Biosimilar insulin and insulin antibodies

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

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.

Highly sensitive ligand-binding assays in pre-clinical and clinical applications: immuno-PCR and other emerging techniques

Recombinant DNA technology and corresponding innovations in molecular biology, chemistry and medicine have led to novel therapeutic biomacromolecules as lead candidates in the pharmaceutical drug development pipelines. While monoclonal antibodies and other proteins provide therapeutic potential beyond the possibilities of small molecule drugs, the concomitant demand for supportive bioanalytical sample testing creates multiple novel challenges. For example, intact macromolecules can usually not be quantified by mass-spectrometry without enzymatic digestion and isotopically labeled internal standards are costly and/or difficult to prepare. Classical ELISA-type immunoassays, on the other hand, often lack the sensitivity required to obtain pharmacokinetics of low dosed drugs or pharmacodynamics of suitable biomarkers. Here we summarize emerging state-of-the-art ligand-binding assay technologies for pharmaceutical sample testing, which reveal enhanced analytical sensitivity over classical ELISA formats. We focus on immuno-PCR, which combines antibody specificity with the extremely sensitive detection of a tethered DNA marker by quantitative PCR, and alternative nucleic acid-based technologies as well as methods based on electrochemiluminescence or single-molecule counting. Using case studies, we discuss advantages and drawbacks of these methods for preclinical and clinical sample testing.

Multiple Source Biosimilar Insulin, What's a Provider to Do?

In the United States the FDA designates generic products that are bioequivalent as AB substitutable (FDA rating signifying the approved application contains adequate scientific evidence establishing through in vivo and/or in vitro studies the bioequivalence of the product to a selected reference product) and are expected to produce the same therapeutic results as the innovator product. In the case of biological proteins that are similar to already approved innovator biologicals, such as recombinant human insulin, the insulin molecule and accompanying secondary and tertiary structures will differ between manufacturing sources. Even subtle differences between innovator (branded) and alternative "biosimilar" products may produce different therapeutic endpoints. Substitution of a branded insulin with a biosimilar insulin product may result in more, less, or equal therapeutic response making in difficult for the practitioner to assess glycemic control between patient follow-up visits. Significant therapeutic difference is possible, which could result in mild to severe hypoglycemia reaction or hyperglycemia induced tissue damage. Slight molecular changes along with different accompanying proteins, protein fragments, and other naturally occurring contaminants theoretically increase odds of insulin resistance or allergic reaction. Current review of medication product and device quality relies on manufacturer self-oversight and individual reporting of product adverse events after use. While this is usually sufficient for oral medications and many medical devices, critical use products such as sterile products, biosimilar insulin, insulin delivery devices, self-monitoring blood glucose monitoring systems, and test strips require much more vigorous oversight to prevent individual and/or large scale catastrophe. Health care providers should advocate for their patient to have access to affordable, consistent, quality-assured products to effectively and safely manage their medical issues. A potential commonsense solution would be to utilize existing nonprofit organizations with access to pharmacy/laboratory services that have vested interest in ensuring product quality throughout the supply pipeline. The old adage "an ounce of prevention is worth a pound of cure" holds even more true in today's medical environment.