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An assessment of trends in the Iranian pharmaceutical market following domestic production of selected medications (2007‒2017) and new considerations for health policymakers 对选定药物国内生产(2007-2017年)后伊朗药品市场趋势的评估以及卫生政策制定者的新考虑
Q2 Medicine Pub Date : 2021-03-15 DOI: 10.5639/GABIJ.2021.1001.003
M. Zargaran, A. Cheraghali, F. Soleymani, Rajabali Daroudi, A. Sari, S. Nikfar
Background: Enacting national policies which empower the local production of medications is a promising way to improve the accessibility and affordability of medications, but this can also have unintended consequences. A number of such policies have been adopted by the Iranian government. This study was designed to examine the changes in the consumption of a number of selected pharmaceuticals which occurred in the years after these selected products began to be domestically produced. The implications of these changes were then evaluated for their potential to suggest possible policy changes. Method: A 10-year trend study was conducted to identify changes which occurred between 2007 and 2017 in the consumption of 28 selected, imported medications after they began to be domestically produced. Results: Six different medication consumption patterns were observed after the development of domestic medication production. In addition, a downward trend in the cost of medications was observed, specifically due to the introduction of domestic pharmaceuticals. Discussion: Examination of the observed changes in the consumption patterns revealed that various factors affect consumption patterns of imported medications. Significant increases in certain domestically manufactured medications indicated that local production might result in the irrational use of medications. In addition, the competitiveness of Iranian products, in terms of quality and accessibility should be considered. Conclusion: New considerations are needed for health policymakers to support domestic production of viable alternative medications. However, increased accessibility of domestically produced medications may result in greater unreasonable use of medications
背景:制定国家政策,授权当地生产药物,是改善药物可及性和可负担性的一种有希望的方法,但这也可能产生意想不到的后果。伊朗政府已经采取了一些这样的政策。这项研究的目的是检查在这些选定的产品开始在国内生产后几年发生的一些选定药物的消费变化。然后对这些变化的影响进行评估,看它们是否有可能建议可能的政策变化。方法:通过一项为期10年的趋势研究,确定28种选定的进口药物在开始国内生产后,在2007年至2017年期间的消费变化。结果:我国药品生产发展至今,出现了6种不同的药品消费模式。此外,观察到药品费用有下降趋势,特别是由于引进了国产药品。讨论:对观察到的消费模式变化的审查显示,各种因素影响进口药物的消费模式。某些国产药物的显著增加表明,当地生产可能导致药物的不合理使用。此外,应考虑到伊朗产品在质量和可获得性方面的竞争力。结论:卫生政策制定者需要考虑新的因素来支持国内生产可行的替代药物。然而,国内生产药物的可及性增加可能导致更多的不合理使用药物
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引用次数: 0
Continuous manufacturing versus batch manufacturing: benefits, opportunities and challenges for manufacturers and regulators 连续生产与批量生产:制造商和监管机构的利益、机遇和挑战
Q2 Medicine Pub Date : 2021-03-15 DOI: 10.5639/GABIJ.2021.1001.004
Sia Chong Hock, Teh Kee Siang, Chan Lai Wah
Continuous manufacturing (CM) is the integration of a series of unit operations, processing materials continually to produce the final pharmaceutical product. In recent years, CM of pharmaceuticals has transformed from buzzword to reality, with at least eight currently approved drugs produced by CM. Propelled by various driving forces, manufacturers and regulators have recognized the benefits of CM and are awaiting the completion of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Q13, a harmonized guideline on CM that would be implemented by ICH members. Although significant progress is evident, the uptake of CM is still sluggish in the pharmaceutical industry due to many existing challenges that have hindered manufacturers from adopting this technology. The top two barriers that manufacturers currently face are regulatory uncertainties and high initial cost. These issues are crucial in unleashing the untapped potential of CM, which has significant implications on patients’ access to life-saving medicines, while mutually benefitting manufacturers and regulators. Despite numerous studies, there have been few existing publications that review current regulatory guidelines, highlight the latest challenges extensively and propose recommendations that are applicable for all pharmaceuticals and biopharmaceuticals. Therefore, this critical review aims to present the recent progress and existing challenges to provide greater clarity for manufacturers on CM. This review also proposes vital recommendations and future perspectives. These include regulatory harmonization, managing financial risks, hybrid processes, capacity building, a culture of quality and Pharma 4.0. While regulators and the industry work towards creating a harmonized guideline on CM, manufacturers should focus on overcoming existing cost, technical and cultural challenges to facilitate the implementation of CM.
连续制造(CM)是一系列单元操作的集成,连续地处理材料以生产最终的药品。近年来,药物CM已经从流行语变成了现实,目前至少有8种药物是CM生产的。在各种驱动力的推动下,制造商和监管机构已经认识到中药的好处,并正在等待国际人用药品技术要求协调委员会(ICH) Q13的完成,这是一个关于中药的协调指南,将由ICH成员实施。尽管取得了明显的重大进展,但由于许多现有的挑战阻碍了制造商采用该技术,CM在制药行业的应用仍然缓慢。制造商目前面临的两大障碍是监管的不确定性和高昂的初始成本。这些问题对于释放CM尚未开发的潜力至关重要,这对患者获得拯救生命的药物具有重大影响,同时使制造商和监管机构相互受益。尽管有大量的研究,但很少有现有的出版物审查当前的监管指南,广泛强调最新的挑战,并提出适用于所有药物和生物制药的建议。因此,这篇重要的综述旨在介绍最近的进展和现有的挑战,为制造商提供更清晰的CM。该审查还提出了重要建议和未来展望。其中包括监管协调、财务风险管理、混合流程、能力建设、质量文化和制药4.0。当监管机构和行业致力于创建CM的统一指导方针时,制造商应该专注于克服现有的成本、技术和文化挑战,以促进CM的实施。
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引用次数: 11
Variation in the prices of oncology medicines across Europe and the implications for the future 欧洲肿瘤药物价格的变化及其对未来的影响
Q2 Medicine Pub Date : 2021-02-03 DOI: 10.5639/gabij.2021.1002.008
B. Godman, S. Simoens, A. Kurdi, G. Selke, J. Yfantopoulos, A. Hill, J. Gulbinovič, A. Martin, A. Timoney, D. Gotham, J. Wale, T. Bochenek, I. Krulichová, E. Allocati, Iris Hoxha, Admir Malaj, Christian Hierländer, A. Nachtnebel, W. Hamelinck, Z. Mitkova, G. Petrova, O. Laius, C. Sermet, Irene Langner, R. Joppi, A. Jakupi, E. Poplavska, Ieva Greičiūtė-Kuprijanov, P. V. Bonanno, Hans Piepenbrink, V. D. Valk, R. Plisko, M. Władysiuk, Vanda Marković-Peković, I. Mardare, T. Novakovic, M. Parker, Jurij Fürst, D Tomek, K. Baňasová, Merce Obach Cortadellas, Corrine Zara, C. Pontes, Maria Juhasz-Haverinen, Peter Skiold, S. McTaggart, D. Wong-Rieger, Stephen M Campbell, R. Hill
Introduction/Objectives: Health authorities are facing increasing challenges to the sustainability of their healthcare systems because of the growing expenditures on medicines, including new, high-priced oncology medicines, and changes in disease prevalence in their ageing populations. Medicine prices in European countries are greatly affected by the ability to negotiate reasonable prices. Concerns have been expressed that prices of patented medicines do not fall sufficiently after the introduction of lower-cost generic oncology medicines. The objective of this study was to examine the associations over time in selected European countries between the prices of oral oncology medicines, population size, and gross domestic product (GDP) before and after the introduction of generic versions. Evidence of periodic reassessments of the price, value, and place in treatment of these medicines was also looked for. The goal of this review was to stimulate debate about possible improvements in approaches to reimbursement negotiations. Methodology: Analysis was performed of reimbursed prices of three oral oncology medicines (imatinib, erlotinib and fludarabine) between 2013 and 2017 across Europe. Correlations were explored between GDP, population size, and prices. Findings were compared with previous research regarding prices of generic oral oncology medicines. Results: The prices of imatinib, erlotinib and fludarabine varied among European countries, and there was limited price erosion over time in the absence of generics. There appeared to be no correlation between population size and price, but higher prices of on-patent oral cancer medicines were seen among countries with higher GDP per capita. Conclusion: Limited price erosion for patented medicines contributed to increases in oncology medicine budgets across the region. There was also a concerning lack of evidence re-assessments of the price, value, and place in treatment of patented oncology medicines following the loss of patent protection of standard medicines. The use of such proactive re-assessments in negotiating tactics might positively impact global expenditures for oncology medicines.
导言/目标:卫生当局正面临着卫生保健系统可持续性方面越来越大的挑战,因为药品支出不断增加,包括新的高价肿瘤药物,以及人口老龄化中疾病流行的变化。欧洲国家的药品价格很大程度上受到合理价格谈判能力的影响。有人担心,在引入成本较低的非专利肿瘤药物后,专利药物的价格没有充分下降。本研究的目的是检查选定的欧洲国家在引入仿制药前后口服肿瘤药物价格、人口规模和国内生产总值(GDP)之间随时间的关系。还寻找对这些药物的价格、价值和在治疗中的地位进行定期重新评估的证据。这次审查的目的是激发关于可能改进报销谈判方法的辩论。方法:分析2013年至2017年欧洲三种口服肿瘤药物(伊马替尼、厄洛替尼和氟达拉滨)的报销价格。研究了GDP、人口规模和价格之间的相关性。研究结果与先前关于非专利口服肿瘤药物价格的研究进行了比较。结果:伊马替尼、厄洛替尼和氟达拉滨的价格在欧洲各国有所不同,在没有仿制药的情况下,随着时间的推移,价格侵蚀有限。人口规模和价格之间似乎没有相关性,但在人均GDP较高的国家,非专利口腔癌药物的价格较高。结论:专利药有限的价格侵蚀促进了整个地区肿瘤药物预算的增加。在标准药物失去专利保护后,对肿瘤专利药物的价格、价值和治疗地位进行重新评估的证据不足也令人担忧。在谈判策略中使用这种主动重新评估可能会对全球肿瘤药物支出产生积极影响。
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引用次数: 1
Is the local tolerance of injectable biosimilars too underestimated? 注射用生物仿制药的局部耐受性是否被低估了?
Q2 Medicine Pub Date : 2020-12-15 DOI: 10.5639/GABIJ.2020.0904.024
A. Astier
This editorial highlights the importance of carrying out comparative studies of patient tolerance to biosimilars and originator products. Minor side effects can affect their acceptability.
这篇社论强调了开展患者对生物仿制药和原研产品耐受性比较研究的重要性。轻微的副作用会影响它们的可接受性。
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引用次数: 1
Medical journal publication during global stress 在全球压力下发表医学杂志
Q2 Medicine Pub Date : 2020-12-15 DOI: 10.5639/GABIJ.2020.0904.023
P. Walson
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引用次数: 0
Pharmaceutical Data Integrity: issues, challenges and proposed solutions for manufacturers and inspectors 制药数据完整性:问题、挑战和制造商和检查员提出的解决方案
Q2 Medicine Pub Date : 2020-12-15 DOI: 10.5639/GABIJ.2020.0904.028
Sia Chong Hock, Vernon Tay, V. Sachdeva, Chan Lai Wah
Data Integrity, which is data deemed Attributable, Legible, Contemporaneous, Original, Accurate, Complete, Consistent, Enduring, and Available (ALCOA-plus), has been the focus of the pharmaceutical industry in recent years. With the growing use of computerized systems and rising prevalence of outsourcing manufacturing processes, ensuring data integrity is becoming more challenging in an increasingly complex pharmaceutical manufacturing industry. To address this issue, multiple legislation and guidance documents such as ‘Data Integrity and Compliance with CGMP Guidance for Industry’ from the US Food and Drug Administration (FDA), ‘GxP’ Data Integrity Guidance and Definitions from the UK Medicines & Healthcare products Regulatory Agency (MHRA), and ‘Guidance on Good Data and Record Management Practices’ from the World Health Organization (WHO), have been published in recent years. However, with rising data integrity issues observed by FDA, WHO, MHRA and other pharmaceutical inspectors even after these guidance documents have been published, their overall effectiveness is yet to be determined. This paper compares and evaluates the legislation and guidance currently in existence; and discusses some of the potential challenges pharmaceutical manufacturers face in maintaining data integrity with such legislation and guidance in place. It appears that these legislation and guidance are insufficient in maintaining data integrity in the industry when used alone. Last, but not least, this paper also reviews other solutions, such as the need for a company culture of integrity, a good database management system, education and training, robust quality agreements between contract givers and acceptors, and performance of effective audits and inspections, to aid in maintaining data integrity in the manufacturing industry. These proposed solutions, if successfully implemented, can address the issues associated with data integrity, and raise the standard of pharmaceutical and biopharmaceutical manufacturing worldwide.
数据完整性,即被认为是可归因的、易读的、同步的、原始的、准确的、完整的、一致的、持久的和可用的数据(alcoa +),近年来一直是制药行业关注的焦点。随着计算机化系统的日益普及和外包制造过程的日益普及,在日益复杂的制药行业中,确保数据完整性变得越来越具有挑战性。为了解决这个问题,近年来已经发布了多个立法和指导文件,如美国食品药品监督管理局(FDA)的“数据完整性和遵从CGMP行业指南”,英国药品和保健产品监管局(MHRA)的“GxP”数据完整性指南和定义,以及世界卫生组织(WHO)的“良好数据和记录管理实践指南”。然而,即使在这些指导文件发表之后,FDA、世卫组织、MHRA和其他药品检查员也观察到越来越多的数据完整性问题,因此它们的总体有效性仍有待确定。本文对现有的立法和指导意见进行了比较和评价;并讨论了制药商在维护数据完整性方面面临的一些潜在挑战,这些立法和指导已经到位。当单独使用时,这些立法和指导似乎不足以维护行业的数据完整性。最后,但并非最不重要的是,本文还回顾了其他解决方案,例如需要诚信的公司文化,良好的数据库管理系统,教育和培训,合同提供者和接受者之间强有力的质量协议,以及有效审计和检查的表现,以帮助维护制造业的数据完整性。这些建议的解决方案,如果成功实施,可以解决与数据完整性相关的问题,并提高全球制药和生物制药生产的标准。
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引用次数: 0
Local policies on biosimilars: are they designed to optimize use of liberated resources? 生物仿制药的地方政策:是否旨在优化释放资源的利用?
Q2 Medicine Pub Date : 2020-12-15 DOI: 10.5639/GABIJ.2020.0904.027
A. Bertolani, C. Jommi
Study Objectives: Different policies have been implemented to enhance uptake of biosimilars. Regarding policies focussing on the demand-side, the literature has mainly concentrated on interchangeability and substitutability recommendations, issued by national or regional policymakers. Information on actions taken by healthcare organisations (HCOs) regarding prescribing behaviour is limited. Furthermore, there is no evidence on whether local authorities implemented a policy framework aimed to appropriately reallocate resources gained through patent expiration. This paper aims to fill these gaps, investigating policies on biosimilars implemented at the local level in the Italian National Health Service. Materials and Methods: Data were retrieved through a structured, validated questionnaire, administered online to all 199 public HCOs. Results: Seventy-six organizations in 16 of 21 Italian regions completed the survey, 89% of HCOs implemented information/educational initiatives on biosimilars. Prescription targets on biosimilars versus originators and off-patent versus in-patent molecules were introduced in 62% and 75% of HCOs, respectively. Prescribers reaching targets are mostly rewarded through monetary incentives. 75% of HCOs performed systematic impact evaluation of biosimilars. However, only 21% of HCOs detect patient under-treatment due to budget constraints and how availability of cheaper drugs could help. Furthermore, according to 25% of respondents, their HCO is involved in studies on biosimilars, but respondents did not provide any evidence of these studies. Discussion and conclusions: The study shows a high level of proactivity by Italian HCOs regarding actions on prescribing behaviour for off-patent biologicals. However, it seems that structured actions aimed at appropriately reallocating resources gained through patent expiration are still lacking.
研究目的:已经实施了不同的政策来提高生物仿制药的吸收。关于侧重于需求侧的政策,文献主要集中于国家或地区政策制定者发布的互换性和可替代性建议。关于医疗保健组织(HCOs)针对处方行为采取的行动的信息有限。此外,没有证据表明地方当局是否实施了旨在适当重新分配通过专利到期获得的资源的政策框架。本文旨在填补这些空白,调查在意大利国家卫生服务的地方一级实施的生物仿制药政策。材料和方法:通过结构化的、有效的问卷收集数据,对所有199家公立hco进行在线管理。结果:意大利21个地区中的16个地区的76个组织完成了调查,89%的hco实施了生物仿制药的信息/教育举措。分别在62%和75%的hco中引入了生物仿制药与原研药、非专利分子与专利内分子的处方靶点。达到目标的处方者大多通过金钱激励来奖励。75%的hco对生物仿制药进行了系统的影响评估。然而,由于预算限制和如何获得更便宜的药物可以提供帮助,只有21%的hco发现患者治疗不足。此外,根据25%的受访者,他们的HCO参与了生物仿制药的研究,但受访者没有提供这些研究的任何证据。讨论和结论:该研究表明意大利hco对非专利生物制剂处方行为的行动具有高度的主动性。然而,似乎仍然缺乏旨在适当重新分配通过专利到期获得的资源的结构化行动。
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引用次数: 6
Physicochemical stability of the bevacizumab biosimilar, ABP 215, after preparation and storage in intravenous bags 贝伐单抗生物仿制药abp215制备和静脉袋储存后的理化稳定性
Q2 Medicine Pub Date : 2020-12-15 DOI: 10.5639/GABIJ.2020.0904.026
J. Šečkutė, I. Castellanos, S. Bane
Study Objectives: To evaluate extended in-use stability of bevacizumab biosimilar, ABP 215, after dilution into intravenous bags, extended storage, and simulated infusion to enable advanced preparation and storage. Methods: Two lots of ABP 215 were diluted to high- (16.5 mg/mL) and low- (1.4 mg/mL) dose concentrations in two types of intravenous bag under ambient light conditions. Dosed intravenous bags were stored at 2°C–8°C for 35 days, followed by 30°C for 2 days, and each bag was infused on Day 37. Analysis of purity and physicochemical stability was performed using size-exclusion high-performance liquid chromatography (SE-HPLC), cation-exchange high-performance liquid chromatography (CEX-HPLC), reduced capillary electrophoresis-sodium dodecyl sulphate (rCE-SDS), subvisible particle detection assays, visual inspection, and by measuring protein concentration and potency. Results: No meaningful changes were seen in ABP 215 purity when analysed by SE-HPLC, CEX-HPLC and rCE-SDS following dilution, storage and infusion of two lots, bags, and doses. Protein concentration remained consistent throughout the study for all samples and no significant loss in potency was detected. No potentially proteinaceous particles or increases in subvisible particles were observed. Discussion: This study investigated the in-use stability of ABP 215 following dilution, extended storage, and infusion, that represent worst-case handling conditions. ABP 215 exhibited consistent product quality and activity, with no significant degradation observed under the conditions tested. Conclusion: ABP 215 retains physicochemical stability after dilution over the recommended dosing concentrations, extended storage, and simulated infusion. This supports the advance preparation and storage of ABP 215 in intravenous bags for infusion.
研究目的:评估贝伐珠单抗生物仿制药abp215在稀释入静脉袋、延长储存和模拟输注后的延长使用稳定性,以实现提前制备和储存。方法:在环境光照条件下,将2批abp215稀释至高剂量浓度(16.5 mg/mL)和低剂量浓度(1.4 mg/mL)的两种静脉输液袋。给药静脉输液袋在2°C - 8°C保存35 d, 30°C保存2 d,第37天每袋输注。采用粒径排除高效液相色谱(SE-HPLC)、阳离子交换高效液相色谱(CEX-HPLC)、还原毛细管电泳-十二烷基硫酸钠(rCE-SDS)、亚可见颗粒检测、目视检测、蛋白质浓度和效价测定等方法进行纯度和理化稳定性分析。结果:用SE-HPLC、CEX-HPLC和rCE-SDS分析稀释、储存和输注两批、两袋、两剂后,abp215的纯度未见显著变化。在整个研究过程中,所有样品的蛋白质浓度保持一致,并且没有检测到显著的效力损失。没有观察到潜在的蛋白质颗粒或不可见颗粒的增加。讨论:本研究调查了abp215在稀释、延长储存和输注后的使用稳定性,这代表了最坏的处理条件。ABP 215表现出一致的产品质量和活性,在测试条件下没有观察到明显的降解。结论:abp215在推荐剂量浓度稀释、延长储存和模拟输注后仍保持理化稳定性。这支持了abp215在静脉输液袋中的预先制备和储存。
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引用次数: 2
A white paper: US biosimilars market on pace with Europe 白皮书:美国生物仿制药市场与欧洲同步
Q2 Medicine Pub Date : 2020-12-15 DOI: 10.5639/GABIJ.2020.0904.025
M. Feldman, M. Reilly
In the US, 28 biosimilars have been approved, with 10 in the last two years. The US is keeping pace with the EU who pioneered biosimilars approvals a decade earlier. Herein, current FDA regulations and hurdles encountered for US biosimilar approval and uptake are discussed.
在美国,已有28种生物仿制药获得批准,其中10种是在过去两年获得批准的。美国正在跟上欧盟的步伐,后者在10年前率先批准了生物仿制药。本文讨论了当前FDA法规和美国生物类似药批准和吸收遇到的障碍。
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引用次数: 1
Can local policies on biosimilars optimize the use of freed resources – experiences from Italy 当地的生物仿制药政策能否优化自由资源的利用——意大利的经验
Q2 Medicine Pub Date : 2020-10-06 DOI: 10.5639/GABIJ.2020.0904.029
B. Godman, E. Allocati, Evelien Moorkens, H. Kwon
There is an increasing need to prescribe biosimilars to fund new medicines and increasing medicine volumes. Bertolani and Jommi document successful measures introduced regionally in Italy.
越来越需要开生物仿制药以资助新药和增加药物量。Bertolani和Jommi记录了在意大利地区引进的成功措施。
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引用次数: 9
期刊
GaBI Journal-Generics and Biosimilars Initiative Journal
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