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Muñoz M, Kocatürk E, Maurer M, Kolkhir P. Emerging Therapeutics in Chronic Urticaria. Immunol Allergy Clin North Am 2024; 44:517-528. [PMID: 38937013 DOI: 10.1016/j.iac.2024.03.008] [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] [Indexed: 06/29/2024]
Abstract
Chronic urticaria (CU) is a common and long-lasting mast cell-mediated skin disease associated with psychiatric and autoimmune comorbidities, high economic costs, and considerable impact on quality of life. Available therapies show limited efficacy in many CU patients, which may be related to distinct underlying pathophysiology. Targeted and disease-modifying treatments with higher and broader efficacy are needed and are under development for CU. These novel drugs, small molecules, and monoclonal antibodies target mast cells and their receptors, signaling pathways, or mediators and other immune cells. In this article, the authors focus on the most promising emerging therapeutics in advanced development and discuss their potential place in future management of CU.
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Affiliation(s)
- Melba Muñoz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Hindenburgdamm 27, Berlin 12203, Germany
| | - Emek Kocatürk
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Hindenburgdamm 27, Berlin 12203, Germany; Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Hindenburgdamm 27, Berlin 12203, Germany
| | - Pavel Kolkhir
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health; Department of Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Hindenburgdamm 27, Berlin 12203, Germany.
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Feng L, Qiu K, Rao Y, Shu T, Song Y, Cheng D, Mao M, Li J, Zhang Z, Wang X, Zeng X, Zhao Y, Ren J. Associations between immune-mediated diseases (IMDs) and the risk of HPV-associated diseases: a UK Biobank cohort analysis. BMJ Open 2023; 13:e072249. [PMID: 37730406 PMCID: PMC10510897 DOI: 10.1136/bmjopen-2023-072249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES To systematically assess the associations between various immune-mediated diseases (IMDs) and human papillomavirus (HPV)-associated diseases. DESIGN Retrospective cohort study. SETTING UK Biobank. PARTICIPANTS A total of 500 371 subjects aged 40-69 years were eligible for the analysis, after excluding those with prevalent HPV-associated diseases at baseline and those who had withdrawn their informed consent or lacked information on sex. EXPOSURE Eighty IMDs (involving allergic/atopic diseases, autoimmune diseases, immunodeficiency diseases, etc) were identified in the UK Biobank. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcome was the incidence of HPV-associated diseases (including warts and malignancies of the cervix, oropharynx, anus, penis, vulva and vagina). Cox proportional hazards model was used to estimate HRs and 95% CIs with particular adjustment for sexual behaviours. We also conducted subgroup analyses based on benign and malignant status, and anatomical sites of HPV-associated diseases, respectively. RESULTS During a median of 12.0 years of follow-up, 2244 cases out of 500 371 subjects developed HPV-associated diseases. Overall, participants with IMDs had a higher risk of HPV-associated diseases than their controls after adjustment for sexual behaviours and other potential confounders (female: HR=1.90, 95% CI=1.66 to 2.17, p<0.001; male: HR=1.66, 95% CI=1.41 to 1.97, p<0.001). Additionally, eight individual IMDs in women (eg, asthma: HR=1.76, 95% CI=1.47 to 2.11, p<0.001) and three in men (eg, chronic nephritic syndrome: HR=6.05, 95% CI=3.32 to 11.04, p<0.001) were associated with increased risk of HPV-associated diseases. Subgroup analyses revealed significant IMD differences between benign and malignant subgroups as well as between oropharyngeal and anogenital subgroups. CONCLUSION In this large retrospective cohort study, IMDs were significantly associated with an elevated risk of HPV-associated diseases. Besides, gender-specific and region-specific associations were also observed between individual IMDs and HPV-associated diseases.
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Affiliation(s)
- Lan Feng
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Ke Qiu
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Yufang Rao
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Tao Shu
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Yao Song
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Danni Cheng
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Minzi Mao
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Junhong Li
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Ziyan Zhang
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Xiaoyu Wang
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
| | - Xinghan Zeng
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
- West China College of Pharmacy, Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
- West China Biomedical Big Data Center, Sichuan University, Chengdu, China
| | - JianJun Ren
- Department of Otolaryngology-Head & Neck Surgery, Sichuan University West China Hospital, Chengdu, China
- West China Biomedical Big Data Center, Sichuan University, Chengdu, China
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Mitkova Z, Manev I, Tachkov K, Boyadzhieva V, Stoilov N, Doneva M, Petrova G. How Managed Entry Agreements Influence the Patients' Affordability to Biological Medicines-Bulgarian Example. Healthcare (Basel) 2023; 11:2427. [PMID: 37685461 PMCID: PMC10486911 DOI: 10.3390/healthcare11172427] [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: 07/22/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Managed entry agreements are applied in almost all European countries in order to improve patients' access to therapy. The current study aims to evaluate the changes in the affordability of biological medicines for patients in Bulgaria during 2019-2022. The study is a top-down macroeconomic analysis of the key economic indicators and reimbursed costs of biologic therapies. Affordability was determined as the number of working hours needed to pay for monthly therapy. The average NHIF budget for pharmaceuticals increased significantly along with inflation in the healthcare sector. Bulgarian patients had to devote a large part of their income to buying medicines if a co-payment existed. The percentage of the monthly income of pensioners needed for therapy co-payment varied between 10% and 280%. The hours of work required to purchase a package of biologicals varied between 7 and 137 working hours. The global economic crisis has affected Bulgaria and led to worsening economic parameters. There are still no well-established practices to control public spending, as the measures taken to reduce the final cost of medicines mainly affect the pharmaceutical companies. This type of cost-containment policy provides an opportunity for innovative treatment with biologicals for patients with inflammatory diseases. Most of the therapies cost more than the patients' monthly income.
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Affiliation(s)
- Zornitsa Mitkova
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Ivan Manev
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Konstantin Tachkov
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Vladimira Boyadzhieva
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Faculty of Medicine, Medical University of Sofia, 1612 Sofia, Bulgaria; (V.B.); (N.S.)
| | - Nikolay Stoilov
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Faculty of Medicine, Medical University of Sofia, 1612 Sofia, Bulgaria; (V.B.); (N.S.)
| | - Miglena Doneva
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
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Joshi D, Khursheed R, Gupta S, Wadhwa D, Singh TG, Sharma S, Porwal S, Gauniyal S, Vishwas S, Goyal S, Gupta G, Eri RD, Williams KA, Dua K, Singh SK. Biosimilars in Oncology: Latest Trends and Regulatory Status. Pharmaceutics 2022; 14:pharmaceutics14122721. [PMID: 36559215 PMCID: PMC9784530 DOI: 10.3390/pharmaceutics14122721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Biologic-based medicines are used to treat a variety of diseases and account for around one-quarter of the worldwide pharmaceutical market. The use of biologic medications among cancer patients has resulted in substantial advancements in cancer treatment and supportive care. Biosimilar medications (or biosimilars) are very similar to the reference biologic drugs, although they are not identical. As patent protection for some of the most extensively used biologics begins to expire, biosimilars have the potential to enhance access and provide lower-cost options for cancer treatment. Initially, regulatory guidelines were set up in Europe in 2003, and the first biosimilar was approved in 2006 in Europe. Many countries, including the United States of America (USA), Canada, and Japan, have adopted Europe's worldwide regulatory framework. The use of numerous biosimilars in the treatment and supportive care of cancer has been approved and, indeed, the count is set to climb in the future around the world. However, there are many challenges associated with biosimilars, such as cost, immunogenicity, lack of awareness, extrapolation of indications, and interchangeability. The purpose of this review is to provide an insight into biosimilars, which include various options available for oncology, and the associated adverse events. We compare the regulatory guidelines for biosimilars across the world, and also present the latest trends and challenges in medical oncology both now and in the future, which will assist healthcare professionals, payers, and patients in making informed decisions, increasing the acceptance of biosimilars in clinical practice, increasing accessibility, and speeding up the health and economic benefits associated with biosimilars.
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Affiliation(s)
- Deeksha Joshi
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
| | - Saurabh Gupta
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Diksha Wadhwa
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | | | - Sumit Sharma
- Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Sejal Porwal
- Department of Pharmaceutical Sciences, Amity University Lucknow, Lucknow 226028, India
| | - Swati Gauniyal
- Department of Pharmacology, KLE College of Pharmacy, Hubballi 580031, India
| | - Sukriti Vishwas
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
| | - Sanjay Goyal
- Department of Internal Medicine, Government Medical College, Patiala 147001, India
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura 333031, India
- Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602117, India
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun 248007, India
| | - Rajaraman D. Eri
- School of Science, STEM College, RMIT University, Melbourne, VIC 3001, Australia
- Correspondence: (R.D.E.); (S.K.S.); Tel.: +61-3-6324-5467 (R.D.E.); +91-9888720835 (S.K.S.)
| | - Kylie A. Williams
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Correspondence: (R.D.E.); (S.K.S.); Tel.: +61-3-6324-5467 (R.D.E.); +91-9888720835 (S.K.S.)
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Mohd Sani N, Aziz Z, Panickar R, Kamarulzaman A. Pharmacists' Perspectives of Biosimilars: A Systematic Review. BioDrugs 2022; 36:489-508. [PMID: 35776294 DOI: 10.1007/s40259-022-00541-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVE While biosimilars are less expensive than their originator biologics, various factors are known to impede their uptake in clinical practice including concerns regarding their interchangeability, efficacy, and safety. Pharmacists are well positioned to promote the adoption of biosimilars, thus, the aim of the review was to assess pharmacists' knowledge and perceptions of biosimilars to identify the need for pharmacist-directed biosimilar education. METHODS We conducted a systematic literature search for published articles indexed in MEDLINE via EBSCOHOST, Web of Science, Scopus, Cochrane Library, Dimensions, and Google Scholar databases. We included studies written in English from their earliest publication dates until December 2021. Only studies concerning pharmacists' perspectives on biosimilars were included. Two reviewers extracted data from the studies that included pharmacists' knowledge, perceptions, and opinions about interchangeability and automatic substitution of biosimilars. We also assessed the methodological quality of the included studies using the Joanna Briggs Institute Analytical Cross-Sectional Studies Assessment (JBI-ACSSA) for quantitative studies and the Critical Appraisal Skills Programme (CASP) for qualitative studies. RESULTS Out of the 22 studies included in the review, 19 were cross-sectional quantitative studies, and the other three were qualitative studies. The sample size of the included studies ranged from 19 to 1500 participants. The level of knowledge of biosimilars graded as good, considerable, above average, or excellent among pharmacists varied from study to study, with a range of 47-86%. Only 22-51% of pharmacists were comfortable if biosimilars were prescribed for all of the indications previously used for the originator products. Pharmacists' acceptability of switching from the originator to a biosimilar also varied, with a range of 26-84%. However, most pharmacists viewed the substitution of the originator with a biosimilar without physicians' permission as unacceptable. Data from three studies reported that 22-74% of pharmacists had attended biosimilar training. They obtained information about biosimilars from scientific publications, pharmaceutical companies, and continuing education. Based on the criteria of JBI-ACSSA and CASP, the overall methodological quality of the studies ranged from moderate to high. The majority of the studies did not describe the sampling methods used and the strategies to deal with confounding factors. CONCLUSIONS Pharmacists' knowledge and perception about biosimilars varied and were limited, especially about interchangeability and substitution, efficacy, safety, and indication extrapolation. A better understanding of biosimilars amongst pharmacists could help them to encourage prescribers' acceptance of biosimilars.
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Affiliation(s)
- Noraisyah Mohd Sani
- Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.,Pharmacy Services Programme, Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | - Zoriah Aziz
- Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia. .,Faculty of Pharmacy, MAHSA University, Jenjarom, Malaysia.
| | - Rema Panickar
- Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.,Pharmacy Services Programme, Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | - Adeeba Kamarulzaman
- Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
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Oqal M, Hijazi B, Alqudah A, Al-Smadi A, A Almomani B, Alnajjar R, Abu Ghunaim M, Irshaid M, Husam A. Awareness and Knowledge of Pharmacists toward Biosimilar Medicines: A Survey in Jordan. Int J Clin Pract 2022; 2022:8080308. [PMID: 35832802 PMCID: PMC9252697 DOI: 10.1155/2022/8080308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aims Pharmacists in all clinical settings are recognized drug experts and integral educators of biosimilar medicines. Therefore, the objective of this study was to assess pharmacists' knowledge, predictors of knowledge, and views toward biosimilar medicines in Jordan. Methods A cross-sectional study was conducted in Jordan during October-December 2020. An Internet-based self-administrated questionnaire on knowledge and views was distributed using social media groups to the pharmacists among different areas in Jordan. A descriptive and univariate analysis was performed. Binary logistic regression was conducted to determine the predictors of knowledge including all variables with p < 0.20 on univariate analysis. Results A total 536 responses were received, 502 of which were completed (93.7% response rate). A total of 52.6% of the pharmacists were knowledgeable about biosimilar medicines and the mean of knowledge level was 6.47 ± 1.62 (range 2-10). Multivariate analysis identified that respondents who had heard about biosimilars before (OR = 1.942, 95% CI = 1.231-3.063, p < 0.05) was more likely to be knowledgeable. Respondents who had not taken the course or the postgraduating training course about biosimilars that were less likely to be knowledgeable (OR = 0.548, 95% CI = 0.357-0.839, p < 0.05). A positive response was noted in pharmacist's view regarding the implementation of biosimilar medicines in healthcare setting, biosimilar medicine prescription related to decreased costs, self-study about biosimilar medicine, and incorporating biosimilar education program at the pharmacy school curriculum universities level. Conclusions Pharmacists' views and knowledge vary regarding the particularities and key issues on biosimilar medicines in Jordan. Incorporating biosimilar course in pharmacy school curriculum could improve their acceptance for future pharmacy jobs.
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Affiliation(s)
- Muna Oqal
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, The Hashemite University, P.O Box 330127, Zarqa 13133, Jordan
| | - Bushra Hijazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Ahmad Al-Smadi
- Department of Adult Health Nursing, Princess Salma Faculty of Nursing, Al Al-Bayt University, Al-Mafraq, Jordan
| | - Basima A Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Roaa Alnajjar
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Majd Abu Ghunaim
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan
| | - Mohammad Irshaid
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, The Hashemite University, P.O Box 330127, Zarqa 13133, Jordan
| | - Aroob Husam
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, The Hashemite University, P.O Box 330127, Zarqa 13133, Jordan
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Scott R, Parker H, Mccartney S, Harrow P, Williams D, Giles I. Outcomes following biosimilar TNF inhibitors use for inflammatory-mediated immune disorders in pregnancy. Obstet Med 2021; 15:104-107. [PMID: 35845229 PMCID: PMC9277732 DOI: 10.1177/1753495x211028779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/15/2021] [Accepted: 06/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background Biosimilar tumour necrosis factor inhibitors (TNFi) are increasingly used to
treat inflammatory immune-mediated disorders as they cost less than the
originator biologic drug. More women are therefore becoming pregnant on
biosimilar TNFi. This is the first paper to explore the safety and efficacy
of biosimilar therapies in pregnancy. Methods A retrospective review of clinical data reviewed pregnancy outcomes and
inflammatory disease activity in 18 pregnancies where the mother was using a
biosimilar TNFi at conception. Results Biosimilar therapy was not associated with congenital abnormalities, preterm
birth or other adverse pregnancy outcomes. Stopping biosimilar TNFi in
pregnancy was associated with childbirth at an earlier gestation, as well as
a flare of inflammatory disease in pregnancy or post-partum. Conclusions Women and clinicians should feel confident in using biosimilar TNFi in early
pregnancy, and continuing them through pregnancy to prevent flares in late
pregnancy or the early post-partum.
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Affiliation(s)
- R Scott
- Department of Obstetrics, University College London Hospital NHS Foundation Trust, London, UK
| | - H Parker
- Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK
| | - S Mccartney
- Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK
| | - P Harrow
- Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK
| | - D Williams
- Department of Obstetrics, University College London Hospital NHS Foundation Trust, London, UK
- The Institute for Women’s Health, University College London, London, UK
| | - I Giles
- Department for Rheumatology, University College London Hospital NHS Foundation Trust, London, UK
- Centre for Rheumatology, University College London, University College London Hospitals NHS Foundation Trust, London, UK
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Biosimilars in Malaysia: Regulatory Framework, Approved Products, and Adverse Effects. Ther Innov Regul Sci 2020; 55:490-502. [PMID: 33231863 DOI: 10.1007/s43441-020-00243-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Biosimilars are a cost-effective alternative to original biologic medicines that allow patients access to biologic therapies for various chronic diseases. Our paper aims to provide an overview of biosimilars in Malaysia with emphasis on the comparison of Malaysian guidelines with guidelines from well-established regulatory agencies, a review of biosimilars' market approval and their reported adverse effects (AEs) as well as clinical trials conducted in Malaysia. METHODS We searched the official websites of the National Pharmaceutical Regulatory Agency (NPRA) Malaysia and three other well-established agencies, online databases of Medline® and EMBASE for guidelines on legislation and regulations of biosimilars. Meanwhile, we extracted the reports of AEs involving biosimilars in Malaysia from the NPRA database and for global AEs from the World Health Organisation VigyLize database. The ClinicalTrials.gov Website by the U.S. National Library of Medicines was the source for data on clinical trials. RESULTS Malaysia followed the principles of the European Medicines Agency biosimilar regulations and issued their guideline in 2008. Since then, NPRA has approved 24 biosimilar products and recorded 499 AE reports, of which 43 (8.6%) were serious. NPRA has also approved ten Phase III clinical trials in Malaysia with four trials still ongoing. CONCLUSION Malaysia follows a stringent regulatory pathway for the approval of biosimilars enacted by well-established regulatory agencies to maintain the quality, efficacy and safety of biosimilars. Introducing biosimilars to the Malaysian market would improve patients' accessibility to biologic therapies.
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Prignano F, Choi J, Pieper B, Iversen L. Anti-tumor necrosis factor agents in psoriasis: addressing key challenges using biosimilars. Expert Opin Biol Ther 2020; 21:75-80. [PMID: 32886008 DOI: 10.1080/14712598.2020.1812576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Anti-tumor necrosis factor agents are key treatment options in moderate-severe psoriasis. The advent of multiple biosimilars of these drugs provides a major opportunity to address this particular factor by helping to reduce costs. Reduced cost can help improve undertreatment, which is one of the challenges in treating moderate-severe psoriasis. There is now a wealth of real-world evidence demonstrating that patients with psoriasis can be initiated on - or transitioned to - an anti-TNF biosimilar without detrimental effects on overall safety and efficacy. Furthermore, recent results suggest that patients can be switched between different biosimilar versions of the same anti-TNF agent without any compromise in outcomes. AREAS COVERED In this review, we summarized the role of anti-TNFs in psoriasis, health economic aspects of anti-TNF biosimilars, and their real-world data in clinical practice and registries. EXPERT OPINION The introduction and competition of anti-TNF biosimilars reduced the cost of biologics and accumulated real-world data support efficacy and safety of anti-TNF biosimilars for psoriasis treatment. Although IL-17 and IL-23 inhibitors show better efficacy in psoriasis patients, long-term efficacy and safety data of anti-TNF and cost-effectiveness of anti-TNF biosimilars may play an important role to increase patient access to biologics through greater adoption of biosimilars.
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Affiliation(s)
- Francesca Prignano
- Department of Health Sciences, Dermatology Unit, University of Florence , Florence, Italy
| | - Jaeyun Choi
- Medical Affairs, Samsung Bioepis Co., Ltd ., Incheon, Republic of Korea
| | - Burkhard Pieper
- Scientific Affairs Biosimilars, Biogen International GmbH , Baar, Switzerland
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital , Aarhus, Denmark
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Zagni E, Colombo D, Fiocchi M, Perrone V, Sangiorgi D, Andretta M, De Sarro G, Nava E, Degli Esposti L. Pharmaco-utilization of biologic drugs in patients affected by psoriasis, psoriatic arthritis and ankylosing spondylitis in an Italian real-world setting. Expert Rev Pharmacoecon Outcomes Res 2020; 20:491-497. [DOI: 10.1080/14737167.2020.1800456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Valentina Perrone
- CliCon S.r.l., Health, Economics & Outcomes Research, Ravenna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Health, Economics & Outcomes Research, Ravenna, Italy
| | | | - Giovambattista De Sarro
- Department of Health Sciences, Clinical Pharmacology and Pharmacovigilance Unit, University of Magna Graecia, Catanzaro, Italy
| | - Eduardo Nava
- Department of Pharmacy, LHU Naples 3 South, Torre Del Greco, Italy
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Wook Hong S, Kim YG, Ye BD. An updated review of infliximab biosimilar, CT-P13, in the treatment of immune-mediated inflammatory diseases. Immunotherapy 2020; 12:609-623. [PMID: 32517574 DOI: 10.2217/imt-2020-0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The introduction of anti-TNFs, such as infliximab (IFX), has revolutionized the treatment of immune-mediated inflammatory diseases. Anti-TNF agents have shown outstanding efficacy and long-term improvement of clinical outcomes, but the cost has been relatively high. Out of this concern, several 'biosimilar' drugs of anti-TNF agents have been developed. CT-P13, the first biosimilar of reference IFX, was approved by the European Medicines Agency and licensed by the US FDA for use in all indications of IFX. This updated review summarizes all aspects of CT-P13, including pharmacology and pharmacokinetics, and evaluates its efficacy, safety and immunogenicity for all indications based on the results of the latest clinical trials as well as on real-world experiences.
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Affiliation(s)
- Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kapoor S, Kaushik VV, Jain R, Rao VKR, Gharia M. Real-life Tolerability and Effectiveness of Adalimumab Biosimilar in Ankylosing Spondylitis: the Adalimumab Biosimilar Patient Registry Data. ACR Open Rheumatol 2019; 1:480-484. [PMID: 31777828 PMCID: PMC6857999 DOI: 10.1002/acr2.11067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/15/2019] [Indexed: 01/17/2023] Open
Abstract
Objective Adalimumab is a well‐established anti–tumor necrosis factor therapy for patients with ankylosing spondylitis (AS). An indigenously developed biosimilar adalimumab (bADA) (ZRC‐3197; Exemptia) is approved for prescribing in India. In this article, we present the effectiveness and tolerability of this bADA in real‐life Indian patients with AS from the Adalimumab Biosimilar Patient Registry (ASPIRE) (ISRCTN: 16838474). Methods ASPIRE is a postmarketing observational registry for evaluating the real‐world experiences of patients with autoimmune inflammatory disorders across multiple centers in India who were prescribed 40 mg of Exemptia subcutaneously every fortnight. For this report, data available until 24 weeks of bADA treatment for patients with AS who were included in the registry were evaluated. Results Data from 308 patients with AS from the registry (median age of 35.0 [range 17‐68] years, 19% women) were analyzed. In analyzable patients with complete data, there was a gradual and significant decrease (P < 0.001) in the primary disease outcome scores (the mean Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] score [n = 107] improved from 6.2 ± 1.54 to 2.1 ± 0.64, and the median visual analogue scale [VAS] score [n = 101] improved from 8 to 2) after 24 weeks of bADA therapy. BASDAI score was lower than 4 in about 94% of patients after 24 weeks of therapy, and 95% of patients achieved BASDAI50 response. The overall global assessment for efficacy and tolerability was ‘good’ to ‘excellent’ for a majority of the patients (≥98%), as rated by physicians as well as patients. The therapy was tolerated well, and there were no new unexpected adverse reactions with the biosimilar's use during this study. Conclusion This report demonstrates the tolerability and effectiveness of bADA (Exemptia) after its clinical use for 24 weeks in real‐world patients with AS from Indian clinical practice.
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Affiliation(s)
| | | | - Rahul Jain
- Narayana Multispeciality Hospital, Jaipur, India
| | | | - Mihir Gharia
- Medical Affairs, Zydus Biovation, Cadila Healthcare Ltd., Ahmedabad, India
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Baumgart DC, Misery L, Naeyaert S, Taylor PC. Biological Therapies in Immune-Mediated Inflammatory Diseases: Can Biosimilars Reduce Access Inequities? Front Pharmacol 2019; 10:279. [PMID: 30983996 PMCID: PMC6447826 DOI: 10.3389/fphar.2019.00279] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/05/2019] [Indexed: 12/30/2022] Open
Abstract
Biological therapies are an effective treatment for a range of immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis, psoriasis, and inflammatory bowel diseases. However, due to their high costs, considerable differences in their utilization exist across the world, even among the various European countries, with many countries restricting access despite professional society guideline recommendations. Adoption of biologics by healthcare providers has been particularly poor in many Central and Eastern European countries. Differences in utilization have also been observed across medical specialties, healthcare providers, and at a regional and national level. The objective of this paper is to provide an overview of the different market access policies for biologics in Europe and to investigate reasons for such differences. One of the potential solutions for providing broader access to IMID patients, where cost is the major barrier, is to encourage the use of biosimilars in place of their reference products. Biosimilars are generally less expensive alternatives to already licensed biological therapies and are approved on the basis that they are similar to the reference product in terms of quality, safety, and efficacy. Budget impact models predict considerable cost savings following the introduction of biosimilars in the next few years. These savings could be used to increase access to biologics and other innovative therapies.
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Affiliation(s)
- Daniel C. Baumgart
- Inflammatory Bowel Disease Unit – Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
- Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - Peter C. Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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Abstract
BACKGROUND Crohn's disease (CD) is a chronic immune-mediated disorder of the gastrointestinal tract. The pathophysiological understanding of this disease is limited and no curative therapy is available so far. Therefore, most patients require long-lasting or even life-long immunosuppressive therapies for the suppression of symptoms to improve quality of life and reduction of long-term risks. However, in a relevant subgroup of patients, these therapeutic goals cannot be sufficiently attained. SUMMARY Clinically established therapies in active CD comprise corticosteroids and immunosuppressants such as azathioprine. After the introduction of anti-TNFα (Tumor necrosis factor alpha) antibodies, other biologicals (e.g., vedolizumab and ustekinumab) have also been approved. New drugs in the pipeline like filgotinib, upadacitinib, risankizumab or rifaximin could improve the therapy of CD in the near future. Thus, an individualized therapy management, based on optimal selection of therapeutic agents will become more important. Additionally, the local application of mesenchymal stem cells might be helpful in the management of fistulas. Key Messages: The targeted biological therapeutic agents (anti-TNFα antibodies, vedolizumab, ustekinumab) are well established for therapy in CD. There are several new substances in the pipeline with promising results in phase II trials (filgotinib, rifaximin, risankizumab, upadacitinib). The upcoming extension of the therapeutic arsenal will require methods for an optimized selection of substances, thus enabling a more individualized therapy.
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Sulforaphane as anticancer agent: A double-edged sword? Tricky balance between effects on tumor cells and immune cells. Adv Biol Regul 2018; 71:79-87. [PMID: 30528536 DOI: 10.1016/j.jbior.2018.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 12/19/2022]
Abstract
Sulforaphane (SFN) is a naturally occurring isothiocyanate derived from cruciferous vegetables such as broccoli. It has been reported to inhibit the growth of a variety of cancers, such as breast, prostate, colon, skin, lung, gastric or bladder cancer. SFN is supposed to act primarily as an antioxidant due to the activation of the Nrf2-Keap1 signaling pathway. This enhances the activity of phase II detoxifying enzymes and the trapping of free radicals. Finally, SFN induces cell cycle arrest or apoptosis of tumor cells. Here, we discuss effects of SFN on the immune defense system. In contrast to the situation in tumor cells, SFN acts pro-oxidatively in primary human T cells. It increases intracellular ROS levels and decreases GSH, resulting in inhibition of T cell activation and T cell effector functions. Regarding the use of SFN as an "anticancer agent" we conclude that SFN could act as a double-edged sword. On the one hand it reduces carcinogenesis, on the other hand it blocks the T cell-mediated immune response, the latter being important for immune surveillance of tumors. Thus, SFN could also interfere with the successful application of immunotherapy by immune checkpoint inhibitors (e.g. CTLA-4 antibodies and PD-1/PD-L1 antibodies) or CAR T cells. Therefore, a combination of SFN with T cell-mediated cancer immunotherapies does not seem advisable.
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Codreanu C, Šírová K, Jarošová K, Batalov A. Assessment of effectiveness and safety of biosimilar infliximab (CT-P13) in a real-life setting for treatment of patients with active rheumatoid arthritis or ankylosing spondylitis. Curr Med Res Opin 2018; 34:1763-1769. [PMID: 29439591 DOI: 10.1080/03007995.2018.1441144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of infliximab biosimilar, CT-P13, administered in a real-life setting to adult patients with active rheumatoid arthritis (RA) or ankylosing spondylitis (AS). METHODS This multi-center, non-interventional, observational study was conducted in Bulgaria, the Czech Republic, and Romania. A total of 151 patients with severe active RA (n = 81) or AS (n = 70) were enrolled and treated with CT-P13 for 24 weeks, according to current medical recommendations. Effectiveness was assessed using the 4-item Disease Activity Score 28 with C-reactive protein (DAS28-CRP) for RA patients, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for AS patients. Safety was assessed by withdrawals and adverse events (AEs). RESULTS A total of 129 patients (RA: 67; AS: 62) were included in the effectiveness analysis. CT-P13 treatment significantly improved DAS28-CRP scores at 12 and 24 weeks (p = .0001 vs baseline for both timepoints) in patients with RA and BASDAI scores at 12 and 24 weeks (p = .0001 vs baseline for both timepoints) in patients with AS. CRP levels were significantly reduced at 12 and 24 weeks (p = .0001 vs baseline for both timepoints). Among 713 infusions, 34 AEs were reported (4.8% of infusions), of which 11 were considered related to CT-P13 treatment. Two of seven serious AEs were considered possibly (hepatocellular injury) or definitely (dyspnoea due to allergic infusion reaction) treatment-related. Eight patients discontinued CT-P13 due to AEs and four patients were withdrawn due to therapeutic failure. CONCLUSIONS CT-P13 was effective and safe in a real-life setting in patients with active RA or AS.
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Affiliation(s)
- Cătălin Codreanu
- a Center for Rheumatic Diseases , University of Medicine and Pharmacy , Bucharest , Romania
| | - Klára Šírová
- b Revmatologie , Revmatologie MU Dr. Klara Sirova, sro , Ostrava , Czech Republic
| | | | - Anastas Batalov
- d Rheumatology , Medical University of Plovdiv, UMHAT "Kaspela" , Plovdiv , Bulgaria
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Biosimilars for Immune-Mediated Chronic Diseases in Primary Care: What a Practicing Physician Needs to Know. Am J Med Sci 2018; 355:411-417. [DOI: 10.1016/j.amjms.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/21/2017] [Accepted: 12/25/2017] [Indexed: 12/13/2022]
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Glintborg B, Kringelbach T, Bolstad N, Warren DJ, Eng G, Sørensen IJ, Loft AG, Hendricks O, Hansen IMJ, Linauskas A, Nordin H, Kristensen S, Lindegaard H, Jensen DV, Goll GL, Høgdall E, Gehin J, Enevold C, Nielsen CH, Krogh NS, Johansen JS, Hetland ML. Drug concentrations and anti-drug antibodies during treatment with biosimilar infliximab (CT-P13) in routine care. Scand J Rheumatol 2018; 47:418-421. [DOI: 10.1080/03009742.2017.1376110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B Glintborg
- The Danish Rheumatologic Biobank, the DANBIO Registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Rheumatology, Gentofte and Herlev Hospital, Copenhagen University Hospital, Gentofte, Denmark
| | - T Kringelbach
- The Danish Rheumatologic Biobank, Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - N Bolstad
- Department of Medical Biochemistry, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - DJ Warren
- Department of Medical Biochemistry, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - G Eng
- Department of Rheumatology, Zealand University Hospital, Køge, Denmark
| | - IJ Sørensen
- The Danish Rheumatologic Biobank, the DANBIO Registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - AG Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - O Hendricks
- King Christian X’s Hospital for Rheumatic Diseases, Graasten, Denmark
| | - IMJ Hansen
- Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - A Linauskas
- Department of Rheumatology, North Denmark Regional Hospital, Hjørring, Denmark
| | - H Nordin
- Department of Rheumatology, Zealand University Hospital, Køge, Denmark
| | - S Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - H Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - DV Jensen
- Department of Rheumatology, Gentofte and Herlev Hospital, Copenhagen University Hospital, Gentofte, Denmark
| | - GL Goll
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Høgdall
- The Danish Rheumatologic Biobank, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - J Gehin
- Department of Medical Biochemistry, Oslo University Hospital, Radiumhospitalet, Norway
| | - C Enevold
- Center for Rheumatology and Spine Diseases, Institute for Inflammation Research (IIR), Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark
| | - CH Nielsen
- Center for Rheumatology and Spine Diseases, Institute for Inflammation Research (IIR), Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark
| | | | - JS Johansen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Rheumatologic Biobank, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Medicine and Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - ML Hetland
- The Danish Rheumatologic Biobank, the DANBIO Registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Farkas K, Molnár T. A review on biosimilar infliximab, CT-P13, in the treatment of inflammatory bowel disease. Immunotherapy 2017; 10:107-117. [PMID: 29124994 DOI: 10.2217/imt-2017-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The introduction of biological agents has led to significant changes in the treatment of inflammatory bowel disease (IBD). The relatively high price of infliximab (IFX) and the expiration of the patents led to the introduction of biosimilar agents. CT-P13 was the first IFX biosimilar approved in the same indications as the reference product; however, the approval was based on randomized clinical trials conducted in patients with rheumatoid arthritis and ankylosing spondylitis. In the past 2-3 years, new findings from prospective observational studies supported the short-, medium- and long-term clinical efficacy and safety of CT-P13 in patients with IBD. This review summarized the clinical use and efficacy of the first biosimilar IFX, CT-P13, in the treatment of IBD.
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Affiliation(s)
- Klaudia Farkas
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
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Abstract
INTRODUCTION In most European countries, an infliximab biosimilar (CT-P13) is currently in common use. In vitro and in vivo studies have proved a high similarity between CT-P13 and the reference infliximab. CT-P13 was licensed for use in patients with Crohn disease (CD) based on the extrapolation of data from preclinical studies and clinical trials in rheumatology indications. The aim of this study was to assess the similarity between CT-P13 and the originator infliximab in induction therapy in CD paediatric patients. METHODS Thirty-six CD paediatric patients from 3 Polish academic centres who started biological therapy with CT-P13 were enrolled in this prospective, observational study. Patients received 3 induction doses (5 mg/kg) of CT-P13 at weeks 0, 2, 6. Assessment was performed before the first infusion and at week 14. RESULTS Overall 34/36 (94.4%) patients completed induction therapy with CT-P13. A clinical response or remission after 3 initial doses was achieved in 31/36 (86%) and 24/36 (67%) of patients, respectively. Clinically and statistically significant decreases in Paediatric Crohn's Disease Activity Index, C-reactive protein, and erythrocyte sedimentation rate were observed in the responders group. An allergic reaction during infusion, which led to treatment discontinuation, was observed in one case. CONCLUSIONS Induction therapy with CT-P13 in children with CD is effective. The profile appears similar to that reported for the reference infliximab. No unexpected adverse events occurred.
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Coiffier B. Pharmacokinetics, efficacy and safety of the rituximab biosimilar CT-P10. Expert Rev Clin Pharmacol 2017; 10:923-933. [DOI: 10.1080/17512433.2017.1359537] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Bertrand Coiffier
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Uhlig T, Goll GL. Reviewing the evidence for biosimilars: key insights, lessons learned and future horizons. Rheumatology (Oxford) 2017; 56:iv49-iv62. [PMID: 28903542 PMCID: PMC5850213 DOI: 10.1093/rheumatology/kex276] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/12/2017] [Indexed: 12/28/2022] Open
Abstract
Biologic therapies have become central to the long-term management of many chronic diseases, including inflammatory rheumatic diseases. Over recent years, the development and licensing pathways for biosimilars have become more standardized, and several biosimilars have been made available for patients with inflammatory rheumatic diseases, such as RA. Pre-licensing requirements for biosimilars mandate the demonstration of comparability with reference products in terms of clinical activity, safety and immunogenicity, whereas post-marketing surveillance and risk minimization requirements are set in place to ensure that long-term, real-world safety data are collected to assess biosimilars in clinical practice. These measures should provide a foundation for physician confidence in biosimilars, which can be established further through clinical experience. Biosimilars may help to fill an unmet need by improving patient access to effective biologic treatments for chronic diseases. Greater access may result in additional clinical benefits, with appropriate use of biologic therapies according to treatment guidelines being associated with improved outcomes and the potential for reduced costs of care. Key challenges for the integration of biosimilars into everyday practice include questions about interchangeability, switching and automatic substitution. Several switching studies have shown that biosimilars can be used in place of reference products while maintaining efficacy and safety. Additional ongoing studies and registries may help to optimize the process of switching, and different funding models are examining the optimal mechanisms to ensure effective uptake of these new treatments.
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Affiliation(s)
- Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology
| | - Guro L. Goll
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Vulto AG, Jaquez OA. The process defines the product: what really matters in biosimilar design and production? Rheumatology (Oxford) 2017; 56:iv14-iv29. [PMID: 28903544 PMCID: PMC5850795 DOI: 10.1093/rheumatology/kex278] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/12/2017] [Indexed: 12/15/2022] Open
Abstract
Biologic drugs are highly complex molecules produced by living cells through a multistep manufacturing process. The key characteristics of these molecules, known as critical quality attributes (CQAs), can vary based on post-translational modifications that occur in the cellular environment or during the manufacturing process. The extent of the variation in each of the CQAs must be characterized for the originator molecule and systematically matched as closely as possible by the biosimilar developer to ensure bio-similarity. The close matching of the originator fingerprint is the foundation of the biosimilarity exercise, as the analytical tools designed to measure differences at the molecular level are far more sensitive and specific than tools available to physicians during clinical trials. Biosimilar development, therefore, has a greater focus on preclinical attributes compared with the development of an original biological agent. As changes in CQAs can occur at different stages of the manufacturing process, even small modifications to the process can alter biosimilar attributes beyond the point of similarity and impact clinical effectiveness and safety. The manufacturer's ability to provide consistent production and quality control will greatly influence the acceptance of biosimilars. To this end, preventing drift from the required specifications over time and avoiding the various implications brought by product shortage will enhance biosimilar integration into daily practice. As most prescribers are not familiar with this new drug development paradigm, educational programmes will be needed so that prescribers see biosimilars as fully equivalent, efficacious and safe medicines when compared with originator products.
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Affiliation(s)
- Arnold G. Vulto
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Orlando A. Jaquez
- Department of Medical Affairs, Biogen International GmbH, Zug, Switzerland
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Inotai A, Prins CPJ, Csanádi M, Vitezic D, Codreanu C, Kaló Z. Is there a reason for concern or is it just hype? - A systematic literature review of the clinical consequences of switching from originator biologics to biosimilars. Expert Opin Biol Ther 2017. [PMID: 28650704 DOI: 10.1080/14712598.2017.1341486] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION While prescribing biosimilars to patients naive to a biologic treatment is a well-accepted practice, switching clinically stable patients from an originator to a biosimilar is an issue for clinicians. Well-designed clinical trials and real-world data which study the consequences of switching from an originator biologic treatment to its biosimilar alternative are limited, especially for monoclonal antibodies. Areas covered: A systematic literature review was conducted on PubMed to identify evidence of the consequences of switching from original biologics to biosimilars. References of included papers were also scrutinized. After a title-, abstract- and full text screening, out of the 153 original hits and 77 additional ones from screening the references, 58 papers (12 empirical papers, 5 systematic reviews and 41 non-empirical papers) were included. Expert opinion: Preventing patients on biologic medicines from switching to biosimilars due to anticipated risks seems to be disproportional compared to the expected cost savings and/or improved patient access. Indeed, it is the opinion of the authors that the concern of switching to biosimilars is overhyped.
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Affiliation(s)
- András Inotai
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy & Health Economics , Faculty of Social Sciences, Eötvös Loránd University (ELTE) Budapest , Hungary
| | - Christiaan P J Prins
- c Department of Pharmaceutical Sciences , Utrecht University , Utrecht , The Netherlands
| | | | - Dinko Vitezic
- d University of Rijeka School of Medicine and University Hospital Centre Rijeka , Rijeka , Croatia
| | - Catalin Codreanu
- e Center for Rheumatic Diseases , University of Medicine and Pharmacy , Bucharest , Romania
| | - Zoltán Kaló
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy & Health Economics , Faculty of Social Sciences, Eötvös Loránd University (ELTE) Budapest , Hungary
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Strand V, Girolomoni G, Schiestl M, Ernst Mayer R, Friccius-Quecke H, McCamish M. The totality-of-the-evidence approach to the development and assessment of GP2015, a proposed etanercept biosimilar. Curr Med Res Opin 2017; 33:993-1003. [PMID: 28133979 DOI: 10.1080/03007995.2017.1288612] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this review is to describe the inherent variability that is natural to biologics and, using the proposed etanercept biosimilar (GP2015) as an example, provide details on the "totality-of-the-evidence" concept, whereby all physicochemical, biologic, preclinical, and clinical data for a biosimilar and reference medicine are evaluated in an iterative, stepwise manner and shown to be highly similar. METHODS This review was carried out by a search of published articles, reviews, abstracts and patents in PubMed/Medline and Google Scholar up to November 2016. RESULTS Analytical, functional, preclinical, and clinical data provide a comprehensive understanding of both GP2015 and reference etanercept, and demonstrate a high level of similarity between the two products in accordance with regulatory requirements. The totality of the evidence from all analyses and performed trials provides a robust scientific bridge between the biosimilar and clinical experience with the reference medicine, and is used to justify the use of the biosimilar in all indications for which the reference medicine is approved. CONCLUSION Biologic therapies have revolutionized the treatment of immune-mediated inflammatory diseases. The availability of biosimilars has the potential to improve patient access to biologic medicines and stimulate innovation. Physicians may be unfamiliar with the totality-of-the-evidence concept; therefore education and information on this unique approach to developing biosimilars is required to facilitate the use of biosimilars in clinical practice and allow physicians to make informed treatment decisions.
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Affiliation(s)
- Vibeke Strand
- a Division of Immunology/Rheumatology , Stanford University School of Medicine , Palo Alto , California , USA
| | - Giampiero Girolomoni
- b Dermatology and Venereology Section , University of Verona School of Medicine , Verona , Italy
| | - Martin Schiestl
- c Sandoz Biopharmaceuticals, Sandoz International GmbH , Kundl , Austria
| | - Robert Ernst Mayer
- c Sandoz Biopharmaceuticals, Sandoz International GmbH , Kundl , Austria
| | - Hilke Friccius-Quecke
- d Global Biopharmaceutical Development, Sandoz International GmbH , Holzkirchen , Germany
| | - Mark McCamish
- d Global Biopharmaceutical Development, Sandoz International GmbH , Holzkirchen , Germany
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Baji P, Gulácsi L, Brodszky V, Végh Z, Danese S, Irving PM, Peyrin-Biroulet L, Schreiber S, Rencz F, Lakatos PL, Péntek M. Cost-effectiveness of biological treatment sequences for fistulising Crohn's disease across Europe. United European Gastroenterol J 2017; 6:310-321. [PMID: 29511561 DOI: 10.1177/2050640617708952] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/15/2017] [Indexed: 12/18/2022] Open
Abstract
Background In clinical practice, treatment sequences of biologicals are applied for active fistulising Crohn's disease, however underlying health economic analyses are lacking. Objective The purpose of this study was to analyse the cost-effectiveness of different biological sequences including infliximab, biosimilar-infliximab, adalimumab and vedolizumab in nine European countries. Methods A Markov model was developed to compare treatment sequences of one, two and three biologicals from the payer's perspective on a five-year time horizon. Data on effectiveness and health state utilities were obtained from the literature. Country-specific costs were considered. Calculations were performed with both official list prices and estimated real prices of biologicals. Results Biosimilar-infliximab is the most cost-effective treatment against standard care across the countries (with list prices: €34684-€72551/quality adjusted life year; with estimated real prices: €24364-€56086/quality adjusted life year). The most cost-effective two-agent sequence, except for Germany, is the biosimilar-infliximab-adalimumab therapy compared with single biosimilar-infliximab (with list prices: €58533-€133831/quality adjusted life year; with estimated prices: €45513-€105875/quality adjusted life year). The cost-effectiveness of the biosimilar-infliximab-adalimumab-vedolizumab three-agent sequence compared wit biosimilar-infliximab -adalimumab is €87214-€152901/quality adjusted life year. Conclusions The suggested first-choice biological treatment is biosimilar-infliximab. In case of treatment failure, switching to adalimumab then to vedolizumab provides meaningful additional health gains but at increased costs. Inter-country differences in cost-effectiveness are remarkable due to significant differences in costs.
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Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Zsuzsanna Végh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Silvio Danese
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
| | - Peter M Irving
- IBD Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Stefan Schreiber
- Department Internal Medicine I, Kiel University, University Hospital, Kiel, Germany
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Semmelweis University Doctoral School of Clinical Medicine, Budapest, Hungary
| | - Péter L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
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Komaki Y, Yamada A, Komaki F, Micic D, Ido A, Sakuraba A. Systematic review with meta-analysis: the efficacy and safety of CT-P13, a biosimilar of anti-tumour necrosis factor-α agent (infliximab), in inflammatory bowel diseases. Aliment Pharmacol Ther 2017; 45:1043-1057. [PMID: 28239873 DOI: 10.1111/apt.13990] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/23/2016] [Accepted: 01/26/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Biosimilars of anti-tumour necrosis factor (TNF)-α agents have now become clinically available for the treatment of inflammatory bowel diseases (IBD). AIM To perform a systematic review and meta-analysis to evaluate the efficacy and safety of biosimilars of anti-TNF-α agents in patients with IBD. METHODS Electronic databases were searched. The outcomes were the pooled rates of clinical response or remission, sustained clinical response or remission, and adverse events in patients with IBD induced with or switched to biosimilars of anti-TNF-α agents. RESULTS Eleven observational studies reporting outcomes in 829 patients treated with biosimilar of infliximab (CT-P13) were identified. The pooled rates of clinical response among Crohn's disease (CD) and ulcerative colitis (UC) at 8-14 weeks were 0.79 (95% confidence interval (CI) = 0.65-0.88) and 0.74 (95% CI = 0.65-0.82), respectively, and at 24-30 weeks were 0.77 (95% CI = 0.63-0.86) and 0.77 (95% CI = 0.67-0.85) respectively. Adverse events were rare (CD, 0.08 (95% CI = 0.02-0.26); UC, 0.08 (95% CI = 0.03-0.17)). The pooled rates of sustained clinical response among CD and UC after switching from infliximab to CT-P13 at 30-32 weeks were 0.85 (95% CI = 0.71-0.93) and 0.96 (95% CI = 0.58-1.00), respectively, and at 48-63 weeks were 0.75 (95% CI = 0.44-0.92) and 0.83 (95% CI = 0.19-0.99) respectively. Adverse events were rare (CD, 0.10, 95% CI = 0.02-0.31; UC, 0.22, 95% CI = 0.04-0.63). CONCLUSIONS CT-P13 was associated with excellent clinical efficacy and safety profile, supporting its use in the treatment of IBD.
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Affiliation(s)
- Y Komaki
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA
| | - A Yamada
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA
| | - F Komaki
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA
| | - D Micic
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - A Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - A Sakuraba
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA
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Gisondi P, Altomare G, Ayala F, Bardazzi F, Bianchi L, Chiricozzi A, Costanzo A, Conti A, Dapavo P, De Simone C, Foti C, Naldi L, Offidani A, Parodi A, Piaserico S, Prignano F, Rongioletti F, Stingeni L, Talamonti M, Girolomoni G. Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol 2017; 31:774-790. [PMID: 28244153 DOI: 10.1111/jdv.14114] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
Abstract
Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.
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Affiliation(s)
- P Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Altomare
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan, Milano, Italy
| | - F Ayala
- Department of Dermatology, University of Naples Federico II, Napoli, Italy
| | - F Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - L Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - A Chiricozzi
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - A Costanzo
- Department of Dermatology, Humanitas Research Hospital, Rozzano, Italy
| | - A Conti
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - C Foti
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - L Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - A Offidani
- Department of Clinical and Molecular Sciences, Dermatology Unit, Polytechnic Marche University, Ancona, Italy
| | - A Parodi
- Department of Dermatology, University of Genoa, Genova, Italy
| | - S Piaserico
- Department of Dermatology, University of Padua, Padova, Italy
| | - F Prignano
- Department of Dermatology, University of Florence, Firenze, Italy
| | - F Rongioletti
- Department of Medical Sciences and Public Health, Section of Dermatology, University of Cagliari, Cagliari, Italy
| | - L Stingeni
- Department of Medicine, Section of Clinical, Allergological and Venereological Dermatology, University of Perugia, Perugia, Italy
| | - M Talamonti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Komaki Y, Yamada A, Komaki F, Kudaravalli P, Micic D, Ido A, Sakuraba A. Efficacy, safety and pharmacokinetics of biosimilars of anti-tumor necrosis factor-α agents in rheumatic diseases; A systematic review and meta-analysis. J Autoimmun 2017; 79:4-16. [PMID: 28209290 DOI: 10.1016/j.jaut.2017.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/01/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of biosimilars of anti-tumor necrosis factor (TNF)-α agents compared to their reference agents in immune mediated diseases. METHODS Electronic databases were searched for randomized controlled trials (RCTs) assessing the efficacy and safety of biosimilars of anti-TNF-α agents compared to their reference agents in patients with various immune mediated diseases. The outcomes were the rates of clinical response and adverse events among patients treated with biosimilars compared to their reference agents. Additionally, occurrence of anti-drug antibodies with the use of biosimilars was compared to the reference agents. RESULTS Nine studies reporting outcomes in 3291 patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) were identified (5 infliximab, 2 adalimumab, and 2 etanercept). No RCTs in other diseases were found. Biosimilars of infliximab showed similar rates of clinical response compared to the reference agent in RA and AS. Frequency of anti-drug antibody and adverse events were similar except for a slightly, but significantly, higher risk of upper respiratory tract infections with biosimilar (RR 1.54, P = 0.047, 95% confidence interval (CI) = 1.01-2.37). Biosimilar of adalimumab showed no differences among any outcomes compared to the reference agent. Biosimilars of etanercept showed no differences for clinical response and frequency of adverse events, but showed a significantly lower rate of anti-drug antibodies at 24-30 weeks (RR 0.05, P <0.0001%, 95% CI = 0.01-0.21). CONCLUSION In the present study, biosimilars of anti-TNF-α agents had an overall comparable efficacy and safety profile compared to their reference agents in RA and AS supporting their use for these conditions.
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Affiliation(s)
- Yuga Komaki
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA
| | - Akihiro Yamada
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA
| | - Fukiko Komaki
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA
| | | | - Dejan Micic
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, USA.
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Brito-Zerón P, Pérez-Alvarez R, Pallarés L, Retamozo S, Baughman RP, Ramos-Casals M. Sarcoidosis: an update on current pharmacotherapy options and future directions. Expert Opin Pharmacother 2017; 17:2431-2448. [PMID: 27817209 DOI: 10.1080/14656566.2016.1258061] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Sarcoidosis is a systemic disease of unknown etiology characterized by the development of non-caseating epitheloid granulomas. The lungs are the most commonly involved organ (>90% of cases), followed by the lymph nodes, the skin, and the eyes. Areas covered: This review summarizes current pharmacotherapy options and future directions for the development of new therapies. Glucocorticoids are the first-line therapy for sarcoidosis. For patients with the most severe forms of sarcoidosis (who will need glucocorticoids for long periods) and for those intolerant or refractory, immunosuppressive drugs are used as sparing agents. The management of extrathoracic sarcoidosis must be tailored to the specific organ or organs involved; however, there is limited data from controlled trials to guide the treatment of these patients. The emergence of biological therapies has increased the therapeutic armamentarium available to treat sarcoidosis, with monoclonal anti-TNF agents being the most promising, but their use is still limited by a lack of licensing and costs. Expert commentary: The treatment of sarcoidosis is still not totally standardized. New effective therapies are urgently needed to enable the reduction or replacement of long-term therapy with glucocorticoids in patients with sarcoidosis.
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Affiliation(s)
- Pilar Brito-Zerón
- a Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases , ICMiD, Hospital Clínic , Barcelona , Spain.,b Autoimmune Diseases Unit, Department of Medicine , Hospital CIMA- Sanitas , Barcelona , Spain
| | | | - Lucio Pallarés
- d Systemic Autoimmune Diseases Unit, Department of Internal Medicine , Hospital de Son Espases , Palma de Mallorca , Spain
| | - Soledad Retamozo
- a Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases , ICMiD, Hospital Clínic , Barcelona , Spain.,e Hospital Privado , Centro Médico de Córdoba , Córdoba , Argentina
| | - Robert P Baughman
- f Department of Medicine , University of Cincinnati Medical Center , Cincinnati , OH , USA
| | - Manuel Ramos-Casals
- a Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases , ICMiD, Hospital Clínic , Barcelona , Spain.,g Department of Medicine , University of Barcelona , Barcelona , Spain
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31
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Velasco-Velázquez MA, Salinas-Jazmín N, Hisaki-Itaya E, Cobos-Puc L, Xolalpa W, González G, Tenorio-Calvo A, Piña-Lara N, Juárez-Bayardo LC, Flores-Ortiz LF, Medina-Rivero E, Pérez NO, Pérez-Tapia SM. Extensive preclinical evaluation of an infliximab biosimilar candidate. Eur J Pharm Sci 2017; 102:35-45. [PMID: 28188909 DOI: 10.1016/j.ejps.2017.01.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/25/2022]
Abstract
Infliximab is therapeutic monoclonal antibody (mAb) against TNF-α employed in the treatment of immunoinflammatory diseases. The development of biosimilar mAbs is a global strategy to increase drug accessibility and reduce therapy-associated costs. Herein we compared key physicochemical characteristics and biological activities produced by infliximab and infliximab-Probiomed in order to identify functionally relevant differences between the mAbs. Binding of infliximab-Probiomed to TNF-α was specific and had kinetics comparable to that of the reference product. Both mAbs had highly similar neutralizing efficacy in HUVEC cell cultures stimulated with TNF-α. In vitro induction of CDC and ADCC were also similar between the evaluated products. In vivo comparability was assessed using a transgenic mouse model of arthritis that expresses human TNF-α in a 13-week multiple-administration study. Infliximab and infliximab-Probiomed showed comparable efficacy, safety, and pharmacokinetic profiles. Our results indicate that infliximab-Probiomed has highly similar activities to infliximab in preclinical models, warranting a clinical evaluation of its biosimilarity.
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Affiliation(s)
- M A Velasco-Velázquez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Cd. Universitaria, Cd. Mx. 04510, México
| | - N Salinas-Jazmín
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, IPN. Prolongación de Carpio y Plan de Ayala s/n, Col. Sto. Tomás, Cd. Mx. 11340, México
| | - E Hisaki-Itaya
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, IPN. Prolongación de Carpio y Plan de Ayala s/n, Col. Sto. Tomás, Cd. Mx. 11340, México
| | - L Cobos-Puc
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, IPN. Prolongación de Carpio y Plan de Ayala s/n, Col. Sto. Tomás, Cd. Mx. 11340, México
| | - W Xolalpa
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, IPN. Prolongación de Carpio y Plan de Ayala s/n, Col. Sto. Tomás, Cd. Mx. 11340, México
| | - G González
- Unidad de Desarrollo e Investigación, Probiomed S.A. de C.V. Cruce de carreteras Acatzingo-Zumpahuacán, 52400 Tenancingo, México
| | - A Tenorio-Calvo
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, IPN. Prolongación de Carpio y Plan de Ayala s/n, Col. Sto. Tomás, Cd. Mx. 11340, México
| | - N Piña-Lara
- Unidad de Desarrollo e Investigación, Probiomed S.A. de C.V. Cruce de carreteras Acatzingo-Zumpahuacán, 52400 Tenancingo, México
| | - L C Juárez-Bayardo
- Unidad de Desarrollo e Investigación, Probiomed S.A. de C.V. Cruce de carreteras Acatzingo-Zumpahuacán, 52400 Tenancingo, México
| | - L F Flores-Ortiz
- Unidad de Desarrollo e Investigación, Probiomed S.A. de C.V. Cruce de carreteras Acatzingo-Zumpahuacán, 52400 Tenancingo, México
| | - E Medina-Rivero
- Unidad de Desarrollo e Investigación, Probiomed S.A. de C.V. Cruce de carreteras Acatzingo-Zumpahuacán, 52400 Tenancingo, México
| | - N O Pérez
- Unidad de Desarrollo e Investigación, Probiomed S.A. de C.V. Cruce de carreteras Acatzingo-Zumpahuacán, 52400 Tenancingo, México.
| | - S M Pérez-Tapia
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, IPN. Prolongación de Carpio y Plan de Ayala s/n, Col. Sto. Tomás, Cd. Mx. 11340, México; Departamento de Inmunología and Unidad de Investigación Desarrollo e Innovación Médica y Biotecnológica (UDIMEB), Escuela Nacional de Ciencias Biológicas, IPN, México.
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McConachie S, Wilhelm SM, Kale-Pradhan PB. Biosimilars in Inflammatory Bowel Disease - Accumulating Clinical Evidence. Expert Rev Clin Pharmacol 2017; 10:391-400. [DOI: 10.1080/17512433.2017.1283983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sean McConachie
- Department of Pharmacy, Harper University Hospital , Detroit, MI, USA
| | - Sheila M. Wilhelm
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, MI, USA
- Harper University Hospital , Detroit, MI, USA
| | - Pramodini B. Kale-Pradhan
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, MI, USA
- St. John Hospital and Medical Center , Detroit, MI, USA
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Abstract
One of the most striking achievements in the pharmacotherapy of rheumatoid arthritis (RA) and other human immunoinflammatory diseases (IIDs) late in the 20th century is associated with the design of a fundamentally new group of medications that received the name biological agents (BAs). However, the introduction of innovative BAs into clinical practice not only could enhance the efficiency of therapy and improve prognosis in patients with the most severe forms of IIDs, but has also led to a dramatic increase in the cost of treatment. Progress in the design of biosimilars is related to many factors, including expiry of the term of patents for many brand-name BAs, such as infliximab, adalimumab, etanercept, and rituximab. Over the last 5 years, a large number of biosimilars have been designed and their design is being continued. The European Medicines Agency, the World Health Organization, and the U.S. Food and Drug Administration have developed a regulatory framework and general requirements for the manufacture and characteristics of biosimilars. Federal Law No. 429-FZ «On Amendments to the Federal Law "On Circulation of Medicines"» dated December 22, 2014 defines a biosimilar drug as a biological medicine product that is similar to the parameters of quality, efficiency, and safety with the reference biologic drug in the same formulation, and the same route of administration. The review presents an update on the requirements for biosimilars used to treat IIDs, their interchangeability and promises in further clinical application. Particular emphasis is laid on the chimeric monoclonal antibodies to tumor necrosis factor-α infliximab biosimilar Flammegis (Egis Pharmaceuticals, Hungary), that has been registered in Russia for the treatment of RA, ankylosing spondylitis and other IIDs, as well as the chimeric monoclonal antibodies to B-lymphocytes rituximab biosimilar Acellbia in a phase III clinical trial that is in the closing stage. Preliminary provisions and recommendations of the All-Russian public organization «Association of Rheumatologists of Russia» concerning the place of biosimilars in rheumatology are formulated.
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Affiliation(s)
- E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology
Institute of Professional Education, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
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Beck M, Michel B, Rybarczyk-Vigouret MC, Levêque D, Sordet C, Sibilia J, Velten M. Knowledge, behaviors and practices of community and hospital pharmacists towards biosimilar medicines: Results of a French web-based survey. MAbs 2016; 9:383-390. [PMID: 27929743 DOI: 10.1080/19420862.2016.1267087] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study's aims were: 1) to extract a comprehensive overview of the knowledge, experience and opinions of both community pharmacists and hospital pharmacists regarding biosimilar medicines in France; and 2) to identify the perceived problems and solutions to promoting their prescription. A 2015 web-based survey was conducted by the Observatoire des Médicaments, des Dispositifs Médicaux et de l'Innovation Thérapeutique of Alsace. A total of 802 pharmacists responded to the survey. Many (536, 66.8%, [95% confidence interval (CI) 63.6-70.1]) indicated that they were not familiar with biosimilars. Half of community pharmacists (95% CI 42.7-57.3) stated that they were not at all informed about biosimilar drugs, compared with 15.7% (95% CI 12.9-18.6) of hospital pharmacists. Almost all respondents (781, 97.4%, [95% CI 96.3-98.5]) had at least one pending question on biosimilars. Most of the questions were related to the manufacturing process, safety, substitution rules and the international non-proprietary name prescription. At the time of the study, 467 pharmacists (58.2%, [95% CI 54.8-61.6]) had already validated a prescription for a biosimilar drug, mainly for filgrastim. These latter were more comfortable in explaining the benefit of biosimilar medicines to the patient. Pharmacists were rather favorable to biosimilar drugs, and about 9 of 10 quoted healthcare cost savings as incentives to their prescription. However, many did not agree with allowing biosimilar substitution. "Patients' wishes to be treated with the originator" and "indication extrapolation" were the two main constraints identified. The survey highlighted the need to provide French pharmacists with accurate and comprehensive information regarding biosimilar medicines.
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Affiliation(s)
- Morgane Beck
- a OMEDIT Alsace, Agence Régionale de Santé Alsace Champagne-Ardenne Lorraine , Strasbourg , France
| | - Bruno Michel
- a OMEDIT Alsace, Agence Régionale de Santé Alsace Champagne-Ardenne Lorraine , Strasbourg , France.,b Service de Pharmacie-Stérilisation, C.H.R.U. Hôpitaux Universitaires de Strasbourg , Strasbourg , France.,c Laboratoire HuManiS (EA 7308), Faculté de pharmacie, Université de Strasbourg , Strasbourg , France
| | | | - Dominique Levêque
- b Service de Pharmacie-Stérilisation, C.H.R.U. Hôpitaux Universitaires de Strasbourg , Strasbourg , France
| | - Christelle Sordet
- d Service de Rhumatologie, C.H.R.U. Hôpitaux Universitaires de Strasbourg , Strasbourg , France
| | - Jean Sibilia
- d Service de Rhumatologie, C.H.R.U. Hôpitaux Universitaires de Strasbourg , Strasbourg , France
| | - Michel Velten
- e Laboratoire d'épidémiologie et de santé publique - EA3430, Faculté de Médecine, Université de Strasbourg , Strasbourg , France
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Beck M, Michel B, Rybarczyk-Vigouret MC, Levêque D, Sordet C, Sibilia J, Velten M. Rheumatologists’ Perceptions of Biosimilar Medicines Prescription: Findings from a French Web-Based Survey. BioDrugs 2016; 30:585-592. [DOI: 10.1007/s40259-016-0202-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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A Critical Review of Biosimilars in IBD: The Confluence of Biologic Drug Development, Regulatory Requirements, Clinical Outcomes, and Big Business. Inflamm Bowel Dis 2016; 22:2513-26. [PMID: 27564646 DOI: 10.1097/mib.0000000000000886] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
On February 9, 2016, the Food and Drug Administration Arthritis Advisory Committee recommended by a vote of 21 to 3, that the biosimilar to infliximab, CT-P13, be approved for rheumatoid arthritis and ankylosing spondylitis and, by extrapolation, for all the indications for which infliximab is currently approved, including adult and pediatric ulcerative colitis and Crohn's disease. On April 5, 2016, the Food and Drug Administration concurred with this recommendation and approved CT-P13 (Inflectra; Pfizer Inc.) for all diseases for which infliximab had previously been approved, including adult and pediatric moderate to severe ulcerative colitis and pediatric and adult moderate to severe and fistulizing Crohn's disease. This was despite the absence of any randomized controlled trials studying the infliximab biosimilar in any inflammatory bowel disease. This highly controversial approach has been criticized by various rheumatology and gastroenterology professional societies around the world. This review will cover the stepwise approach to biosimilar development, issues of extrapolation and interchangeability, and conclude with a discussion of the regulatory, intellectual property issues, and financial implications, which will all intersect in the decision and ability to prescribe a biosimilar or reference anti-tumor necrosis factor drug.
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Infliximab Biosimilar (CT-P13; Infliximab-dyyb): A Review in Autoimmune Inflammatory Diseases. BioDrugs 2016; 30:469-480. [DOI: 10.1007/s40259-016-0193-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Sieczkowska J, Jarzębicka D, Meglicka M, Oracz G, Kierkus J. Experience with biosimilar infliximab (CT-P13) in paediatric patients with inflammatory bowel diseases. Therap Adv Gastroenterol 2016; 9:729-35. [PMID: 27582886 PMCID: PMC4984328 DOI: 10.1177/1756283x16650155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Infliximab was the first monoclonal antibody used in the treatment of inflammatory bowel disease (IBD). Over several years, this antitumour necrosis factor (TNF) treatment proved its efficacy in both induction and maintenance therapy. In many cases this biological treatment stopped the progression of the disease, probably also decreasing morbidity and hospitalization rates, and improving patients' comfort. When the patent on infliximab started to expire, the first biosimilar of a monoclonal antibody was introduced onto the pharmacological market. Biosimilar infliximab was studied in rheumatology and proved a high similarity to the reference drug. Based on extrapolation, biosimilars were approved to treat adult and paediatric IBD patients. Biosimilar infliximab, mainly because of its lower cost, has started to be in common use in Europe. The first studies have shown a similar efficacy and safety profile in comparison with reference drug. Biosimilar infliximab is raising hopes for improving the availability of this effective treatment.
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Affiliation(s)
- Joanna Sieczkowska
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Dorota Jarzębicka
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Monika Meglicka
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Grzegorz Oracz
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children’s Memorial Health Institute, Warsaw, Poland
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Pasina L, Casadei G, Nobili A. Biological agents and biosimilars: Essential information for the internist. Eur J Intern Med 2016; 33:28-35. [PMID: 27342030 DOI: 10.1016/j.ejim.2016.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/19/2022]
Abstract
Biologics embrace a wide range of substances synthesized by cells or living organisms by means of different biological processes, including recombinant DNA technology, controlled gene expression, or antibody technologies. A biosimilar establishes similarity to the reference medicinal product in terms of quality characteristics, biological activity, safety, and efficacy based on a comprehensive comparability exercise. Minimizing development costs and accelerating their market access create a convergence of interests between health services, worried about sustainability, and generic manufacturers. While the demonstration of bioequivalence is sufficient for small synthetic molecules, this approach is not scientifically applicable to a copy of biological drug constituted by large and complex molecules, which are similar but not identical to the originator and are also subject to different post-translational processes. Internists should be confident that the development process of biosimilars ensures a comparable risk-to-benefit balance with the originators. On the basis of available evidence and pharmacovigilance network, there are no grounds to believe that the use of a biosimilar carries more risks for the patient than the use of an originator. Since the first biosimilar was authorized in Europe in 2006, no clinical alerts have raised red flags about the established EMA biosimilar pathway. In this article, we discuss some of the most frequent concerns raised by clinicians about biosimilars and try to explains the scientific principles underlying the biosimilar concept established in the EU in order to license biosimilar drugs.
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Affiliation(s)
- Luca Pasina
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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Hudson M, Tascilar K, Suissa S. Comparative effectiveness research with administrative health data in rheumatoid arthritis. Nat Rev Rheumatol 2016; 12:358-66. [DOI: 10.1038/nrrheum.2016.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Beck M, Michel B, Rybarczyk-Vigouret MC, Sordet C, Sibilia J, Velten M. Biosimilar infliximab for the management of rheumatoid arthritis in France: what are the expected savings? Eur J Hosp Pharm 2016; 24:85-90. [PMID: 31156910 DOI: 10.1136/ejhpharm-2016-000904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 12/30/2022] Open
Abstract
Objectives Biosimilar infliximab, the first similar biological medicinal product containing monoclonal antibodies to be commercialised, is likely to contribute to a significant reduction in healthcare costs. We aimed to assess the cost savings potential over 1 year of the use of biosimilar infliximab for the treatment of rheumatoid arthritis (RA) patients in Alsace and in France, in a real-life setting. Methods The analysis was based on a previously conducted observational study which evaluated the annual cost of the care of patients with RA treated with biological therapies in 2012 in Alsace. Average annual costs to manage RA patients were calculated, taking into account the decrease in the retail price between 2012 and 2015 (as given in the official national price list) and the local negotiated price for biosimilar infliximab. Annual cost savings for different biosimilar prescription scenarios were calculated using 2015 prices. Results Management of RA patients with biosimilar infliximab was significantly cheaper than with adalimumab or etanercept (€11 907 vs €12 981 and €13 551, respectively). The projected annual cost savings reached €13.6 million nationally, if all adult RA patients treated with the originator infliximab switched to the biosimilar drug. These savings, if fully reallocated for the treatment of RA, would enable the treatment of 1141 additional patients. Conclusions The study showed a positive financial impact of introducing biosimilar infliximab for the treatment of RA patients in France. Such savings could contribute to improved patient care by allowing more patients to be treated without more money being spent.
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Affiliation(s)
- M Beck
- OMEDIT Alsace, Agence Régionale de Santé d'Alsace, Strasbourg, France
| | - B Michel
- OMEDIT Alsace, Agence Régionale de Santé d'Alsace, Strasbourg, France.,Service de Pharmacie-Stérilisation, C.H.R.U. Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - C Sordet
- Service de Rhumatologie, C.H.R.U. Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J Sibilia
- Service de Rhumatologie, C.H.R.U. Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Velten
- Laboratoire d'épidémiologie et de santé publique-EA3430, Faculté de Médecine, Université de Strasbourg, Strasbourg, France
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Hernández MV, Sanmartí R, Cañete JD. The safety of tumor necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis. Expert Opin Drug Saf 2016; 15:613-24. [PMID: 26927029 DOI: 10.1517/14740338.2016.1160054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Tumor necrosis factor inhibitors (TNFi) were the first biologic therapy authorized for rheumatoid arthritis (RA) treatment and are currently the most used biological drugs in these patients. Although clinical efficacy is proven, adverse events associated with these agents have been described, and further knowledge is essential to facilitate detection at very early stages. AREAS COVERED We reviewed the safety profile of TNFi, including both articles and congress communications published on this topic, such as clinical trials, meta-analyses, observational studies, data from registries, and spontaneous clinical reports. We classified studies according to the most common and relevant adverse events associated with TNFi. EXPERT OPINION There is a broad spectrum of possible adverse events associated with TNFi treatment, ranging from mild to serious, and with diverse clinical manifestations. However, most adverse events may be minimized by appropriate screening before starting treatment and with ongoing surveillance to ensure an early diagnosis. In conclusion, TNFi have a reasonable safety profile, and, globally, the benefits far outweigh the possible risk of adverse events, especially compared with the risk of the untreated underlying inflammatory condition.
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Affiliation(s)
| | - Raimon Sanmartí
- a Arthritis Unit, Rheumatology Department , Hospital Clínic of Barcelona , Barcelona , Spain
| | - Juan D Cañete
- a Arthritis Unit, Rheumatology Department , Hospital Clínic of Barcelona , Barcelona , Spain
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Villacorta R. A biosimilarity index for psoriasis. Br J Dermatol 2016; 174:259-60. [PMID: 26871915 DOI: 10.1111/bjd.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Villacorta
- Informatics and Research Analytics, Independence Blue Cross, 1901 Market Street, Philadelphia, PA, U.S.A..
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