adverse Event Profiles of Adalimumab in Children: A Disproportionality Analysis. Pharmaceuticals (Basel) 2024; 17:1028. [PMID: 39204132 PMCID: PMC11357133 DOI: 10.3390/ph17081028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/27/2024] [Accepted: 08/01/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Adalimumab has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of adult rheumatoid arthritis (RA), and subsequently approved for pediatric treatment of various autoimmune diseases in children of different ages. Due to genetic differences between children and adults in terms of physiology and immunity, there is a need to explore the safety of adalimumab in children in the real world. The aim of this study is to identify potential adverse event (AE) signals associated with the use of adalimumab in pediatric patients (<18 years old) using data from the FDA Adverse Event Reporting System (FAERS). METHODS AEs associated with adalimumab in pediatric patients reported in the FAERS database from the first quarter (Q1) of 2017 to the third quarter (Q3) of 2022 were systematically gathered. Reporting odds ratio (ROR), the proportional reporting ratio (PRR), the information component (IC), and the empirical Bayes geometric mean (EBGM) were used to assess the relationship between adalimumab and AEs in children. RESULTS Out of 8,363,304 reports collected from the FAERS database during the study period, 3819 reports on children on adalimumab were identified. Adalimumab-related AEs reports were concentrated on 10 toxicity areas and a total of 202 positive signals were detected, of which injection site papule (ROR = 261.97) and intestinal fistula (ROR = 122.09) had the strongest signals. Unexpected significant AEs, including intestinal obstruction, immunodeficiency, abdominal abscess, and Takayasu's arteritis might also occur. In comparison with patients of all ages in the same time window, the median onset time of children was shorter (99 vs. 149 days). Most of the AE cases occurred in children within the first 1 (1.71%), 2 (8.12%), and 3 months (8.39%) and had early failure types after adalimumab initiation. Methotrexate, folic acid, prednisone, azathioprine, and mesalamine were the top five drugs used concomitantly for adalimumab-associated AEs. CONCLUSIONS When adalimumab is used in children, especially in the first 3 months of treatment, in addition to the AEs recorded in the drug package insert, close attention should be paid to the new potential AEs off-label to ensure the safety of adalimumab in children.
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Affiliation(s)
- Wenting Zhang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (W.Z.); (Y.S.)
| | - Ziqi Xu
- Department of Clinical Pharmacy, General Hospital of Central Theater Command of Chinese People’s Liberation Army, Wuhan 430060, China;
| | - Yamin Shu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (W.Z.); (Y.S.)
| | - Sainan Shu
- Department of Pediatric Gastroenterology and Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Qilin Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, China
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Allegretti JR, Brady JH, Wicker A, Latymer M, Wells A. Relevance of Adalimumab Product Attributes to Patient Experience in the Biosimilar Era: A Narrative Review. Adv Ther 2024; 41:1775-1794. [PMID: 38466559 PMCID: PMC11052875 DOI: 10.1007/s12325-024-02818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/07/2024] [Indexed: 03/13/2024]
Abstract
Adalimumab (ADL, Humira®, reference product), an anti-TNF-α biologic, has transformed the treatment of chronic, immune-mediated inflammatory diseases. However, the high cost of ADL therapy has driven the development of more affordable ADL biosimilars, agents with no clinically meaningful differences from the reference product. This review summarizes the product attributes of reference ADL and the nine ADL biosimilars approved and available in the USA in relation to patient experience of injection-site pain (ISP). Product formulation, delivery volume and device features (e.g., type and needle gauge size) influence patient experience of ISP with potential clinical consequences. Citrate-free formulations generally cause less ISP; injection volumes of > 1.5 ml may be associated with increased ISP. Reference ADL and all ADL biosimilars offer a citrate-free formulation, and reference ADL and four ADL biosimilars offer a high-concentration solution that allows a smaller injection volume. All available ADL products are injected subcutaneously using either a pre-filled pen (PFP) or pre-filled syringe (PFS). Patients prefer the PFP, but the PFS permits better control over the speed and duration of injection. Smaller (29-gauge) needle outer diameter is associated with less ISP; reference ADL and seven ADL biosimilars offer a device with a 29-gauge needle. In the USA, an approved biosimilar can be designated "interchangeable," allowing pharmacy-level substitution, where state law permits. In the USA, two ADL biosimilars have received interchangeability designation; others are seeking interchangeability designation from the Food and Drug Administration (n = 2), are being evaluated in clinical studies to support interchangeability (n = 2), or do not have/are not seeking interchangeability designation (n = 3). Product-related attributes influence patient experience of ISP caused by subcutaneous ADL injection. Reference ADL and ADL biosimilar products differ in their attributes, so discussion with patients about treatment options is essential to optimize adherence and outcomes.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | | | | | | | - Alvin Wells
- Department of Rheumatology, Advocate Health Medical Group, Franklin, WI, USA
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5
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Müller-Ladner U, Dignass A, Gaffney K, Jadon D, Matucci-Cerinic M, Lobaton T, Carron P, Gisbert JP, Pande I, Utzinger M, Addison J. The PROPER Study: A 48-Week, Pan-European, Real-World Study of Biosimilar SB5 Following Transition from Reference Adalimumab in Patients with Immune-Mediated Inflammatory Disease. BioDrugs 2023; 37:873-889. [PMID: 37632666 PMCID: PMC10581927 DOI: 10.1007/s40259-023-00616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The non-interventional PROPER study generated real-world evidence on clinical outcomes following transition in routine practice from reference adalimumab to the EMA-approved SB5 biosimilar adalimumab in patients with immune-mediated inflammatory disease. METHODS Adults with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), Crohn's disease (CD), or ulcerative colitis (UC) were enrolled at 63 sites across Europe. Eligible patients received ≥ 16 weeks of routine treatment with reference adalimumab before transitioning to SB5, and were followed for 48 weeks post-transition. The primary objective was to evaluate candidate predictors (clinically relevant baseline variables with incidence ≥ 15% by indication cohort) associated with persistence on SB5 at 48 weeks post-initiation. Key primary outcome measures were persistence on SB5 (estimated by Kaplan-Meier methodology) and clinical characteristics and disease activity scores at the time of transition to SB5 treatment (baseline). RESULTS A total of 955 eligible patients were enrolled (RA, n = 207; axSpA, n = 127; PsA, n = 162; CD, n = 447; UC, n = 12), of whom 932 (97.6%) completed follow-up and 722 (75.6%) were still receiving SB5 at week 48. Kaplan-Meier estimates (95% confidence interval, CI) of persistence on SB5 at week 48 for RA, axSpA, PsA, and CD were 0.86 (0.80-0.90), 0.80 (0.71-0.86), 0.81 (0.74-0.86), and 0.72 (0.67-0.76), respectively. The single candidate predictor associated with probability of SB5 discontinuation before week 48 was female sex [RA, axSpA, and CD cohorts; HR (95% CI): 3.53 (1.07-11.67), 2.38 (1.11-5.14), and 2.21 (1.54-3.18), respectively]. Disease activity scores remained largely unchanged throughout the study, with proportions by cohort in remission at baseline versus week 48 being 59.2% versus 57.2%, 81.0% versus 78.0%, 94.7% versus 93.7%, and 84.0% versus 85.1% for patients with RA, axSpA, PsA, and CD, respectively. Similarly, the SB5 dosing regimen remained unchanged for the majority of patients from baseline to week 48, the most common regimen being 40 mg every 2 weeks. In total, 232 patients (24.3%) reported at least one adverse drug reaction, and most events were mild; eight patients (3.9%) in the RA cohort experienced nine serious adverse events (SAEs; two possibly related to SB5); eight patients (4.9%) in the PsA cohort experienced nine SAEs (one possibly related to SB5); 22 patients (4.9%) in the CD cohort experienced 27 SAEs (four possibly related to SB5); and no SAEs were observed in the UC cohort. CONCLUSIONS With the exception of female sex in RA, axSpA, and CD, none of the candidate predictors were associated with SB5 discontinuation. Persistence on SB5 was high, treatment effectiveness was maintained, and no safety signals were detected. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov: NCT04089514.
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Affiliation(s)
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe University, Frankfurt, Germany
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Deepak Jadon
- Rheumatology Research Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marco Matucci-Cerinic
- Department of Internal Medicine, University of Florence, Florence, Italy
- UNIRAR, Hospital San Raffaele, Milan, Italy
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, Center for Inflammation Research, VIB-UGent, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ira Pande
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abitbol V, Benkhalifa S, Habauzit C, Marotte H. Navigating adalimumab biosimilars: an expert opinion. J Comp Eff Res 2023; 12:e230117. [PMID: 37855223 PMCID: PMC10690439 DOI: 10.57264/cer-2023-0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
The patent expiry of Humira® in 2018 opened up the current European market to eight adalimumab biosimilars - (in alphabetical order) Amgevita®, Amsparity®, Hulio®, Hukyndra®, Hyrimoz®, Idacio®, Imraldi® and Yuflyma® - for the treatment of various immune and inflammatory conditions. Amjevita, Hadlima®, Hyrimoz and Yuflyma have recently become available in the USA, with others expected to reach this market in 2023 as the US patent protection for Humira ends. Although adalimumab biosimilars demonstrate efficacy, safety and immunogenicity similar to the originator, they may differ in product excipient(s) and preservatives, along with their device type(s). Physicians may find it both difficult and time consuming to navigate their way among the array of available adalimumab biosimilars when they need to make a treatment decision. This article explores the characteristics of various adalimumab biosimilars to help clinicians navigate the various options available across Europe and the USA. In addition to drug selection, effective patient-physician communication is needed to nurture realistic patient expectations and minimise potential nocebo effects when prescribing biosimilars.
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Affiliation(s)
- Vered Abitbol
- Service de gastroentérologie, Hôpital Cochin, AP-HP, Université Paris Cité, Paris, 75014, France
| | | | | | - Hubert Marotte
- Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Service de Rhumatologie, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, Saint-Etienne, 42023, France
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7
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Desai M, Kundu A, Hageman M, Lou H, Boisvert D. Monoclonal antibody and protein therapeutic formulations for subcutaneous delivery: high-concentration, low-volume vs. low-concentration, high-volume. MAbs 2023; 15:2285277. [PMID: 38013454 DOI: 10.1080/19420862.2023.2285277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
Biologic drugs are used to treat a variety of cancers and chronic diseases. While most of these treatments are administered intravenously by trained healthcare professionals, a noticeable trend has emerged favoring subcutaneous (SC) administration. SC administration of biologics poses several challenges. Biologic drugs often require higher doses for optimal efficacy, surpassing the low volume capacity of traditional SC delivery methods like autoinjectors. Consequently, high concentrations of active ingredients are needed, creating time-consuming formulation obstacles. Alternatives to traditional SC delivery systems are therefore needed to support higher-volume biologic formulations and to reduce development time and other risks associated with high-concentration biologic formulations. Here, we outline key considerations for SC biologic drug formulations and delivery and explore a paradigm shift: the flexibility afforded by low-to-moderate-concentration drugs in high-volume formulations as an alternative to the traditionally difficult approach of high-concentration, low-volume SC formulation delivery.
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Affiliation(s)
- M Desai
- Medical Affairs, Enable Injections, Inc, Cincinnati, OH, USA
| | - A Kundu
- Manufacturing Sciences, Takeda Pharmaceuticals, Brooklyn Park, MN, USA
| | - M Hageman
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, KS, USA
| | - H Lou
- Biopharmaceutical Innovation & Optimization Center, The University of Kansas, Lawrence, KS, USA
| | - D Boisvert
- Independent Chemistry Manufacturing & Controls (CMC) Consultant, El Cerrito, CA, USA
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Barbier L, Vandenplas Y, Boone N, Huys I, Janknegt R, Vulto AG. How to select a best-value biological medicine? A practical model to support hospital pharmacists. Am J Health Syst Pharm 2022; 79:2001-2011. [PMID: 36002245 PMCID: PMC9452170 DOI: 10.1093/ajhp/zxac235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE With the growing availability of biosimilars on the global market, clinicians and pharmacists have multiple off-patent biological products to choose from. Besides the competitiveness of the product's price, other criteria should be considered when selecting a best-value biological. This article aims to provide a model to facilitate transparent best-value biological selection in the off-patent biological medicines segment. SUMMARY The presented model was developed on the basis of established multicriteria decision analysis tools for rational and transparent medicine selection, ie, the System of Objectified Judgement Analysis and InforMatrix. Criteria for the model were informed by earlier research, a literature search, and evaluation by the authors. The developed model includes up-to-date guidance on criteria that can be considered in selection and provides background on the allocation of weights that may aid hospital pharmacists and clinicians with decision-making in practice. Three main categories of criteria besides price were identified and included in the model: (1) product-driven criteria, (2) service-driven criteria, and (3) patient-driven criteria. Product-driven criteria include technical product features and licensed therapeutic indications. Service-driven criteria consist of supply conditions, value-added services, and environment and sustainability criteria. Patient-driven criteria contain product administration elements such as ease of use and service elements such as patient support programs. Relative weighting of the criteria is largely context dependent and should in a given setting be determined at the beginning of the process. CONCLUSION The practical model described here may support hospital pharmacists and clinicians with transparent and evidence-based best-value biological selection in clinical practice.
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Affiliation(s)
- Liese Barbier
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Yannick Vandenplas
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Niels Boone
- Hospital Pharmacy, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
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Livesey ACS, Hu YWE, Boldt BF, Sturgill SB, Serafine MS, Fraser JJ. Battlefield Acupuncture for Palliation of Periprocedural and Postprocedural Pain during Platelet-Rich Plasma Injections. Curr Sports Med Rep 2022; 21:265-266. [PMID: 35946844 DOI: 10.1249/jsr.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Audrey C S Livesey
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
| | | | - Brandon F Boldt
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
| | - Sarah B Sturgill
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
| | - Matthew S Serafine
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Camp Pendleton, CA
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Chabra S, Gill BJ, Gallo G, Zhu D, Pitou C, Payne CD, Accioly A, Puig L. Ixekizumab Citrate-Free Formulation: Results from Two Clinical Trials. Adv Ther 2022; 39:2862-2872. [PMID: 35449322 PMCID: PMC9022732 DOI: 10.1007/s12325-022-02126-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
Introduction Subcutaneous (SC) injection is a common route of drug administration; however, injection site pain (ISP) might create a negative patient experience. We evaluated ISP, bioequivalence, and overall safety of the citrate-free (CF) formulation of ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A. Methods Two phase 1, single-blind studies were conducted in healthy participants. The crossover study A (NCT03848403) evaluated pain intensity on injection as measured by visual analog scale of pain (VAS) scores. Subjects (N = 70) were randomized 1:1:1 at the beginning to three possible treatment sequences and received a 1 mL SC injection of the three formulations sequentially in the abdomen on days 1, 8, and 15, respectively. A mixed-effects repeated measures analysis model was used to analyze VAS score by time post-injection. Study B (NCT04259346) evaluated the bioequivalence of a single 80 mg dose of CF formulation compared to the original commercial formulation. Subjects (N = 245) were randomized 1:1 to either commercial or CF formulation and received a single SC injection into the abdomen, arm, or thigh. Results Primary endpoint was achieved in both studies. In study A, least-squares mean (LSM) difference of VAS scores immediately post injection between commercial (n = 61) and CF formulation (n = 63) was − 21.7 (p < 0.0001), indicating a lower degree of pain associated with CF formulation. In study B, bioequivalence of the CF formulation was established as 90% CIs for the ratio of geometric LSM AUC0–tlast, AUC0–∞, and Cmax between treatments were contained within the prespecified limits of 0.8 and 1.25. Except for less ISP in the CF formulation, overall safety profile was comparable. Conclusion Ixekizumab CF formulation proved to be bioequivalent, was associated with less ISP, and had no other notable differences in the safety profile compared to the original commercial formulation. Trail Registration ClinicalTrials.gov identifier NCT03848403, NCT04259346. Video Abstract
Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02126-0.
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Dhalla AK, Al-Shamsie Z, Beraki S, Dasari A, Fung LC, Fusaro L, Garapaty A, Gutierrez B, Gratta D, Hashim M, Horlen K, Karamchedu P, Korupolu R, Liang E, Ong C, Owyang Z, Salgotra V, Sharma S, Syed B, Syed M, Vo AT, Abdul-Wahab R, Wasi A, Yamaguchi A, Yen S, Imran M. A robotic pill for oral delivery of biotherapeutics: safety, tolerability, and performance in healthy subjects. Drug Deliv Transl Res 2022; 12:294-305. [PMID: 33604838 PMCID: PMC8677648 DOI: 10.1007/s13346-021-00938-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/16/2022]
Abstract
Biotherapeutics are highly efficacious, but the pain and inconvenience of chronic injections lead to poor patient compliance and compromise effective disease management. Despite innumerable attempts, oral delivery of biotherapeutics remains unsuccessful due to their degradation in the gastrointestinal (GI) environment and poor intestinal absorption. We have developed an orally ingestible robotic pill (RP) for drug delivery, which protects the biotherapeutic drug payload from digestion in the GI tract and auto-injects it into the wall of the small intestine as a safe, pain-free injection since the intestines are insensate to sharp stimuli. The payload is delivered upon inflation of a balloon folded within the RP, which deflates immediately after drug delivery. Here we present results from two clinical studies demonstrating the safety, tolerability and performance of the RP in healthy humans. In the first study, three versions of the RP (A, B and C) were evaluated, which were identical in all respects except for the diameter of the balloon. The RP successfully delivered a biotherapeutic (octreotide) in 3 out of 12 subjects in group A, 10 out of 20 subjects in group B and 16 out of 20 subjects in group C, with a mean bioavailability of 65 ± 9% (based on successful drug deliveries in groups A and B). Thus, reliability of drug delivery with the RP ranged from 25 to 80%, with success rate directly related to balloon size. In a separate study, the deployment of the RP was unaffected by fed or fasting conditions suggesting that the RP may be taken with or without food. These promising clinical data suggest that biotherapeutics currently administered parenterally may be safely and reliably delivered via this versatile, orally ingestible drug delivery platform.
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Affiliation(s)
- Arvinder K Dhalla
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA.
| | - Ziad Al-Shamsie
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Simret Beraki
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Anvesh Dasari
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Leonard C Fung
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Laura Fusaro
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Anusha Garapaty
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Betsy Gutierrez
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Delia Gratta
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Mir Hashim
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Kyle Horlen
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Padma Karamchedu
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Radhika Korupolu
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Eric Liang
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Chang Ong
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Zachary Owyang
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Vasudha Salgotra
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Shilpy Sharma
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Baber Syed
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Mansoor Syed
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - April T Vo
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | | | - Asad Wasi
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Alyson Yamaguchi
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Shane Yen
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
| | - Mir Imran
- Rani Therapeutics, LLC, 2051 Ringwood Ave, San Jose, CA, 95131, USA
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Davidson A, Brimhall D, Kay J, Keystone E, Lee SJ, Kim SH, Bae YJ, Choi EJ, Furst DE. Randomised, phase I pharmacokinetic study of adalimumab biosimilar CT-P17 (40 mg/0.4 mL) by autoinjector and prefilled syringe in healthy subjects. Br J Clin Pharmacol 2021; 87:4323-4333. [PMID: 33822406 PMCID: PMC8597139 DOI: 10.1111/bcp.14850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS To evaluate pharmacokinetic equivalence and preliminary safety of the adalimumab biosimilar CT-P17 administered via autoinjector (CT-P17 AI) or prefilled syringe (CT-P17 PFS) in healthy subjects. METHODS This phase I, open-label study (ClinicalTrials.gov: NCT04295356) randomised subjects (1:1) to receive a single 40-mg (100 mg/mL) dose of CT-P17 AI or CT-P17 PFS. Primary endpoint was pharmacokinetic equivalence of CT-P17 AI to CT-P17 PFS for: area under the concentration-time curve from time zero to infinity (AUC0-inf ); area under the concentration-time curve from time zero to the last quantifiable concentration (AUC0-last ); maximum serum concentration (Cmax ). Equivalence was determined if the 90% confidence interval for the geometric least-squares mean ratio was within the 80-125% equivalence margin. Additional pharmacokinetic endpoints, safety and immunogenicity were evaluated. RESULTS Of 193 subjects who were randomised (98 CT-P17 AI; 95 CT-P17 PFS), 180 received study drug. Pharmacokinetic equivalence was demonstrated: 90% confidence intervals were within the 80-125% equivalence margin (AUC0-inf : 93.98-114.29; AUC0-last : 91.09-121.86; Cmax : 94.08-111.90). Mean serum CT-P17 concentrations, secondary pharmacokinetic parameters and numbers of subjects with antidrug antibodies (ADAs) or neutralising ADAs were comparable between groups. AUC0-inf , AUC0-last and Cmax were numerically lower for ADA-positive than for ADA-negative subjects (both groups); pharmacokinetic equivalence was also demonstrated among ADA-positive subjects. CT-P17 AI and CT-P17 PFS were well tolerated, with comparable overall safety profiles. CONCLUSIONS CT-P17 AI and CT-P17 PFS were pharmacokinetically equivalent. Overall safety and immunogenicity were comparable between the 2 delivery devices.
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Affiliation(s)
| | | | - Jonathan Kay
- University of Massachusetts Medical School and UMass Memorial Medical CenterWorcesterMassachusettsUSA
| | | | | | | | | | | | - Daniel E. Furst
- University of CaliforniaLos AngelesCaliforniaUSA
- University of WashingtonSeattleWashingtonUSA
- University of FlorenceFlorenceItaly
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Gross M, Terjung B. Neues zu COVID-19, Kolon & CED vom europäischen Gastroenterologie-Kongress. GASTRO-NEWS 2021. [PMCID: PMC8200380 DOI: 10.1007/s15036-021-2348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Coghlan J, He H, Schwendeman AS. Overview of Humira® Biosimilars: Current European Landscape and Future Implications. J Pharm Sci 2021; 110:1572-1582. [PMID: 33556387 PMCID: PMC8014989 DOI: 10.1016/j.xphs.2021.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Humira® (adalimumab) by AbbVie has been the top-selling biologic drug product for the last few years - reaching nearly $20 billion in annual sales in 2018. Upon the October 2018 release of four adalimumab biosimilars into the European market, those sales began to shrink. By the end of 2019, the annual sales of Humira®, albeit still high, dipped closer to $19 billion as nearly 35% of European patients had been switched from Humira® to a biosimilar. Diminishing sales are expected to continue as the adoption of adalimumab biosimilars increases in Europe and Humira®'s patent protection is lost in the United States come 2023. In this review we discuss how impactful the availability of biosimilars has been to the European adalimumab market approximately two years after their release. We further analyze the marketed biosimilars with regards to differences in their formulation, delivery devices, biological activity, physicochemical properties, clinical trials data, and current financial foothold. More importantly, though, we highlight how "similar" these biosimilars are to Humira®. In doing so, we seek to educate the public on what they may be able to expect once adalimumab biosimilars enter the United States market in 2023.
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Affiliation(s)
- Jill Coghlan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Hongliang He
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Anna S Schwendeman
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Biointerfaces Institute, University of Michigan, NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
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St Clair-Jones A, Prignano F, Goncalves J, Paul M, Sewerin P. Understanding and Minimising Injection-Site Pain Following Subcutaneous Administration of Biologics: A Narrative Review. Rheumatol Ther 2020; 7:741-757. [PMID: 33206343 PMCID: PMC7672413 DOI: 10.1007/s40744-020-00245-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023] Open
Abstract
Injection-site pain (ISP) is a subjective side effect that is commonly reported with the subcutaneous administration of biological agents, yet it may only be a concern to some. Multiple factors related to the product formulation, such as pH, volume and excipients, and/or to the injection process have the potential to contribute to ISP, while patient-related factors, such as low body weight, gender and age, can make an individual more susceptible to experiencing ISP. While total elimination of ISP remains unlikely with any subcutaneously administered agent, it can be minimised by helping the patient to develop a confident and competent injection technique via robust and effective training. Careful management of patient expectations along with open discussion regarding the potential risk of ISP may serve to minimise treatment-related anxieties and, importantly, allow the patient to remain in control of his/her treatment. Other interventions to help minimise ISP include psychological interventions, allowing biologics to reach room temperature prior to injection, using the most suitable injection device for the individual patient and selecting an alternative drug formulation, when available. Productive patient–physician communication remains important in order to support and optimise treatment experience and adherence, while also providing the opportunity for patients to discuss any ISP-related issues.
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Affiliation(s)
- Anja St Clair-Jones
- Pharmacy Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - Francesca Prignano
- Section of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Joao Goncalves
- iMed-Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
| | - Muriel Paul
- Department of Pharmacy, AP-HP, Henri-Mondor Hospital, Créteil, France
- University of Paris-Est Créteil, Epidemiology in Dermatology and Evaluation of Therapeutics (EpidermE), EA 7379, UPEC, Créteil, 94010, France
| | - Philipp Sewerin
- Department and Hiller Research Unit of Rheumatology, University Clinic Düsseldorf (UKD), Heinrich Heine University, Düsseldorf, Germany
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Mannion ML, Xie F, Horton DB, Ringold S, Correll CK, Dennos A, Beukelman T. Biologic Switching Among Nonsystemic Juvenile Idiopathic Arthritis Patients: A Cohort Study in the Childhood Arthritis and Rheumatology Research Alliance Registry. J Rheumatol 2020; 48:1322-1329. [PMID: 32934124 DOI: 10.3899/jrheum.200437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Biologic medications have significantly improved disease control and outcomes of patients with juvenile idiopathic arthritis (JIA). Current treatment recommendations suggest escalating therapy, including changing biologics if needed, when inactive or low disease activity is not attained. The patterns and reasons for switching biologics in clinical practice in North America are not well described. METHODS We used the Childhood Arthritis and Rheumatology Research Alliance Registry and included individuals with JIA if they newly started a biologic after January 1, 2008, and had at least 12 months of subsequent observable time. Subjects with systemic JIA were excluded. We compared characteristics of switchers and nonswitchers using chi-square for categorical variables and Wilcoxon rank-sum test for continuous variables, and used linear regression for time analysis. RESULTS Of the eligible children, 1361 with JIA in the registry started a biologic (94% tumor necrosis factor inhibitors [TNFi]). Median followup time was 30 months and 349 (26%) switched biologics. Among biologic switchers, ineffectiveness/disease flare was the most common reason for switch (202, 58%). The most common documented switch was from etanercept to another TNFi (221, 63%). The median time to switch to a second biologic decreased substantially from 55.2 months in 2008 to 7.2 months in 2016. CONCLUSION In a multicenter cohort of patients with JIA starting a biologic, one-quarter switched to a second biologic, and the time to switching decreased in recent years. Additional studies should evaluate the outcomes and optimal timing of switching and preferred sequence of biologic use.
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Affiliation(s)
- Melissa L Mannion
- M.L. Mannion, MD, MSPH, Assistant Professor, T. Beukelman, MD, MSCE, Associate Professor, Division of Pediatric Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama;
| | - Fenglong Xie
- F. Xie, PhD, MS, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel B Horton
- D.B. Horton, MD, MSCE, Assistant Professor, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, and Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Sarah Ringold
- S. Ringold, MD, MS, Assistant Professor, Division of Pediatric Rheumatology, Seattle Children's Hospital, Seattle, Washington
| | - Colleen K Correll
- C.K. Correll, MD, MPH, Assistant Professor, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Anne Dennos
- A. Dennos, MSPH, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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