1
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Enzymatic synthesis of low molecular weight heparins from N-sulfo heparosan depolymerized by heparanase or heparin lyase. Carbohydr Polym 2022; 295:119825. [DOI: 10.1016/j.carbpol.2022.119825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/22/2022]
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2
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Qneibi D, Ramacciotti E, Macedo AS, Caffaro RA, Agati LB, Siddiqui F, Kouta A, Hoppensteadt D, Fareed J, Carter CA. Comparative Studies on the Anticoagulant Profile of Branded Enoxaparin and a New Biosimilar Version. Clin Appl Thromb Hemost 2021; 26:1076029620960820. [PMID: 32996340 PMCID: PMC7533927 DOI: 10.1177/1076029620960820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Low molecular weight heparins (LMWH) represent depolymerized heparin prepared by various methods that exhibit differential, biochemical and pharmacological profiles. Enoxaparin is prepared by benzylation followed by alkaline depolymerization of porcine heparin. Upon the expiration of its patent, several biosimilar versions of enoxaparin have become available. Heparinox (Sodic enoxaparine; Cristália Produtos Químicos Farmacêuticos LTDA, Sao Paulo, Brazil) is a new biosimilar form of enoxaparin. We assessed the molecular weight and the biochemical profile of Heparinox and compared its properties to the original branded enoxaparin (Lovenox; Sanofi, Paris, France). Clotting profiles compared included activated clotting time, activated partial thromboplastin time (aPTT), and thrombin time (TT). Anti-protease assays included anti-factor Xa and anti-factor IIa activities. Thrombin generation was measured using a calibrated automated thrombogram and thrombokinetic profile included peak thrombin, lag time and area under the curve. USP potency was determined using commercially available assay kits. Molecular weight profiling was determined using high performance liquid chromatography. We determined that Heparinox and Lovenox were comparable in their molecular weight profile. Th anticoagulant profile of the branded and biosimilar version were also similar in the clot based aPTT and TT. Similarly, the anti-Xa and anti-IIa activities were comparable in the products. No differences were noted in the thrombin generation inhibitory profile of the branded and biosimilar versions of enoxaparin. Our studies suggest that Heparinox is bioequivalent to the original branded enoxaparin based upon in vitro tests however will require further in vivo studies in animal models and humans to determine their clinical bioequivalence.
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Affiliation(s)
- Dalia Qneibi
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Department of Pathology and Laboratory Medicines, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | | | | | | | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Ahmed Kouta
- Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Charles A Carter
- Department of Clinical Research, College of Pharmacy & Health Sciences, 2078Campbell University, Buies Creek, NC, USA
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3
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Brouwers JRBJ, Roeters van Lennep JE, Beinema MJ. Biosimilars of low molecular weight heparins: Relevant background information for your drug formulary. Br J Clin Pharmacol 2019; 85:2479-2486. [PMID: 31378961 DOI: 10.1111/bcp.14081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 12/27/2022] Open
Abstract
Biosimilars of low molecular weight heparins (LMWHs) are more alike the originator than different branded LMWHs. The latter differ largely in molecular weight, anti-FXa/anti-FIIa ratio and antithrombin binding. The Food and Drug Administration and European Medicines Agency guidelines are sufficient for the clinical use of high quality LMWHs. However, the Food and Drug Administration guideline lacks the results of a phase I clinical trial in the approval process. Most information about biosimilars is available for enoxaparin given that many biosimilars of enoxaparin have received market access. The guidelines of many International Thrombosis Societies for LMWH biosimilars are too stringent, not updated and impractical for formulary uptake discussions. This review gives background information on critical factors for the formulary uptake process of LMWHs with special attention for the use of the System of Objectified Judgment Analysis/Infomatrix model.
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Affiliation(s)
- Jacobus R B J Brouwers
- Unit Pharmacotherapy -Epidemiology and -Economy, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Expertise Centre Pharmacotherapy in Old Persons, Oranjewoud, The Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine-subdivision Vascular Medicine, Erasmus Medical Center Rotterdam, The Netherlands
| | - Maarten J Beinema
- Anticoagualation Center, Deventer Hospital, Deventer, The Netherlands
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4
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Sadowski R, Gadzała-Kopciuch R, Buszewski B. Recent Developments in the Separation of Low Molecular Weight Heparin Anticoagulants. Curr Med Chem 2019; 26:166-176. [PMID: 28982317 DOI: 10.2174/0929867324666171005114150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/11/2016] [Accepted: 09/05/2017] [Indexed: 11/22/2022]
Abstract
The general function of anticoagulants is to prevent blood clotting and growing of the existing clots in blood vessels. In recent years, there has been a significant improvement in developing methods of prevention as well as pharmacologic and surgical treatment of thrombosis. For over the last two decades, low molecular weight heparins (LMWHs) have found their application in the antithrombotic diseases treatment. These types of drugs are widely used in clinical therapy. Despite the biological and medical importance of LMWHs, they have not been completely characterized in terms of their chemical structure. Due to both, the structural complexity of these anticoagulants and the presence of impurities, their structural characterization requires the employment of advanced analytical techniques. Since separation techniques play the key role in these endeavors, this review will focus on the presentation of recent developments in the separation of LMWH anticoagulants.
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Affiliation(s)
- Radosław Sadowski
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Torun, Poland.,Interdisciplinary Centre of Modern Technologies, Nicolaus Copernicus University, Toruń, Poland
| | - Renata Gadzała-Kopciuch
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Torun, Poland.,Interdisciplinary Centre of Modern Technologies, Nicolaus Copernicus University, Toruń, Poland
| | - Bogusław Buszewski
- Department of Environmental Chemistry and Bioanalytics, Faculty of Chemistry, Nicolaus Copernicus University, Torun, Poland.,Interdisciplinary Centre of Modern Technologies, Nicolaus Copernicus University, Toruń, Poland
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5
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Ramacciotti E, Ferreira U, Costa AJV, Raymundo SRO, Correa JA, Neto SG, Osvaldt AB, Agati L, Aguiar VCR, Davila R, Caltabiano TB, Magella FM, Volpiani GG, Castelli V, Caffaro RA, DalAcqua LZ, Matheus WE, Sato DY, Russeff GJDS, de Souza DG, Pazetto LE, de Lima TAM, Colnago EMDS, Fugii EY, Mussalem JS, Assao VT, Toffoletto O, Rodrigues DG, Afiune JB, Araujo GR. Efficacy and Safety of a Biosimilar Versus Branded Enoxaparin in the Prevention of Venous Thromboembolism Following Major Abdominal Surgery: A Randomized, Prospective, Single-Blinded, Multicenter Clinical Trial. Clin Appl Thromb Hemost 2018; 24:1208-1215. [PMID: 30021463 PMCID: PMC6714771 DOI: 10.1177/1076029618786583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several biosimilar versions of enoxaparin are already approved and in use globally. Analytical characterization can establish good quality control in manufacturing, but they may not assure similarity in clinical outcomes between biosimilar and branded enoxaparin. This study evaluated the efficacy and safety of biosimilar Cristália versus branded Sanofi enoxaparin in venous thromboembolism (VTE) prevention in patients undergoing major abdominal surgery at risk for VTE. In this randomized, prospective single-blind study, we compared Cristália enoxaparin (Ce), a biosimilar version, versus branded Sanofi enoxaparin (Se; at a dose of 40 mg subcutaneously per day postoperatively from 7 to 10 days) in 243 patients submitted to major abdominal surgery at risk for VTE for VTE prevention. The primary efficacy outcome was occurrence of VTE or death related to VTE. The principal safety outcomes were a combination of major bleeding and clinically relevant non-major bleeding. Bilateral duplex scanning of the legs was performed from days 10 to 14, and follow-ups were performed up to 60 days after surgery. The incidence of VTE was 4.9% in the Cristália group and 1.1% in the Sanofi group (absolute risk difference = 3.80%, 95% confidence interval [CI]: −1.4%-9.0%) yielding noninferiority since the 95% CI does not reach the prespecified value Δ = 20%. Clinically significant bleeding occurred in 9.9% in the Cristália group and in 5.5% in the Sanofi group (n.s. ). In conclusion, this study suggests that 40 mg once daily of Ce, a biosimilar enoxaparin, is as effective and safe as the branded Sanofi enoxaparin in the prophylaxis of VTE in patients submitted to major abdominal surgery at risk for VTE.
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Affiliation(s)
- Eduardo Ramacciotti
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,2 Loyola University Medical Center, Maywood, IL, USA
| | - Ubirajara Ferreira
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Agenor José Vasconcelos Costa
- 4 Vascular Surgery Department, Hospital Estadual Mário Covas, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | - João Antônio Correa
- 6 Vascular Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, São Paulo, Brazil
| | - Salvador Gullo Neto
- 7 Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Leandro Agati
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil
| | | | - Ronaldo Davila
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Flávia Magalhães Magella
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil
| | - Giuliano Giova Volpiani
- 1 Vascular Surgery, Hospital e Maternidade Dr. Christóvão da Gama, Santo André, São Paulo, Brazil.,9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Valter Castelli
- 9 Vascular Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Lucas Zeponi DalAcqua
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Wagner Eduardo Matheus
- 3 Oncological Urology Group-FCM-UNICAMP-Universidade Estadual de Campinas, São Paulo, Brazil
| | - Debora Yuri Sato
- 5 Fundação Faculdade Regional de Medicina de São José do Rio Preto, São Paulo, Brazil
| | | | | | - Lucas Eduardo Pazetto
- 5 Fundação Faculdade Regional de Medicina de São José do Rio Preto, São Paulo, Brazil
| | | | | | - Eliane Yumii Fugii
- 6 Vascular Surgery, Hospital de Ensino da Faculdade de Medicina do ABC, São Paulo, Brazil
| | | | | | - Odaly Toffoletto
- 10 Cristália Produtos Químicos Farmacêuticos LTDA, São Paulo, Brazil
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6
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Choi JM, Bourassa V, Hong K, Shoga M, Lim EY, Park A, Apaydin K, Udit AK. Polyvalent Hybrid Virus-Like Nanoparticles with Displayed Heparin Antagonist Peptides. Mol Pharm 2018; 15:2997-3004. [DOI: 10.1021/acs.molpharmaceut.8b00135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Justin M. Choi
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Valerie Bourassa
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Kevin Hong
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Michael Shoga
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Elizabeth Y. Lim
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Andrew Park
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Kazim Apaydin
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Andrew K. Udit
- Department of Chemistry, Occidental College, Los Angeles, California 90041, United States
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7
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Nahain AA, Ignjatovic V, Monagle P, Tsanaktsidis J, Ferro V. Heparin mimetics with anticoagulant activity. Med Res Rev 2018; 38:1582-1613. [PMID: 29446104 DOI: 10.1002/med.21489] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/16/2017] [Accepted: 01/12/2018] [Indexed: 01/10/2023]
Abstract
Heparin, a sulfated polysaccharide belonging to the glycosaminoglycan family, has been widely used as an anticoagulant drug for decades and remains the most commonly used parenteral anticoagulant in adults and children. However, heparin has important clinical limitations and is derived from animal sources which pose significant safety and supply problems. The ever growing shortage of the raw material for heparin manufacturing may become a very significant issue in the future. These global limitations have prompted much research, especially following the recent well-publicized contamination scandal, into the development of alternative anticoagulants derived from non-animal and/or totally synthetic sources that mimic the structural features and properties of heparin. Such compounds, termed heparin mimetics, are also needed as anticoagulant materials for use in biomedical applications (e.g., stents, grafts, implants etc.). This review encompasses the development of heparin mimetics of various structural classes, including synthetic polymers and non-carbohydrate small molecules as well as sulfated oligo- and polysaccharides, and fondaparinux derivatives and conjugates, with a focus on developments in the past 10 years.
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Affiliation(s)
- Abdullah Al Nahain
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Clinical Haematology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - John Tsanaktsidis
- CSIRO Materials Science and Engineering, Clayton South, Victoria, Australia
| | - Vito Ferro
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
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8
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Ofosu F. A review of the two major regulatory pathways for non-proprietary low-molecular-weight heparins. Thromb Haemost 2017; 107:201-14. [DOI: 10.1160/th11-06-0409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 11/12/2011] [Indexed: 11/05/2022]
Abstract
SummaryWith the expiry or pending expiry of originator low-molecular-weight heparin (LMWH) patents, pharmaceutical companies have invested in developing non-proprietary versions of LMWHs. LMWHs are manufactured by depolymerising highly purified unfractionated heparin. In contrast to traditional synthetic drugs with well-defined chemical structures, LMWHs contain complex oligosaccharide mixtures and the different manufacturing processes for LMWHs add to the heterogeneity in their physicochemical properties such that the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) consider existing originator LMWHs to be distinct medicinal entities that are not clinically interchangeable. The FDA views LMWHs as drugs and has approved two non-proprietary (generic) LMWHs, using the Abbreviated New Drug Application pathway. In contrast, the World Health Organization and the EMA view LMWHs as biological medicines. Therefore, the EMA and also the Scientific and Standardization Subcommittee on Anticoagulation of the International Society on Thrombosis and Haemostasis and the South Asian Society of Atherosclerosis and Thrombosis have all published specific guidelines for assessing non-proprietary (biosimilar) LMWHs. This manuscript reviews why there are two distinct pathways for approving non-proprietary LMWHs. Available literature on non-proprietary LMWHs approved in some jurisdictions is also reviewed in order to assess whether they satisfy the requirements for LMWHs in the three guidance documents. The review also highlights some of the significant difficulties the two pathways pose for manufacturers and an urgent need to develop a consensus governing the manufacture and regulation of non-proprietary LMWHs to make them more widely available.
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9
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Cheong HY, Groner M, Hong K, Lynch B, Hollingsworth WR, Polonskaya Z, Rhee JK, Baksh MM, Finn MG, Gale AJ, Udit AK. Heparin Binding to an Engineered Virus-like Nanoparticle Antagonist. Biomacromolecules 2017; 18:4113-4120. [DOI: 10.1021/acs.biomac.7b01174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ho Yong Cheong
- Department
of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Myles Groner
- Department
of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Kevin Hong
- Department
of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | - Brennen Lynch
- Department
of Chemistry, Occidental College, Los Angeles, California 90041, United States
| | | | - Zinaida Polonskaya
- Department
of Chemistry, The Scripps Research Institute, La Jolla, California 92037, United States
| | - Jin-Kyu Rhee
- Department
of Food Science and Engineering, Ewha Womans University, Seou 03760, Korea
| | - Michael M. Baksh
- School
of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - M. G. Finn
- School
of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Andrew J. Gale
- Department
of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California 92037, United States
| | - Andrew K. Udit
- Department
of Chemistry, Occidental College, Los Angeles, California 90041, United States
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10
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Hiebert LM. Repeated Oral or Subcutaneous LMWH Has similar Antithrombotic Activity in a Rat Venous Thrombosis Model: Antithrombotic Activity Correlates With Heparin on Endothelium When Orally Administered. J Cardiovasc Pharmacol Ther 2016; 22:264-272. [PMID: 27653610 DOI: 10.1177/1074248416667601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-molecular-weight heparins (LMWHs) endure as important drugs for thromboprophylaxis. Although clinical use relies on the subcutaneous (SC) route, our previous studies show that single-dose orally administered LMWHs have antithrombotic activity. Since thromboprophylaxis requires long-term treatment, we examined antithrombotic effects of subacute oral LMWHs in a rat venous thrombosis model and compared results to SC or single-dose oral administration. We measured LMWH in endothelium and plasma, weight change and complete blood counts (CBC). Oral LMWH tinzaparin (3 × 0.1 mg/kg/12 or 24 hours) or reviparin (3 × 0.025 mg/kg/24 hours) significantly decreased thrombosis compared to saline. In the subacute study (60 × 0.1 mg/kg/12 hours), oral or SC tinzaparin significantly reduced thrombosis compared to saline but not to single or 3 × 0.1 mg/kg/12 hours oral tinzaparin. Antithrombotic effects were similar between oral and SC administration. LMWH was found on endothelium following oral but not SC administration. Endothelial concentrations were significantly correlated with incidence of stable thrombi ( P = 0.021 and 0.04 for aortic and vena cava endothelium respectively, χ2 test) and total thrombi ( P = 0.003 for vena cava endothelium). Anti-Xa activity was significantly greater for oral or SC LMWH than saline and significantly greater for SC versus oral LMWH. Values for CBCs were within normal ranges (mean ± 2 SD). There was no evidence of bleeding. Weight gain was similar between groups. In conclusion, subacute oral and SC LMWH have similar antithrombotic effects. Antithrombotic activity with oral administration is correlated with endothelial LMWH concentrations but not with plasma anticoagulant activity.
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Affiliation(s)
- Linda M Hiebert
- 1 Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
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11
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Nandurkar H, Chong B, Salem H, Gallus A, Ferro V, McKinnon R. Low-molecular-weight heparin biosimilars: potential implications for clinical practice. Australian Low-Molecular-Weight Heparin Biosimilar Working Group (ALBW). Intern Med J 2015; 44:497-500. [PMID: 24816308 DOI: 10.1111/imj.12417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/29/2013] [Indexed: 11/28/2022]
Abstract
A working group of clinicians and scientists was formed to review the clinical considerations for use of low-molecular-weight heparin (LMWH) biosimilars. LMWH are biological molecules of significant complexity; the full complexity of chemical structure is still to be elucidated. LMWH biosimilars are products that are biologically similar to their reference product and rely on clinical data from a reference product to establish safety and efficacy. The complex nature of LMWH molecules means that it is uncertain whether a LMWH biosimilar is chemically identical to its reference product; this introduces the possibility of differences in activity and immunogenicity. The challenge for regulators and clinicians is to evaluate the level of evidence required to demonstrate that a LMWH is sufficiently similar to the reference product. The consensus opinion of the working group is that prior to clinical use a LMWH biosimilar should have proven efficacy and safety, similar to the reference product with prospective studies, which should be confirmed with a proactive post-marketing pharmacovigilance programme.
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Affiliation(s)
- H Nandurkar
- Department of Medicine and Haematology, The University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia
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12
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Dooley C, Kaur R, Sobieraj DM. Comparison of the efficacy and safety of low molecular weight heparins for venous thromboembolism prophylaxis in medically ill patients. Curr Med Res Opin 2014; 30:367-80. [PMID: 23971722 DOI: 10.1185/03007995.2013.837818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To conduct a systematic review and mixed-treatment comparison (MTC) meta-analysis to compare the efficacy and safety of low molecular weight heparins (LMWHs) for venous thromboembolism (VTE) prophylaxis in hospitalized medically ill patients. As a secondary objective we compared all therapies within the network to each other. METHODS We conducted a systematic literature search for randomized trials that evaluated pharmacologic VTE prophylaxis in hospitalized medically ill patients. We conducted a traditional meta-analysis for all pairwise comparisons using a random effects model, reporting relative risks (RRs) and 95% confidence intervals for each outcome. To determine the relative efficacy and safety of included therapies we conducted a MTC meta-analysis using a Bayesian framework, reporting odds ratios (OR) and 95% credible intervals. RESULTS Twenty trials met inclusion criteria. Enoxaparin, dalteparin, nadroparin and certoparin were the LMWHs evaluated although none in direct comparative trials. Upon MTC, the relative efficacy of all LMWHs was similar in preventing mortality and VTE as well as in the odds of major and minor bleeding. Dalteparin was not included in the network to evaluate deep vein thrombosis (DVT) and pulmonary embolism (PE) due to lack of reported data and the remaining LMWHs were found to be similar in relative efficacy in preventing these outcomes. LIMITATIONS Traditional meta-analysis was not possible for many drug comparisons made within the MTC. Heterogeneity was observed in several of the traditional meta-analyses although this may be an inherent limitation of the studied population. Overall rarity of events contributed to imprecise estimates demonstrated by the wide confidence intervals. CONCLUSIONS Enoxaparin, dalteparin, nadroparin and certoparin are similar in relative efficacy for the prevention of mortality and VTE and in the odds of major or minor bleeding while enoxaparin, nadroparin and certoparin are similar in relative efficacy for the prevention of PE and DVT in hospitalized medical patients.
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13
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Walenga JM, Lyman GH. Evolution of heparin anticoagulants to ultra-low-molecular-weight heparins: a review of pharmacologic and clinical differences and applications in patients with cancer. Crit Rev Oncol Hematol 2013; 88:1-18. [PMID: 23849978 DOI: 10.1016/j.critrevonc.2013.06.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/22/2013] [Accepted: 06/14/2013] [Indexed: 01/26/2023] Open
Abstract
The burden of venous thromboembolism (VTE) is high in patients with cancer, particularly those with metastatic disease and those receiving chemotherapy. The use of heparin and heparin derivatives should be considered for primary prevention of VTE in hospitalized patients with cancer and in patients undergoing cancer surgery. Preliminary evidence also suggests that heparins may have direct anticancer benefits owing to effects on tumor growth, angiogenesis, and metastasis. Despite the potential benefits of heparin-derived anticoagulants, many at-risk patients do not receive adequate thromboprophylaxis. The evolution of unfractionated heparin to low-molecular-weight and ultra-low-molecular-weight heparins has provided practitioners with alternatives for VTE prevention in cancer, although these alternatives present challenges related to clinically relevant pharmacologic differences between agents. In this review, we present results from our review of the medical literature focusing on the use of the heparin-derived anticoagulants in prospective interventional studies of primary thromboprophylaxis in patients with cancer in surgical, hospitalized, and ambulatory settings.
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Affiliation(s)
- Jeanine M Walenga
- Thoracic & Cardiovascular Surgery and Pathology, Cardiovascular Institute, Loyola University Medical Center, Maywood, IL, USA.
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14
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Scientific considerations in the review and approval of generic enoxaparin in the United States. Nat Biotechnol 2013; 31:220-6. [DOI: 10.1038/nbt.2528] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 02/08/2013] [Indexed: 12/16/2022]
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Inchiosa MA, Pothula S, Kubal K, Sanchala VT, Navarro I. Rapid point-of-care assay of enoxaparin anticoagulant efficacy in whole blood. J Vis Exp 2012:3852. [PMID: 23093300 PMCID: PMC3490316 DOI: 10.3791/3852] [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] [Indexed: 10/31/2022] Open
Abstract
There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the low-molecular-weight-heparin (LMWH), enoxaparin. There are also urgent clinical situations where it would be important if this could be determined rapidly. The present assay is designed to accomplish this. We only assayed human blood samples that were spiked with known concentrations of enoxaparin. The essential feature of the present assay is the quantification of the efficacy of enoxaparin in a patient's blood sample by degrading it to complete inactivity with heparinase. Two blood samples were drawn into Vacutainer tubes (Becton-Dickenson; Franklin Lakes, NJ) that were spiked with enoxaparin; one sample was digested with heparinase for 5 min at 37 °C, the other sample represented the patient's baseline anticoagulated status. The percent shortening of clotting time in the heparinase-treated sample, as compared to the baseline state, yielded the anticoagulant contribution of enoxaparin. We used the portable, battery operated Hemochron 801 apparatus for measurements of clotting times (International Technidyne Corp., Edison, NJ). The apparatus has 2 thermostatically controlled (37 °C) assay tube wells. We conducted the assays in two types of assay cartridges that are available from the manufacturer of the instrument. One cartridge was modified to increase its sensitivity. We removed the kaolin from the FTK-ACT cartridge by extensive rinsing with distilled water, leaving only the glass surface of the tube, and perhaps the detection magnet, as activators. We called this our minimally activated assay (MAA). The use of a minimally activated assay has been studied by us and others. (2-4) The second cartridge that was studied was an activated partial thromboplastin time (aPTT) assay (A104). This was used as supplied from the manufacturer. The thermostated wells of the instrument were used for both the heparinase digestion and coagulation assays. The assay can be completed within 10 min. The MAA assay showed robust changes in clotting time after heparinase digestion of enoxaparin over a typical clinical concentration range. At 0.2 anti-Xa I.U. of enoxaparin per ml of blood sample, heparinase digestion caused an average decrease of 9.8% (20.4 sec) in clotting time; at 1.0 I.U. per ml of enoxaparin there was a 41.4% decrease (148.8 sec). This report only presents the experimental application of the assay; its value in a clinical setting must still be established.
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Gomes M, Ramacciotti E, Henriques AC, Araujo GR, Szultan LA, Miranda F, Thethi I. Generic Versus Branded Enoxaparin in the Prevention of Venous Thromboembolism Following Major Abdominal Surgery. Clin Appl Thromb Hemost 2011; 17:633-9. [DOI: 10.1177/1076029611418967] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Several generic low-molecular-weight heparins (LMWHs) have recently become available worldwide, including the United States. Companies have filed for regulatory approval of generic versions in many countries, based only on compound biochemical characteristics or its immunogenicity. Methods: Prospective study to evaluate the comparative effect of 2 enoxaparins (Sanofi-Aventis branded enoxaparin [SAe] vs eurofarma-enoxaparin [Ee], a generic version) as prophylaxis for venous thromboembolism (VTE) following major abdominal surgery. A total of 200 patients were randomized in a 1:1 ratio either to receive 40 mg of SAe or Ee subcutaneously (sc) once daily (od) postoperatively for 7 to 10 days. Compressive ultrasound was performed on day 10 + 4. Results: No statistically significant differences between the 2 groups were detected. In all, 2 SAe patients presented deep vein thrombosis ([DVT] 2.1%), none of the Ee group. No major bleeding events occurred. Conclusions: This exploratory trial suggests that the generic LMWH is probably as safe and as effective as the branded enoxaparin (Lovenox, Brazil) in the prophylaxis of VTE in this population.
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Affiliation(s)
- Marise Gomes
- Loyola University Medical Center, Maywood, IL, USA
| | | | | | | | - Luiz Arnaldo Szultan
- General Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brazil
| | - Fausto Miranda
- Vascular Surgery, Escola paulista de Medicina, Sao Paulo, SP, Brazil
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Kaffenberger BH, Bekaii-Saab T. Recurrent life-threatening deep tissue hematomas after switching to generic enoxaparin: a report and perspective on the approval process for biological compounds. Clin Appl Thromb Hemost 2011; 18:104-6. [PMID: 21873360 DOI: 10.1177/1076029611416641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In the United States, the Food and Drug Administration (FDA) has allowed makers of biologic therapies to use the abbreviated new drug application, which does not require safety and efficacy studies. Instead this relies on proving equivalency with the original compound and demonstrating in vitro activity and similar pharmacodynamics. In the United States, a low-molecular-weight heparin, enoxaparin, was recently approved in a generic format through the abbreviated new drug application. We present a patient treated with branded enoxaparin for 4 years with no complications. After the switch to the generic enoxaparin, the patient developed 2 life-threatening hemorrhages within 4 months of the initiation of the compound. This case suggests that the FDA should follow the European Medicine Administration (EMA) guidance by tightening its approval process for generic bioequivalents and requiring studies demonstrating similar safety and efficacy as the parent compound, prior to approval of a generic biologically active compound.
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Fareed J, Adiguzel C, Thethi I. Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism. Thromb J 2011; 9:5. [PMID: 21443789 PMCID: PMC3078835 DOI: 10.1186/1477-9560-9-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 03/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevention of venous thromboembolism has been identified as a leading priority in hospital safety. Recommended parenteral anticoagulant agents with different indications for the prevention and treatment of venous thromboembolism include unfractionated heparin, low-molecular-weight heparins and fondaparinux. Prescribing decisions in venous thromboembolism management may seem complex due to the large range of clinical indications and patient types, and the range of anticoagulants available. METHODS MEDLINE and EMBASE databases were searched to identify relevant original articles. RESULTS Low-molecular-weight heparins have nearly replaced unfractionated heparin as the gold standard antithrombotic agent. Low-molecular-weight heparins currently available in the US are enoxaparin, dalteparin, and tinzaparin. Each low-molecular-weight heparin is a distinct pharmacological entity with different licensed indications and available clinical evidence. Enoxaparin is the only low-molecular-weight heparin that is licensed for both venous thromboembolism prophylaxis and treatment. Enoxaparin also has the largest body of clinical evidence supporting its use across the spectrum of venous thromboembolism management and has been used as the reference standard comparator anticoagulant in trials of new anticoagulants. As well as novel oral anticoagulant agents, biosimilar and/or generic low-molecular-weight heparins are now commercially available. Despite similar anticoagulant properties, studies report differences between the branded and biosimilar and/or generic agents and further clinical studies are required to support the use of biosimilar low-molecular-weight heparins. The newer parenteral anticoagulant, fondaparinux, is now also licensed for venous thromboembolism prophylaxis in surgical patients and the treatment of acute deep-vein thrombosis; clinical experience with this anticoagulant is expanding. CONCLUSIONS Parenteral anticoagulants should be prescribed in accordance with recommended dose regimens for each clinical indication, based on the available clinical evidence for each agent to assure optimal safety and efficacy.
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Affiliation(s)
- Jawed Fareed
- Departments of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Pharmacology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Cafer Adiguzel
- Departments of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Pharmacology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Medicine, Division of Hematology, Marmara University Medical School, Istanbul, Turkey
| | - Indermohan Thethi
- Department of Medicine, Aurora Memorial Hospital, Burlington, WI, USA
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Inchiosa MA, Pothula S, Kubal K, Sanchala VT, Navarro I. Toward development of a point-of-care assay of enoxaparin anticoagulant activity in whole blood. J Thromb Thrombolysis 2011; 32:47-53. [PMID: 21213019 DOI: 10.1007/s11239-010-0546-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kalodiki E, Fareed J. New and Generic Anticoagulants and Biosimilars: Safety Considerations. Clin Appl Thromb Hemost 2010; 17:136-9. [DOI: 10.1177/1076029610387128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The recent health care changes and approval of a generic low-molecular-weight heparin (LMWH) by the US Food and Drug Administration (FDA) merit a review of the facts regarding the new and generic anticoagulants. Fatal hypotension from anaphylactoid type reactions following heparin administration was responsible for more than 149 deaths all over the world. Researchers detected a heparin-like semisynthetic contaminant, over-sulfated chondroitin sulfate (OSCS), that appeared to be intentional. Low-molecular-weight heparins are produced using unfractionated heparin and OSCS has been found in various batches of LMWHs. Some newer anticoagulants are claiming to be free from the need to monitor for therapeutic effect and bleeding risk. Therefore, monitoring assays are not being developed and there is no antidote to reverse bleeding. In addition, there are concerns about reproducibility, product variation, and quality. In conclusion, although the generic LMWHs and newer anticoagulants may appear to be effective for qualified indications, their safety remains to be a concern.
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Affiliation(s)
- Evi Kalodiki
- Vascular Surgery Department, Ealing Hospital and Imperial College London, SW7 2AZ, UK, Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Centre, Maywood, IL, USA,
| | - Jawed Fareed
- Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Centre, Maywood, IL, USA
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Fillinger J, Antus B. Low-molecular-weight heparins do not modify obliterative airway disease in rat tracheal allografts. Exp Lung Res 2010; 36:625-31. [PMID: 20860540 DOI: 10.3109/01902148.2010.499443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Immunosuppressive and antiproliferative effects of heparin may be beneficial in the field of solid organ transplantation. The aim of this study was to examine the effect of low-molecular-weight heparin (LMWH) compounds on the development of obliterative airway disease (OAD) in the rat tracheal transplant model. Allogenic heterotopic tracheal transplantations were performed from Brown-Norway into Lewis rats. Recipients were treated either with nadroparin, enoxaparin, parnaparin, or vehicle from day 0 until harvesting at day 7 or 21. Graft rejection was morphometrically assessed to determine the extent of luminal obliteration end epithelial necrosis. All tracheal grafts harvested at day 7 demonstrated nearly equivalent degree of luminal obstruction regardless of treatment regimen. Likewise, at day 21 the extent of airway narrowing and the degree of inflammatory cell infiltration were similar among the groups. Moreover, loss of airway epithelium was not prevented by LMWH treatments. Finally, intragraft mRNA expression for transforming growth factor-β1 and platelet-derived growth factor-A, interleukin-2, interferon-γ, and monocyte chemoattractant protein-1 did not differ between the groups. In contrast with findings in other animal models, treatment with LMWH preparations did not modify the development of OAD in rat tracheal allografts.
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Affiliation(s)
- Janos Fillinger
- Department of Pathology, National Koranyi Institute for TB and Pulmonology, Budapest, Hungary
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Direct comparison of enoxaparin and nadroparin in a rabbit model of arterial thrombosis prevention. Thromb Res 2010; 126:56-60. [PMID: 20382412 DOI: 10.1016/j.thromres.2010.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 01/09/2010] [Accepted: 03/03/2010] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate and compare the efficacy of standard unfractionated heparin (UFH) and low-molecular weight heparins (LMWH's). MATERIALS AND METHODS We modified a previously published rabbit model of arterial thrombosis prevention [1,2] to compare unfractionated heparin and two different doses of two low-molecular weight heparin fragments--nadroparin and enoxaparin. Thrombosis in the distal aorta was triggered by vessel wall injury and critical stenosis. Blood flow in the damaged arterial segment was monitored by a flow probe placed distal to the constrictor. The primary endpoints of the study were: (1) cumulative flow, (2) time to occlusion and (3) residual clot weight. Thirty six animals were split into 6 groups with six animals in each group. Control groups were given saline or heparin and four more groups were used to compare LMWH's at 2 different doses. RESULTS In our study, all treatments were superior to the saline control group (alpha<or=0,01). Standard heparin was inferior (alpha<or=0,05) to both low molecular weight heparins for all primary endpoints (cumulative flow, time to occlusion and residual clot weight). There were no differences between the LMWH's except for cumulative flow at high doses. CONCLUSIONS This study revealed no relevant differences between nadroparin and enoxaparin for the primary endpoints of our model. Clinical use of each drug remains a personal preference.
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Sharma V, Madhu S, Natarajan P, Muniyandi G, Jaiswal V, Saxena R. A comparison of the biological activity of 2 formulations of enoxaparin in 12 healthy volunteers. Clin Appl Thromb Hemost 2009; 16:387-93. [PMID: 19671565 DOI: 10.1177/1076029609338044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION India is one of the few countries where biosimilar enoxaparin is available for clinical use. Despite availability since past 4 to 5 years, there is a paucity of published literature regarding their biological activity. The aim of the current study is to compare the biological activity of an endogenously developed formulation of enoxaparin with the branded formulation. MATERIALS AND METHODS Twelve healthy male volunteers received 1 subcutaneous injection of 2 different formulations of enoxaparin in a randomized, open-label, balanced, 2-treatment, 2-period, 2-sequence, cross-over study. The test formulation was Injection Troynoxa (enoxaparin sodium 40 mg/0.4 mL, Troikaa Pharmaceuticals Ltd., India) and reference formulation was Injection Clexane (enoxaparin sodium 40 mg/ 0.4 mL, Sanofi-Aventis, UK). The plasma anti-Xa activity and activated partial thromboplastin time (aPTT) were estimated on fully automated coagulometer predose and at 2, 4, 6, 8, and 10 hours following dosing with 40 mg/0.4 mL of enoxaparin. RESULTS The results of mixed model analysis of repeated measures analysis of variance (ANOVA) for estimating difference between least square means of test and reference formulations, at all time points, showed no significant differences in anti-Xa activity and plasma aPTT levels. Both formulations were well tolerated and there were no bleeding episodes. CONCLUSION After a single-dose injection in healthy participants, anti-Xa activities of 2 formulations of LMWH enoxaparin were comparable. No significant difference was observed in the mean plasma aPTT. It remains to be seen whether the 2 formulations would show comparable clinical efficacy.
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Affiliation(s)
- Vineeta Sharma
- All India Institute of Medical Sciences, New Delhi, India
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Patel RP, Narkowicz C, Jacobson GA. Investigation of the effect of heating on the chemistry and antifactor Xa activity of enoxaparin. J Pharm Sci 2009; 98:1700-11. [PMID: 18979533 DOI: 10.1002/jps.21556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective of this study was to investigate the effects of heating on the chemistry, physical properties and antifactor Xa activity of enoxaparin. Samples of enoxaparin heated at 70 degrees C lost 27% of their initial AFXa activity after 8 h, then activity increased to 94% of the initial activity over the next 4 h. Activity then decreased to 84% of control after 48 h and further to 80% of control over 22 days. The initial activity loss correlated with desulfation as demonstrated by sulfate and amine analysis. Fragmentation of oligosaccharides occurred, as demonstrated by reducing capacity and capillary electrophoresis analysis. Individual enoxaparin fractions obtained by high performance size exclusion chromatography were analysed. Early eluting fractions, containing aggregated oligosaccharides, increased in concentration following heating. Up to 65% of sulfate was lost from some fractions, containing hexa- and octa-saccharides, after 8 h, corresponding with decreased activity. Low mass oligosaccharide fractions increased in concentration and had increased activity between 8 and 12 h. Reversed-phase ion-interaction HPLC analysis supported these findings. Deca-, dodeca- and tetradeca-saccharides were resistant to thermal degradation. Desulfation, fragmentation and aggregation occur during the heating of enoxaparin and result in the initial rapid loss, recovery and subsequent gradual loss of activity.
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Affiliation(s)
- Rahul P Patel
- School of Pharmacy, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia.
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Differences Among Low-Molecular-Weight Heparins: Evidence in Patients With Acute Coronary Syndromes. J Cardiovasc Pharmacol 2009; 53:440-5. [DOI: 10.1097/fjc.0b013e3181a59abc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel RP, Narkowicz C, Jacobson GA. Investigation of freezing- and thawing-induced biological, chemical, and physical changes to enoxaparin solution. J Pharm Sci 2009; 98:1118-28. [PMID: 18661541 DOI: 10.1002/jps.21483] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study investigated the effect of freezing and thawing on the biological, physical, and chemical properties of enoxaparin solution. Solutions were frozen and thawed under different conditions, in the presence or absence of dimethyl sulfoxide (DMSO) or 1,2-propanediol (1,2-PD), and the antifactor Xa (AFXa) activity was determined. Enoxaparin solution lost more than 60% of its AFXa activity when thawed rapidly after freezing at -196 degrees C. The loss of AFXa activity was less with higher freezing temperatures and increased with the number of freeze/thaw cycles, but was independent of the duration of freezing. Slow freezing to -196 degrees C with rapid thawing, or rapid freezing with slow thawing, resulted in negligible loss of AFXa activity. The loss of AFXa activity did not involve the loss of N-sulfate groups, the breakdown of glycosidic bonds or the glassy state transition. Controlling the freezing or thawing conditions, dilution with water or addition of a small percentage of DMSO ameliorated the loss of enoxaparin AFXa activity. The loss in AFXa activity was found by size exclusion chromatography to be primarily due to aggregation and was reversed by sonication in the presence of DMSO. These results may provide insight into solutions for the long-term storage of concentrated or diluted enoxaparin.
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Affiliation(s)
- Rahul P Patel
- School of Pharmacy, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia.
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Effective reversed-phase ion pair high-performance liquid chromatography method for the separation and characterization of intact low-molecular-weight heparins. Anal Biochem 2009; 387:113-21. [DOI: 10.1016/j.ab.2009.01.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 01/01/2009] [Accepted: 01/04/2009] [Indexed: 11/21/2022]
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Udit AK, Everett C, Gale AJ, Kyle JR, Ozkan M, Finn MG. Heparin antagonism by polyvalent display of cationic motifs on virus-like particles. Chembiochem 2009; 10:503-10. [PMID: 19156786 PMCID: PMC2751660 DOI: 10.1002/cbic.200800493] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Indexed: 11/06/2022]
Abstract
Particles to the rescue! The construction of cationic amino acid motifs on the surface of bacteriophage Qbeta by genetic engineering or chemical conjugation gives particles that are potent inhibitors of the anticoagulant action of heparin, which is a common anticlotting agent subject to clinical overdose.Polyvalent interactions allow biological structures to exploit low-affinity ligand-receptor binding events to affect physiological responses. We describe here the use of bacteriophage Qbeta as a multivalent platform for the display of polycationic motifs that act as heparin antagonists. Point mutations to the coat protein allowed us to generate capsids bearing the K16M, T18R, N10R, or D14R mutations; because 180 coat proteins form the capsid, the mutants provide a spectrum of particles differing in surface charge by as much as +540 units (K16M vs. D14R). Whereas larger poly-Arg insertions (for example, C-terminal Arg(8)) did not yield intact virions, it was possible to append chemically synthesized oligo-Arg peptides to stable wild-type (WT) and K16M platforms. Heparin antagonism by the particles was evaluated by using the activated partial thrombin time (aPTT) clotting assay; this revealed that T18R, D14R, and WT-(R(8)G(2))(95) were the most effective at disrupting heparin-mediated anticoagulation (>95 % inhibition). This activity agreed with measurements of zeta potential (ZP) and retention time on cation exchange chromatography for the genetic constructs, which distribute their added positive charge over the capsid surface (+180 and +360 for T18R and D14R relative to WT). The potent activity of WT-(R(8)G(2))(95), despite its relatively diminished overall surface charge is likely a consequence of the particle's presentation of locally concentrated regions with high positive charge density that interact with heparin's extensively sulfated domains. The engineered cationic capsids retained their ability to inhibit heparin at high concentrations and showed no anticlotting activity of the kind that limits the utility of antiheparin polycationic agents that are currently in clinical use.
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Affiliation(s)
- Andrew K. Udit
- Dr. A. K. Udit, C. Everett, Prof. M. G. Finn, Department of Chemistry and the Skaggs Institute for Chemical Biology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037 (USA), Fax: (+ 1)858-784-8850, E-mail: ,
| | - Chris Everett
- Dr. A. K. Udit, C. Everett, Prof. M. G. Finn, Department of Chemistry and the Skaggs Institute for Chemical Biology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037 (USA), Fax: (+ 1)858-784-8850, E-mail: ,
| | - Andrew J. Gale
- Prof. A. J. Gale, Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037 (USA)
| | - Jennifer Reiber Kyle
- J. Reiber Kyle, Prof. M. Ozkan, Department of Electrical Engineering, University of California, Riverside, CA 92521 (USA)
| | - Mihri Ozkan
- J. Reiber Kyle, Prof. M. Ozkan, Department of Electrical Engineering, University of California, Riverside, CA 92521 (USA)
| | - M. G. Finn
- Dr. A. K. Udit, C. Everett, Prof. M. G. Finn, Department of Chemistry and the Skaggs Institute for Chemical Biology, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037 (USA), Fax: (+ 1)858-784-8850, E-mail: ,
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Fareed J, Jeske W, Fareed D, Clark M, Wahi R, Adiguzel C, Hoppensteadt D. Are all low molecular weight heparins equivalent in the management of venous thromboembolism? Clin Appl Thromb Hemost 2008; 14:385-92. [PMID: 18815137 DOI: 10.1177/1076029608319881] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low molecular weight heparins are replacing unfractionated heparin in a number of clinical indications because of their improved subcutaneous bioavailability and more predictable antithrombotic response. Clinical trials have demonstrated that low molecular weight heparins are at least as safe and effective as unfractionated heparin for the initial treatment of venous thromboembolism, and unfractionated heparin and warfarin for primary and secondary thromboprophylaxis. The mechanism behind the antithrombotic action of low molecular weight heparins is not fully understood but is likely to involve inhibition of coagulation factors Xa and IIa (thrombin), release of tissue-factor-pathway inhibitor, and inhibition of thrombin activatable fibrinolytic inhibitor. Different low molecular weight heparins have been shown to have various effects on coagulation parameters. Seven low molecular weight heparins are currently marketed worldwide, each demonstrated distinct chemical entities with unique pharmacokinetic and pharmacodynamic profiles. Each low molecular weight heparin is approved for specific indications based on the available efficacy and safety data for that product. The relative efficacy and safety of the low molecular weight heparins are unclear because there have been very few direct comparisons in randomized clinical trials. While recommending low molecular weight heparins for the prevention and treatment of venous thromboembolism, clinical guidelines have not specified individual agents. National and international organizations recognize that low molecular weight heparins are distinct entities and that they should not be used interchangeably in clinical practice. Each low molecular weight heparin should be used at the recommended dose when efficacy and safety data exist for the condition being treated. When these data are not available, the dosing and administration of low molecular weight heparins must be adapted from existing data and recommendations.
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Affiliation(s)
- Jawed Fareed
- Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153, USA.
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A capillary electrophoretic method for fingerprinting low molecular weight heparins. Anal Biochem 2008; 380:229-34. [DOI: 10.1016/j.ab.2008.05.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/27/2008] [Accepted: 05/29/2008] [Indexed: 11/20/2022]
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Kuczka K, Harder S, Picard-Willems B, Warnke A, Donath F, Bianchini P, Parma B, Blume H. Biomarkers and coagulation tests for assessing the biosimilarity of a generic low-molecular-weight heparin: results of a study in healthy subjects with enoxaparin. J Clin Pharmacol 2008; 48:1189-96. [PMID: 18716314 DOI: 10.1177/0091270008322911] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low-molecular-weight heparins (LMWHs) differ considerably in their influence on clotting tests and release of tissue factor pathway inhibitor (TFPI). Biosimilarity therefore becomes an issue when generic forms of LMWHs are developed. So far, no bioequivalence study with a generic LMWH has been reported. A generic enoxaparin (test) was compared with the originator (reference) in 20 volunteers after single-dose subcutaneous administration (40 mg enoxaparin sodium, 4000 IU/mL anti-factor Xa (anti-FXa; activity). Target variables were anti-FXa and anti-FIIa activity, activated partial thromboplastin time (aPTT), prothrombinase-induced clotting time (PiCT), and TFPI over 24 hours. The statistical evaluation of the anti-FXa activity profile demonstrated bioequivalence of test and reference with confidence intervals of area under the plasma concentration-time curve (AUC0-tlast) (93%-99%) and Amax (88%-95%). Confidence intervals of AUC(0-tlast) (89%-102%) and Amax (90%-103%) of anti-FIIa activity also fulfill bioequivalence criteria. The 90% confidence interval for the maximum concentration of TFPI ranged from 90% to 113%. The claim of similarity was also supported by aPTT and PiCT profiles. Bioequivalence with the originator enoxaparin could be demonstrated by ex vivo inhibition of FXa and FIIa activity, by coagulation tests (aPTT and PiCT), and by in vivo release of TFPI. Whether such data also prove biosimilarity of the generic enoxaparin needs to be determined.
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Affiliation(s)
- Karina Kuczka
- Pharmazentrum frankfurt/ZAFES, Institute for Clinical Pharmacology, University Hospital Frankfurt, Germany
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Patel RP, Narkowicz C, Hutchinson JP, Hilder EF, Jacobson GA. A simple capillary electrophoresis method for the rapid separation and determination of intact low molecular weight and unfractionated heparins. J Pharm Biomed Anal 2007; 46:30-5. [PMID: 18024047 DOI: 10.1016/j.jpba.2007.10.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 09/26/2007] [Accepted: 10/05/2007] [Indexed: 10/22/2022]
Abstract
A simple, selective and accurate capillary electrophoresis (CE) method has been developed for the rapid separation and identification of various low molecular weight heparins (LMWHs) and unfractionated heparin. Separation and operational parameters were investigated using dalteparin sodium as the test LMWH. The developed method used a 70 cm fused silica capillary (50 microm i.d.) with a detection window 8.5 cm from the distal end. Phosphate electrolyte (pH 3.5; 50 mM), an applied voltage of -30 k V, UV detection at 230 nm and sample injection at 20 mbar for 5s were used. The method performance was assessed in terms of linearity, selectivity, intra- and inter-day precision and accuracy. The method was successfully applied to the European Pharmacopeia LMWH standard, dalteparin sodium, enoxaparin sodium and heparin sodium with a significant reduction in the run time and increased resolution compared with previously reported CE methods. Different CE separation profiles were obtained for various LMWHs and unfractionated heparin showing significant structural diversity. The current methodology was sensitive enough to reveal minor constituent differences between two different batches of enoxaparin sodium. This CE method also clearly showed chemical changes that occurred to LMWHs under different stress conditions. The sensitivity, selectivity and simplicity of the developed method allow its application in research or manufacturing for the identification, stability analysis, characterization and monitoring of batch-to-batch consistency of different low molecular weight and unfractionated heparins.
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Affiliation(s)
- Rahul P Patel
- School of Pharmacy, University of Tasmania, Private Bag 26, Hobart, Tasmania 7001, Australia.
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Stief TW. The anticoagulant capacity of plasmatic unfractionated heparin decreases at 23°C. Blood Coagul Fibrinolysis 2007; 18:209-12. [PMID: 17287642 DOI: 10.1097/mbc.0b013e3280121c5e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are important clinical anticoagulants. As polynegative molecules they are potential triggers of the contact phase of coagulation. An incubation temperature lower than the physiological 37 degrees C favours intrinsic haemostasis activation by the polynegative molecule SiO2. The efficiency of UFH and LMWH after a plasmatic preincubation at 37 or at 23 degrees C is therefore studied. Samples (150 mul) of unfrozen pooled normal plasma supplemented with 0, 0.01, 0.1, or 1 IU/ml heparin or dalteparin in 5-ml polystyrole tubes were incubated for 10-70 min at 37 or at 23 degrees C. The extrinsic coagulation activity assay (EXCA) was then performed. Preincubation at 37 degrees C of 0.1 IU/ml plasmatic UFH does not result in any thrombin generation in EXCA-1, whereas preincubation at 23 degrees C results in a thrombin generation of about 0.1 IU/ml thrombin. Plasmatic UFH (0.01 IU/ml) at 23 degrees C acts nearly half as efficiently as 0.01 IU/ml plasmatic LMWH. Polynegatively charged niches particularly in the larger UFH molecule might trigger the contact system of haemostasis, especially at 23 degrees C. In contrast, the anticoagulant capacity of LMWH does not change significantly with temperature.
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Affiliation(s)
- Thomas W Stief
- Department of Clinical Chemistry, University Hospital, Marburg, Germany.
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