1
|
Yanagi Y, Takahashi K, Iida T, Gomi F, Onishi H, Morii J, Sakamoto T. Cost-effectiveness Analysis of Ranibizumab Biosimilar for Neovascular Age-Related Macular Degeneration and its Subtypes from the Societal and Patient Perspectives in Japan. Ophthalmol Ther 2024:10.1007/s40123-024-01011-z. [PMID: 39126559 DOI: 10.1007/s40123-024-01011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION This study evaluated the cost-effectiveness of anti-vascular endothelial growth factor (VEGF) therapies for subtypes of neovascular age-related macular degeneration (nAMD) from the societal perspective, and for any nAMD from the patient perspective in Japan. METHODS A Markov model was developed to simulate the lifetime transitions of a cohort of patients with nAMD through various health states based on the involvement of nAMD, the treatment status, and decimal best-corrected visual acuity. Ranibizumab biosimilar was compared with aflibercept from the societal perspective regardless of treatment regimen for the analysis of three subtypes (typical nAMD, polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP)). Two analyses from the patient perspective focusing on the treat-and-extend regimens were performed, one with a cap on patients' copayments and one without. Ranibizumab biosimilar was compared with branded ranibizumab, aflibercept, aflibercept as the loading dose switching to ranibizumab biosimilar during maintenance (aflibercept switching to ranibizumab biosimilar), and best supportive care (BSC), for patients with any nAMD. RESULTS In the subtype analyses, ranibizumab biosimilar when compared with aflibercept resulted in incremental quality-adjusted life years (QALYs) of - 0.015, 0.026, and 0.009, and the incremental costs of Japanese yen (JPY) - 50,447, JPY - 997,243, and JPY - 1,286,570 for typical nAMD, PCV, and RAP, respectively. From the patient perspective, ranibizumab biosimilar had incremental QALYs of 0.015, 0.009, and 0.307, compared with aflibercept, aflibercept switching to ranibizumab biosimilar, and BSC, respectively. The incremental costs for ranibizumab biosimilar over a patient lifetime excluding the cap on copayment were estimated to be JPY - 138,948, JPY - 391,935, JPY - 209,099, and JPY - 6,377,345, compared with branded ranibizumab, aflibercept, aflibercept switching to ranibizumab biosimilar, and BSC, respectively. CONCLUSIONS Ranibizumab biosimilar was demonstrated as a cost-saving option compared to aflibercept across all subtypes of nAMD, irrespective of the perspectives considered.
Collapse
Affiliation(s)
- Yasuo Yanagi
- Department of Ophthalmology and Micro-technology, Yokohama City University, Yokohama, Kanagawa, Japan.
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Osaka, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | | | | | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| |
Collapse
|
2
|
Papaioannou C. Advancements in the treatment of age-related macular degeneration: a comprehensive review. Postgrad Med J 2024; 100:445-450. [PMID: 38330506 DOI: 10.1093/postmj/qgae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
Age-related macular degeneration (AMD) stands as a leading cause of irreversible blindness, particularly affecting central vision and impeding daily tasks. This paper provides a thorough exploration of AMD, distinguishing between its two main subtypes-Wet and Dry AMD-while shedding light on the prevalence and risk factors, including age, genetics, and smoking. The focus shifts to the current and future treatment landscape, examining both Dry and Wet AMD. Regarding Dry AMD, interventions such as antioxidant supplementation and ongoing clinical trials offer hope. Notable among these is Pegcetacoplan which is the only Food and Drug Administration (FDA)-approved medication, displaying promising results in reducing geographic atrophy lesions. For Wet AMD, anti-Vascular Endothelial Growth Factor therapies like Ranibizumab (Lucentis®) have been instrumental, and newer drugs like Faricimab and OPT-302 show comparable efficacy with extended dosing intervals. Additionally, gene therapies such as RGX-314 present a potential paradigm shift, reducing or eliminating the need for frequent injections. Biosimilars offer cost-effective alternatives. The paper also delves into the integration of technology and artificial intelligence in AMD management, highlighting the role of smartphone apps for patient monitoring and artificial intelligence algorithms for diagnosis and surveillance. Furthermore, patient perspectives on artificial intelligence demonstrate a positive correlation between understanding and trust. The narrative concludes with a glimpse into ground-breaking technologies, including retinal implants and bionic chips, offering hope for vision restoration. Overall, this paper underscores the multifaceted approach in addressing AMD, combining traditional and innovative strategies, paving the way for a more promising future in AMD treatment.
Collapse
Affiliation(s)
- Christos Papaioannou
- Department of Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, TW7 6AF, London, United Kingdom
| |
Collapse
|
3
|
Chakraborty D, Boral S, Sinha TK, Das A, Mukherjee A, Majumdar S, Bhattacharya R, Maitra R. Transitioning from Aflibercept to Biosimilar Ranibizumab in Neovascular AMD (The TRANSFORM Trial): A Multicenter Observational Study. Clin Ophthalmol 2024; 18:1819-1828. [PMID: 38948341 PMCID: PMC11212807 DOI: 10.2147/opth.s459085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose This study investigates the efficacy of transitioning patients with neovascular age-related macular degeneration (nAMD) from aflibercept (T1) to biosimilar ranibizumab (T2), an approach not previously documented in literature. Methods In this multicenter observational study, patients over 50 years of age with nAMD were shifted from intravitreal aflibercept (IVI AFL) to biosimilar ranibizumab (B-RBZ) due to financial constraints. This study employed standardized ophthalmological methods to assess visual acuity (VA), central macular thickness (CMT), and subretinal and intraretinal fluid. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and linear regression. Results A total of 29 eyes (12 males and 17 females) were analyzed. Mean age was 72.55 ±6.43 years. VA improved significantly during T1, with a mean increase from 55.0 ± 10.2 to 70.0 ± 8.5 ETDRS letters at the switch time point (p < 0.01), then a slight decrease to 62.3 ± 8.9 at 12 months (p < 0.05) was noted during T2. The mean CMT decreased notably from 400 ± 50 to 290 ± 45 μm at the switch. The final CMT at 12 months after switching to B-RBZ was 280 ± 40 μm (p < 0.01). There was a significant decrease in the retinal and intra retinal fluid during T1, followed by a gradual increase during T2. A significant correlation (p < 0.05) was noted between the presence of intraretinal fluid and increased injection frequency of B-RBZ. Conclusion The switch from IVI AFL to IVI B-RBZ in patients with nAMD demonstrated efficacy in maintaining the VA and macular anatomy, with some challenges in fluid management.
Collapse
Affiliation(s)
- Debdulal Chakraborty
- Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Subhendu Boral
- Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Tushar Kanti Sinha
- Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Arnab Das
- Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Angshuman Mukherjee
- Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Saptorshi Majumdar
- Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India
| | | | | |
Collapse
|
4
|
Ghosh AK, Nikumbh US, Shukla CK, Laul RS, Dixit A, Mahapatra SK, Nayak S, Shah UM, Parwal S, Venkatapathy N, Radhakrishnan N, Kelgaonkar A, Saxena S, Mishra D, Dave VP, Khan P, Saswade MR, Shantilal MS, Ramasamy K, Sreekanta S, Rajurkar M, Doshi M, Behera S, Patel P, Dhawan S, Lakhwani L. Efficacy, Safety and Immunogenicity of Sun's Ranibizumab Biosimilar in Neovascular Age-Related Macular Degeneration: A Phase 3, Double-Blind Comparative Study. Ophthalmol Ther 2024; 13:1369-1382. [PMID: 38530568 DOI: 10.1007/s40123-024-00883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/04/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION The study aimed to evaluate comparability in terms of efficacy, safety and immunogenicity of Sun's ranibizumab biosimilar with reference ranibizumab in patients with neovascular age-related macular degeneration (nAMD). METHODS This prospective, randomised, double-blind, two-group, parallel-arm, multicentre, phase 3 comparative study included patients with nAMD ≥ 50 years, randomised (in a 2:1 ratio) in a double-blind manner to receive 0.5 mg (0.05 mL) intravitreal injection of either Sun's ranibizumab or reference ranibizumab in the study eye every 4 weeks until week 16 (total of four doses). RESULTS Primary endpoint results demonstrated equivalence in the proportion of patients who lost fewer than 15 letters from baseline best-corrected visual acuity (BCVA) to the end of week 16 (99% of patients in Sun's ranibizumab and 100% in reference ranibizumab; p > 0.9999), with the proportional difference (90% confidence interval) at -1% (-2.51, +0.61) lying within a pre-specified equivalence margin. Visual acuity improved by 15 or more letters in 43% of Sun's ranibizumab group and 37% of the reference ranibizumab group (p = 0.4267). The mean increase in BCVA was 15.7 letters in Sun's ranibizumab group and 14.6 letters in the reference ranibizumab group (p < 0.001 within both groups and p = 0.5275 between groups). The mean change in central macular thickness was comparable between groups (p = 0.7946). Anti-ranibizumab antibodies were found in one patient of the reference ranibizumab group, while neutralising antibodies were not found in any patients. Both products were well tolerated. CONCLUSION Sun's ranibizumab biosimilar is found to be therapeutically equivalent to reference ranibizumab in patients with nAMD. There were no additional safety or immunogenicity concerns. TRIAL REGISTRATION CTRI/2020/09/027629, registered on 07 September 2020.
Collapse
Affiliation(s)
- Asim K Ghosh
- Regional Institute of Ophthalmology, Kolkata, India
| | - Usha S Nikumbh
- B. J. Govt. Medical College and Sassoon General Hospital, Pune, India
| | | | - Rohit S Laul
- Chopda Medicare & Research Centre Pvt. Ltd, Nashik, India
| | - Abhishek Dixit
- Sankat Mochan Nethralaya and Dental Care, Varanasi, India
| | - Santosh K Mahapatra
- JPM Rotary Club of Cuttack Eye Hospital & Research Institute, Cuttack, India
| | | | | | | | | | | | | | | | | | | | - Perwez Khan
- Department of Ophthalmology, GSVM Medical College, Kanpur, India
| | | | | | - Kim Ramasamy
- Aravind Eye Hospital & Postgraduate Institute of Opthalmology, Coimbatore, India
| | | | - Mandodari Rajurkar
- India Clinical Research, Sun Pharma Laboratories Ltd, Sun House, Plot Number 201 B/1, Western Express Highway, Goregaon (East), Mumbai, 400063, India.
| | - Maulik Doshi
- Ex Sun Pharma Laboratories Limited, Mumbai, India
| | - Sapan Behera
- Ex Sun Pharma Laboratories Limited, Mumbai, India
| | - Piyush Patel
- Ex Sun Pharma Laboratories Limited, Mumbai, India
| | | | | |
Collapse
|
5
|
Chatzimichail E, Pfau K, Gatzioufas Z, Panos GD. Ranibizumab Biosimilars in Treating Retinal Disorders: A Cost-Effective Revolution? Drug Des Devel Ther 2024; 18:365-374. [PMID: 38347957 PMCID: PMC10860804 DOI: 10.2147/dddt.s457303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
Ranibizumab, is a humanized, monoclonal antibody fragment that binds and inactivates vascular endothelial growth factor-A (VEGF-A) and VEGF-B. One of the main indications for an intravitreal treatment with ranibizumab is age-related macular degeneration (AMD), which is a retinal disease with a high worldwide socioeconomic impact. Biosimilars constitute biological products that demonstrate similar pharmacodynamic and pharmacokinetic characteristics with a reference product, as well as comparable clinical efficacy, safety and immunogenicity. Since the approval of the first biosimilar Razumab, there has been a variety of new biosimilars available on the market. They offer the advantage of the same good clinical and safety results at a better price. All Ranibizumab biosimilars that have gained approval were tested in double masked Phase 3 clinical studies. The use of Ranibizumab biosimilars in neovascular AMD is well reported in the bibliography. Nevertheless, over the last few years, there is a tendency of using biosimilars in other retinal diseases like retinopathy of prematurity (ROP), diabetic macular edema (DME) or polypoidal choroidal vasculopathy (PCV). In conclusion, ranibizumab biosimilars offer a promising avenue for the management of retinal diseases, especially in countries with lower socioeconomic status, where there is lack of availability of innovator ranibizumab. However, further research is required to fully explore their efficacy, safety, and long-term outcomes in a plethora of retinal diseases.
Collapse
Affiliation(s)
| | - Kristina Pfau
- Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital of Basel, Basel, Switzerland
| | - Georgios D Panos
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, UK
- Division of Ophthalmology and Visual Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
6
|
Sharma A, Kumar N, Parachuri N, Loewenstein A, Bandello F, Kuppermann BD. Preparing for the next decade of anti-VEGF biosimilars for retinal diseases: a focus on South Asia. Expert Opin Biol Ther 2023; 23:689-692. [PMID: 37470687 DOI: 10.1080/14712598.2023.2239706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION South Asian countries such as India, South Korea, and Japan have played a key role in spearheading the research and development of biosimilars of the anti-vascular endothelial growth factor (anti-VEGF) ranibizumab for retinal diseases. It is important to understand how this region is preparing for the next decade in the field of anti-VEGF biosimilars for retinal diseases. AREAS COVERED We discuss the existing anti-VEGF ranibizumab biosimilars along with the biosimilars that might receive approval in the coming decade. Furthermore, we discuss the development status of aflibercept biosimilars that might receive approval as soon as the aflibercept patent expires. EXPERT OPINION The South Asian region seems to be well prepared, with multiple ranibizumab and aflibercept biosimilars in the pipeline. However, it has to be seen whether these therapies will have widespread global clearance or will simply obtain approval from the Asian regional authorities.
Collapse
Affiliation(s)
- Ashish Sharma
- Lotus Eye Hospital and Institute, Coimbatore, TN, India
| | | | - Nikulaa Parachuri
- Department of Vitreoretina, Sankara Eye Hospital, Coimbatore, TN, India
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical, Tel Aviv University, Israel
| | - Francesco Bandello
- Scientific Institute San Raffaele, University Vita-Salute, Milano, Italy
| | - Baruch D Kuppermann
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA
| |
Collapse
|