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Glerum PJ, Yamada WM, Neely MN, Burger DM, Maliepaard M, Neef C. Interchangeability of generic drugs for subpopulations: Bioequivalence simulation from a nonparametric PK model of gabapentin generic drugs. Br J Clin Pharmacol 2024; 90:1576-1585. [PMID: 36482842 DOI: 10.1111/bcp.15629] [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: 05/09/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Patients are often switched between generic formulations of the same drug, but in some cases generic interchangeability is questioned. For generic drugs to be approved, bioequivalence with the innovator drug should be demonstrated, but evidence of bioequivalence is not required in the intended patient population or relative to other approved generics. AIM We aim to identify pathophysiological pharmacokinetic subpopulations for whom there is a difference in comparative bioavailability compared to a healthy population. METHODS We used simulated exposures from a nonparametric model of multiple generics and the originator gabapentin. Exposure was simulated for virtual populations with pharmacokinetic characteristics beyond those of healthy subjects with regard to rate of absorption, volume of distribution and reduced renal function. Virtual parallel design bioequivalence studies were performed using a random sample of 24 simulated subjects, with standard acceptance criteria. RESULTS Results indicated increased pharmacokinetic variability for patient populations with a lower rate of absorption or a reduced renal function, but no change in the average comparable bioavailability ratio. This increased variability results in a reduced likelihood of demonstrating bioequivalence. Observations were similar for comparisons between all different formulations, as well as between subjects who received the identical formulation in a repeated fashion. No relevant effect was observed for simulations with increased volume of distribution. CONCLUSION Our simulations indicate that the reduced likelihood of demonstrating bioequivalence for subjects with altered pharmacokinetics is not influenced by a formulation switch, nor does the average comparable bioavailability ratio change, therefore these results support generic interchangeability and current approval requirements for generics.
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Affiliation(s)
- Pieter J Glerum
- Medicines Evaluation Board, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Walter M Yamada
- Laboratory of Applied Pharmacokinetics and Bioinformatics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Michael N Neely
- Laboratory of Applied Pharmacokinetics and Bioinformatics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marc Maliepaard
- Medicines Evaluation Board, Utrecht, The Netherlands
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, CARIM, Maastricht University, Maastricht, The Netherlands
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2
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Lechat P, Kir F, Marquet P, Woillard JB. Within-subject pharmacokinetic variability has a strong influence on individual exposure ratios in bioequivalence studies, hence on drug formulation interchangeability. Eur J Clin Pharmacol 2023; 79:1565-1578. [PMID: 37737912 DOI: 10.1007/s00228-023-03565-6] [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: 05/12/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Bioequivalence between a reference and a generic drug is based on the hypothesis that a ± 20% change in blood exposure (or ± 10% for drugs with narrow therapeutic index, NTI) following the generic/reference switch will not have any therapeutic consequences. However, the individual exposure ratio between generic and reference can be higher than 1.20 (or 1.10). This study aims to analyse the different parameters influencing the individual exposure ratio, hence the conditions for reference/generic interchangeability. METHODS Bioequivalence studies with a double cross-over design for a virtual drug were simulated using 100 random sets of 12, 24, 48 or 100 pairs of areas under the curve (AUC), varying the generic/reference AUC geometric mean ratios between 0.80 and 1.25 and the within-subject exposure variance of the reference and the generic formulations. RESULTS The proportion of subjects with an exposure generic/reference ratio outside the ± 10% or ± 20% acceptance intervals increases when (1) the reference within-subject variance increases; (2) the ratio of the generic within-subject variance on the reference within-subject variance increases; and (3) the generic/reference mean AUC ratio diverges from 1.0. When only considering replicated administrations of the reference, the individual exposure ratio increases with the within-subject variance, yielding values outside the usually accepted individual exposure ratio range of 0.5 to 2 for drugs with narrow therapeutic index as soon as the within-subject variance standard deviation is ≥ 0.25 (equivalent to within-patient CV% > 25%). CONCLUSIONS Interchangeability between reference and generic formulations, especially for drugs with narrow therapeutic index can only be assumed if, the within-subject variance of generic is less or equal to the within-subject variance of reference or, if this is not the case, if the distribution of the generic/generic individual exposure ratios is included within the therapeutic margins of the reference drug.
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Affiliation(s)
- Philippe Lechat
- Paris-cité University, Paris, France.
- Pharmacology and Toxicology Department, Georges Pompidou European Hospital, Drug Evaluation unit, Agence Générale des équipements et des produits de santé (AGEPS), 7 rue du fer à moulin, 75005 Paris, Assistance Publique des Hôpitaux de Paris, France.
| | - Fatma Kir
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Lokman Hekim University, Ankara, Turkey
| | - Pierre Marquet
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
| | - Jean-Baptiste Woillard
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
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3
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Response to Comment on "Interchangeability Between Generic and Reference Products: Limits of Average Bioequivalence Methodology". Eur J Drug Metab Pharmacokinet 2023; 48:217-219. [PMID: 36670338 DOI: 10.1007/s13318-022-00813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/22/2023]
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4
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Glerum PJ, Neef C, Burger DM, Yu Y, Maliepaard M. Pharmacokinetics and Generic Drug Switching: A Regulator's View. Clin Pharmacokinet 2021; 59:1065-1069. [PMID: 32557345 PMCID: PMC7467961 DOI: 10.1007/s40262-020-00909-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There appears to be a mismatch between the assumed therapeutic equivalence of generic drugs, their interchangeability, and reported clinical discomfort following generic drug use and drug switches. In this article, we describe why we are of the opinion that the current regulatory approach to the evaluation of generic drugs based on average bioequivalence is sufficient to expect therapeutic equivalence in the clinical setting. This has often been debated, specifically as adverse drug reactions related to generic drug switches are regularly reported. We agree that clinical discomfort during a bioequivalent drug switch may indeed be caused by different exposures to the active substance. However, this difference in exposure is not a result of the characteristics or quality of generic drugs; it is caused by the pharmacokinetic within-subject variability of the active substance, i.e., the variability on the bioavailability of the active substance, when comparing two occasions of administration of the same drug product, to the same patient. Therefore, reported clinical discomfort following generic drug use and drug switches does not warrant a change in the regulatory approach to the evaluation of the bioequivalence of generic drugs. Switching from a brand-name drug to currently approved generic drugs, or between different generic drugs, will in principle result in comparable exposure, within boundaries determined by the within-subject variability of the pharmacokinetics of the active substance involved.
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Affiliation(s)
- Pieter J Glerum
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yang Yu
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marc Maliepaard
- Medicines Evaluation Board, CBG-MEB, P.O. Box 8275, 3503 GB, Utrecht, The Netherlands. .,Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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5
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An H, Shin D. Multivariate Assessment for Bioequivalence Based on the Correlation of Random Effect. Drug Des Devel Ther 2021; 15:3675-3683. [PMID: 34465979 PMCID: PMC8396372 DOI: 10.2147/dddt.s318576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Bioequivalence tests are fundamental step in assessing the equivalence in bioavailability between a test and reference product. In practice, two separate linear mixed models (LMMs) with random subject effects, which have an area under the concentration-time curve (AUC) and the peak concentration (Cmax) as the responses, have become the gold standard for evaluating bioequivalence. Recently, Lee et al developed a multivariate hierarchical generalized linear model (HGLM) for several responses that modeled correlations among multivariate responses via correlated random effects. The objective of this study was to apply this multivariate analysis to the bioequivalence test in practice and to compare the performance of multivariate HGLM and separate LMMs. Methods Three pharmacokinetic datasets, fixed-dose combination (naproxen and esomeprazole), tramadol and fimasartan data were analyzed. We compared the 90% confidence interval (CI) for the geometric mean ratio (GMR) of a test product to a reference product using the multivariate HGLM and two conventional separate LMMs. Results We found that the 90% CIs for the GMRs of both AUC and Cmax from the multivariate HGLM were narrower than those from the separate LMMs: (0.843, 1.152) vs (0.825, 1.177) for Cmax of esomeprazole in fixed-dose combination data; (0.805, 0.931) vs (0.797, 0.941) for Cmax in tramadol data; (0.801, 1.501) vs (0.762, 1.578) for Cmax and (1.163, 1.332) vs (1.009, 1.341) for AUC in fimasartan data, consistent with the random subject effects from two separate LMMs being highly correlated in the three datasets (correlation coefficient r = 0.883; r = 0.966; r = 0.832). Conclusion This multivariate HGLM had good performance in the bioequivalence test with multiple endpoints. This method would provide a more reasonable option to reduce the 90% CI by adding correlation parameters and thus an advantage especially in evaluating the bioequivalence of highly variable drugs with broad 90% CIs.
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Affiliation(s)
- Hyungmi An
- Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Dongseong Shin
- Department of Pharmacology, Gachon University College of Medicine, Incheon, Korea.,Clinical Trials Center, Gachon University Gil Medical Center, Incheon, Korea
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6
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Huh KY, Kim E, Lee S, Yoo H, Yoon S, Yu KS, Chung JY. Current Bioequivalence Study Designs in South Korea: A Comprehensive Analysis of Bioequivalence Study Reports Between 2013 and 2019. Front Pharmacol 2021; 12:651790. [PMID: 34045962 PMCID: PMC8147690 DOI: 10.3389/fphar.2021.651790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/31/2021] [Indexed: 12/02/2022] Open
Abstract
Demonstration of bioequivalence (BE) is mandatory while developing generic drugs. The scientific concept of BE applies equally to different regulatory agencies. However, the application of the concept may differ for each agency, which can affect the design of BE studies. To evaluate the study practices in terms of the BE concept in South Korea, we retrospectively analyzed BE study reports available from Ministry of Food and Drug Safety between 2013 and 2019. Statistical estimation of the pharmacokinetic parameters, including peak concentration and area under the concentration-time curve to the last measurable concentration, as well as study design, number of subjects in a study, study duration, fasting status, and formulation of specific drugs were obtained. The drugs were classified per World Health Organization Anatomical Therapeutic Chemical Classification and Biopharmaceutics Classification System. Post-hoc intrasubject coefficient of variation and corresponding sample sizes were calculated from the 90% confidence intervals of pharmacokinetic parameters. A total of 143 generic drugs in 588 BE studies were analyzed. The largest number of studies were performed in the area of Cardiovascular system (172 studies), followed by Nervous system (143 studies) and Alimentary tract and metabolism (92 studies). Overall, BE studies in South Korea were conducted in accordance with the global guideline despite the differences in details. BE studies were focused on the several therapeutic areas and conducted in a similar manner. The number of subjects was generally larger than that estimated with 90% power.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Eunwoo Kim
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Soyoung Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Hyounggyoon Yoo
- Department of Clinical Pharmacology and Therapeutics, CHA University Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, South Korea
| | - Seonghae Yoon
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Bundang Hospital, Gyeonggi-do, South Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Jae-Yong Chung
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Bundang Hospital, Gyeonggi-do, South Korea
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7
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Wiria MSS, Tran HM, Nguyen PHB, Valencia O, Dutta S, Pouteau E. Relative bioavailability and pharmacokinetic comparison of calcium glucoheptonate with calcium carbonate. Pharmacol Res Perspect 2020; 8:e00589. [PMID: 32302064 PMCID: PMC7164401 DOI: 10.1002/prp2.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022] Open
Abstract
Adequate calcium intake is important for the prevention of bone loss and osteoporosis. For some populations such as those of Southeast Asia where calcium intake is very low, supplements represent a suitable dietary source of calcium. The objective of this study was to compare the relative oral bioavailability of calcium from calcium glucoheptonate, a highly soluble calcium salt containing 8.2% of elemental calcium, to that of calcium carbonate. A single-dose, randomized-sequence, open-label, two-period crossover study, with a 7-day washout period, was conducted in 24 Indonesian healthy adult volunteers. After a 12-hour (overnight) fast, subjects received either two oral ampoules of 250 mg/10 mL of calcium glucoheptonate each or one effervescent tablet of calcium carbonate containing 500 mg of elemental calcium. The relative oral bioavailability of calcium from calcium glucoheptonate as compared to calcium carbonate was 92% within 6 hours and 89% within 12 hours after study drug administration. The 90% confidence intervals for the mean test/reference ratios of the maximum plasma concentration and the area under the concentration-time curve at 12 hours post-administration were 77.09%-120.31% and 60.58%-122.30%, respectively. Five subjects experienced a total of eight adverse events which were all mild and transient; no serious adverse events or deaths were reported. These results indicate that calcium glucoheptonate is associated with a high relative bioavailability of calcium compared to calcium carbonate, and is well-tolerated. Calcium glucoheptonate might thus be a potential choice for calcium supplementation in Southeast Asian populations.
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Affiliation(s)
- MSS Wiria
- Department of Pharmacology and TherapeuticsFaculty of MedicineUniversity of IndonesiaJakartaIndonesia
- PT Pharma Metric LabsJakartaIndonesia
| | - Hung Manh Tran
- Faculty of PharmacyUniversity of Medicine and PharmacyHo Chi Minh CityVietnam
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8
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Nicolas P. Comment on: "Why Were More Than 200 Subjects Required to Demonstrate the Bioequivalence of a New Formulation of Levothyroxine with an Old One?". Clin Pharmacokinet 2019; 59:273-275. [PMID: 31802399 DOI: 10.1007/s40262-019-00849-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Patrick Nicolas
- Assistance Publique des Hôpitaux de Paris (APHP), Bobigny, Seine Saint-Denis, France.
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9
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Authors' Reply to Yu et al.: "Levothyrox ® New and Old Formulations: Are They Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 59:283-285. [PMID: 31802402 PMCID: PMC7007434 DOI: 10.1007/s40262-019-00852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Concordet D, Gandia P, Montastruc JL, Bousquet-Mélou A, Lees P, Ferran AA, Toutain PL. Authors' Reply to Nicolas: "Why Were More than 200 Subjects Required to Demonstrate the Bioequivalence of a New Formulation of Levothyroxine with an Old One?". Clin Pharmacokinet 2019; 59:277-279. [PMID: 31802398 PMCID: PMC7007421 DOI: 10.1007/s40262-019-00851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Didier Concordet
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Peggy Gandia
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Faculté de Médecine, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | - Alain Bousquet-Mélou
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Peter Lees
- The Royal Veterinary College, University of London, London, UK
| | - Aude A Ferran
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France
| | - Pierre-Louis Toutain
- INTHERES, Université de Toulouse, INRA, ENVT, 23 Chemin des Capelles, 31076, Toulouse, France. .,The Royal Veterinary College, University of London, London, UK.
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11
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Comment on "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?". Clin Pharmacokinet 2019; 59:281-282. [PMID: 31802403 DOI: 10.1007/s40262-019-00850-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Kim S, Ko JW, Kim JR. Pharmacokinetic and Safety Profiles of a Fixed-Dose Combination of Amlodipine, Valsartan, and Atorvastatin: A 3-Period Replicate Crossover Study. Clin Pharmacol Drug Dev 2019; 9:386-394. [PMID: 31373174 PMCID: PMC7187173 DOI: 10.1002/cpdd.727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022]
Abstract
The objective of study was to compare the pharmacokinetic and safety profiles of a fixed‐dose combination (FDC) formulation of 5/160/20 mg amlodipine/valsartan/atorvastatin with those of separate formulations of a 5/160‐mg amlodipine/valsartan tablet and a 20‐mg atorvastatin tablet. This was a randomized, open‐label, single‐dose, 3‐sequence, 3‐period replicate crossover study with 42 subjects. Serial blood samples for pharmacokinetic assessment were collected up to 72 hours postdose. For establishing bioequivalence (BE) for amlodipine, valsartan, and atorvastatin, a reference‐scaled average BE approach was used if applicable, as well as the conventional limit of 0.80‐1.25. The 90% confidence intervals (CIs) for the geometric mean ratios (GMRs) for the maximum plasma concentration (Cmax) and the area under the curve to the last measurable concentration (AUCt) between the FDC and separate formulations were within the 0.80‐1.25 limit for all analytes but atorvastatin. The estimated within‐subject standard deviation of the log‐transformed values of the separate formulations, the reference intervention, was 0.3804 for the Cmax of atorvastatin, being set at 0.7489‐1.3352 for the BE acceptance limit. For both the Cmax and AUCt for atorvastatin, the GMRs lay within 0.80‐1.25, and the 90%CIs for the GMRs were within the BE acceptance limit. This 3‐period replicate crossover study demonstrated the BE of the FDC formulation of amlodipine, valsartan, and atorvastatin and the separate formulations of an amlodipine/valsartan tablet and an atorvastatin tablet. A similar incidence of treatment‐emergent adverse events (TEAEs) was observed in both interventions, and headache was the most common TEAE.
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Affiliation(s)
- Seokuee Kim
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae-Wook Ko
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Seoul, Republic of Korea
| | - Jung-Ryul Kim
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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13
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Van Lancker G, Van Bortel L, Delafontaine B, Boussery K, Swart E, Chahbouni A, Van Bocxlaer J, Colin P. Switchability of Gabapentin Formulations: A Randomized Trial to Assess Bioequivalence Between
Neurontin
and
Gabasandoz
on the Individual Subject Level. Clin Pharmacol Ther 2019; 106:195-203. [DOI: 10.1002/cpt.1353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Griet Van Lancker
- Heymans Institute of PharmacologyGhent University Ghent Belgium
- Drug Research Unit GhentGhent University Hospital Ghent Belgium
| | - Luc Van Bortel
- Heymans Institute of PharmacologyGhent University Ghent Belgium
- Drug Research Unit GhentGhent University Hospital Ghent Belgium
| | - Brant Delafontaine
- Heymans Institute of PharmacologyGhent University Ghent Belgium
- Drug Research Unit GhentGhent University Hospital Ghent Belgium
| | - Koen Boussery
- Laboratory of Medical Biochemistry and Clinical AnalysisFaculty of Pharmaceutical SciencesGhent University Ghent Belgium
- Pharmaceutical Care UnitFaculty of Pharmaceutical SciencesGhent University Ghent Belgium
| | - Eleonora Swart
- Department of Clinical Pharmacology and PharmacyVU University Medical Center Amsterdam The Netherlands
| | - Abdel Chahbouni
- Department of Clinical Pharmacology and PharmacyVU University Medical Center Amsterdam The Netherlands
| | - Jan Van Bocxlaer
- Laboratory of Medical Biochemistry and Clinical AnalysisFaculty of Pharmaceutical SciencesGhent University Ghent Belgium
| | - Pieter Colin
- Laboratory of Medical Biochemistry and Clinical AnalysisFaculty of Pharmaceutical SciencesGhent University Ghent Belgium
- Department of AnesthesiaUniversity Medical Center GroningenGroningen University Groningen The Netherlands
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14
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Burger D, Oosterhof P. Generic substitution of antiretroviral agents: never a problem? Antivir Ther 2019; 24:389-391. [DOI: 10.3851/imp3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
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15
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Yu Y, Maliepaard M. Interchangeability of Generics-Experiences and Outlook Toward Pharmacokinetics Variability and Generic-Generic Substitution. Clin Pharmacol Ther 2018; 105:292-294. [PMID: 30460681 PMCID: PMC6587430 DOI: 10.1002/cpt.1250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Yang Yu
- Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc Maliepaard
- Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
Many of the best-selling 'blockbuster' biological medicinal products are, or will soon be, facing competition from similar biological medicinal products (biosimilars) in the EU. Biosimilarity is based on the comparability concept, which has been used successfully for several decades to ensure close similarity of a biological product before and after a manufacturing change. Over the last 10 years, experience with biosimilars has shown that even complex biotechnology-derived proteins can be copied successfully. Most best-selling biologicals are used for chronic treatment. This has triggered intensive discussion on the interchangeability of a biosimilar with its reference product, with the main concern being immunogenicity. We explore the theoretical basis of the presumed risks of switching between a biosimilar and its reference product and the available data on switches. Our conclusion is that a switch between comparable versions of the same active substance approved in accordance with EU legislation is not expected to trigger or enhance immunogenicity. On the basis of current knowledge, it is unlikely and very difficult to substantiate that two products, comparable on a population level, would have different safety or efficacy in individual patients upon a switch. Our conclusion is that biosimilars licensed in the EU are interchangeable.
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17
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Yu Y, Teerenstra S, Neef C, Burger D, Maliepaard M. A comparison of the intrasubject variation in drug exposure between generic and brand-name drugs: a retrospective analysis of replicate design trials. Br J Clin Pharmacol 2016; 81:667-78. [PMID: 26574160 DOI: 10.1111/bcp.12828] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 10/27/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022] Open
Abstract
AIMS The aim of the present study was to investigate whether differences in total and peak drug exposure upon generic substitution are due to differences between formulations or to intrasubject pharmacokinetic variability of the active substance. METHODS The study was designed as a retrospective reanalysis of existing studies. Nine replicate design bioequivalence studies representing six drug classes - i.e. for alendronate, atorvastatin, cyclosporin, ebastine, exemestane, mycophenolate mofetil, and ropinirole - were retrieved from the Dutch Medicines Regulatory Authority. RESULTS In most studies, the intrasubject variability in total and peak drug exposure was comparable for the brand-name [in the range 0.01-0.24 for area under the concentration-time curve (AUCt ) and 0.02-0.29 for peak plasma concentration (Cmax ) on a log scale] and generic (0.01-0.23 for AUCt and 0.08-0.33 for Cmax ) drugs, and was comparable with the intrasubject variability upon switching between those drugs (0.01-0.23 for AUCt and 0.06-0.33 for Cmax ). The variance related to subject-by-formulation interaction could be considered negligible (-0.069 to 0.047 for AUCt and -0.091 to 0.02 for Cmax ). CONCLUSION In the investigated studies, the variation in total and peak exposure seen when a patient is switched from a brand-name to a generic drug is comparable with that seen following repeated administration of the brand-name drug in the patient. Only the intrasubject variability seems to play a crucial and decisive role in the variation in drug exposure seen; no additional formulation-dependent variation in exposure is observed upon switching. Thus, our data support that, for the medicines that were included in the present investigation, from a clinical pharmacological perspective, the benefit-risk balance of a generic drug is comparable with that of the brand-name drug.
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Affiliation(s)
- Yang Yu
- Department of Pharmacology and Toxicology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
| | - Steven Teerenstra
- Medicines Evaluation Board, Utrecht, The Netherlands.,Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Cees Neef
- Department of Pharmacology and Toxicology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Pharmacology and Toxicology, CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - David Burger
- Department of Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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