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Liu S, Zhang R, Liu C, Shi D. P-PBFT: An improved blockchain algorithm to support large-scale pharmaceutical traceability. Comput Biol Med 2023; 154:106590. [PMID: 36736098 DOI: 10.1016/j.compbiomed.2023.106590] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/27/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Abstract
To solve the problems of high latency, high system overhead, and small supported scale in the current application of pharmaceutical traceability combined with blockchain technology, an algorithm called Pharmaceutical-Practical Byzantine Fault Tolerance (P-PBFT) based on PBFT, grouping, and credit voting is proposed. The algorithm combines the characteristics of a pharmaceutical supply chain, optimizes the consistency protocol in the original algorithm, divides large-scale network nodes into different consensus sets by response speed, and performs grouping consensus. The algorithm's credit model and voting mechanism dynamically updates user status according to the behavior of nodes in consensus, evaluates the reliability of users, and also serves as a basis for electing management nodes. Experimental results show that the improved P-PBFT consensus algorithm provides smaller latency and higher throughput for pharmaceutical traceability systems, supports larger-scale traceability, effectively alleviates the dramatic increase in communication among network nodes, and reduces the influence of malicious nodes.
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Affiliation(s)
- Shannan Liu
- College of Information Science and Technology, Shihezi University, Shihezi, China
| | - Ronghua Zhang
- College of Information Science and Technology, Shihezi University, Shihezi, China.
| | - Changzheng Liu
- College of Information Science and Technology, Shihezi University, Shihezi, China.
| | - Du Shi
- Department of Urology, The First Hospital of China Medical University, Shenyang, China.
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2
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Edrovska D, Grozdanova A, Ancevska Netkovska K, Naumovska Z. Traceability of biologicals: challenges in pharmacovigilance. MAKEDONSKO FARMACEVTSKI BILTEN 2022. [DOI: 10.33320/maced.pharm.bull.2022.68.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Dragica Edrovska
- Agency for drugs and medical devices, Blvd. Ss. Cyril and Methodius 54, 1000 Skopje, R.N. Macedonia
| | - Aleksandra Grozdanova
- Faculty of Pharmacy, University “Ss Cyril and Methodius”, Mother Theresa 47, 1000 Skopje, Republic of N. Macedonia
| | - Katerina Ancevska Netkovska
- Faculty of Pharmacy, University “Ss Cyril and Methodius”, Mother Theresa 47, 1000 Skopje, Republic of N. Macedonia
| | - Zorica Naumovska
- Faculty of Pharmacy, University “Ss Cyril and Methodius”, Mother Theresa 47, 1000 Skopje, Republic of N. Macedonia
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Correia Pinheiro L, Giezen TJ, Wolff-Holz E, Weise M, Laslop A, Hidalgo-Simon A. Identifiability of Biologicals: An Analysis Using EudraVigilance, the European Union's Database of Reports of Suspected Adverse Drug Reactions. Clin Pharmacol Ther 2021; 110:1311-1317. [PMID: 34472087 PMCID: PMC9292214 DOI: 10.1002/cpt.2411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/08/2021] [Indexed: 01/21/2023]
Abstract
The relevance of biological therapies for an increasing number of conditions is on the rise. Following the expiry of the initial period of market exclusivity, many of these successful therapies have seen the arrival of biosimilars on the market. The clear identification of the precise medicine responsible for an adverse drug reaction (ADR) report is an important element for pharmacovigilance, allowing timely detection of potential product-specific safety signals. We looked at the identifiability of biologicals up to the level of commercial product name in ADR reports received from European clinical practice between 2011 and December 2019. A good level of identification (91.5%) was observed overall, but at the same time a downward trend was observed in the last 5 years. This reduction in the level of identifiability of biological products (originators and biosimilars) at the commercial name level in general was driven by five widely used substances, whereas the identification of all other biologics stayed consistent over time (at over 90%). We observed that those five substances were used mostly within oncology. The introduction of the first biosimilar in the market did not appear to affect their identifiability. These results show that although the general level of identification at the commercial product name level in ADRs in Europe is robust and generally stable over time, decreasing trends can be down to a few commonly used substances, which need to be monitored to reverse the trend.
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Affiliation(s)
| | - Thijs J Giezen
- Foundation Pharmacy for Hospitals in Haarlem, Haarlem, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands.,Biosimilar Medicinal Products Working Party (BMWP), European Medicines Agency, Amsterdam, The Netherlands
| | - Elena Wolff-Holz
- Biosimilar Medicinal Products Working Party (BMWP), European Medicines Agency, Amsterdam, The Netherlands.,Bundesinstitut für Arzneimittel und Medizinprodukte, Bonn, Germany
| | - Martina Weise
- Biosimilar Medicinal Products Working Party (BMWP), European Medicines Agency, Amsterdam, The Netherlands.,Paul-Ehrlich-Institut, Langen, Germany.,Committee for Medicinal Products for Human Use (CHMP), European Medicines Agency, Amsterdam, The Netherlands
| | - Andrea Laslop
- Committee for Medicinal Products for Human Use (CHMP), European Medicines Agency, Amsterdam, The Netherlands.,Bundesamt für Sicherheit im Gesundheitswesen (BASG), Vienna, Austria
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4
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Soleimani B, Murray K, Hunt D. Established and Emerging Immunological Complications of Biological Therapeutics in Multiple Sclerosis. Drug Saf 2020; 42:941-956. [PMID: 30830572 DOI: 10.1007/s40264-019-00799-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Biologic immunotherapies have transformed the treatment landscape of multiple sclerosis. Such therapies include recombinant proteins (interferon beta), as well as monoclonal antibodies (natalizumab, alemtuzumab, daclizumab, rituximab and ocrelizumab). Monoclonal antibodies show particular efficacy in the treatment of the inflammatory phase of multiple sclerosis. However, the immunological perturbations caused by biologic therapies are associated with significant immunological adverse reactions. These include development of neutralising immunogenicity, secondary immunodeficiency and secondary autoimmunity. These complications can affect the balance of risks and benefits of biologic agents, and 2018 saw the withdrawal from the market of daclizumab, an anti-CD25 monoclonal antibody, due to concerns about the development of severe, unpredictable autoimmunity. Here we review established and emerging risks associated with multiple sclerosis biologic agents, with an emphasis on their immunological adverse effects. We also discuss the specific challenges that multiple sclerosis biologics pose to drug safety systems, and the potential for improvements in safety frameworks.
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Affiliation(s)
| | - Katy Murray
- Anne Rowling Clinic, University of Edinburgh, Edinburgh, UK
| | - David Hunt
- Anne Rowling Clinic, University of Edinburgh, Edinburgh, UK. .,MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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5
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The UK BIO-TRAC Study: A Cross-Sectional Study of Product and Batch Traceability for Biologics in Clinical Practice and Electronic Adverse Drug Reaction Reporting in the UK. Drug Saf 2019; 43:255-263. [PMID: 31872358 PMCID: PMC7048707 DOI: 10.1007/s40264-019-00891-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction Due to the complexity of biologics and the inherent challenges for manufacturing, it is important to know the specific brand name and batch number of suspected biologics in adverse drug reaction (ADR) reports. Objective The aim of this study was to assess the extent to which biologics are traceable by brand name and batch number in UK hospital practice and in ADRs reported by patients and healthcare professionals. Methods We performed an online hospital pharmacist survey to capture information on how specific product details are recorded during the processes of prescribing, dispensing and administration of biologics in routine UK hospital practice. We also assessed the proportion of ADR reports specifying brand name and batch number from electronic ADR reports submitted to the UK national spontaneous reporting database, the Yellow Card Scheme, between 1 January 2009 and 30 September 2017. Results Brand name recording in routine hospital processes ranged from 79 to 91%, whereas batch numbers were less routinely recorded, ranging from 38 to 58%. Paper-based recording of product details was more commonly used for recording information. A total of 6108 electronic ADR reports were submitted to the Yellow Card Scheme for recombinant biologics, of which 38% and 15%, respectively, had an identifiable brand name and batch numbers. Whereas batch number traceability in electronic ADR reports improved slightly after the implementation of the European Union pharmacovigilance legislation in 2012, no improvement of brand name traceability was observed. Conclusion Brand name and batch number traceability for biologics in UK ADR reports are generally low. Shortcomings in the systematic recording of product details in UK clinical practice may contribute to the limited traceability. Electronic supplementary material The online version of this article (10.1007/s40264-019-00891-6) contains supplementary material, which is available to authorized users.
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6
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Ingrasciotta Y, Cutroneo PM, Marcianò I, Giezen T, Atzeni F, Trifirò G. Safety of Biologics, Including Biosimilars: Perspectives on Current Status and Future Direction. Drug Saf 2019; 41:1013-1022. [PMID: 29796832 DOI: 10.1007/s40264-018-0684-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In recent years, marketing of highly innovative and costly biologics improved the management of high-burden diseases such as autoimmune diseases, cancers, and chronic renal failure. Several widely prescribed biologics have recently lost or will shortly lose their patents, thus opening avenues to the marketing of a growing number of biosimilars worldwide, which are products similar in terms of quality, safety, and efficacy to already licensed reference products, thus allowing for potential savings in pharmaceutical expenditure. Numerous debates about the interchangeability between biosimilars and reference products are still ongoing, owing to concerns about potential immunogenicity raised by switching, which may cause a lack of effect and toxicity. Patients successfully treated with biologic therapy may theoretically receive biosimilars to contain costs, if reference product and related biosimilar are judged as interchangeable. However, the positions of regulatory agencies on the interchangeability and automatic substitution of biologics with biosimilars are very different. The benefit-risk profile of biosimilars has been often questioned by clinicians owing to the limited amount of pre-marketing information on clinical efficacy and safety, despite biosimilarity being based on a comparability exercise with the reference product to gain the biosimilar approval. Nevertheless, after more than 10 years of marketing from the first biosimilar approval in Europe, no proof of differences in terms of the safety profile of biosimilars and originators has been reported. In this context, post-marketing evaluation of both biologics and biosimilars safety profiles through analyses from spontaneous reporting databases and claims databases is crucial. An important issue for the pharmacovigilance of biologics concerns the traceability, indicating the brand name and batch number in spontaneous adverse drug reaction reports, but this requirement is not frequently addressed. This review aims to provide an overview of the characteristics and potential challenges in the safety profile assessment of biologics with a focus on the post-marketing setting.
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Affiliation(s)
- Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Paola M Cutroneo
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy.,Sicilian Regional Pharmacovigilance Center, Messina, Italy
| | - Ilaria Marcianò
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Thijs Giezen
- Foundation Pharmacy for Hospitals in Haarlem, Haarlem, The Netherlands
| | - Fabiola Atzeni
- Unit of Rheumatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy. .,Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy.
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7
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Kowalski SC, Benavides JA, Roa PAB, Galarza-Maldonado C, Caballero-Uribe CV, Soriano ER, Pineda C, Azevedo VF, Avila-Pedretti G, Babini AM, Cachafeiro-Vilar A, Cifuentes-Alvarado M, Cohen SB, Díaz PE, Soto LD, Encalada C, Garro B, Sariego IAG, Guibert-Toledano M, Rodriguez VJK, Lopez MEL, Ortega AP, Russell AS, Santos-Moreno P, Terán IS, Vargas A, Vásquez G, Xavier RM, Firedman DXX, Mysler E, Kay J. PANLAR consensus statement on biosimilars. Clin Rheumatol 2019; 38:1485-1496. [DOI: 10.1007/s10067-019-04496-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 01/28/2023]
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8
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Vermeer NS, Giezen TJ, Zastavnik S, Wolff-Holz E, Hidalgo-Simon A. Identifiability of Biologicals in Adverse Drug Reaction Reports Received From European Clinical Practice. Clin Pharmacol Ther 2019; 105:962-969. [PMID: 30460997 PMCID: PMC6590109 DOI: 10.1002/cpt.1310] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022]
Abstract
Biologicals are established treatment options that require pharmacovigilance adapted to their specific nature, including the need for products to be identifiable up to the specific manufacturer in reports of adverse drug reactions (ADRs). This study explored the identifiability of 10 classes of similar and related biologicals up to the level of the manufacturer in ADR reports received from European clinical practice between 2011 and June 2016. Adequate identifiers were reported for 96.7% of the suspected biologicals, ranging from 89.5% for filgrastim to 99.8% for interferon beta‐1a. The product identifiability remained consistently high over time for classes of biologicals for which biosimilars were introduced during follow‐up. The overall batch traceability was, however, only ensured for 20.5% of the suspected biologicals and needs further improvement. This study shows that the European system for identification of ADRs to the level of the manufacturer is robust, allowing for the timely detection of potential product‐specific safety signals for biologicals.
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Affiliation(s)
- Niels S Vermeer
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, the Netherlands
| | - Thijs J Giezen
- Foundation Pharmacy for Hospitals in Haarlem, Haarlem, the Netherlands
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9
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O'Callaghan J, Griffin BT, Morris JM, Bermingham M. Knowledge of Adverse Drug Reaction Reporting and the Pharmacovigilance of Biological Medicines: A Survey of Healthcare Professionals in Ireland. BioDrugs 2018; 32:267-280. [PMID: 29721705 PMCID: PMC5990561 DOI: 10.1007/s40259-018-0281-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background In Europe, changes to pharmacovigilance legislation, which include additional monitoring of medicines, aim to optimise adverse drug reaction (ADR) reporting systems. The legislation also makes provisions related to the traceability of biological medicines. Objective The objective of this study was to assess (i) knowledge and general experience of ADR reporting, (ii) knowledge, behaviours, and attitudes related to the pharmacovigilance of biologicals, and (iii) awareness of additional monitoring among healthcare professionals (HCPs) in Ireland. Methods Hospital doctors (n = 88), general practitioners (GPs) (n = 197), nurses (n = 104) and pharmacists (n = 309) completed an online questionnaire. Results There were differences in mean knowledge scores relating to ADR reporting and the pharmacovigilance of biologicals among the HCP groups. The majority of HCPs who use biological medicines in their practice generally record biologicals by brand name but practice behaviours relating to batch number recording differed between some professions. HCPs consider batch number recording to be valuable but also regard it as being more difficult than brand name recording. Most respondents were aware of the concept of additional monitoring but awareness rates differed between some groups. Among those who knew about additional monitoring, there was higher awareness of the inverted black triangle symbol among pharmacists (> 86.4%) compared with hospital doctors (35.1%), GPs (35.6%), and nurses (14.9%). Hospital pharmacists had more experience and knowledge of ADR reporting than other practising HCPs. Conclusion This study highlights the important role hospital pharmacists play in post-marketing surveillance. There is a need to increase pharmacovigilance awareness of biological medicines and improve systems to support their batch traceability. Electronic supplementary material The online version of this article (10.1007/s40259-018-0281-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J O'Callaghan
- Regulatory Science Ireland, c/o School of Pharmacy, University College Cork, Cork, Ireland.,School of Pharmacy, University College Cork, Cork, Ireland.,Health Products Regulatory Authority, Kevin O'Malley House, Earlsfort Centre, Earlsfort Terrace, Dublin 2, Ireland
| | - B T Griffin
- Regulatory Science Ireland, c/o School of Pharmacy, University College Cork, Cork, Ireland.,School of Pharmacy, University College Cork, Cork, Ireland
| | - J M Morris
- Regulatory Science Ireland, c/o School of Pharmacy, University College Cork, Cork, Ireland
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10
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The Role of European Healthcare Databases for Post-Marketing Drug Effectiveness, Safety and Value Evaluation: Where Does Italy Stand? Drug Saf 2018; 42:347-363. [DOI: 10.1007/s40264-018-0732-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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11
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Scheinberg M, Pineda C, Castañeda-Hernández G, Zarbá JJ, Damião A, Arantes Jr LH, Jacobs I. Biosimilars in oncology and inflammatory diseases: current and future considerations for clinicians in Latin America. MAbs 2018; 10:827-842. [PMID: 30156950 PMCID: PMC6152448 DOI: 10.1080/19420862.2018.1484977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/21/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
Biological therapies have revolutionized the treatment of several cancers and systemic immune-mediated inflammatory conditions. Expiry of patents protecting a number of biologics has provided the opportunity to commercialize highly similar versions, known as biosimilars. Biosimilars are approved by regulatory agencies via an independent pathway that requires extensive head-to-head comparison with the originator product. Biosimilars have the potential to provide savings to healthcare systems and expand patient access to biologics. In Latin American countries, regulatory frameworks for biosimilar approval have been introduced in recent years, and biosimilars of monoclonal antibody and fusion protein therapies are now emerging. However, the situation in this region is complicated by the presence of "non-comparable biotherapeutics" (also known as "intended copies"), which have not been rigorously compared with the originator product. We review the considerations for clinicians in Latin American countries, focusing on monoclonal antibody biosimilars relevant to oncology, rheumatology, gastroenterology, and dermatology.
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Affiliation(s)
- Morton Scheinberg
- Rheumatology Section – Orthopedics Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Gilberto Castañeda-Hernández
- Department of Pharmacology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Juan José Zarbá
- Oncology Department, Hospital Centro de Salud Zenón J. Santillán, San Miguel de Tucumán, Argentina
- Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán, Argentina
| | - Aderson Damião
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
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12
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EU pharmacovigilance regulatory requirements of anticancer biosimilar monoclonal antibodies. Int J Clin Pharm 2018; 40:778-782. [PMID: 30094558 PMCID: PMC6132979 DOI: 10.1007/s11096-018-0709-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022]
Abstract
An increasing number of innovative oncology monoclonal antibodies (mAbs) have been introduced into the global market, and biosimilar versions have now also been approved in Europe. Being complex to develop and difficult to manufacture, the biosimilar is a drug similar but not identical in physicochemical characteristics, efficacy, and safety to an original biological drug already approved in the European Union, for which marketing exclusivity rights have expired. Generally, the safety monitoring of biosimilars follows the same requirements that apply to all biologicals, even if specific pharmacovigilance measures exist and some of them are still being debated. The manufacturing process, immunogenicity, traceability, and extrapolation of indication are keywords which may impact on the achievement of additional knowledge about the safety of a biosimilar mAb. In this article, we aim to discuss elements that play a central role in the pharmacovigilance legislation of biosimilar mAbs.
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13
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Agoro OO, Kibira SW, Freeman JV, Fraser HSF. Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation. J Am Med Inform Assoc 2018; 25:627-634. [PMID: 29040656 PMCID: PMC6664850 DOI: 10.1093/jamia/ocx102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/07/2017] [Accepted: 09/01/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation. Materials and Methods Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya. Results The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system. Discussion Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives. Conclusion While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.
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Affiliation(s)
- Oscar O Agoro
- Ministry of Health, Medical Department, Nairobi, Kenya
| | | | - Jenny V Freeman
- Yorkshire Centre for Health Informatics, University of Leeds, Leeds, UK
| | - Hamish S F Fraser
- Yorkshire Centre for Health Informatics, University of Leeds, Leeds, UK
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14
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Biosimilars: Concepts and controversies. Pharmacol Res 2018; 133:251-264. [PMID: 29428205 DOI: 10.1016/j.phrs.2018.01.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 12/24/2022]
Abstract
Biosimilars are copies of reference biological drugs, developed as the patents for original biologicals expire. They are thus developed to replicate an original biological medicine just a generics are intended to replicate a chemically-synthesized medicine; however, there are important technical and regulatory differences between the two. Unlike chemical drugs, molecular identity cannot generally be established for any two biological drugs. Accordingly, their pharmacological properties cannot be assumed to be the same. This is due to the complexity of the production of biologicals and to the presence of minor natural variations in the molecular structure (collectively known as microheterogeneity). Further, biological production yields slightly different versions of the drug over time, particularly when changes are introduced in the production process. In this case the prechange and postchange versions of the biological are analyzed in what is called a comparability exercise. The comparable versions thus validated are considered not to have any significant differences at the clinical level. Likewise, biosimilars are not identical copies but comparable versions of the original biological drug, also validated through a comparability exercise, although of a much broader scope. Although current knowledge about biosimilars has increased significantly, they still arise a number of controversies and misconceptions, particularly regarding issues like extrapolation of indications, immunogenicity and substitution. This review deals with concepts and controversies in the biosimilar field.
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15
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Blandizzi C, Galeazzi M, Valesini G. Transitioning from first- to second-generation biosimilars: An appraisal of regulatory and post-marketing challenges. Pharmacol Res 2018; 128:306-314. [DOI: 10.1016/j.phrs.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 12/28/2022]
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16
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Cohen AD, Wu JJ, Puig L, Chimenti S, Vender R, Rajagopalan M, Romiti R, de la Cruz C, Skov L, Zachariae C, Young HS, Foley P, van der Walt JM, Naldi L, Prens EP, Blauvelt A. Biosimilars for psoriasis: worldwide overview of regulatory guidelines, uptake and implications for dermatology clinical practice. Br J Dermatol 2017. [PMID: 28646580 DOI: 10.1111/bjd.15756] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The introduction of biological drugs for the treatment of patients with psoriasis has revolutionized treatment paradigms and enabled numerous patients to achieve disease control with an acceptable safety profile. However, the high cost of biologics limits access to these medications for the majority of patients worldwide. In recent years, the introduction of biosimilars for inflammatory diseases has become a fast evolving field. The future use of biosimilars offers the potential for decreased cost and increased access to biologics for patients with psoriasis. For approval of biosimilars, different regulatory agencies use highly variable methods for definition, production, approval, marketing and postmarketing surveillance. Due to potential interchangeability between biologics and biosimilars, traceability and pharmacovigilance are required to collect accurate data about adverse events in patients with psoriasis; spontaneous reporting, registries and use of 'big data' should facilitate this process on a global basis. The current article describes biosimilar regulatory guidelines and examples of biosimilar uptake in clinical practice in several countries around the world. As it is apparent that biological therapy treatment decisions may become more physician independent, the International Psoriasis Council recommends that dermatologists should take an active role in the development of biosimilar prescribing policies with their respective healthcare settings and government agencies.
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Affiliation(s)
- A D Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - J J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, U.S.A
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Chimenti
- University of Rome Tor Vergata, Rome, Italy
| | - R Vender
- Dermatrials Research Inc. & Venderm Innovations in Psoriasis, Hamilton, ON, Canada
| | - M Rajagopalan
- Department of Dermatology, Apollo Hospitals, Chennai, India
| | - R Romiti
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
| | | | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - H S Young
- The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Department of Dermatology, Salford Royal NHS Foundation Trust, Manchester, U.K
| | - P Foley
- Skin & Cancer Foundation Inc., Carlton, Vic., Australia.,Department of Dermatology, The University of Melbourne, Melbourne, Vic., Australia.,St Vincent's Hospital, Melbourne, Vic., Australia
| | | | - L Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - E P Prens
- Deptartment of Dermatology, Erasmus MC, P.O. Box 5201, 3008, AE Rotterdam, the Netherlands
| | - A Blauvelt
- Oregon Medical Research Center, Portland, OR, U.S.A
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Stergiopoulos S, Brown CA, Felix T, Grampp G, Getz KA. A Survey of Adverse Event Reporting Practices Among US Healthcare Professionals. Drug Saf 2017; 39:1117-1127. [PMID: 27638657 PMCID: PMC5045838 DOI: 10.1007/s40264-016-0455-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction The under-reporting of adverse drug events (ADEs) is an international health concern. A number of studies have assessed the root causes but, to our knowledge, little information exists relating under-reporting to practices and systems used for the recording and tracking of drug‐related adverse event observations in ambulatory settings, institutional settings, and retail pharmacies. Objectives Our objective was to explore the process for reporting ADEs in US hospitals, ambulatory settings, and retail pharmacies; to explore gaps and inconsistencies in the reporting process; and to identify the causes of under-reporting ADEs in these settings. Methods The Tufts Center for the Study of Drug Development (Tufts CSDD) interviewed 11 thought leaders and conducted a survey between May and August 2014 among US-based healthcare providers (HCPs) in diverse settings to assess their experiences with, and processes for, reporting ADEs. Results A total of 123 individuals completed the survey (42 % were pharmacists; 27 % were nurses; 15 % were physicians; and 16 % were classified as ‘other’). HCPs indicated that the main reasons for under-reporting were difficulty in determining the cause of the ADE, given that most patients receive multiple therapies simultaneously (66 % of respondents); that HCPs lack sufficient time to report ADEs (63 % of respondents); poor integration of ADE-reporting systems (53 % of respondents); and uncertainty about reporting procedures (52 % of respondents). Discussion The results of this pilot study identify that key factors contributing to the under-reporting of ADEs relate to a lack of standardized process, a lack of training and education, and a lack of integrated health information technologies. Electronic supplementary material The online version of this article (doi:10.1007/s40264-016-0455-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stella Stergiopoulos
- Tufts Center for the Study of Drug Development, Tufts Medical School, 75 Kneeland Street, Ste 1100, Boston, MA, 02111, USA.
| | - Carrie A Brown
- Tufts Center for the Study of Drug Development, Tufts Medical School, 75 Kneeland Street, Ste 1100, Boston, MA, 02111, USA
| | | | | | - Kenneth A Getz
- Tufts Center for the Study of Drug Development, Tufts Medical School, 75 Kneeland Street, Ste 1100, Boston, MA, 02111, USA
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Azevedo V, Dörner T, Strohal R, Isaacs J, Castañeda-Hernández G, Gonçalves J, McInnes I. Biosimilars: considerations for clinical practice. ACTA ACUST UNITED AC 2017. [DOI: 10.1136/conmed-2017-100005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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19
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Serra López-Matencio JM, Morell Baladrón A, Castañeda S. Fármacos biosimilares: un nuevo escenario en las terapias biológicas. ACTA ACUST UNITED AC 2017; 13:287-293. [DOI: 10.1016/j.reuma.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/16/2016] [Accepted: 05/22/2016] [Indexed: 11/26/2022]
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20
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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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21
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Assessing awareness and attitudes of healthcare professionals on the use of biosimilar medicines: A survey of physicians and pharmacists in Ireland. Regul Toxicol Pharmacol 2017; 88:252-261. [DOI: 10.1016/j.yrtph.2017.06.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
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22
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Marcianò I, Ingrasciotta Y, Giorgianni F, Bolcato J, Chinellato A, Pirolo R, Di Giorgio A, Manna S, Ientile V, Gini R, Santarpia M, Genazzani AA, Uomo I, Pastorello M, Pollina Addario SW, Scondotto S, Cananzi P, Da Cas R, Traversa G, Rossi M, Sottosanti L, Caputi AP, Trifirò G. How did the Introduction of Biosimilar Filgrastim Influence the Prescribing Pattern of Granulocyte Colony-Stimulating Factors? Results from a Multicentre, Population-Based Study, from Five Italian Centres in the Years 2009-2014. BioDrugs 2017; 30:295-306. [PMID: 27138636 DOI: 10.1007/s40259-016-0175-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Granulocyte colony-stimulating factors (G-CSFs) are biological products for which the main indication of use is chemotherapy-induced neutropenia. Biosimilars of G-CSFs have been available in Europe since 2007. OBJECTIVE The objective of this study was to investigate the prescribing pattern of G-CSFs in five Italian centres using different healthcare policy interventions to promote the use of biosimilars in routine care. METHODS This retrospective, population-based drug utilization study was conducted during the years 2009-2014 using the administrative databases of the Caserta, Treviso and Palermo Local Health Units (LHUs) and the Tuscany and Umbria regions. G-CSF users were characterized and the prevalence of use, proportion of biosimilar users and switching pattern of different G-CSFs were evaluated over time and across centres. RESULTS Overall, 30,247 patients were treated with G-CSFs in the years 2009-2014, of which 29,083 (96.2 %) were naïve users. The overall prevalence of G-CSF use increased from 0.8 per 1000 inhabitants in 2009 to 1.1 per 1000 in 2014. An increase in the proportion of the use of the biosimilar filgrastim by the total G-CSF users was observed in all centres: from 0.2 % (2009) to 66.2 % (2014). However, heterogeneity across different centres was reported, with the largest increase in Treviso LHU (from 0 to 89.1 % from 2009 to 2014). During the first year of treatment, switching between different G-CSFs was frequent (20.3 %). CONCLUSIONS Heterogeneity in the use of G-CSF and, in particular, biosimilar filgrastim across different Italian centres was observed, probably due to different regional healthcare policy interventions. During the first year of treatment, switching between different G-CSFs was frequent. Considering the impact of biological drugs on pharmaceutical expenses, it is necessary to harmonize healthcare policies promoting the use of biological drugs with the lowest cost.
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Affiliation(s)
- Ilaria Marcianò
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Ylenia Ingrasciotta
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | | | - Jenny Bolcato
- Pharmaceutical Service, Local Health Authority (ULSS9), Treviso, Italy
| | | | - Roberta Pirolo
- Pharmaceutical Service, Local Health Authority (ULSS9), Treviso, Italy
| | | | - Sonia Manna
- Caserta-1 Local Health Service, Caserta, Italy
| | - Valentina Ientile
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | | | - Armando A Genazzani
- Department of Pharmaceutical Sciences, "A. Avogadro" University, Novara, Italy
| | - Ilaria Uomo
- Department of Pharmacy, Palermo Local Health Unit, Palermo, Italy
| | | | | | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Pasquale Cananzi
- Sicilian Regional Centre of Pharmacovigilance, Servizio 7-Farmaceutica, Health Department of Sicily, Palermo, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Mariangela Rossi
- Health-Unit for Pharmaceutical Governance, Umbria Region, Perugia, Italy
| | | | - Achille P Caputi
- Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy. .,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Klein K, Scholl JHG, Vermeer NS, Broekmans AW, Van Puijenbroek EP, De Bruin ML, Stolk P. Traceability of Biologics in The Netherlands: An Analysis of Information-Recording Systems in Clinical Practice and Spontaneous ADR Reports. Drug Saf 2016; 39:185-92. [PMID: 26719190 PMCID: PMC4735237 DOI: 10.1007/s40264-015-0383-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction and Objective Pharmacovigilance requirements for biologics mandate that EU Member States shall ensure that any biologic that is the subject of a suspected adverse drug reaction (ADR) is identifiable by brand name and batch number. Recent studies showed that brand name identification is well established, whereas batch numbers are (still) poorly reported. We evaluated information-recording systems and practices in the Dutch hospital setting to identify determinants for brand name and batch number recording as well as success factors and bottlenecks for traceability. Methods We surveyed Dutch hospital pharmacists with an online questionnaire on systems and practices in hospitals for recording brand names and batch numbers. Additionally, we performed an analysis of the traceability of recombinant biologics in spontaneous ADR reports (received between 2009 and 2014) from the Netherlands Pharmacovigilance Centre Lareb. Results The survey showed that brand names are not routinely recorded in the clinical practice of Dutch hospitals, whereas batch numbers are poorly recorded. Seventy-six percent of the 1523 ADR reports for recombinant biologics had a traceable brand name whereas 5 % of these reports contained a batch number. The results suggest a possible relationship between the availability of brand and batch number information in clinical practice and the inclusion of this information in ADR reports for biologics. Conclusion The limited traceability of brand names and batch numbers in ADR reports may be primarily caused by the shortcomings in the recording of information in clinical practice. We recommend efforts to improve information-recording systems as a first step to improve the traceability of biologics in ADR reporting. Electronic supplementary material The online version of this article (doi:10.1007/s40264-015-0383-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kevin Klein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
- TI Pharma Escher, Leiden, The Netherlands.
- Exon Consultancy, Amsterdam, The Netherlands.
| | - Joep H G Scholl
- The Netherlands Pharmacovigilance Centre Lareb, Den Bosch, The Netherlands
| | - Niels S Vermeer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands
| | | | | | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
- Medicines Evaluation Board (MEB), Utrecht, The Netherlands.
| | - Pieter Stolk
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- TI Pharma Escher, Leiden, The Netherlands
- Exon Consultancy, Amsterdam, The Netherlands
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Moorkens E, Jonker-Exler C, Huys I, Declerck P, Simoens S, Vulto AG. Overcoming Barriers to the Market Access of Biosimilars in the European Union: The Case of Biosimilar Monoclonal Antibodies. Front Pharmacol 2016; 7:193. [PMID: 27445826 PMCID: PMC4925708 DOI: 10.3389/fphar.2016.00193] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/17/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2014, six of the top ten blockbuster medicines were monoclonal antibodies. This multibillion-dollar market with expiring patents is the main driver for the development of biosimilar mAbs. With the ever-increasing cost of healthcare and the economic pressure to reduce or sustain healthcare expenses, biosimilars could be instrumental in reducing costs for medication and increasing patient access to treatment. OBJECTIVES The aim of this study is to identify and describe the barriers to market access of biosimilar mAbs in the European Union and to analyze how these barriers could be overcome. METHODS A narrative literature review was carried out using the databases PubMed, Embase, and EconLit. Studies were published in English or Dutch. Additionally, the reference list of the articles was checked for relevant studies. Articles and conference papers known to the authors were included as well. Articles were also identified by searching on the website of the Generics and Biosimilars Initiative (GaBI) journal. RESULTS Six barriers were identified based on available literature: The manufacturing process, the regulatory process, intellectual property rights, lack of incentive, the impossibility of substitution, and the innovator's reach. These six barriers are presented as a possible framework to study the market access of biosimilar mAbs. Based on the literature search, recommendations can be made to overcome these barriers: (i) invest initially in advanced production processes with the help of single-use technology, experience or outsourcing (ii) gain experience with the regulatory process and establish alignment between stakeholders (iii) limit patent litigation, eliminate evergreening benefits, build out further the unitary patent and unified patent litigation system within the EU (iv) create demand-side policies, disseminate objective information (v) change attitude toward biosimilar switching/substitution, starting with physician, and patient education (vi) differentiate the biosimilar by service offerings, use an appropriate comparator in cost-effectiveness analyses. CONCLUSIONS Barriers to the market access of biosimilar mAbs could be reduced when more transparency and communication/education is used in all steps toward market access in order to increase the trust in biosimilar mAbs by all stakeholders. Only then biosimilar mAbs will be able to fully capture their cost saving potential.
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Affiliation(s)
- Evelien Moorkens
- Department of Pharmaceutical and Pharmacological Sciences, University of LeuvenLeuven, Belgium
| | - Clara Jonker-Exler
- Hospital Pharmacy, The Erasmus University Medical CenterRotterdam, Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, University of LeuvenLeuven, Belgium
| | - Paul Declerck
- Department of Pharmaceutical and Pharmacological Sciences, University of LeuvenLeuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, University of LeuvenLeuven, Belgium
| | - Arnold G. Vulto
- Hospital Pharmacy, The Erasmus University Medical CenterRotterdam, Netherlands
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25
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Ingrasciotta Y, Giorgianni F, Bolcato J, Chinellato A, Pirolo R, Tari DU, Troncone C, Fontana A, Ientile V, Gini R, Santoro D, Santarpia M, Genazzani A, Uomo I, Pastorello M, Addario WSP, Scondotto S, Cananzi P, Caputi AP, Trifirò G. How Much Are Biosimilars Used in Clinical Practice? A Retrospective Italian Population-Based Study of Erythropoiesis-Stimulating Agents in the Years 2009-2013. BioDrugs 2016; 29:275-84. [PMID: 26169209 PMCID: PMC4561997 DOI: 10.1007/s40259-015-0132-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose To explore the prescription patterns of erythropoiesis-stimulating agents (ESAs) in four large Italian geographic areas, where different health policy interventions to promote biosimilar use in routine care are undertaken. Methods A retrospective drug utilization study was conducted during the years 2009–2013. The data sources were the administrative databases of the Tuscany region and of the Caserta, Palermo, and Treviso Local Health Units (LHUs). The characteristics, prevalence, and switching patterns of different ESAs (biosimilars and reference products), stratified by indication for use, were calculated over time and across centers. Results Overall, 49,491 patients were treated with ESAs during the years 2009–2013 in the four centers. Of these, 41,286 patients (83.4 %) were naive users. The prevalence of ESA use increased from 2.9 to 3.4 per 1000 inhabitants in the years 2009–2011 but decreased thereafter (3.0 per 1000 in 2013). Moreover, the proportion of biosimilar users increased overall from 1.8 % in 2010 to 33.6 % in 2013, with larger increase in Treviso (from 0.0 to 45.0 %) and Tuscany (from 0.7 to 37.6 %) than in Caserta (from 7.5 to 22.9 %) and Palermo (from 0.0 to 27.7 %). Switching between different ESAs during the first year of therapy was frequent (17.0 %), much more toward reference products than toward biosimilars. Conclusion Overall, the prevalence of ESA use decreased slightly, while use of biosimilar ESAs, especially in naive patients, increased significantly but to different extents in these four large Italian geographic areas. Switching between different ESAs during the first year of treatment was very frequent, which may affect pharmacovigilance monitoring. New strategies are necessary to further improve market penetration of low-cost medicines, such as biosimilars, and also to harmonize effective health policy interventions that aim to reduce pharmaceutical expenses and optimize patient benefit across all regions. Electronic supplementary material The online version of this article (doi:10.1007/s40259-015-0132-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ylenia Ingrasciotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy,
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Swamy S, Mourya M, Kadhe G, Mane A, Sawant S. Safety reporting through a comprehensive and pragmatic pharmcovigilance process for India and emerging markets: an industry perspective. Expert Opin Drug Saf 2016; 14:1409-20. [PMID: 26292785 DOI: 10.1517/14740338.2015.1071792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pharmacovigilance (PV) deals with the drug-related adverse reactions ensuring patients' safety. Emerging markets of India, South East Asia (SEA), Russia, Latin America (LA), Middle East and North Africa (MENA) have developed their own PV programs. However, under/manual reporting accompanied with lack of awareness regarding adverse drug reactions (ADRs) are major drawbacks that continue to exist due to lack of co-ordination and disparity in the regulatory approach. AREAS COVERED Of the 118 studies identified using various databases, 60 were included for the review. The authors discuss the present PV scenario of India, SEA, Russia, LA and MENA, and explain a basic process for uniform PV data input-output across industry, which includes data collection, analysis, processing, causality assessment and data distribution systems. EXPERT OPINION As the number of clinical trials conducted are rising in the emerging markets, there is a need to understand and implement a robust PV system, where electronically globalized, evidence based, public health oriented and regulatory compliant PV system is established. This would also improve transparency in system and ensure enhancement in safety data reporting ensuring premature and trouble-free detection of ADRs. It might result in implementing various PV boosting activities, which could yield robust patient safety data from India and emerging markets.
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Affiliation(s)
- Shashidhar Swamy
- a 1 Wockhardt Limited , Wockhardt Towers, Bandra Kurla Complex, Mumbai, India +91 99 20 168 771 ;
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27
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Stergiopoulos S, Getz K. Evaluating AE Reporting of Two Off-Patent Biologics to Inform Future Biosimilar Naming and Reporting Practices. Drug Saf 2016; 38:687-92. [PMID: 26108298 DOI: 10.1007/s40264-015-0310-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Historical studies of voluntary, spontaneous drug reports show poor attribution of adverse events to generic versions of commonly prescribed medications. As biosimilars enter the market place, it may be similarly difficult to accurately attribute adverse events to their respective reference products. At this time, lack of global consensus with regard to biosimilar naming conventions may result in drug reporting confusion, misattribution of adverse events and insufficient active monitoring of safety signals. Now, with the first biosimilar approval in the USA and many biosimilars expected to be launched globally in the near future, US Food and Drug Administration (FDA) guidance on biosimilar naming conventions will be essential. To inform the FDA and the global drug development community, the Tufts Center for the Study of Drug Development (Tufts CSDD) examined primary suspect reports sent to the FDA's Adverse Event Reporting System (FAERS) from US reporters for two biologics that have lost patent exclusivity--somatropin and human insulin--and extracted 4703 insulin reports and 6487 somatropin reports from FAERS. The results show that reporting practices are inconsistent between the two biologics that were evaluated and that manufacturer identifiability and traceability are lacking. Ways to improve biosimilar naming conventions and improve reporting practices are suggested.
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Affiliation(s)
- Stella Stergiopoulos
- Center for the Study of Drug Development, Tufts University School of Medicine, Boston, MA, USA
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28
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Ebbers HC, Tienda NFD, Hoefnagel MC, Nibbeling R, Mantel-Teeuwisse AK. Characteristics of product recalls of biopharmaceuticals and small-molecule drugs in the USA. Drug Discov Today 2016; 21:536-9. [DOI: 10.1016/j.drudis.2015.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/09/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
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Stergiopoulos S, Brown CA, Grampp G, Felix T, Getz KA. Identifying and Quantifying the Accuracy of Product Name Attribution of US-Sourced Adverse Event Reports in MedWatch of Somatropins and Insulins. Ther Innov Regul Sci 2015; 49:706-716. [PMID: 30227042 DOI: 10.1177/2168479015578156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND As of 2014, the US FDA was considering policy options to promote accurate attribution of adverse events for biosimilars. In order to assess the identification and traceability of biologics from multiple sources, Tufts University's Center for the Study of Drug Development conducted a study reviewing the current FDA Adverse Event Reporting System (FAERS) for reports related to insulin and growth hormone products. METHODS For this study, all primary suspect reports that were received by FAERS for human growth hormone (hGH) and human insulin between the fourth quarter of 2005 and the third quarter of 2013 were extracted and analyzed. RESULTS The rates of "accurate" brand (ie, identifiable) drug names were generally high, with a higher incidence for hGH drugs than for insulin drugs (92% of hGH primary suspect reports vs 84% of insulin primary suspect reports). Lot number completion rates were generally low, with a higher incidence for insulin drugs than for hGH drugs (37% of insulin primary suspect reports vs 13% of hGH primary suspect reports). There were 13.5% of insulin reports that could not be linked to manufacturers, while 7.5% of hGH reports could not be linked to a manufacturer. CONCLUSIONS The completion and accuracy rates of FAERS data on biologics observed in this study are consistent with those observed in earlier studies and suggest that traceability in adverse event reports can be improved through more consistent use of brand names or other product specific identifiers and through more frequent inclusion of lot numbers.
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Vermeer NS, Ebbers HC, Straus SMJM, Leufkens HGM, Egberts TCG, De Bruin ML. The effect of exposure misclassification in spontaneous ADR reports on the time to detection of product-specific risks for biologicals: a simulation study. Pharmacoepidemiol Drug Saf 2015; 25:297-306. [PMID: 26676881 DOI: 10.1002/pds.3929] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 11/11/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE The availability of accurate product-specific exposure information is essential in the pharmacovigilance of biologicals, because differences in the safety profile may emerge between products containing the same active substance. In spontaneous adverse drug reaction (ADR) reports, drug exposure may, however, be misclassified, that is, attributed to the incorrect product. The aim of this study was to explore the effect of exposure misclassification on the time to detection of product-specific risks in spontaneous reporting systems. METHODS We used data simulations to explore the effect of exposure misclassification. We simulated an active substance-specific subset of a spontaneous reporting system and used the proportional reporting ratio for signal detection. The effect of exposure misclassification was evaluated in three test cases representing product-specific ADRs that may occur for biologicals and studied in relative terms by varying the model parameters (market share and relative risk). RESULTS We found that exposure misclassification results in the largest delay in identification of risks that have a weak association (relative risk < 2 or 3) with the product of interest and in situations where the product associated with the unique risk has a large (>50%) market share. The absolute public health impact of exposure misclassification, in terms of cases/time to detection, varied considerably across the test cases. CONCLUSION Exposure misclassification in ADR reports may result in a delayed detection of product-specific risks, particularly in the detection of weak drug-event associations. Our findings can help inform the future implementation and refinement of product-specific and batch-specific signal detection procedures.
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Affiliation(s)
- Niels S Vermeer
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
| | - Hans C Ebbers
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Sabine M J M Straus
- Medicines Evaluation Board, Utrecht, The Netherlands.,Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hubert G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
| | - Toine C G Egberts
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie L De Bruin
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,Medicines Evaluation Board, Utrecht, The Netherlands
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Polimeni G, Trifirò G, Ingrasciotta Y, Caputi AP. The advent of biosimilars for the treatment of diabetes: current status and future directions. Acta Diabetol 2015; 52:423-31. [PMID: 25990669 DOI: 10.1007/s00592-015-0771-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022]
Abstract
Biosimilar insulins are likely to enter the market of diabetes therapies as patents for major branded insulin products start to expire in the next few years (on June 2014, the European Medicines Agency authorized the first biosimilar of insulin glargine, Abasria, 100 Units/ml, for the treatment of diabetes mellitus). This would allow providing comparable clinical benefits of the current available insulins at a significantly lower cost, thus increasing the affordability and access of insulin treatment for patients with diabetes. Biosimilars are approved via a stringent regulatory pathway demonstrating quality, safety, and efficacy comparable to the reference product. However, the production complexities of such products raise important considerations for treatment efficacy and patient safety, including naming and product tracking, substitution practices, and pharmacovigilance. Additionally, as practitioners' knowledge regarding the differences about pharmacological, clinical, and regulatory aspects between biosimilars and generic small molecules is often suboptimal, specific education on biosimilar prescribing, dispensing, and administering is critical for ensuring patients' benefit and safety. This article discusses all the issues concerning biosimilar, especially biosimilar insulins.
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Affiliation(s)
- Giovanni Polimeni
- Unit of Clinical Pharmacology, Sicilian Regional Centre of Pharmacovigilance, A.U.O. Policlinico "G. Martino", Torre Biologica, Via Consolare Valeria, 98125, Gazzi, Messina, Italy,
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