Biosimilar epoetin zeta: extrapolation of indications and real world utilization experience

Biosimilar erythropoietin in anemia treatment (BEAT)-Efficacy and safety of a 1:1 dose conversion from EPREX® to EPIAO® in patients with end-stage renal disease on hemodialysis: A prospective, randomized, double blind, parallel group study

BACKGROUND

EPREX®/ERYPO®/PROCRIT® (epoetin alfa, Janssen-Cilag GmbH) was the first available recombinant human erythropoietin (rHuEPO) and was universally reference product as per the recommendation provided by European Medicines Agency. EPIAO® is a biosimilar formulation of EPREX®, and making it a 1:1 dose conversion from EPREX® according to recommendation of European Medicines Agency. This study evaluated the clinical efficacy and safety of EPIAO® in subjects with end-stage renal disease receiving hemodialysis after intravenous administration.

METHODS

This study was a multicenter, prospective, randomized, double-blind, parallel-group, 2-cohort, maintenance phase, therapeutic equivalence study to evaluate a 1:1 dose conversion from EPREX® to EPIAO® in terms of clinical efficacy and safety that was conducted at 20 sites in 2 countries in patients with end-stage renal disease on hemodialysis. Eligible subjects were treated with EPREX® (reference product of epoetin) for a period of at least 3 months before the treatment period, and then were randomly assigned to the group of EPREX® or EPIAO®. Primary endpoints were mean absolute change in hemoglobin level and mean absolute change in weekly epoetin dosage from baseline to 6 months after treatment with EPIAO®/EPREX® in parallel groups.

RESULTS

A total of 200 people received the random intervention and were included in the safety set. After 6, 9, and 12 months of treatment with EPIAO® or EPREX®, there were no significant differences in the hemoglobin levels of the 2 groups compared with baseline. The 95% confidence interval for the treatment difference was within the predetermined acceptable range: ±0.5 g/dL. There were no significant differences in the epoetin dosage of the 2 groups compared with the baseline. The 95% confidence interval for the treatment difference was within the predetermined acceptable range: ± 45 IU/kg. There were no significant differences in the incidence of adverse events between the EPIAO® and EPREX® groups. Most adverse events were mild to moderate and were reverted/resolved.

CONCLUSION

EPIAO® demonstrated promising effectiveness and manageable safety in patients with end-stage renal disease on hemodialysis.

[Knowledge and perceptions of biosimilar medicines by health professionals in Tunisia]

INTRODUCTION

Biosimilar drugs occupy a strategic place in the global pharmaceutical market. However, there are brakes on their use. The objective of our study is to assess the knowledge and perceptions of healthcare professionals on biosimilar drugs in a developing country.

MATERIAL AND METHODS

This is a prospective survey via an anonymous 18-question multiple-choice questionnaire developed and published online through the "Google Forms" application over a period of one month. This questionnaire is intended for Tunisian pharmacists and doctors of all ranks.

RESULTS

A total of 240 health professionals responded to this questionnaire, including 158 pharmacists and 82 physicians. Among them, 73 are not informed about the biosimilar drugs and were excluded from the rest of the questionnaire. Questions regarding the definition of biosimilar drugs and their differences from generic drugs obtained the best rate of 76 % of correct answers. In contrast, the questions that generated the most errors mainly concerned the regulation of biosimilar drugs. Participants felt that they were under-informed about biosimilar drugs in 65 % of the cases. In addition, 92 % were in favor of the development of this class of drugs and 85 % estimated significant to very significant savings related to their use.

CONCLUSION

Our study confirms the lack of information of pharmacists and physicians on biosimilar drugs. Sensitization of healthcare professionals on the safety and effectiveness of the use of these drugs seems to be necessary in order to allow their development.

Bevacizumab biosimilars: scientific justification for extrapolation of indications

The first biosimilar of bevacizumab was approved by the US FDA; other potential biosimilars of bevacizumab are in late-stage clinical development. Their availability offers opportunity for increased patient access across a number of oncologic indications. The regulatory pathway for biosimilar approval relies on the totality of evidence that includes a comprehensive analytical assessment, and a clinical comparability study in a relevant disease patient population. Extrapolation of indications for a biosimilar to other eligible indications held by the originator, in the absence of direct clinical comparison, frequently forms part of the regulatory judgment. Herein, we consider the evidence required to demonstrate biosimilarity for bevacizumab biosimilars, with particular focus on the rationale for extrapolation across oncologic indications.