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European prescribers’ attitudes and beliefs on biologicals prescribing and automatic substitution 欧洲处方者对生物制剂处方和自动替代的态度和信念
Q2 Medicine Pub Date : 2020-09-15 DOI: 10.5639/gabij.2020.0903.020
M. Feldman, M. Reilly
Introduction: The European Union (EU) and the European Medicines Agency (EMA) have led the development of a regulatory framework for biosimilars since 2004. By end of December 2019, 64 biosimilars of 15 originator biological medicines have a marketing authorization in Europe. Now, for the second time, the Alliance for Safe Biologic Medicines (ASBM) asked European prescribers for their views on the prescribing, adverse drug reaction reporting, automatic substitution and switching of biologicals and biosimilars. Methods: In March 2019, the ASBM surveyed 579 prescribers in France, Germany, Italy, Spain, Switzerland and the UK. Prescribers were asked for their views on authority over prescribing and dispensing of biologicals/biosimilars, reporting biological/biosimilar use and adverse drug reactions (ADR) and switching. There were also questions related to their familiarity with, knowledge of, attitudes to, and beliefs in, biosimilars. Results: Since the previous European prescriber study conducted in 2013, the percentage of respondents considering themselves highly familiar with biosimilar medicines has increased from 76% to 90%. Four out of five prescribers said they are legally required to report ADR that are brought to their attention and they file detailed ADR reports taking 10‒20 minutes. Four out of five prescribers feel very strongly about having control over what is prescribed and dispensed to their patients. While highly comfortable prescribing biosimilars to naïve patients, physician comfort level decreased when switching a stable patient to a biosimilar. Comfort level decreased further when prescribers were asked about switching a patient to a biosimilar for non-medical reasons, e.g. cost, and further still if the switch is initiated by a third party. Conclusion: European physicians have increased their familiarity with biosimilars since the 2013 survey. Physicians increasingly believe they should always have control of treatment decisions including the decision to switch to a biosimilar. It was also highlighted that governments should make multiple therapeutic options available through tenders.
自2004年以来,欧盟(EU)和欧洲药品管理局(EMA)领导了生物仿制药监管框架的发展。截至2019年12月底,15种原研生物药物的64种生物仿制药在欧洲获得了上市许可。现在,安全生物药品联盟(ASBM)第二次向欧洲处方医师询问他们对处方、药物不良反应报告、生物制剂和生物仿制药的自动替代和切换的看法。方法:2019年3月,ASBM对法国、德国、意大利、西班牙、瑞士和英国的579名处方医师进行了调查。处方者被问及他们对生物制剂/生物类似药的处方和配药、报告生物/生物类似药的使用和药物不良反应(ADR)以及转换的权威的看法。还有一些问题与他们对生物仿制药的熟悉程度、知识、态度和信仰有关。结果:自2013年进行的上一次欧洲处方者研究以来,认为自己非常熟悉生物仿制药的受访者比例从76%增加到90%。五分之四的处方者表示,法律要求他们报告引起他们注意的不良反应,他们需要10-20分钟提交详细的不良反应报告。五分之四的开处方者非常强烈地认为自己可以控制给病人开的处方和配发的药物。虽然给naïve患者开生物仿制药非常舒服,但当将稳定的患者换成生物仿制药时,医生的舒适度降低了。当处方者被问及出于非医疗原因(如费用)将患者切换为生物仿制药时,舒适度进一步下降,如果切换是由第三方发起的,舒适度进一步下降。结论:自2013年调查以来,欧洲医生对生物仿制药的熟悉程度有所提高。医生们越来越相信他们应该始终拥有治疗决策的控制权,包括转向生物仿制药的决定。会议还强调,各国政府应通过招标提供多种治疗选择。
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引用次数: 0
Pelmeg®, a biosimilar pegfilgrastim developed in the context of evolving regulatory guidelines Pelmeg®是在不断发展的监管指南背景下开发的生物仿制药pegfilgrastim
Q2 Medicine Pub Date : 2020-09-15 DOI: 10.5639/gabij.2020.0903.021
Karsten Roth, H. Wessels, J. Hoefler, U. Scholz, Dirk Lehnick
Pelmeg® is a biosimilar pegfilgrastim, which obtained European Union (EU) regulatory approval in September 2018, with marketing beginning in January 2019. A comprehensive analytical, functional and preclinical comparability programme demonstrated a high degree of similarity between Pelmeg® and its reference product Neulasta®. A targeted clinical development programme was conducted with Pelmeg®, consisting of two comparative pharmacokinetic (PK)/pharmacodynamic (PD) studies in healthy subjects. Since a surrogate endpoint for efficacy (absolute neutrophil count [ANC]) was available, efficacy and safety studies in patients were waived by the regulatory authorities. Clinical studies with Pelmeg® were designed in close dialogue with regulatory authorities in Europe. During the development process for Pelmeg®, the EU biosimilar guidelines, in particular relating to granulocyte colony-stimulating factor (G-CSF), were modified. The development of Pelmeg® demonstrates that regular discussions with regulators, in the form of scientific advice or other interactions, are valuable opportunities for dialogue regarding scientific progress related to the comparability of biosimilars. Regulators – at least in the area of biosimilar development – were found to be open to improvements and to deviate from existing guidelines if there was agreement that the scientific state-of-the-art has superseded some aspect of the guidelines. Overall, we suggest that abridged development programmes waiving the need for phase III studies, as described for Pelmeg®, are possible, in particular if good surrogate endpoints are available. In line with this, the number of waivers for phase III studies in biosimilar development has increased in recent years.
Pelmeg®是一种生物仿制药pegfilgrastim,于2018年9月获得欧盟(EU)监管机构批准,将于2019年1月开始上市。一项全面的分析、功能和临床前可比性计划表明Pelmeg®与其参考产品Neulasta®之间存在高度相似性。Pelmeg®进行了一项针对性的临床开发计划,包括在健康受试者中进行两项比较药代动力学(PK)/药效学(PD)研究。由于疗效的替代终点(绝对中性粒细胞计数[ANC])是可用的,因此监管机构放弃了对患者的疗效和安全性研究。Pelmeg®的临床研究是在与欧洲监管机构密切对话的情况下设计的。在Pelmeg®的开发过程中,欧盟生物仿制药指南,特别是与粒细胞集落刺激因子(G-CSF)相关的指南进行了修改。Pelmeg®的发展表明,与监管机构定期讨论,以科学建议或其他互动的形式,是就与生物仿制药可比性相关的科学进展进行对话的宝贵机会。监管机构——至少在生物仿制药开发领域——被发现对改进和偏离现有指导方针持开放态度,如果人们一致认为最先进的科学技术已经取代了指导方针的某些方面。总的来说,我们建议缩短开发计划,如Pelmeg®所述,放弃III期研究的需要是可能的,特别是如果有良好的替代终点可用。与此相一致的是,近年来生物类似药开发的III期研究的豁免数量有所增加。
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引用次数: 0
3rd Colombian educational workshop on regulatory assessment of biosimilars 2019 – Report 第三届哥伦比亚生物仿制药监管评估教育研讨会2019 -报告
Q2 Medicine Pub Date : 2020-09-15 DOI: 10.5639/gabij.2020.0903.022
J. Borg, Yolanda Elias Gramajo, A. Laslop, R. Thorpe, Jian Wang
Introduction: Biosimilars have the potential to improve access to medicines for many across the globe. However, work is required to ensure adequate regulation, pharmacovigilance and education about biosimilars. Colombia implemented biosimilars regulation in 2017 and a 3rd Colombian Educational Workshop was organized by GaBI and the Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA) in 2019 to follow up on progress and provide a forum for further discussion. Methods: The 3rd Colombian Educational Workshop on Regulatory Assessment was held in Bogotá, Colombia on 30 April 2019. The format included expert speaker presentations, a panel discussion, Q&A sessions and case study workgroup discussions. Participants included regulators, clinicians, pharmacists, academics and healthcare professionals from Colombia who are involved in biological/ biosimilar medicines evaluation, and expert speakers from Canada, Europe and the US. Results: Presentations and topics of discussion included the current status of biosimilars regulation in Colombia, how to carry out a quality assessment of a biological/biosimilar, pharmacological and clinical studies, and extrapolation of indications. Conclusion: The meeting helped to clarify many regulatory concepts and concerns, and highlighted Colombia’s initial successes since the implementation of its regulatory guidelines. In addition, the meeting acted as a forum to exchange knowledge on best practice, and to discuss pharmacovigilance and the future plans for education regarding biosimilars in Colombia. Several key action points were concluded following the discussions.
生物仿制药有可能改善全球许多人获得药物的机会。然而,需要开展工作,以确保对生物仿制药进行充分的监管、药物警戒和教育。哥伦比亚于2017年实施了生物仿制药法规,GaBI和国家医疗保健和食品监督研究所(INVIMA)于2019年组织了第三届哥伦比亚教育研讨会,以跟进进展并提供进一步讨论的论坛。方法:第三届哥伦比亚监管评估教育研讨会于2019年4月30日在哥伦比亚波哥大举行。会议形式包括专家演讲、小组讨论、问答环节和案例研究工作组讨论。与会者包括来自哥伦比亚参与生物/生物类似药评估的监管机构、临床医生、药剂师、学者和卫生保健专业人员,以及来自加拿大、欧洲和美国的专家演讲者。结果:演讲和讨论的主题包括哥伦比亚生物类似药监管的现状,如何对生物/生物类似药进行质量评估,药理学和临床研究,以及适应症的推断。结论:会议有助于澄清许多监管概念和关注的问题,并强调了哥伦比亚自实施其监管准则以来取得的初步成功。此外,会议还作为交流最佳做法知识的论坛,讨论了哥伦比亚关于生物仿制药的药物警戒和未来教育计划。讨论之后总结了几个关键的行动要点。
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引用次数: 0
Quality standards for biopharmaceuticals: the importance of good manufacturing practice 生物药品质量标准:良好生产规范的重要性
Q2 Medicine Pub Date : 2020-09-15 DOI: 10.5639/gabij.2020.0903.017
E. Griffiths
Regulatory standards for rDNA derived medicinal products put in place over 40 years ago provided a framework for moving forward with novel biotechnologies and biosimilars leading to their success as highly effective medicines. As biologicals and biosimilars are increasingly developed, licensed and used worldwide less experienced manufacturers and regulatory agencies need support in dealing with these highly complex products. This Commentary highlights the need for regulatory convergence and support, notes the critical role of GMP and draws attention to the comprehensive review by Sia Chong Hock et al. which strongly advocates improving harmonization of regulatory efforts especially in the Association of South East Asian Nations (ASEAN).
40多年前制定的rDNA衍生药品监管标准为推进新型生物技术和生物仿制药提供了框架,使其成功成为高效药物。随着生物制剂和生物仿制药在世界范围内的开发、许可和使用日益增多,缺乏经验的制造商和监管机构在处理这些高度复杂的产品时需要支持。本评论强调了监管趋同和支持的必要性,指出了GMP的关键作用,并提请注意Sia Chong Hock等人的全面审查,该审查强烈主张改善监管工作的协调,特别是在东南亚国家联盟(东盟)。
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引用次数: 1
Qualitative survey-based evaluation of operability and convenience for the etanercept biosimilar YLB113 in a unique injection pen in patients with rheumatoid arthritis 基于定性调查的类风湿关节炎患者依那西普生物仿制药YLB113独特注射笔的可操作性和方便性评价
Q2 Medicine Pub Date : 2020-09-15 DOI: 10.5639/gabij.2020.0903.018
T. Hibino, Tomohiko Yoshida, A. Sagawa, I. Masuda, T. Fukuda
Study objective: Needle fear is common among patients with rheumatoid arthritis (RA) who require subcutaneous (SC) injections. The convenience, usability and safety of the etanercept biosimilar YLB113 in an injection pen were evaluated among patients who switched from syringe injection. Methods: Patients with RA who had completed the phase III clinical study of YLB113 in a pre-filled syringe (YLB113-002) were enrolled (n = 35) and received once-weekly SC injections with the injection pen (YLB113 50 mg) for 8 weeks. After 8 weeks, patients completed a qualitative survey evaluating the form and design of the pen, its operability, and patient preference for pen or syringe. Adverse events were evaluated throughout the study. Results: Most patients reported the pen was ‘very easy to grasp’ or ‘easy to grasp.’ The pen was also reported to be easy to operate. The click signalling the start and end of the injection could be heard ‘very well’ or ‘well’. Similarly, the injection solution check window could be seen by most patients. About three-quarters of respondents preferred the pen over a syringe. The pen was considered easier to use for the following reasons: the body is easy to grasp; the procedure is easy to understand; and the procedure can be performed without anxiety, fear, or tenseness. Conclusions: The majority of these Japanese subjects with RA in the study judged the YLB113 50 mg delivered by injection pen to be easy to use, convenient and well tolerated
研究目的:针恐惧在需要皮下注射的类风湿关节炎(RA)患者中很常见。对依那西普生物仿制药YLB113在注射笔中使用的便利性、可用性和安全性进行了评价。方法:纳入已完成预充式注射器YLB113 (YLB113-002) III期临床研究的RA患者(n = 35),并接受每周一次的注射笔SC注射(YLB113 50 mg),持续8周。8周后,患者完成了一项定性调查,评估笔的形式和设计、可操作性以及患者对笔或注射器的偏好。在整个研究过程中对不良事件进行评估。结果:大多数患者报告笔“非常容易抓握”或“容易抓握”。据报道,这支笔也很容易操作。发出注射开始和结束信号的咔哒声可以听到“非常好”或“好”。同样,大多数患者可以看到注射溶液检查窗口。大约四分之三的受访者更喜欢钢笔而不是注射器。这支笔被认为更容易使用,原因如下:笔身易于掌握;程序很容易理解;这个过程可以在没有焦虑、恐惧或紧张的情况下进行。结论:本研究中大部分日本RA患者认为YLB113 50mg注射笔给药使用方便,耐受性好
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引用次数: 0
Latest features in GaBI Journal, 2020, Issue 3 《GaBI杂志》,2020年第3期
Q2 Medicine Pub Date : 2020-09-15 DOI: 10.5639/gabij.2020.0903.016
P. Walson
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引用次数: 0
Systematic analysis of injection-site pain and reactions caused by subcutaneous administration of the adalimumab biosimilar FKB327 versus the adalimumab reference product via different delivery methods 系统分析阿达木单抗生物仿制药FKB327与阿达木单抗参考产品通过不同给药方式皮下给药引起的注射部位疼痛和反应
Q2 Medicine Pub Date : 2020-09-15 DOI: 10.5639/gabij.2020.0903.019
R. Alten, H. Kellner, M. Boyce, Takuma Yonemura, Takahiro Ito, M. Genovese
Introduction/Study objectives: FKB327 is a biosimilar of the adalimumab reference product. Studies in healthy subjects and patients with rheumatoid arthritis demonstrated biosimilarity between FKB327 and the reference product in safety profile, efficacy and immunogenicity. FKB327 formulation excipients differ from the citrate-containing formulation of the reference product, and injection-site pain differences have been reported. The current analysis examines pooled data to assess the amount of injection-site pain resulting from injecting FKB327 using a prefilled syringe, autoinjector, or vial/syringe versus the reference product. Methods: Data from four studies were pooled to compare injection-site pain upon subcutaneous administration of FKB327 versus the reference product. Pooled data were analysed to compare FKB327 with the reference product and to compare the autoinjector, pre-filled syringe and vial/syringe. Results: Data were analysed from 2007 assessments in 1,001 subjects. A linear mixed model of the injection-site pain visual analogue scale score across all studies showed a 12.6-point lower pain score for FKB327 versus the reference product (95% confidence interval, –14.3 to –10.8; p > 0.001). The autoinjector pain score was 4.4 points lower than the vial/syringe (95% confidence interval, –5.9 to –2.8; p > 0.001) and 1.7 points lower than the pre-filled syringe (95% confidence interval, –3.3 to –0.1; p = 0.035). No statistically significant differences were identified for gender, age, body weight, needle gauge, or injection site. Conclusion: FKB327 showed less injection-site pain compared with the reference product. No statistically significant differences were seen in injection-site reactions or related adverse events between FKB327 and the reference product or among FKB327 injection methods.
FKB327是阿达木单抗参考产品的生物仿制药。对健康受试者和类风湿性关节炎患者的研究表明,FKB327与参比产品在安全性、有效性和免疫原性方面具有生物相似性。FKB327制剂辅料不同于参比制剂中含有柠檬酸盐的制剂,注射部位疼痛差异已被报道。目前的分析检查了汇总的数据,以评估使用预充注射器、自动注射器或小瓶/注射器注射FKB327与参考产品注射时引起的注射部位疼痛的程度。方法:汇集了四项研究的数据,比较FKB327皮下给药与对照产品的注射部位疼痛。对合并数据进行分析,比较FKB327与参比产品,并比较自动进样器、预充式注射器和小瓶/注射器。结果:分析了2007年1001名受试者的评估数据。所有研究的注射部位疼痛视觉模拟量表评分的线性混合模型显示,与参考产品相比,FKB327的疼痛评分低12.6分(95%置信区间,-14.3至-10.8;P > 0.001)。自动注射器疼痛评分比小瓶/注射器低4.4分(95%置信区间,-5.9 ~ -2.8;P > 0.001),比预充注射器低1.7点(95%置信区间,-3.3 ~ -0.1;P = 0.035)。性别、年龄、体重、针规或注射部位没有统计学上的显著差异。结论:与参比品相比,FKB327的注射部位疼痛减轻。FKB327注射部位反应或相关不良事件在FKB327与参比产品或FKB327注射方式之间无统计学差异。
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引用次数: 3
Global challenges in the manufacture, regulation and international harmonization of GMP and quality standards for biopharmaceuticals 生物药品GMP和质量标准的生产、监管和国际协调方面的全球挑战
Q2 Medicine Pub Date : 2020-06-15 DOI: 10.5639/gabij.2020.0902.010
Sia Chong Hock, Sia Ming Kian, Chan Lai Wah
Biopharmaceuticals belong to a class of medicinal products whose active pharmaceutical ingredient (API) is manufactured using living systems such as microbial and mammalian cells. With the patent expiry of the originator biopharmaceuticals, a surge in the production of biopharmaceuticals in the form of biosimilars is to be expected. However, biopharmaceuticals are inherently more complex than conventional chemical-based pharmaceuticals, hence requiring a more complicated manufacturing process. This paper provides a brief overview of the biopharmaceutical manufacturing processes and reveals that most biopharmaceuticals share similar processes and considerations. The complex nature of biopharmaceuticals presents various manufacturing challenges such as the inherent variation in quality and demand for extensive process and product understanding. Furthermore, downstream processing bottleneck also presents another manufacturing challenge. A brief comparison of the good manufacturing practice (GMP) standards of various regulatory authorities (RAs) and international organizations (IOs) reveals that the standards are largely similar and appropriate in addressing the manufacturing challenges. This review is one of the few covering the biopharmaceutical industry and the regulatory framework of the Association of South East Asian Nations (ASEAN). However, GMP alone does not address regulatory challenges such as evaluation of biosimilarity, differing outlook on interchangeability and a growing occurrence of data integrity lapses. Solutions such as the implementation of Industry 4.0, improved harmonization of regulatory efforts and creating a culture of quality within the organization may help to address the forgoing challenges.
生物制药属于一类药物产品,其活性药物成分(API)是使用微生物和哺乳动物细胞等生命系统制造的。随着原始生物制药的专利到期,预计生物仿制药形式的生物制药生产将激增。然而,生物制药本质上比传统的化学药物更复杂,因此需要更复杂的制造过程。本文提供了生物制药制造过程的简要概述,并揭示了大多数生物制药共享类似的过程和考虑因素。生物制药的复杂性质提出了各种制造挑战,例如质量的内在变化以及对广泛的工艺和产品理解的需求。此外,下游加工瓶颈也提出了另一个制造挑战。对不同监管机构(RAs)和国际组织(IOs)的良好生产规范(GMP)标准的简要比较表明,这些标准在很大程度上是相似的,并且适用于解决生产挑战。这篇综述是为数不多的涵盖生物制药工业和东南亚国家联盟(东盟)监管框架的综述之一。然而,仅GMP并不能解决诸如生物相似性评估、对可互换性的不同看法以及越来越多的数据完整性失误等监管挑战。诸如实施工业4.0、改进监管工作的协调以及在组织内创建质量文化等解决方案可能有助于应对上述挑战。
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引用次数: 3
What to look forward to in GaBI Journal, 2020, Issue 2 《GaBI杂志》2020年第2期有什么值得期待的
Q2 Medicine Pub Date : 2020-06-15 DOI: 10.5639/gabij.2020.0902.008
P. Walson
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引用次数: 0
Current trends for biosimilars in the Latin American market 拉丁美洲市场生物仿制药的当前趋势
Q2 Medicine Pub Date : 2020-06-15 DOI: 10.5639/gabij.2020.0902.011
E. Ortiz-Prado, Jorge Ponce-Zea, J. Vásconez, Diana Castillo, Diana C Checa-Jaramilloz, Nathalia Rodríguez-Burneo, Felipe Andrade, Damaris P Intriago Baldeón, C. Galarza-Maldonado
The number of approved biological medicines in the global pharmaceutical market has increased in recent decades. However, their high costs have also promoted the development of biosimilar medicines, following the expiry of the patent of the reference drug. Biosimilars are approved medicines of biological origin which have no statistically significant differences in terms of quality, safety and therapeutic efficacy in comparison with the reference biological. Drugs marketed as biomimics meanwhile are copies of monoclonal antibodies and fusion proteins that have not demonstrated bioequivalence to their reference biologicals. Across the world, regulations have been developed to ensure the safety and efficacy of biosimilar products, which can reduce public health expenditure and improve patient access to biological medicines. As a result, Latin America has begun to invest in the development of these drugs. The objective of this literature review is to describe the development of the biosimilar and biomimic market in Latin America.
近几十年来,全球制药市场上批准的生物药物数量有所增加。然而,随着参比药的专利到期,它们的高成本也促进了生物类似药的发展。生物仿制药是经批准的生物来源药物,与参比生物相比,在质量、安全性和疗效方面没有统计学上的显著差异。与此同时,作为仿生学上市的药物是单克隆抗体和融合蛋白的复制品,它们没有证明与其参考生物制剂具有生物等效性。在世界各地,已经制定了法规,以确保生物类似药产品的安全性和有效性,这可以减少公共卫生支出并改善患者获得生物药物的机会。因此,拉丁美洲已开始投资于这些药物的开发。这篇文献综述的目的是描述生物仿制药和仿生学市场在拉丁美洲的发展。
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引用次数: 6
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