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Tursi A, Mocci G, Del Gaudio A, Papa A. Clinical use of biologics for Crohn's disease in adults: lessons learned from real-world studies. Expert Opin Biol Ther 2024:1-19. [PMID: 38321868 DOI: 10.1080/14712598.2024.2316180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/05/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The therapeutic armamentarium for managing Crohn's disease (CD) has expanded significantly in recent decades. Several biologics with three different mechanisms of action [anti-tumor necrosis factor (TNF)-α, anti-integrin α4β7, and anti-IL 12/23] are currently available to manage CD. AREA COVERED This narrative review aims to summarize the most significant efficacy and safety data on the use of infliximab (IFX), adalimumab (ADA), vedolizumab (VDZ) and ustekinumab (UST) for the treatment of CD obtained from studies conducted in the real world (RW), compared to the results of randomized clinical trials (RCTs). EXPERT OPINION RW studies reported that biologic agents included in this analysis have higher remission rates and lower adverse event rates than findings from RCTs for treating patients with CD. All biological agents have proven effective and safe in RW studies, even when using biosimilars or switching to subcutaneous administration of the molecules for which they are available. Finally, anti-TNF-α agents, particularly IFX, have a higher rate of adverse events (AEs) than VDZ and UST. Therefore, patients at higher risk of AEs may benefit from other biologics than anti-TNF-α. However, further long-term RW studies are needed to confirm these findings.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Italy
- Department of Medical and Surgical Sciences, Catholic University, School of Medicine, Rome, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Angelo Del Gaudio
- Division of Internal Medicine and Gastroenterology, Policlinico Universitario "A. Gemelli" IRCCS Foundation, Rome, Italy
| | - Alfredo Papa
- Department of Medical and Surgical Sciences, Catholic University, School of Medicine, Rome, Italy
- Division of Internal Medicine and Gastroenterology, Policlinico Universitario "A. Gemelli" IRCCS Foundation, Rome, Italy
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Tay SW, Teh KKJ, Ang TL, Tan M. Ulcerative colitis: STRIDE-ing beyond symptoms with new standards. Singapore Med J 2024; 65:99-105. [PMID: 34823326 PMCID: PMC10942141 DOI: 10.11622/smedj.2021173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022]
Abstract
The landscape of ulcerative colitis has changed in the last two decades. Advancements in pharmacotherapeutics have heralded the introduction of new treatment options, with many agents in development. Better clinical outcomes are seen with tighter disease control, made possible with greater understanding of inflammatory pathways and their blockade with drugs. There has been a resultant shift in treatment targets, beyond symptoms to endoscopic and histological healing. Controlling the burden of disease activity also lowers the risk of developing colorectal cancer. Colorectal cancer screening now requires the use of dye-based agents and high-definition colonoscopy to improve the detection of colonic neoplasms.
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Affiliation(s)
- Shu Wen Tay
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Kevin Kim Jun Teh
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Tiing-Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Medicine ACP, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Malcolm Tan
- Medicine ACP, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Macaluso FS, Casà A, Renna S, Grova M, Mannino M, Orlando A. Switching from SB2 to PF-06438179/GP1111 and back in inflammatory bowel disease: "The Superswitchers". Dig Liver Dis 2023; 55:424-425. [PMID: 36609013 DOI: 10.1016/j.dld.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Affiliation(s)
| | - Angelo Casà
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Mauro Grova
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Patil SA, Bhat S, Limdi JK, Farraye FA, Cross RK. The Sincerest Form of Flattery? Biosimilars in Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1915-1923. [PMID: 35353189 DOI: 10.1093/ibd/izac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 12/13/2022]
Abstract
Lay Summary
Biosimilar medications have the potential to significantly reduce the cost of treatment in patients with inflammatory bowel disease. Observational studies have shown similar efficacy and safety of biosimilars to biologic reference products. Shared decision-making is crucial to the successful implementation of these agents.
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Affiliation(s)
- Seema A Patil
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Shubha Bhat
- Departments of Pharmacy and Gastroenterology, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Jimmy K Limdi
- Division of Gastroenterology-Section of IBD, The Northern Care Alliance Hospitals NHS Foundation Trust, Manchester Academic Health Sciences, University of Manchester, 2.41 Fairfield House, Manchester, BL9 7TD, UK
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
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Yossef L, Wright M, Benedict J, Morris GA, McNicol M, Boyle B, Dotson JL, Michel HK, Maltz RM. Patient and Caregivers' Perspectives on Biosimilar Use in Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2022; 75:59-63. [PMID: 35442227 DOI: 10.1097/MPG.0000000000003462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Studies assessing adult inflammatory bowel disease (IBD) patient perspectives on biosimilar use revealed that most were unfamiliar with biosimilars and had a negative perception. The objective of this study was to evaluate the perspectives of pediatric patients with IBD and their caregivers regarding biosimilar use and non-medical switches. METHODS A survey was given to a cross section of patients with IBD ages 11-21 years receiving the intravenous anti-tumor necrosis factor originator and caregivers of patients with IBD ages 3-21 years receiving the originator. Recruitment occurred via mail, during clinic visits, and infusions. Fisher exact tests were used to test for statistically significant differences. RESULTS Response rate amongst caregivers was 49% (n = 98) and among patients was 35% (n = 67). Sixty-four percent of caregivers and 79% of patients had never heard of biosimilars. There was increased discomfort surrounding the use of biosimilars and switching to a biosimilar amongst caregivers who had previously heard of biosimilars compared to caregivers who had not previously heard of biosimilars ( P < 0.05). Similar concerns were not seen in patient respondents. The length of time on the originator had no effect on patient or caregiver concerns related to biosimilar efficacy, adverse effects, or switches. CONCLUSION The majority of pediatric patients and caregivers had never heard of biosimilars. Caregivers that had heard of biosimilars before the study were more likely to have a negative perception of them. This study highlights the importance of providing thorough and accurate education to pediatric patients and families regarding the safety and efficacy of biosimilars.
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Hanzel J, Jansen JM, ter Steege RWF, Gecse KB, D’Haens GR. Multiple Switches From the Originator Infliximab to Biosimilars Is Effective and Safe in Inflammatory Bowel Disease: A Prospective Multicenter Cohort Study. Inflamm Bowel Dis 2022; 28:495-501. [PMID: 34013959 PMCID: PMC8972297 DOI: 10.1093/ibd/izab099] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Though a single nonmedical switch from the originator infliximab (IFX) to a biosimilar is considered effective and safe for most patients with inflammatory bowel disease (IBD), very limited data are available on multiple successive switches. METHODS We performed a prospective multicenter cohort study of adult IBD patients who underwent 2 switches from the originator IFX to CT-P13 to SB2 (group 1), 1 switch from CT-P13 to SB2 (group 2), and 1 switch from the originator IFX to CT-P13 (group 3). Patients were assessed at 4 and 12 months since the most recent switch for remission using clinical (physician's assessment) and biochemical (C-reactive protein [CRP], and fecal calprotectin [FC]) measures. Patients discontinuing treatment for ineffectiveness or adverse events before month 12 were imputed as nonremitters. RESULTS One hundred seventy-six patients (Crohn's disease 71%, ulcerative colitis 27.8%, IBD unclassified 1.2%; group 1, 69; group 2, 80; group 3, 27) were included. At 12 months after the most recent switch 76.9% (40 of 52, group 1), 65.7% (46 of 70, group 2) and 76.9% (20 of 26, group 3) of patients were in clinical remission. Treatment persistence at 12 months was 85.0%, 87.0%, and 70.1%, respectively. There were no significant differences in the rate of clinical, CRP, FC remission, or treatment persistence at 12 months between the 3 groups. Infusion reactions occurred in 1.7% of patients (3/176), all in patients with antidrug antibodies from group 2. CONCLUSIONS Multiple successive switching and switching between biosimilars of IFX seemed to be effective and safe.
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Affiliation(s)
- Jurij Hanzel
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
- Medical Faculty, University of Ljubljana, Department of Gastroenterology, UMC Ljubljana, Ljubljana, Slovenia
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Rinze W F ter Steege
- Department of Gastroenterology and Hepatology, Martini Ziekenhuis, Groningen, the Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Geert R D’Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
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Laredo V, Gargallo-Puyuelo CJ, Gomollón F. How to Choose the Biologic Therapy in a Bio-Naïve Patient with Inflammatory Bowel Disease. J Clin Med 2022; 11:jcm11030829. [PMID: 35160280 PMCID: PMC8837085 DOI: 10.3390/jcm11030829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 02/01/2023] Open
Abstract
The availability of biologic therapies in inflammatory bowel disease (IBD) is increasing significantly. This represents more options to treat patients, but also more difficulties in choosing the therapies, especially in the context of bio-naïve patients. Most evidence of safety and efficacy came from clinical trials comparing biologics with placebo, with a lack of head-to-head studies. Network meta-analysis of biologics and real-world studies have been developed to solve this problem. Despite the results of these studies, there are also other important factors to consider before choosing the biologic, such as patient preferences, comorbidities, genetics, and inflammatory markers. Given that resources are limited, another important aspect is the cost of biologic therapy, since biosimilars are widely available and have been demonstrated to be effective with a significant decrease in costs. In this review, we summarize the evidence comparing biologic therapy in both Crohn´s disease (CD) and ulcerative colitis (UC) in different clinical situations. We also briefly synthesize the evidence related to predictors of biologic response, as well as the biologic use in extraintestinal manifestations and the importance of the drug-related costs.
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Affiliation(s)
- Viviana Laredo
- Department of Gastroenterology, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain;
- Correspondence: (V.L.); (C.J.G.-P.)
| | - Carla J. Gargallo-Puyuelo
- Department of Gastroenterology, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain;
- Institute for Health Research Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Correspondence: (V.L.); (C.J.G.-P.)
| | - Fernando Gomollón
- Department of Gastroenterology, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain;
- Institute for Health Research Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, 50009 Zaragoza, Spain
- Liver and Digestive Diseases Networking Biomedical Research Centre (Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, CIBEREHD), 28029 Madrid, Spain
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Tapete G, Bertani L, Pieraccini A, Lynch EN, Giannotta M, Morganti R, Biviano I, Naldini S, Mumolo MG, De Nigris F, Calella F, Bagnoli S, Minciotti M, Maltinti S, Rentini S, Ceccarelli L, Lionetti P, Milla M, Costa F. Effectiveness and Safety of Nonmedical Switch From Adalimumab Originator to SB5 Biosimilar in Patients With Inflammatory Bowel Diseases: Twelve-Month Follow-Up From the TABLET Registry. Inflamm Bowel Dis 2022; 28:62-69. [PMID: 33570142 DOI: 10.1093/ibd/izab027] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few data are currently available about SB5 in inflammatory bowel diseases (IBD). The aim of this study was to assess the effectiveness and safety of SB5 in a cohort of patients with IBD in stable remission switched from the adalimumab (ADA) originator and in a cohort of patients with IBD naïve to ADA. METHODS We prospectively enrolled patients with IBD who started ADA treatment with SB5 (naïve cohort) and those who underwent a nonmedical switch from the ADA originator to SB5 (switching cohort). Clinical remission and safety were assessed at baseline and at 3, 6, and 12 months. In addition, in a small cohort of patients who were switched, we assessed the ADA serum trough levels and antidrug antibodies at baseline, 3, and 6 months. RESULTS In the naïve cohort, the overall remission rate at 12 months was 60.42%, whereas in the switching cohort it was 89.02%. Fifty-three (36.3%) patients experienced an adverse event, and injection site pain was the most common; it was significantly more frequent in the switching cohort (P = 0.001). No differences were found in terms of ADA serum trough levels at baseline, 3, and 6 months after switching. No patient developed antidrug antibodies after the switch. CONCLUSIONS We found that SB5 seemed effective and safe in IBD, both in the naïve cohort and in the switching cohort. Further studies are needed to confirm these data in terms of mucosal healing.
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Affiliation(s)
- Gherardo Tapete
- Department of General Surgery-Gastrointestinal Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Bertani
- Department of General Surgery-Gastrointestinal Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alberto Pieraccini
- IBD Referral Center, Gastroenterology Clinic, Careggi University Hospital, Florence, Italy
| | - Erica Nicola Lynch
- IBD Referral Center, Gastroenterology Clinic, Careggi University Hospital, Florence, Italy
| | - Martina Giannotta
- S.O.C. Gastroenterologia ed Endoscopia Digestiva-Usl Toscana Centro, Ospedale S. Giovanni di Dio, Florence, Italy
| | | | - Ivano Biviano
- A.O.U.S.-U.O.C. Gastroenterologia ed Endoscopia Operativa, Siena, Italy
| | - Sara Naldini
- Pediatric Hospital Meyer, University of Florence, Florence, Italy
| | - Maria Gloria Mumolo
- Department of General Surgery-Gastrointestinal Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesca De Nigris
- S.O.C. Gastroenterologia ed Endoscopia Digestiva-Usl Toscana Centro, Ospedale S. Giovanni di Dio, Florence, Italy
| | - Francesca Calella
- U.O.C. Gastroenterologia-Azienda USL Empoli-Ospedale San Giuseppe, Empoli, Italy
| | - Siro Bagnoli
- IBD Referral Center, Gastroenterology Clinic, Careggi University Hospital, Florence, Italy
| | - Moira Minciotti
- SSD Endoscopia Digestiva-Ospedale Apuane-ASL Nordovest, Massa, Italy
| | - Simona Maltinti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Rentini
- A.O.U.S.-U.O.C. Gastroenterologia ed Endoscopia Operativa, Siena, Italy
| | - Linda Ceccarelli
- Department of General Surgery-Gastrointestinal Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Paolo Lionetti
- Pediatric Hospital Meyer, University of Florence, Florence, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Clinic, Careggi University Hospital, Florence, Italy
| | - Francesco Costa
- Department of General Surgery-Gastrointestinal Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Tursi A, Mocci G, Allegretta L, Aragona G, Bianco MA, Colucci R, Cuomo A, Della Valle N, Ferronato A, Forti G, Gaiani F, Graziani MG, Lorenzetti R, Luzza F, Paese P, Penna A, Pica R, Pranzo G, Rodinò S, Scarcelli A, Zampaletta C, Brozzi L, Cicerone C, Cocco A, De' Angelis G, Donnarumma L, Fiorella S, Iannelli C, Larussa T, Le Grazie M, Luppino I, Meucci C, FaggianI R, Pagnini C, Perazzo P, Rodriguez-Castro KI, Sacco R, Sebkova L, Serio M, De Monti A, Picchio M, Napolitano D, Schiavoni E, Turchini L, Scaldaferri F, Pugliese D, Guidi L, Laterza L, Privitera G, Pizzoferrato M, Lopetuso LR, Armuzzi A, Elisei W, Maconi G, Papa A. Comparison of performances of infliximab biosimilars CT-P13 versus SB2 in the treatment of inflammatory bowel diseases: a real-life multicenter, observational study in Italy. Expert Opin Biol Ther 2021; 22:313-320. [PMID: 34904510 DOI: 10.1080/14712598.2022.2007881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To compare the performances of Infliximab (IFX) biosimilar CT-P13 and SB2 in the treatment of Inflammatory Bowel Diseases (IBD) outpatients in Italy. RESEARCH DESIGN AND METHODS Three hundred and eighty IBD outpatients were retrospectively evaluated. The primary endpoint was to compare the two IFX biosimilars in terms of reaching and maintenance of remission at any timepoint. RESULTS 197 patients with Ulcerative Colitis (UC) and 183 patients with Crohn's Disease (CD) treated with CT-P13 or SB2 and having a median (IQR) follow-up of 12 (6-36) months were compared: 230 (60.5%) were naïve to anti-TNFα, 20 (5.26%) were switched from IFX originator or from IFX CT-P13 to IFX SB2. Clinical remission was achieved in 133 (67.5%) UC patients and in 164 (89.6%) CD patients (p < 0.000), with no differences between CT-P13 and SB2 in the rate of remission in UC (p = 0.667) and CD (p = 0.286). Clinical response, steroid-free remission, rate of surgery, mucosal healing (MH) in UC, switching from IFX originator or from other biosimilar, and safety were similar. Higher MH rate was obtained in CD patients treated with CT-P13 (p = 0.004). CONCLUSION This first comparative study found that both IFX biosimilars CT-P13 and SB2 are effective and safe in managing IBD outpatients.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, Asl Bat, Andria, Italy.,Department of Medical and Surgical Sciences, Post-graduate School of Digestive Diseases Catholic University, Rome, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Leonardo Allegretta
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina, Italy
| | - Giovanni Aragona
- Division of Gastroenterology, "Guglielmo Da Saliceto" Hospital, Piacenza, Italy
| | | | - Raffaele Colucci
- Digestive Endoscopy Unit, "San Matteo Degli Infermi" Hospital, Spoleto, Italy
| | - Antonio Cuomo
- Division of Gastroenterology, "Umberto I" Hospital, Nocera Inferiore, Italy
| | - Nicola Della Valle
- Division of Gastroenterology, "Ospedali Riuniti" Hospital, Foggia, Italy
| | | | - Giacomo Forti
- Digestive Endoscopy Unit, "S. Maria Goretti" Hospital, Latina, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Roberto Lorenzetti
- Division of Gastroenterology, "Nuovo Regina Margherita" Territorial Hospital, Rome, Italy
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Pietro Paese
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Antonio Penna
- Territorial Gastroenterology Service, Asl Ba, Bari, Italy
| | - Roberta Pica
- Division of Gastroenterology, Ibd Unit, "S. Pertini" Hospital, Rome, Italy
| | - Giuseppe Pranzo
- Ambulatory for Ibd Treatment, "Valle D'Itria" Hospital, Martina Franca, Italy
| | - Stefano Rodinò
- Division of Gastroenterology, "Ciaccio-pugliese" Hospital, Catanzaro, Italy
| | | | | | - Lorenzo Brozzi
- Digestive Endoscopy Unit, ULSS7 Pedemontana, Santorso, Italy
| | - Clelia Cicerone
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Andrea Cocco
- Division of Gastroenterology, Ibd Unit, "S. Pertini" Hospital, Rome, Italy
| | - Gianluigi De' Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Laura Donnarumma
- Division of Gastroenterology, "Umberto I" Hospital, Nocera Inferiore, Italy
| | | | - Chiara Iannelli
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Tiziana Larussa
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Marco Le Grazie
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ileana Luppino
- Division of Gastroenterology, "Annunziata" Hospital, Cosenza, Italy
| | - Costantino Meucci
- Division of Gastroenterology, "T. Maresca" Hospital, Torre Del Greco, Italy
| | - Roberto FaggianI
- Division of Gastroenterology, "S. Camillo" Hospital, Rome, Italy
| | - Cristiano Pagnini
- Division of Gastroenterology, "S. Giovanni - Addolorata" Hospital, Rome, Italy
| | - Patrizia Perazzo
- Division of Gastroenterology, "Guglielmo Da Saliceto" Hospital, Piacenza, Italy
| | | | - Rodolfo Sacco
- Division of Gastroenterology, "Ospedali Riuniti" Hospital, Foggia, Italy
| | - Ladislava Sebkova
- Division of Gastroenterology, "Ciaccio-pugliese" Hospital, Catanzaro, Italy
| | - Mariaelena Serio
- Division of Gastroenterology, "San Salvatore" Hospital, Pesaro, Italy
| | - Alberta De Monti
- Division of Gastroenterology, "L. Sacco" University Hospital, Milan, Italy
| | - Marcello Picchio
- Division of General Surgery, "P. Colombo" Hospital, Velletri, Italy
| | - Daniele Napolitano
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Elisa Schiavoni
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Laura Turchini
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Franco Scaldaferri
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Daniela Pugliese
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Luisa Guidi
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Lucrezia Laterza
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Giuseppe Privitera
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Marco Pizzoferrato
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Loris R Lopetuso
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy.,Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Alessandro Armuzzi
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
| | - Walter Elisei
- Division of Gastroenterology, "S. Camillo" Hospital, Rome, Italy
| | - Giovanni Maconi
- Division of Gastroenterology, "L. Sacco" University Hospital, Milan, Italy
| | - Alfredo Papa
- Department of Medical and Surgical Sciences, Università Cattolica Del S. Cuore and Cemad, Fondazione Policlinico Universitario "A. Gemelli," Irccs, Rome, Italy
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10
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Huguet JM, Cortés X, Bosca-Watts MM, Aguas M, Maroto N, Martí L, Amorós C, Paredes JM. Real-world data on the infliximab biosimilar CT-P13 (Remsima ®) in inflammatory bowel disease. World J Clin Cases 2021; 9:11285-11299. [PMID: 35071559 PMCID: PMC8717518 DOI: 10.12998/wjcc.v9.i36.11285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, biological therapies have revolutionized the management of inflammatory bowel disease (IBD); however, they are expensive. The development of biosimilar products has allowed us to reduce healthcare costs and improve patients’ access to these treatments. Although various studies support the similarity between infliximab and its biosimilar CT-P13 in terms of efficacy and safety, there are unmet needs regarding research on these agents in the context of IBD.
AIM To analyze clinical response rates to CT-P13 and adverse events in IBD patients treated in real-life practice.
METHODS An observational, prospective, multicenter study of IBD patients treated with CT-P13 in clinical practice who were naïve to biological treatments or failed to respond to other anti-tumor necrosis factor drugs or had switched from infliximab originator was carried out. No diagnostic or follow-up interventions were conducted on patients outside usual clinical practice. The primary endpoints were clinical response rates and number of adverse events. The primary efficacy variable was the proportion of patients who were in clinical remission and/or had a clinical response at 3, 6, 9, and 12 mo.
RESULTS A total of 220 IBD patients treated with CT-P13 (Remsima®) were included in the study: 87 (40%) with ulcerative colitis and 133 (60%) with Crohn’s disease. Mean age of the patients was 41.47 (SD 15.74) years, and 58% were female. Nineteen (9%) patients started treatment with CT-P13 after switching from infliximab. Of the remaining 201 patients, 142 (65%) were naïve to biologic agents. At baseline, 68.6% (n = 138/201) of patients presented with active disease. After 12 mo of treatment, 14.8% (n = 12/81) presented with active disease, and 64.2% (n = 52/81) were in clinical remission without corticosteroids. After 3 mo, 75.5% (n = 115/152) had a clinical response or achieved clinical remission, which was sustained for 12 mo (85.2%; n = 69/81). There was a decrease in specific IBD indices at 3, 6, 9, and 12 mo (P < 0.001). A total of 34 adverse events were reported by 27 (12.3%) patients, 9 (26.5%) of which were serious.
CONCLUSION CT-P13 is an effective and safe infliximab biosimilar for the treatment of IBD in real-life practice and may be a valid and attractive alternative for the treatment of IBD.
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Affiliation(s)
- Jose María Huguet
- Department of Gastroenterology, General University Hospital of Valencia, Valencia 46014, Spain
| | - Xavier Cortés
- Department of Gastroenterology, Hospital de Sagunto, Sagunto 46520, Spain
| | - Marta Maia Bosca-Watts
- Department of Gastroenterology, Hospital Clinico Universitario de Valencia, Valencia 46010, Spain
| | - Marian Aguas
- Department of Gastroenterology, Hospital Universitario y Politecnico la Fe de Valencia, Valencia 46026, Spain
| | - Nuria Maroto
- Department of Gastroenterology, Hospital de Manises, Manises 46940, Spain
| | - Lidia Martí
- Department of Gastroenterology, Hospital Comarcal Francesc de Borja, Gandia 46702, Spain
| | - Cirilo Amorós
- Department of Gastroenterology, Hospital Arnau de Vilanova de Valencia, Valencia 46015, Spain
| | - Jose María Paredes
- Department of Gastroenterology, Hospital Universitario Doctor Peset de Valencia, Valencia 46017, Spain
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11
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Mirjalili SZ, Sabourian R, Sadeghalvad M, Rezaei N. Therapeutic applications of biosimilar monoclonal antibodies: Systematic review of the efficacy, safety, and immunogenicity in autoimmune disorders. Int Immunopharmacol 2021; 101:108305. [PMID: 34741996 DOI: 10.1016/j.intimp.2021.108305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Biosimilars are biological products that could be used instead of reference biological drugs to provide a less costly option for treating patients with autoimmune disorders. With the introduction of biosimilar monoclonal antibodies into the drug market, the main concern is confirming the similarity in terms of efficacy, safety, and immunogenicity of these biosimilars with their reference products. The presence of valuable comparative clinical trials to demonstrate these similarities with analytical methods is challenging. This review discusses the similarity between biosimilar mAbs and reference products as candidates for autoimmune diseases. METHODS Data on efficacy endpoints, adverse events, production of anti-drug antibodies (ADAs), and neutralizing antibodies (nAbs) were collected from trials. FINDINGS Overall, these data suggest the similarity between biosimilar mAbs and reference products in terms of safety and efficacy. IMPLICATIONS Biosimilars are used in a wider range of diseases, and by examining their similarities in all those diseases with reference drugs, more comprehensive results can be obtained.
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Affiliation(s)
- Seyedeh Zohreh Mirjalili
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Reyhaneh Sabourian
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mona Sadeghalvad
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Macaluso FS, Cappello M, Busacca A, Fries W, Viola A, Costantino G, Magnano A, Vinci E, Ferracane C, Privitera AC, Piccillo G, Belluardo N, Giangreco E, Romano C, Citrano M, Graziano F, Garufi S, Bertolami C, Ventimiglia M, Scrivo B, Teresi G, Renna S, Rizzuto G, Casà A, Orlando A. SPOSAB ABP 501: A Sicilian Prospective Observational Study of Patients with Inflammatory Bowel Disease Treated with Adalimumab Biosimilar ABP 501. J Gastroenterol Hepatol 2021; 36:3041-3049. [PMID: 34152636 DOI: 10.1111/jgh.15590] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM There are few clinical data on Adalimumab (ADA) biosimilars in inflammatory bowel disease. We aimed to perform a multicenter, observational, prospective study on safety and effectiveness of ADA biosimilar ABP 501 in patients with inflammatory bowel disease. METHODS All consecutive patients from the cohort of the Sicilian Network for Inflammatory Bowel Disease treated with ADA biosimilar ABP 501 from February 2019 to February 2020 were enrolled. Patients were divided into three groups: group A, naïve to ADA and naïve to anti-tumor necrosis factors; group B, naïve to ADA and previously exposed to anti-tumor necrosis factors; and group C: switched from ADA originator to ABP 501. RESULTS A total of 559 patients (median age 39 years; Crohn's disease 88.0%, ulcerative colitis 12.0%) were included, with a follow-up time of 403.4 patient-years. Thirty-six serious adverse events occurred in 36 patients (6.4%; incidence rate [IR]: 8.9 per 100 person-years [PY]). The IR of serious adverse events was higher among patients in group A compared with group C (17.4 vs 4.8 per 100 PY; IR ratio = 3.61; P < 0.001) and among patients in group B compared with group C (16.4 vs 4.8 per 100 PY; IR ratio = 3.42; P = 0.041). Among ADA-naïve patients (group A + B), 188 (85.8%) had a clinical response after 12 weeks, including 165 (75.3%) who achieved steroid-free remission. Higher treatment persistence estimates were reported for patients in group C compared with groups A and B (log-rank P < 0.001). CONCLUSIONS Safety and effectiveness of ABP 501 seem to be overall similar to those reported for ADA originator. Switching from originator to ABP 501 was safe and effective.
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Affiliation(s)
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Anita Busacca
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Giuseppe Costantino
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Elisa Vinci
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Concetta Ferracane
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, A.O. "Cannizzaro", Catania, Italy
| | | | | | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Michele Citrano
- Pediatric Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | | | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Barbara Scrivo
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Teresi
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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13
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Mazza S, Piazza O Sed N, Conforti FS, Fascì A, Rimondi A, Marinoni B, Casini V, Ricci C, Munari F, Pirola L, Invernizzi P, Girelli C, Lupinacci G, Pastorelli L, Cavallaro F, Ferraris L, Colucci A, Amato A, Eugenio Tontini G, Vecchi M, Fiorino G, Caprioli F. Safety and clinical efficacy of the double switch from originator infliximab to biosimilars CT-P13 and SB2 in patients with inflammatory bowel diseases (SCESICS): A multicenter cohort study. Clin Transl Sci 2021; 15:172-181. [PMID: 34523800 PMCID: PMC8742653 DOI: 10.1111/cts.13131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/17/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Data regarding double switching from originator infliximab (IFX) to IFX biosimilars in inflammatory bowel diseases (IBDs) are lacking. The purpose of this study was to evaluate the safety and efficacy of switching from originator IFX to CT‐P13 and subsequently to SB2 (double switch) in patients with IBD. Patients undergoing IFX‐double switch in eight Centers in Lombardy (Italy) from November 2018 to May 2019 were retrospectively analyzed. The IFX discontinuation rate, incidence and type of adverse events (AEs), and clinical remission rate were recorded. A comparison with a control group of patients with IBD single‐switched from originator IFX to CT‐P13 was performed, before and after an inverse probability of treatment weighting (IPTW)‐based propensity score analysis. Fifty‐two double‐switched patients with IBD were enrolled. The 24‐ and 52‐week proportions of patients continuing on IFX therapy following the second switch (CTP13 → SB2) were 98% (95% confidence interval [CI] 94%–100%) and 90% (95% CI 81%–99%), respectively. Four patients experienced a total of five AEs, all graded 1–3 according to Common Terminology Criteria for Adverse Events (CTCAE). No infusion reactions were observed. The 24‐week and follow‐up end clinical remission rates following the second switch were 94% and 88%, respectively. No differences were observed in the safety and efficacy outcomes by comparing the double‐switch group with a single‐switch group of 66 patients with IBD; all these results were confirmed by IPTW‐adjusted analysis. The study suggests both the safety and efficacy of the double switch from originator IFX to CT‐P13 and SB2 in patients with IBD is maintained. This strategy may be associated with potential cost implications.
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Affiliation(s)
- Stefano Mazza
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Nicole Piazza O Sed
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Francesco Simone Conforti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Alberto Fascì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Rimondi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Beatrice Marinoni
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | | | - Lorena Pirola
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Carlo Girelli
- Gastroenterology and Digestive Endoscopy Unit, Busto Arsizio Hospital, Varese, Italy
| | - Guido Lupinacci
- Gastroenterology and Endoscopy Unit, Ospedale Maggiore, Crema, Italy
| | - Luca Pastorelli
- Gastroenterology and Liver Unit, ASST Santi Paolo e Carlo, Ospedale San Paolo Milan, Italy.,Department of Health Sciences, Univeristà degli Studi di Milano, Milan, Italy
| | - Flaminia Cavallaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy
| | - Luca Ferraris
- Gastroenterology and Endoscopy Unit, Gallarate Hospital, Varese, Italy
| | - Alice Colucci
- Gastroenterology and Endoscopy Unit, Gallarate Hospital, Varese, Italy
| | - Arnaldo Amato
- Gastroenterology and Digestive Endoscopy Unit, Valduce Hospital, Como, Italy
| | - Gian Eugenio Tontini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Vecchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Humanitas Clinical and Research Center, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Flavio Caprioli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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14
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Santos JDM, Peña-Sánchez JN, Fowler SA. Patients' perspectives on medication for inflammatory bowel disease: a mixed-method systematic review. Eur J Gastroenterol Hepatol 2021; 33:1139-47. [PMID: 32773507 DOI: 10.1097/MEG.0000000000001861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Inflammatory bowel disease (IBD) is a lifelong chronic disease that frequently requires long-term medical treatment to maintain remission. Patient perspectives on IBD medication are important to understand as nonadherence to IBD medication is common. We aim to synthesize the evidence about patients' perspectives on medication for IBD. A mixed-method systematic review was conducted on Scopus, EMBASE, Web of Science, and CINAHL. The convergent integrated approach to synthesis and integration of qualitative and quantitative findings was used for data analysis. Twenty-five articles from 20 countries were included in this review (20 quantitative, 3 qualitative, and 2 mixed-method studies). Patients have identified a lack of knowledge in the areas of efficacy, side effects, and characteristics of medications as key elements. Some negative views on IBD medication may also be present (e.g. the high number of pills and potential side effects). Lack of knowledge about medication for IBD was identified as a common issue for patients. Health services delivery for IBD should take into consideration these patients' perspectives. A focus on improving patient education in these areas could help empower patients and alleviate doubts resulting in better disease management and improved healthcare outcomes.
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15
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Agboton C, Salameh J. Biosimilars in chronic inflammatory diseases: facts and remaining questions 5 years after their introduction in Europe. Expert Opin Biol Ther 2021; 22:157-167. [PMID: 34338115 DOI: 10.1080/14712598.2021.1963435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Five years after the launch of the first infliximab biosimilar, biologics have found their place in the treatment of chronic inflammatory conditions, but there are remaining questions. This is a review of the introduction of antibody biosimilars in Europe; the reasons for their success and how biosimilar hesitancy was quailed. AREAS COVERED We provide an overview of the concepts of biosimilarity, extrapolation, and interchangeability, using examples in rheumatology and gastroenterology for illustration. A review of the evidence collected from switching studies using robust designs is included. Remaining questions such as 'inter-switching' are also discussed. EXPERT OPINION Biosimilars have democratized access to powerful medicines. Efficacy and safety studies provided reassuring data, but knowledge gaps persist. The availability of so-called 'bio-betters' might open new avenues and change clinical practice.
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Affiliation(s)
- Christian Agboton
- Global medical affairs, Takeda Pharmaceuticals AG, Zürich, Switzerland
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16
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Cheon JH, Nah S, Kang HW, Lim YJ, Lee SH, Lee SJ, Kim SH, Jung NH, Park JE, Lee YJ, Jeon DB, Lee YM, Kim JM, Park SH. Infliximab Biosimilar CT-P13 Observational Studies for Rheumatoid Arthritis, Inflammatory Bowel Diseases, and Ankylosing Spondylitis: Pooled Analysis of Long-Term Safety and Effectiveness. Adv Ther 2021; 38:4366-4387. [PMID: 34250583 DOI: 10.1007/s12325-021-01834-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Long-term, real-world safety and effectiveness data are required to support biosimilar use. This analysis pooled 5-year findings from observational studies of infliximab biosimilar CT-P13 treatment in patients with rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and ankylosing spondylitis (AS). METHODS Patients enrolled in the CT-P13 4.2, 4.3, or 4.4 Korea/European Union registries were analysed if they had initiated infliximab treatment with CT-P13 (CT-P13 group) or had switched from reference infliximab to CT-P13 (switched to CT-P13 group). The primary objective was to investigate long-term safety by evaluating adverse events of special interest (AESIs) per the CT-P13 risk-management plan. Incidence rates per 100 patient-years (PYs) were calculated. Additional long-term safety endpoints, immunogenicity (assessments optional), and effectiveness were evaluated. RESULTS Overall, 736 patients (642 CT-P13; 94 switched to CT-P13) were analysed. Median (range) exposure to CT-P13 was 19.433 (0.03-63.11) months overall. The incidence of treatment-emergent adverse events was 69.0% (CT-P13 group) and 60.6% (switched to CT-P13 group). Infusion-related reaction/hypersensitivity/anaphylactic reaction was the most frequent AESI overall, with an incidence of 4.3828 per 100 PY (95% confidence interval: 3.3603-5.6185). For most AESIs, incidence rates per 100 PY were broadly comparable between treatment groups, considering overlapping 95% confidence intervals. At baseline, 42/445 (9.4%) and 21/59 (35.6%) evaluable patients in the CT-P13 and switched to CT-P13 groups, respectively, were antidrug antibody (ADA)-positive. After CT-P13 treatment during the study, 188/425 (44.2%) evaluable patients had ≥ 1 ADA-positive result, including 147/425 (34.6%) patients with negative or no ADA results reported at baseline. Effectiveness tended to increase over time for all indications. CONCLUSION The analysis did not identify any new safety findings for patients with RA, IBD, and AS treated with CT-P13 for up to 5 years in those who were infliximab-naïve at CT-P13 initiation, or those who had switched from reference infliximab to CT-P13. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT02557295 (CT-P13 4.2; retrospectively registered on 23 September 2015); NCT02326155 (CT-P13 4.3; retrospectively registered on 25 December 2014); NCT02557308 (CT-P13 4.4; retrospectively registered on 23 September 2015).
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Affiliation(s)
- Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seongsu Nah
- Department of Internal Medicine, Soonchunhyuang University Hospital, Cheonan, Republic of Korea
| | - Hyoun Woo Kang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University, College of Medicine, Goyang, Republic of Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University, College of Medicine, Goyang, Republic of Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
- Arthritis and Rheumatism Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 137-701, Republic of Korea.
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Bhat S, Limdi JK, Cross RK, Farraye FA. Does Similarity Breed Contempt? A Review of the Use of Biosimilars in Inflammatory Bowel Disease. Dig Dis Sci 2021; 66:2513-32. [PMID: 34176024 DOI: 10.1007/s10620-021-07114-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
The introduction of therapeutic monoclonal antibodies directed against tumor necrosis factor-α has revolutionized the treatment of inflammatory bowel disease (IBD) by improving quality of life, decreasing the frequency and length of hospital admissions, and reducing corticosteroid use. Nevertheless, biologics are very expensive, substantially contributing to the cost of care for patients with IBD. To reduce this cost and improve treatment access, biosimilars, which are therapeutic monoclonal antibodies (biologicals) similar to but not identical to the reference biologic, were introduced. Despite their potential benefits, the adoption and uptake of biosimilars have varied considerably across the USA and Europe. Here, we highlight the current biosimilar therapeutic landscape, discuss barriers to their use, and provide an overview of published studies evaluating the efficacy and safety of biosimilars in IBD.
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Smith JT, Velayos FS, Niu F, Liu V, Delate T, Pola S, Le K, Hui RL. Retrospective Cohort Study Comparing Infliximab-dyyb and Infliximab in Biologic-Naive Patients With Inflammatory Bowel Disease in the United States. Crohns Colitis 360 2021; 3:otab051. [PMID: 36776661 PMCID: PMC9802363 DOI: 10.1093/crocol/otab051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Real-world assessments of biosimilars are needed to understand their effectiveness and safety in practice settings that may differ from those seen in clinical trials or healthcare systems in different countries. To assess the effectiveness and safety of a biosimilar (infliximab-dyyb) and its reference product (infliximab) in patients with inflammatory bowel disease (IBD) in the United States. Methods We conducted a retrospective cohort study of biologic-naive patients with IBD who started treatment with infliximab-dyyb or infliximab. The study included 3206 patients identified through electronic health records in a US integrated healthcare delivery system. The effectiveness outcome was a composite of IBD-related surgery, IBD-related emergency room visit, and IBD-related hospitalization within 12 months of initiation. Safety outcomes included incidence of any or serious infection, cancer, acute liver dysfunction, and tuberculosis. We used a non-inferiority test with an upper-limit margin of 10% to analyze effectiveness. Doubly robust methods incorporating Cox proportional hazard regression with standardized inverse probability of treatment weighting were used to analyze both effectiveness and safety outcomes. Results The composite effectiveness outcome occurred in 107 of 870 patients (12.3%) in the infliximab-dyyb and 379 of 2336 patients (16.2%) in the infliximab groups. Infliximab-dyyb was non-inferior (P < .01) and was not different (hazard ratio [HR] 0.81; confidence interval [CI] 0.65-1.01; P = .06) to infliximab. Safety outcomes were not different between infliximab-dyyb and infliximab for any infections (HR 1.01; CI 0.86-1.17; P = .95), serious infections (HR 0.83; CI 0.54-1.26; P = .38), cancers (HR 0.83; CI 0.44-1.54; P = .55), and tuberculosis (HR 0.59; CI 0.10-3.55; P = .57). Conclusions Initiation of infliximab-dyyb was non-inferior to infliximab among biologic-naive patients with IBD in an US integrated healthcare delivery system.
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Affiliation(s)
- Joshua T Smith
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Fernando S Velayos
- Division of Gastroenterology and Hepatology, The Permanente Medical Group, San Francisco, California, USA
| | - Fang Niu
- Kaiser Permanente National Pharmacy, Pharmacy Outcomes Research Group, National Pharmacy Services, Downey, California, USA
| | - Vincent Liu
- Division of Research, Kaiser Permanente National Pharmacy, Oakland, California, USA
| | - Thomas Delate
- Pharmacy Outcomes Research Group, National Pharmacy Services, Aurora, Colorado, USA
| | - Suresh Pola
- Kaiser Permanente National Pharmacy, Department of Gastroenterology, Southern California Permanente Medical Group, San Diego, California, USA
| | - Kim Le
- Kaiser Permanente National Pharmacy, Drug Evaluation, Strategy and Outcomes, National Pharmacy Services, Kaiser Permanente National Pharmacy, Downey, California, USA
| | - Rita L Hui
- Kaiser Permanente National Pharmacy, Pharmacy Outcomes Research Group, National Pharmacy Services, Oakland, California, USA,Address correspondence to: Rita L. Hui, PharmD, MS, Pharmacy Outcomes Research Group, National Pharmacy Services, Kaiser Permanente, 1800 Harrison St., #1301, Oakland, CA 94612, USA ()
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Maltz RM, McNicol M, Wingate L, Buchanan S, Sandell A, Kim SC, Rubin DT. There Is No Substitute for Effective Education About Biosimilars. Crohns Colitis 360 2021; 3:otab047. [PMID: 36777278 PMCID: PMC9802262 DOI: 10.1093/crocol/otab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ross M Maltz
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA,Address correspondence to: Ross M. Maltz, MD, Division of Pediatric Gastroenterology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA ()
| | - Megan McNicol
- Department of Pharmacy, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Laura Wingate
- Crohn’s & Colitis Foundation, New York, New York, USA
| | | | - Angela Sandell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Golisano Children’s Hospital, Rochester, New York, USA
| | - Sandra C Kim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois, USA
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20
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Parrish RH. Biosimilar Interchangeability and Emerging Treatment Strategies for Inflammatory Bowel Diseases: A Commentary. Gastroenterology Insights 2021; 12:293-301. [DOI: 10.3390/gastroent12030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This commentary summarizes a collection of key references published within the last ten years, and identifies pharmacologic research directions to improve treatment access and success through greater biosimilar or “follow-on” biologic utilization combined with other targeted small molecule agents that possess unique pathophysiologic mechanisms for inflammatory bowel diseases (IBD) in adult and pediatric patients. Since they are not identical to the originator or reference biologic agent, all biosimilars are not generically equivalent. However, in the US and other countries, they are considered therapeutically interchangeable if the manufacturer has demonstrated no clinically meaningful differences from the reference product. Comparisons of different clinical initiation and switching scenarios are discussed with reference to interchangeability, immunogenicity, nocebo effect, cost effectiveness, and time courses for discontinuation rates.
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21
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Guberna L, Nyssen OP, Chaparro M, Gisbert JP. Frequency and Effectiveness of Empirical Anti-TNF Dose Intensification in Inflammatory Bowel Disease: Systematic Review with Meta-Analysis. J Clin Med 2021; 10:2132. [PMID: 34069295 PMCID: PMC8156358 DOI: 10.3390/jcm10102132] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
Loss of response to antitumor necrosis factor (anti-TNF) therapies in inflammatory bowel disease occurs in a high proportion of patients. Our aim was to evaluate the loss of response to anti-TNF therapy, considered as the need for dose intensification (DI), DI effectiveness and the possible variables influencing its requirements. Bibliographical searches were performed. SELECTION prospective and retrospective studies assessing DI in Crohn's disease and ulcerative colitis patients treated for at least 12 weeks with an anti-TNF drug. EXCLUSION CRITERIA studies using anti-TNF as a prophylaxis for the postoperative recurrence in Crohn's disease or those where DI was based on therapeutic drug monitoring. DATA SYNTHESIS effectiveness by intention-to-treat (random effects model). Data were stratified by medical condition (ulcerative colitis vs. Crohn's disease), anti-TNF drug and follow-up. RESULTS One hundred and seventy-three studies (33,241 patients) were included. Overall rate of the DI requirement after 12 months was 28% (95% CI 24-32, I2 = 96%, 41 studies) in naïve patients and 39% (95% CI 31-47, I2 = 86%, 18 studies) in non-naïve patients. The DI requirement rate was higher both in those with prior anti-TNF exposure (p = 0.01) and with ulcerative colitis (p = 0.02). The DI requirement rate in naïve patients after 36 months was 35% (95% CI 28-43%; I2 = 98%; 18 studies). The overall short-term response and remission rates of empirical DI in naïve patients were 63% (95% CI 48-78%; I2 = 99%; 32 studies) and 48% (95% CI: 39-58%; I2 = 92%; 25 studies), respectively. The loss of response to anti-TNF agents-and, consequently, DI-occurred frequently in inflammatory bowel disease (approximately in one-fourth at one year and in one-third at 3 years). Empirical DI was a relatively effective therapeutic option.
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Affiliation(s)
- Laura Guberna
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (L.G.); (O.P.N.); (M.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Olga P. Nyssen
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (L.G.); (O.P.N.); (M.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - María Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (L.G.); (O.P.N.); (M.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Javier P. Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain; (L.G.); (O.P.N.); (M.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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Limdi JK, Farraye FA. The Great Debate With IBD Biosimilars: Pro: Biosimilars Should Be Routinely Used as a First Line Biologic and May Be Switched From Reference Biologics. Crohns Colitis 360 2021; 3:otab015. [PMID: 36776664 PMCID: PMC9802304 DOI: 10.1093/crocol/otab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Indexed: 12/24/2022] Open
Abstract
The relatively high cost of anti-TNF agents and looming or actual expiry of patents for several biologics have led to the development of "highly similar" versions of the "originator" drugs called "biosimilars." The approval of biosimilars has been based on "extrapolation," whereby approval is granted in licensed indications for the reference product without the need for clinical trials. We discuss efficacy and safety data in support of biosimilar use from prospective studies, switching from originator biologic, impact on immunogenicity, pharmaco-economic, and practical considerations for clinicians.
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Affiliation(s)
- Jimmy K Limdi
- Inflammatory Bowel Diseases Section, Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, The Mayo Clinic, Jacksonville, Florida, USA,Address correspondence to: Francis A. Farraye, MD, MSc, Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, The Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA ()
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Lee SJ, Baek K, Lee S, Lee YJ, Park JE, Lee SG. Post-Marketing Pooled Safety Analysis for CT-P13 Treatment of Patients with Immune-Mediated Inflammatory Diseases in Observational Cohort Studies. BioDrugs 2020; 34:513-28. [PMID: 32356239 DOI: 10.1007/s40259-020-00421-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background At EU marketing authorisation, safety data for CT-P13 (biosimilar infliximab) were limited, particularly in some indications, and uncommon adverse events (AEs) could not be evaluated among relatively small analysis populations. Objectives Our objective was to investigate the overall safety profile and incidence rate of AEs of special interest (AESIs), including serious infections and tuberculosis, in CT-P13-treated patients. Methods Data were pooled from six observational studies representing authorised indications of CT-P13 (ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, adult and paediatric Crohn’s disease and ulcerative colitis). Patients were analysed by indication and treatment (patients who received CT-P13 or those who switched from reference infliximab to CT-P13 ≤ 6 months prior to enrolment or during the study). Results Overall, 4393 patients were included (n = 3677 CT-P13 group; n = 716 switched group); 64.03% of patients had inflammatory bowel disease and 6.31% of patients were antidrug antibody positive. Overall, 32.94% and 9.58% of patients experienced treatment-emergent AEs (TEAEs) and treatment-emergent serious AEs, respectively. Across indications, TEAEs were more frequent with CT-P13 than with the switched group. Infections including tuberculosis were the most frequent serious AESI overall (2.48%) and by treatment group or indication. In total, 14 patients (0.32%) reported active tuberculosis. Overall incidence rates per 100 patient-years (95% confidence interval) were 3.40 (2.788–4.096) for serious infections including tuberculosis and 0.44 (0.238–0.732) for active tuberculosis. Infusion-related reactions were the second most frequent AESI following infection including tuberculosis. Conclusion The CT-P13 safety profile appears consistent with previous studies for CT-P13 and reference infliximab, supporting the favourable risk/benefit balance for CT-P13 treatment. Electronic supplementary material The online version of this article (10.1007/s40259-020-00421-2) contains supplementary material, which is available to authorized users.
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24
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Martínez-Lozano H, Miranda-Bautista J, González-Lama Y, Carpio D, Barreiro-de Acosta M, Pérez-Calle JL, Relea Pérez L, Villa K, Matallana V, Calvo M, Vera MI, Pérez Galindo P, Mora-Cuadrado N, López-Serrano P, Marín-Jiménez I, Menchén L. Comparison of original and biosimilar infliximab (CTP-13) in biologic-naïve patients with Crohn's disease and ulcerative colitis: a retrospective, multicenter real-life study in Spain. Rev Esp Enferm Dig 2021; 113:170-178. [PMID: 33213166 DOI: 10.17235/reed.2020.6847/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE biosimilar infliximab (CTP-13) has been recently approved for the treatment of several immune-mediated inflammatory disorders, including inflammatory bowel disease (IBD). Comparative studies between this biosimilar and original infliximab in the real clinical practice are scarce. The objective of this study was to compare short and long-term safety and efficacy of original (O) and biosimilar infliximab (B-IFX) in biologic-naïve, IBD patients in the real life clinical practice. METHODS a retrospective, multicentric study was performed in five Spanish hospitals. Consecutive IBD, biologic-naïve patients from an historic cohort who initiated O-IFX from January 2013 were compared with biologic-naïve patients, who started treatment with B-IFX since its approval in January 2015. The evaluation of efficacy was assessed after the induction phase, at week 14 and week 54 of treatment. Time to dose escalation or treatment persistence of both O-IFX and B-IFX was also considered. The appearance of serious adverse events was recorded. RESULTS two hundred and thirty-nine IBD biologic-naïve patients who started with O-IFX or B-IFX were included: 153 patients were diagnosed with Crohn's disease (95 treated with O- and 58 treated with B-IFX) and 86 with ulcerative colitis (40 received O- and 46 received B-IFX). At weeks 14 and 54, both O-IFX and B-IFX groups reached a similar clinical response and remission rates. Time to dose escalation, treatment persistence and safety profile were comparable between both groups. CONCLUSIONS this long-term real-life experience provides additional evidence of the similarity of O- and B-IFX CTP-13 in terms of efficacy and safety in IBD patients.
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Affiliation(s)
| | | | | | - Daniel Carpio
- Gastroenterología, Complexo Hospitalario Universitario de Pontevedra
| | | | | | | | - Keyla Villa
- Aparato Digestivo, Hospital Universitario Puerta de Hierro
| | | | - Marta Calvo
- Aparato Digestivo, Hospital Universitario Puerta de Hierro
| | - María I Vera
- Aparato Digestivo, Hospital Universitario Puerta de Hierro
| | | | | | | | | | - Luis Menchén
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón
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Solitano V, D’Amico F, Da Rio L, Peyrin-Biroulet L, Danese S. The European Perspective and History on Biosimilars for the Treatment of Inflammatory Bowel Diseases. Crohns Colitis 360 2021; 3:otab012. [PMID: 36798960 PMCID: PMC9927805 DOI: 10.1093/crocol/otab012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the expiration of biologics' patents, biosimilars entered the market as a promising opportunity to reduce health-care costs in the field of inflammatory bowel diseases. Although biosimilars were initially poorly accepted, the growing evidence about their efficacy and safety has changed this situation, resulting in their widespread use. However, there is still an unmet need of improving patients' education about biosimilars to minimize nocebo responses and to accept nonmedical switching. Looking to the future, the use of recently authorized adalimumab biosimilars and the first attempts of adopting different strategies of switching (eg, cross-, multiple-) will fill some residual knowledge gaps.
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Affiliation(s)
| | | | - Leonardo Da Rio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Address correspondence to: Silvio Danese, MD, PhD, Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy ()
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Lovero R, Losurdo G, La Fortezza RF, Terracciano F, Biscaglia G, Martino G, Nardella M, Di Leo A, Principi M, Andriulli A, Bossa F. Safety and efficacy of switching from infliximab biosimilar CT-P13 to infliximab biosimilar SB2 in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2021; 32:201-7. [PMID: 33369956 DOI: 10.1097/MEG.0000000000001988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION For patients with inflammatory bowel diseases, switching from infliximab originator to biosimilars is effective and safe. Few data on single switch have been published, and data on multiple switches of different infliximab are unavailable. METHODS A retrospective analysis of patients who switched from CT-P13 to SB2, and of those with multiple switches among different infliximab compounds was conducted. Clinical activity, C reactive protein (CRP), adverse events (AE) and loss of response (LOR) were recorded. RESULTS Thirty-six patients (26 males, 14 Crohn's disease and 22 ulcerative colitis) were enrolled and followed up for >6 months. All patients switched from CT-P13 to SB2; 12 of them (33.3%) had already switched from reference Infliximab to CT-P13, and for the remaining patients CT-P13 was the first infliximab. The clinical remission rate six months before and three months after SB2-switch was the same (58.3%) and the rate of mild activity varied from 27.8 to 33.3% (P = 0.68); the percentage of patients with normal CRP values passed from 94.4 to 91.7% (P = 1). Two patients (5.5%) had AE and 11 (30.5%) a LOR. At univariate analysis, patients with a single switch had a non-significant risk of LOR during SB2 [odds ratio (OR) = 7.86; 95% confidence interval (CI) 0.87-71, P = 0.06]. SB2-LOR was associated with previous AE under CT-P13 (OR = 9.1, 95% CI 0.82-100, P = 0.07). None of such factors was significant at multivariate analysis. CONCLUSION Switching from CT-P13 to SB2 seems to be safe and effective either in patients with a single than in those with multiple switches.
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Macaluso FS, Fries W, Viola A, Centritto A, Cappello M, Giuffrida E, Privitera AC, Piccillo G, Magnano A, Vinci E, Vassallo R, Trovatello A, Belluardo N, Giangreco E, Camilleri S, Garufi S, Bertolami C, Ventimiglia M, Renna S, Orlando R, Rizzuto G, Orlando A. The SPOSIB SB2 Sicilian Cohort: Safety and Effectiveness of Infliximab Biosimilar SB2 in Inflammatory Bowel Diseases, Including Multiple Switches. Inflamm Bowel Dis 2021; 27:182-189. [PMID: 32083291 DOI: 10.1093/ibd/izaa036] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND No data on the recently introduced infliximab (IFX) biosimilar SB2 in inflammatory bowel disease (IBD) are available. METHODS The Sicilian Prospective Observational Study of Patients With IBD Treated With Infliximab Biosimilar SB2 is a multicenter, observational, prospective study performed among the cohort of the Sicilian Network for Inflammatory Bowel Disease. All consecutive IBD patients starting the IFX biosimilar SB2 from its introduction in Sicily (March 2018) to September 2019 (18 months) were enrolled. RESULTS Two hundred seventy-six patients (Crohn disease: 49.3%, ulcerative colitis: 50.7%) were included: 127 (46.0%) were naïve to IFX and naïve to anti-tumor necrosis factor medications (anti-TNFs), 65 (23.5%) were naïve to IFX and previously exposed to anti-TNFs, 17 (6.2%) were switched from an IFX originator to SB2, 43 (15.6%) were switched from the biosimilar CT-P13 to SB2, and 24 (8.7%) were multiply switched (from IFX originator to CT-P13 to SB2). The cumulative number of infusions of SB2 was 1798, and the total follow-up time was 182.7 patient-years. Sixty-seven serious adverse events occurred in 57 patients (20.7%; incidence rate: 36.7 per 100 patient-year), and 31 of these events caused the withdrawal of the drug. The effectiveness after 8 weeks of treatment was evaluated in patients naïve to IFX (n = 192): 110 patients (57.3%) had steroid-free remission, while 56 patients had no response (29.2%). At the end of follow-up, 72 patients (26.1%) interrupted the treatment, without significant differences in treatment persistency estimations between the five groups (log-rank P = 0.15). CONCLUSIONS The safety and effectiveness of SB2 seem to be overall similar to those reported for the IFX originator and CT-P13.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Andrea Centritto
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico G. Giaccone, Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico G. Giaccone, Palermo, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, A.O. Cannizzaro, Catania, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Elisa Vinci
- Gastroenterology Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, A.O. Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | | | | | | | | | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. S. Elia- M. Raimondi, Caltanissetta, Italy
| | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
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Queiroz NSF, Saad-Hossne R, FrÓes RDSB, Penna FGCE, Gabriel SB, Martins AL, Teixeira FV. DISCONTINUATION RATES FOLLOWING A SWITCH FROM A REFERENCE TO A BIOSIMILAR BIOLOGIC IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS. Arq Gastroenterol 2021; 57:232-243. [PMID: 32935741 DOI: 10.1590/s0004-2803.202000000-45] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biologics have revolutionized the treatment of inflammatory bowel disease (IBD). However, these drugs had a significant influence on treatment-related costs, which resulted in the development of biosimilars. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the drug discontinuation rate in the IBD population who switched from originator to biosimilars in real-world switching studies and address potential nocebo effects as reasons for drug discontinuation. METHODS Medline (via PubMed), EMBASE, Cochrane Library, and abstract databases of selected congresses were screened for reports of monoclonal antibody (mAb) switching with a minimum post-switch follow-up of >6 months or three infusions. All available information on discontinuation rates was assessed. RESULTS A total of 30 observational studies were included, involving 3,594 patients with IBD. Twenty-six studies reported a switch from infliximab to CT-P13, two studies involved a switch to SB2, and switching information was not available in two studies. The discontinuation rates were 8%, 14%, and 21% at 6, 12, and 24 months, respectively. The main reasons for drug discontinuation and their respective risks were: disease worsening (2%), remission (4%), loss of adherence (4%), adverse events (5%), and loss of response (7%). The quality of the evidence ranged from low to very low depending on the outcome analyzed. Subjective symptoms leading to drug discontinuation were infrequently reported, and the nocebo effect was clearly assessed in just one of the included papers. CONCLUSION Discontinuation rates following a switch to a biosimilar in patients with IBD increase over time. However, it was not possible to confirm the nocebo effect as a reason for discontinuation. Therefore, long-term studies evaluating the use of biosimilars to monitor adverse events and potential nocebo effects in post-marketing surveillance are still needed.
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Affiliation(s)
| | - Rogerio Saad-Hossne
- Universidade Estadual Paulista (Unesp), Cirurgia Digestiva, Botucatu, SP, Brasil
| | | | | | | | - Adalberta Lima Martins
- GEAF- SESA, Ambulatório de Doenças Inflamatórias Intestinais e Gerência Estadual de Assistência Farmacêutica, Vitória, ES, Brasil
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Fischer S, Cohnen S, Klenske E, Schmitt H, Vitali F, Hirschmann S, Ramming A, Zundler S, Rath T, Krebs S, Dörje F, Uter W, Nagore D, Meyer S, Neurath MF, Atreya R. Long-term effectiveness, safety and immunogenicity of the biosimilar SB2 in inflammatory bowel disease patients after switching from originator infliximab. Therap Adv Gastroenterol 2021; 14:1756284820982802. [PMID: 33505519 PMCID: PMC7812413 DOI: 10.1177/1756284820982802] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/26/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Long-term data on inflammatory bowel disease (IBD) patients switched from originator to biosimilar infliximab SB2 are lacking. The aim of the conducted study was to investigate the effectiveness, immunogenicity and safety of a large prospectively followed-up IBD patient cohort that was entirely switched from originator infliximab to biosimilar SB2 treatment. METHODS This was a prospective, single-center, longitudinal, observational study describing clinical outcomes in IBD patients, over an 80-week period following switch from originator infliximab to SB2. Primary outcome measures were change of disease activity [Harvey-Bradshaw Index for Crohn's disease (CD), partial Mayo Score for ulcerative colitis (UC)], C-reactive protein (CRP), infliximab trough levels (TLs), anti-drug antibodies (ADAs) and adverse events. RESULTS One hundred and forty-four IBD patients (94 CD, 50 UC), with median duration of 30.5 months' (range 2-110) treatment with originator infliximab were evaluated. Mean change of disease activity compared with baseline was -0.9 (SD 2.6), -0.4 (2.2) and -0.4 (2.0) in CD; 0.1 (1.1), 0.1 (1.1) and 0.1 (1.3) in UC patients at weeks 24, 48 and 72. Median infliximab TLs were 6.2 µg/ml (interquartile range 2.3-12.2), 5.0 µg/ml (2.7-10.0), 6.6 µg/ml (3.5-12.4) and 5.1 µg/ml (2.7-10.9) at baseline and weeks 24, 48 and 72. Median CRP levels were within normal ranges throughout the study. After the switch, 9.8% of the patients developed new ADAs. Persistence on SB2 was 90% (95% confidence interval 0.85-0.95), 79% (0.72-0.86), 72% (0.64-0.80) at weeks 26, 52 and 78. Serious adverse events occurred in 11 patients. CONCLUSION Over the individual patient follow-up of 80 weeks, switch to biosimilar SB2 from originator infliximab does not result in increased disease activity or changed immunogenicity patterns. The switch to SB2 was well tolerated.
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Affiliation(s)
- Sarah Fischer
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Sarah Cohnen
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Entcho Klenske
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Heike Schmitt
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Francesco Vitali
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Simon Hirschmann
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Ramming
- Department of Medicine 3, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Sebastian Zundler
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Timo Rath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Sabine Krebs
- Pharmacy Department, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Frank Dörje
- Pharmacy Department, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Sebastian Meyer
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen University Hospital, Erlangen, Germany
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Abstract
Over the past 2 decades, biological therapy with monoclonal antibodies targeting tumor necrosis factor-α has become a cornerstone of treatment of patients with inflammatory bowel disease. Although clinically effective, the biological therapies remain expensive, and their availability and utilization have been at times limited due to their high costs. Biosimilars are biological products similar to but not identical to the original biological agent or "reference biologic," also called "originator biologic." It is hoped that the use of biosimilars might enable these agents to become more available and, thus, decrease further expenditures related to the use of the original reference agents such as infliximab and adalimumab. In this study, we review the currently available evidence and shortcomings of these data supporting the use of biosimilars for the treatment of patients with inflammatory bowel disease, including their efficacy and safety as related to initiating therapy with biosimilar agents or switching between reference and biosimilar biologic agents.
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Macaluso FS, Leone S, Previtali E, Ventimiglia M, Armuzzi A, Orlando A. Biosimilars: The viewpoint of Italian patients with inflammatory bowel disease. Dig Liver Dis 2020; 52:1304-1309. [PMID: 32807691 DOI: 10.1016/j.dld.2020.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The viewpoint on biosimilars among patients with inflammatory bowel diseases (IBD) is largely unknown. AIMS We aimed at exploring the confidence and opinion on biosimilars among Italian patients with IBD. METHODS An anonymous, 20-item, questionnaire was sent via e-mail to all members of the Italian IBD patients' association (AMICI Onlus). Three sets of questions were formulated: 1: Characteristics of respondents; 2: The use of biologics and biosimilars in clinical practice; 3: General opinions on biologics and biosimilars. RESULTS Of the 4,302 total surveys sent, there were 1,749 respondents (response rate: 40.6%). There was an equal distribution between males and females (48.3% and 51.7%, respectively), and between patients with Crohn's disease and ulcerative colitis (46.9% and 51.3%, respectively), while most of the patients were aged between 19 and 45 years and between 46 and 65 years (45.5% and 42.0%, respectively). Approximately 45% of the respondents declared to have never been informed about the existence of biosimilars. The great majority of patients (73.9%) did not know if originators and biosimilars could be considered equivalent, or if efficacy or safety of biosimilars could be lower than those of originators. Approximately half of the respondents (53.5%) had no idea that the use of low-cost biosimilars could be useful to increase the overall economic resources for the treatment of IBD. CONCLUSIONS An extensive lack of knowledge and confidence in biosimilars exists among Italian patients with IBD. Efforts carried out by scientific societies and IBD patients' associations are required to overcome this issue.
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Affiliation(s)
| | | | | | | | - Alessandro Armuzzi
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
The advent of biologics has changed outcomes in many chronic conditions, including inflammatory bowel disease (IBD). Biologics have been used for the induction and remission of ulcerative colitis and Crohn's disease for almost two decades and are effective in patients who used to fail conventional treatment with steroids, immunomodulators. The use of biologics in the treatment of IBD has increased over the last few years, partly due to the rise in its incidence and the use of biologics as a first-line treatment in severe disease as well as in complicated diseases like penetrating/fistulating Crohn's disease. However, their use is associated with a significant burden to the society with respect to healthcare costs, resulting in the premature discontinuation of therapy in some patients, leading to exacerbations and complications. The introduction of biosimilars a decade ago seems to be a promising approach to reducing the costs related to therapy. Since their introduction, numerous studies conducted in adults and some in children show the efficacy of biosimilars with a similar side-effect profile to biologics. This review discusses the history of biosimilars in the treatment of IBD, enumerates several such studies and discusses the possibility of using biosimilars in the future.
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Affiliation(s)
- Saurabh Talathi
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
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Ismailov RM, Pouillon L, Selinger CP, Khasanova ZD. Knowledge and awareness of biosimilars and shared decision-making among gastroenterology team members in Colorado, USA. Expert Opin Biol Ther 2020; 21:111-119. [PMID: 33107355 DOI: 10.1080/14712598.2020.1842355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: There are gaps in gastroenterologist team members' understanding of various topics related to biosimilars. We aimed to examine perspectives, views, and attitudes toward biosimilar and shared decision-making (SDM) among gastroenterology team members in Colorado, USA. The ultimate goal was to increase knowledge and awareness of biosimilars and SDM. Research design and methods: We developed educational materials focused on biosimilars and SDM and distributed them to each participating gastroenterology office. Subsequently, we conducted a survey of all team members from participating offices. Results: Responses were obtained from 54 gastroenterology team members. Most respondents identified the correct answer regarding biosimilars, the nocebo effect, and SDM. Almost half (47.2%) of respondents scored their level of awareness regarding biosimilars prior to reading our educational materials as poor, and nearly one quarter (26.4%) indicated so for SDM. Improvement in scores after reading our materials was significant for both biosimilars and SDM (i.e. biosimilar: z = 6.276, p-value <0.001 and SDM z = 6.328, p-value <0.001). Conclusions: Educational efforts effectively increased the low baseline knowledge and awareness of biosimilars and SDM among gastroenterology team members. More educational projects focused on biosimilars and SDM are needed to reduce the nocebo effect and prevent hampering of the cost-savings of biosimilars.
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Affiliation(s)
- Rovshan M Ismailov
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation , Denver, CO, USA
| | - Lieven Pouillon
- Imelda GI Clinical Research Centre, Imeldaziekenhuis Bonheiden , Bonheiden, Belgium
| | - Christian P Selinger
- Gastroenterology, Leeds Teaching Hospitals NHS Trust , Leeds, UK.,University of Leeds , Leeds, UK
| | - Zaytuna D Khasanova
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation , Denver, CO, USA
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Pugliese D, Guidi L, Privitera G, Bertani L, Tolusso B, Papparella LG, Maltinti S, Di Mario C, Onali S, Ceccarelli L, Rapaccini GL, Scaldaferri F, Gremese E, Gasbarrini A, Costa F, Armuzzi A. Switching from IFX originator to biosimilar CT-P13 does not impact effectiveness,safety and immunogenicity in a large cohort of IBD patients. Expert Opin Biol Ther 2020; 21:97-104. [PMID: 33074723 DOI: 10.1080/14712598.2020.1839045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Switching from IFX originator to CT-P13 is safe; however, little data on immunogenicity exists. RESEARCH DESIGN AND METHODS Consecutive IBD patients on IFX originator were switched to CT-P13 and followed-up for 12 months. Clinical activity, infliximab trough levels (ITLs), anti-drug antibodies (ATIs), and adverse events were recorded at predefined timepoints (baseline, second CT-P13 infusion, 6 and 12 months). The outcomes investigated were immunogenicity, pharmacokinetics, effectiveness and safety. RESULTS 119 patients were switched to CT-P13 after a median time with IFX of 5.8 years. No changes in mean ITLs were observed. ATIs were detected in 30 patients (25.2%): 14 before and 16 after switch. Mean persistent ATIs were significantly higher compared to mean transient ones (109.74 ng/mL ±84.70 vs 18.22 ng/mL ±11.37, p < 0.001), with significantly lower ITLs associated (mean 0.32 µg/mL ±0.6 vs 3.08 µg/mL ±3.22, p < 0.001). A significant decrease of patients in steroid-fee clinical remission was observed after the switch (p = 0.004), with subsequent improvement at 6 months (p = 0.005). Eighteen patients (15.1%) discontinued IFX, only 6 (5%) for loss of response. CONCLUSIONS Switching from infliximab originator to CT-P13 seems safe and effective, without differences in immunogenicity. A temporary reduction of clinical benefit after switching could be potentially explained by a 'nocebo-effect response'.
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Affiliation(s)
- Daniela Pugliese
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy
| | - Luisa Guidi
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Lorenzo Bertani
- Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa , Pisa, Italy
| | - Barbara Tolusso
- OU Rheumatology Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Luigi Giovanni Papparella
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy
| | - Simona Maltinti
- Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa , Pisa, Italy
| | - Clara Di Mario
- OU Rheumatology Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Sara Onali
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy
| | - Linda Ceccarelli
- Division of Rheumatology, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Gian Lodovico Rapaccini
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Franco Scaldaferri
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy
| | - Elisa Gremese
- OU Rheumatology Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Antonio Gasbarrini
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Francesco Costa
- Department of General Surgery and Gastroenterology, IBD Unit, Pisa University Hospital , Pisa, Italy
| | - Alessandro Armuzzi
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS , Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore , Rome, Italy
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Martínez-Feito A, Bravo-Gallego LY, Hernández-Breijo B, Diez J, García-Ramirez L, Jaquotot M, Plasencia-Rodríguez C, Nozal P, Mezcua A, Martín-Arranz MD, Pascual-Salcedo D. Infliximab concentrations in two non-switching cohorts of patients with inflammatory bowel disease: originator vs. biosimilar. Sci Rep 2020; 10:17099. [PMID: 33051546 PMCID: PMC7555902 DOI: 10.1038/s41598-020-74235-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Abstract
Biosimilars are replacing originator compounds due to their similar effectiveness, safety and pharmacokinetics. Our objective was to compare the differences in pharmacokinetics and clinical outcomes between the originator infliximab (Ifx) and the biosimilar CT-P13 in a patient cohort with inflammatory bowel disease (IBD). Our cohort study included 86 patients from a historical and a prospective cohort from the start of infliximab treatment to 22 weeks later. Serum infliximab, antidrug antibody levels and other serum biomarkers were measured at weeks 0, 2, 6, 14 and 22. Remission outcomes were evaluated at weeks 14 and 22. Drug levels were measured prospectively and analysed using MANOVA. Of the 86 patients, 44 (51%) and 42 (49%) were administered the originator and CT-P13, respectively. Originator trough levels were higher than the biosimilar trough levels (35 vs. 21, 20.1 vs. 11, 6.6 vs. 2.9 and 4.3 vs. 1.7 μg/mL at weeks 2, 6, 14 and 22, respectively). A post-hoc analysis demonstrated changes in mean serum drug levels over time (p < 0.001) and according to the drug employed (p = 0.001). At week 22, 13 (81%) patients administered the originator achieved clinical remission compared with 5 (19%) patients with the biosimilar (p = 0.02). None of the patients administered the originator withdrew from the treatment compared with 7 for the biosimilar. During the study, there were significant differences in serum infliximab levels between the originator and the CT-P13 in the patients with IBD. The clinical outcomes were influenced by the type of compound administered.
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Affiliation(s)
- Ana Martínez-Feito
- Immuno-Rheumatology Group, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain. .,Immunology Unit, La Paz University Hospital, Madrid, Spain.
| | - Luz Yadira Bravo-Gallego
- Immunology Unit, La Paz University Hospital, Madrid, Spain.,Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ) and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Borja Hernández-Breijo
- Immuno-Rheumatology Group, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Jesús Diez
- Biostatistics Section, La Paz University Hospital, Madrid, Spain
| | - Laura García-Ramirez
- Unit of Inflammatory Bowel Disease, Gastroenterology Department. Innate Immunity Group, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Marta Jaquotot
- Unit of Inflammatory Bowel Disease, Gastroenterology Department. Innate Immunity Group, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - Pilar Nozal
- Immunology Unit, La Paz University Hospital, Madrid, Spain
| | - Araceli Mezcua
- Immunology Unit, La Paz University Hospital, Madrid, Spain
| | - María Dolores Martín-Arranz
- Unit of Inflammatory Bowel Disease, Gastroenterology Department. Innate Immunity Group, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Dora Pascual-Salcedo
- Immuno-Rheumatology Group, La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
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Ditto MC, Parisi S, Priora M, Sanna S, Peroni CL, Laganà A, D'Avolio A, Fusaro E. Efficacy and safety of a single switch from etanercept originator to etanercept biosimilar in a cohort of inflammatory arthritis. Sci Rep 2020; 10:16178. [PMID: 32999362 PMCID: PMC7527334 DOI: 10.1038/s41598-020-73183-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
AntiTNF-α biosimilars are broadly available for the treatment of inflammatory arthritis. There are a lot of data concerning the maintenance of clinical efficacy after switching from originators to biosimilars; therefore, such a transition is increasingly encouraged both in the US and Europe. However, there are reports about flares and adverse events (AE) as a non-medical switch remains controversial due to ethical and clinical implications (efficacy, safety, tolerability). The aim of our work was to evaluate the disease activity trend after switching from etanercept originator (oETA-Enbrel) to its biosimilar (bETA-SP4/Benepali) in a cohort of patients in Turin, Piedmont, Italy. In this area, the switch to biosimilars is stalwartly encouraged. We switched 87 patients who were in a clinical state of stability from oETA to bETA: 48 patients were affected by Rheumatoid Arthritis (RA),26 by Psoriatic Arthritis (PsA) and 13 by Ankylosing Spondylitis (AS).We evaluated VAS-pain, Global-Health, CRP, number of swollen and tender joints, Disease Activity Score on 28 joints (DAS28) for RA, Disease Activity in Psoriatic Arthritis (DAPSA) for PsA, Health Assessment Questionnaire (HAQ) and Health Assessment Questionnaire for the spondyloarthropathies (HAQ-S),Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for AS patients. 11/85 patients (12.6%) stopped treatment after switching to biosimilar etanercept. No difference was found between oETA and bETA in terms of efficacy. However, some arthritis flare and AE were reported. Our data regarding maintenance of efficacy and percentage of discontinuation were in line with the existing literature.
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Affiliation(s)
- Maria Chiara Ditto
- Department of General and Specialistic Medicine, Rheumatology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
- Medical Science, Rheumatology Unit, Azienda Ospedaliera Universitaria di Padova, Padua, Italy.
| | - Simone Parisi
- Department of General and Specialistic Medicine, Rheumatology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marta Priora
- Department of General and Specialistic Medicine, Rheumatology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Silvia Sanna
- Department of General and Specialistic Medicine, Rheumatology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Clara Lisa Peroni
- Department of General and Specialistic Medicine, Rheumatology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angela Laganà
- Department of General and Specialistic Medicine, Rheumatology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Turin, Italy
| | - Enrico Fusaro
- Department of General and Specialistic Medicine, Rheumatology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
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Solitano V, D'Amico F, Fiorino G, Peyrin-Biroulet L, Danese S. Biosimilar switching in inflammatory bowel disease: from evidence to clinical practice. Expert Rev Clin Immunol 2020; 16:1019-1028. [PMID: 32954893 DOI: 10.1080/1744666x.2021.1826311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION After patents' expiration of biological originators, several biosimilars of infliximab and adalimumab have been authorized. The approval is based on data extrapolated from other indications for which the originator has been previously tested. Despite rigorous approval processes by regulatory entities, physicians' and patients' knowledge about biosimilars is limited and some concerns about their use persist. AREAS COVERED This article summarizes the evidence on efficacy, safety, and immunogenicity of biosimilars currently approved in Europe for IBD treatment, by reviewing the literature on PubMed, EMBASE, and Web of Science databases up to mid-July 2020. Particular emphasis was placed on the need to further improve communication with patients and physicians' knowledge on biosimilars. EXPERT OPINION Adoption of biosimilars in clinical practice represents a great opportunity from an economic point of view, reducing healthcare costs and increasing patients' access to effective biologic treatments. Clinicians should be aware and confident of the latest evidence on available biosimilars and be very careful in communicating information to patients. Nocebo effect should not be overlooked since it can negatively influence outcomes of biosimilar-treated subjects, limiting the wide use of biosimilars. Evaluating the outcomes of reverse, multiple, and cross-switch will be a challenge for the next years.
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Affiliation(s)
- Virginia Solitano
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University , Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine , Vandoeuvre-lès-Nancy, France
| | - Gionata Fiorino
- Department of Biomedical Sciences, Humanitas University , Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center, IRCCS , Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine , Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University , Milan, Italy.,Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center, IRCCS , Milan, Italy
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Somers M, Bossuyt P, Ferrante M, Peeters H, Baert F. Belgian IBD Research Group [BIRD] Position Statement 2019 on the Use of Adalimumab Biosimilars in Inflammatory Bowel Diseases. J Crohns Colitis 2020; 14:680-685. [PMID: 31875891 DOI: 10.1093/ecco-jcc/jjz209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The emergence of biosimilars is generally considered as an opportunity to guarantee accessibility to affordable treatments and to enhance financial sustainability of national health systems. Since 2017, five biosimilars of adalimumab were approved by the European Medicines Agency [EMA] for use in inflammatory bowel disease: ABP 510, SB5, GP2017, FKB327, and MSB11022. In this position statement, the available efficacy and safety data of the different adalimumab biosimilars in immune-mediated inflammatory diseases are summarised. Furthermore, the Belgian IBD research group [BIRD] formulates statements concerning the use of adalimumab biosimilars in inflammatory bowel disease.
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Affiliation(s)
- Michaël Somers
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - Peter Bossuyt
- Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, UZ Leuven, KU Leuven, Leuven, Belgium
| | - Harald Peeters
- Department of Gastroenterology, AZ Sint-Lucas, Ghent, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
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Bronswijk M, Moens A, Lenfant M, Tops S, Compernolle G, Van Assche G, Vermeire S, Gils A, Ferrante M. Evaluating Efficacy, Safety, and Pharmacokinetics After Switching From Infliximab Originator to Biosimilar CT-P13: Experience From a Large Tertiary Referral Center. Inflamm Bowel Dis 2020; 26:628-634. [PMID: 31400283 DOI: 10.1093/ibd/izz167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of infliximab biosimilar CT-P13 has increased in patients with inflammatory bowel disease. Nevertheless, doubts about switching from infliximab originator to biosimilar still exist among patients and health care professionals. METHODS Our tertiary referral center underwent a mandatory switch from infliximab originator to CT-P13 in 2017. We investigated pharmacokinetics, efficacy, and safety of this switch. The primary endpoint was infliximab discontinuation within 6 months of switching. Secondary endpoints included loss of clinical remission, need for treatment optimization, adverse events, evolution of patient-reported outcome, C-reactive protein, infliximab trough levels, and antidrug-antibodies. RESULTS A total of 361 patients (54.0% male, 70.0% Crohn's disease, 55.6% in clinical remission) were enrolled. Infliximab discontinuation within 6 months was observed in 4%. Loss of clinical remission, adverse events, and antidrug-antibodies were identified in only 2.0%, 2.2%, and 1.1% of patients, respectively. C-reactive protein concentrations and infliximab trough levels remained stable. Independent factors associated with remission at 6 months were lower PRO2 at switch (HR 6.024; 95% CI, 4.878-8.000; P < 0.0001) and higher hemoglobin levels (HR 1.383; 95% CI, 1.044-2.299; P = 0.018). CONCLUSIONS Switching from infliximab originator to CT-P13 was not associated with an increased risk of treatment discontinuation, loss of clinical remission, or adverse events. No significant changes in infliximab trough levels or immunogenicity could be identified.
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Annick Moens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in GastroIntestinal Disorders (TARGID), Department of Chronic Diseases, Aging, and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Matthias Lenfant
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sophie Tops
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Griet Compernolle
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Gert Van Assche
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in GastroIntestinal Disorders (TARGID), Department of Chronic Diseases, Aging, and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in GastroIntestinal Disorders (TARGID), Department of Chronic Diseases, Aging, and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Ann Gils
- Laboratory for Therapeutic and Diagnostic Antibodies, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Translational Research in GastroIntestinal Disorders (TARGID), Department of Chronic Diseases, Aging, and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
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Bernard EJ, Fedorak RN, Jairath V. Systematic Review: Non-medical Switching of Infliximab to CT-P13 in Inflammatory Bowel Disease. Dig Dis Sci 2020; 65:2354-2372. [PMID: 31970610 PMCID: PMC7369127 DOI: 10.1007/s10620-019-06036-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 12/28/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Biosimilar approval, such as Inflectra™ (CT-P13) for treating ulcerative colitis (UC) and Crohn's disease (CD), has reduced direct drug costs. Though clinicians are comfortable with biosimilar use in treatment-naïve patients, there are concerns in some jurisdictions that there are insufficient data from well-controlled trials to support non-medical switching. A systematic review, along with a critical assessment of the study design, was conducted to assess the potential impact of switching stable CD/UC patients from infliximab to CT-P13. METHODS A literature search using PubMed and abstracts/posters from 3 major gastroenterology conferences from 2014 to 2018 was completed. Two individual reviewers extracted data from each relevant report and compiled it into evidence tables to facilitate descriptive analyses. Key randomized trial and observational study designs were critically assessed to contextualize data relevance. RESULTS A total of 49 reports (3 randomized controlled trials, 40 observational trials, and 1 case series) were included. Most studies revealed no efficacy, safety, or immunogenicity concerns with non-medical switch. Limitations of supporting data include a small number of randomized controlled trials; predominance of observational studies with varying outcome assessments and lack of appropriate controls; and scarcity of research on biosimilar switch long-term effects. CONCLUSIONS The majority of studies suggested non-medical switch is safe. However, clinicians and regulatory bodies should be aware of differences and limitations in study designs when making inferences about the risks and benefits of switching stable IBD patients to biosimilars.
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Affiliation(s)
- Edmond-Jean Bernard
- CHUM, Université de Montréal, 1051 Rue Sanguinet, Montréal, QC H2X 3E4 Canada
| | - Richard N. Fedorak
- Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Edmonton, AB T6G 2R7 Canada
| | - Vipul Jairath
- Epidemiology and Biostatistics, Division of Gastroenterology, London Health Sciences Centre, Western University, 339 Windermere Rd, London, ON N6A 5A5 Canada
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Catt H, Bodger K, Kirkham JJ, Hughes DA. Value Assessment and Quantitative Benefit-Risk Modelling of Biosimilar Infliximab for Crohn's Disease. Pharmacoeconomics 2019; 37:1509-1523. [PMID: 31372948 DOI: 10.1007/s40273-019-00826-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Regulatory approval of biosimilars often depends on extrapolating evidence from one clinical indication to all of those of the originator biologic. We aimed to develop a quantitative benefit-risk analysis to assess whether the resulting increase in the uncertainty in the clinical performance of biosimilars (i.e. risk) may be countered by their lower pricing (benefit). METHODS A 1-year decision-analytic model was developed for the biosimilar infliximab (Inflectra®) for Crohn's disease. The perspective was that of the National Health Service in the UK and costs were valued to 2015/16. A hypothetical cohort of biologic-naïve patients with moderate-to-severe Crohn's disease was simulated through the model. Immunogenicity to infliximab was a key modifier, influencing rates of non-response and infusion reactions. Net health benefit was estimated based on quality-adjusted life-years. A range of sensitivity analyses tested the robustness of the results and explored how the biosimilar price must respond to varying immunogenicity to remain the preferred option. RESULTS The base-case analysis predicted a positive incremental net health benefit of 0.04 (95% central range 0.00-0.09) favouring the biosimilar, based on 0.803 quality-adjusted life-years, and costs of £18,087 and £19,176 for the biosimilar and originator, respectively. Two-way sensitivity analyses suggested that if 50% of patients developed antibodies, the value-based price of £410 per vial must be lower than that of the originator (£420), but remain higher than the actual market price (£378). CONCLUSIONS The model supports the use of Inflecta® for Crohn's disease in the UK, and provides a framework for the quantitative evaluation of biosimilars in the context of a health technology assessment. Value-based pricing using this methodology could protect health systems from the potential risks of biosimilars where they are untested in the approved populations.
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Affiliation(s)
- Heather Catt
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
- School of Health Sciences, Division of Population Health, Health Services Research and Primary Care, Manchester University, Manchester, UK
| | - Keith Bodger
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
- Aintree University Hospital NHS Trust, Digestive Diseases Centre, Liverpool, UK
| | - Jamie J Kirkham
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, LL57 2PZ, UK.
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Ilias A, Szanto K, Gonczi L, Kurti Z, Golovics PA, Farkas K, Schafer E, Szepes Z, Szalay B, Vincze A, Szamosi T, Molnar T, Lakatos PL. Outcomes of Patients With Inflammatory Bowel Diseases Switched From Maintenance Therapy With a Biosimilar to Remicade. Clin Gastroenterol Hepatol 2019; 17:2506-2513.e2. [PMID: 30630103 DOI: 10.1016/j.cgh.2018.12.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/31/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is evidence that it is safe and effective for patients with inflammatory bowel diseases (IBD) to switch from maintenance therapy with an original infliximab drug to a biosimilar, but little is known about outcomes of reverse switches and/or multiple switches. We aimed to evaluate the effects of a reverse switch (from a biosimilar to Remicade) in a real-life cohort. METHODS We performed a prospective observational study of 174 unselected and consecutive patients with IBD (136 with Crohn's disease [CD] and 38 with ulcerative colitis [UC]) who received maintenance therapy with the biosimilar in Hungary. In September 2017, patients were switched from the biosimilar (CT-P13) to Remicade, due to reimbursement policies. In our cohort, 8% (n = 14) patients had been previously exposed to the originator Remicade. We collected clinical and biochemical information from patients at baseline (time of the switch) and 16 and 24 weeks thereafter. Clinical remission was defined as a Crohn's disease activity index <150 points or no fistula drainage, or a partial Mayo score <3 points for patients with UC. Serum drug trough levels and anti-drug antibodies were measured at baseline and week 16. RESULTS There was no significant difference in the proportion of patients in clinical remission at week 8 before the switch (82.5% with CD and 82.9% with UC), at baseline (80.6% with CD and 81.6% with UC), at week 16 (77.5% with CD and 83.7% with UC), or at week 24 (CD 76.3% with CD and 84.9% with UC) (P = .60 among groups for patients with CD and P = .98 among groups for patients with UC). For all patients, mean serum trough levels of infliximab were 5.33 ± 4.70 μg/mL at baseline and 5.69 ± 4.94 μg/mL at week 16 (P = .71); we did not find significant differences in prevalence of anti-drug antibody at baseline (16.2%) compared with week 16 (16.9%) (P = .87). Four infusion reactions occurred, until week 24 of follow up. There was no difference in outcomes or trough or antidrug antibody levels between patients with or without previous exposure to Remicade. CONCLUSIONS We collected data from a real-life cohort of patients with CD or UC who were switched from maintenance therapy with a biosimilar to Remicade or were treated with only Remicade. No significant changes were observed in remission, trough levels, or antidrug antibodies in patients switched from the biosimilar to Remicade. No new safety signals were detected.
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Affiliation(s)
- Akos Ilias
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Kata Szanto
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Lorant Gonczi
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kurti
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Anna Golovics
- Department of Gastroenterology, Military Hospital - State Health Centre, Budapest, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Eszter Schafer
- Department of Gastroenterology, Military Hospital - State Health Centre, Budapest, Hungary
| | - Zoltan Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Balazs Szalay
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Aron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Tamas Szamosi
- Department of Gastroenterology, Military Hospital - State Health Centre, Budapest, Hungary
| | - Tamas Molnar
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Peter Laszlo Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, Canada.
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Chaparro M, Garre A, Guerra Veloz MF, Vázquez Morón JM, De Castro ML, Leo E, Rodriguez E, Carbajo AY, Riestra S, Jiménez I, Calvet X, Bujanda L, Rivero M, Gomollón F, Benítez JM, Bermejo F, Alcaide N, Gutiérrez A, Mañosa M, Iborra M, Lorente R, Rojas-Feria M, Barreiro-de Acosta M, Kolle L, Van Domselaar M, Amo V, Argüelles F, Ramírez E, Morell A, Bernardo D, Gisbert JP. Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:1380-1386. [PMID: 30976785 DOI: 10.1093/ecco-jcc/jjz070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®. METHODS Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The 'switch cohort' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the 'non-switch' cohort [NC] patients remained under Remicade®. RESULTS A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]. CONCLUSIONS Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe.
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Affiliation(s)
- M Chaparro
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - A Garre
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - M F Guerra Veloz
- Gastroenterology Units from Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J M Vázquez Morón
- Gastroenterology Units from Hospital Juan Ramón Jiménez, Huelva, Spain
| | - M L De Castro
- Gastroenterology Units from Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - E Leo
- Gastroenterology Units from Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Rodriguez
- Gastroenterology Units from Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - A Y Carbajo
- Gastroenterology Units from Hospital Universitario Río Hortega, Valladolid, Spain
| | - S Riestra
- Gastroenterology Units from Hospital Universitario Central de Asturias and ISPA, Asturias, Spain
| | - I Jiménez
- Gastroenterology Units from Hospital de Galdakao-Usansolo, Vizcaya, Spain
| | - X Calvet
- Gastroenterology Units from Consorcí Corporació Sanitària Parc Tauli de Sabadell and CIBERehd, Barcelona, Spain
| | - L Bujanda
- Gastroenterology Units from Instituto Biodonostia, Universidad del País Vasco [UPV/EHU] and CIBERehd, San Sebastián, Spain
| | - M Rivero
- Gastroenterology Units from Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - F Gomollón
- Gastroenterology Units from Hospital Clínico Universitario Lozano Blesa, IIS Aragón and CIBERehd, Zaragoza, Spain
| | - J M Benítez
- Gastroenterology Units from Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Bermejo
- Gastroenterology Units from Hospital Universitario de Fuenlabrada and Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - N Alcaide
- Gastroenterology Units from Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Gutiérrez
- Gastroenterology Units from Hospital General Universitario de Alicante and CIBERehd, Alicante, Spain
| | - M Mañosa
- Gastroenterology Units from Hospital Germans Trials i Pujol and CIBERehd, Barcelona, Spain
| | - M Iborra
- Gastroenterology Units from Hospital Universitario y Politécnico de La Fe and CIBERehd, Valencia, Spain
| | - R Lorente
- Gastroenterology Units from Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - M Rojas-Feria
- Gastroenterology Units from Hospital Universitario Nuestra Señora de Valme, Sevilla, Spain
| | - M Barreiro-de Acosta
- Gastroenterology Units from Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - L Kolle
- Gastroenterology Units from Hospital General de La Palma, La Palma, Spain
| | - M Van Domselaar
- Gastroenterology Units from Hospital Universitario de Torrejón, Madrid, Spain
| | - V Amo
- Gastroenterology Units from Hospital Regional Universitario de Málaga, Málaga, Spain
| | - F Argüelles
- Gastroenterology Units from Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - E Ramírez
- Gastroenterology Units from Pharmacy Unit, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - A Morell
- Gastroenterology Units from Pharmacy Unit, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - D Bernardo
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - J P Gisbert
- Gastroenterology Units from Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
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Abstract
Introduction: CT-P13 was developed as an infliximab biosimilar in 2013. The primary structure of CT-P13 is identical to that of original infliximab and it has highly similar higher order structure, physiochemical characteristics, and biological properties. To date, data from real-life cohorts and randomized controlled trials show comparable clinical efficacy, safety and immunogenicity of biosimilar CT-P13, and the original reference medicinal Product (RMP). Areas covered: This article reviews the comparability of CT-P13 and the RMP and focuses on the emerging clinical trial and observational cohorts data on efficacy and safety of CT-P13 in inflammatory bowel disease (IBD) patients. The development of a subcutaneous formulation of Infliximab CT-P13 is also addressed. Expert opinion: There is a plethora of evidence to show CT-P13 is non-inferior to infliximab RMP in IBD and that a switch from RMP to this biosimilar is feasible and safe. However, interchangeability and multiple switches can still not be endorsed for introduction into clinical practice.
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Affiliation(s)
- Ahmad Albshesh
- Department of Gastroenterology, Sheba medical center, Sackler School of Medicine Tel-Aviv University , Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba medical center, Sackler School of Medicine Tel-Aviv University , Israel
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Nakagawa T, Kobayashi T, Nishikawa K, Yamada F, Asai S, Sameshima Y, Suzuki Y, Watanabe M, Hibi T. Infliximab biosimilar CT-P13 is interchangeable with its originator for patients with inflammatory bowel disease in real world practice. Intest Res 2019; 17:504-515. [PMID: 31422647 PMCID: PMC6821950 DOI: 10.5217/ir.2019.00030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS An interim analysis of post-marketing surveillance of CT-P13, an infliximab biosimilar, was performed to evaluate its safety and efficacy in Japanese patients with inflammatory bowel disease. METHODS Patients were prospectively enrolled between November 2014 and March 2017, after the launch of CT-P13 in Japan, and case report forms of patients followed for at least 4 months were analyzed as of July 2018. RESULTS Of 523 patients in the analysis set, 372 remained on CT-P13 therapy, while 54 (20.2%) of 267 patients with Crohn's disease, and 97 (37.9%) of 256 patients with ulcerative colitis were withdrawn during follow-up. A total of 144 adverse drug reactions (ADRs) were reported in 106 patients (20.3%). Infusion reaction was the most frequent ADR observed in 49 patients (9.4%). Efficacy parameters decreased immediately after the start of treatment in naïve patients to anti-tumor necrosis factor-α antibody. In the patients switched from originator infliximab for nonmedical reasons, the decreased parameters due to proceeded treatment with the originator were maintained in low ranges, and the treatment continuation rate was high with low ADR incidence. In contrast, in patients switched for medical reasons such as adverse event or loss of response, the incidence of ADRs was high. However, the efficacy parameters were improved, and the treatment continuation rate was not significantly different from that of the naïve patient group. CONCLUSIONS In this interim analysis, CT-P13 was comparable to the originator infliximab with respect to ADRs and efficacy, and is therefore considered to be a cost-efficient interchangeable biosimilar for Japanese patients with inflammatory bowel disease.
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Affiliation(s)
- Tomoo Nakagawa
- Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kiyohiro Nishikawa
- Quality & Pharmacovigilance Division, Pharmaceuticals Group, Nippon Kayaku Co., Ltd., Tokyo, Japan
| | - Fumika Yamada
- Quality & Pharmacovigilance Division, Pharmaceuticals Group, Nippon Kayaku Co., Ltd., Tokyo, Japan
| | - Satoshi Asai
- Department of Gastroenterology, Tane General Hospital, Osaka, Japan
| | | | - Yasuo Suzuki
- Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Meyer A, Rudant J, Drouin J, Coste J, Carbonnel F, Weill A. The effectiveness and safety of infliximab compared with biosimilar CT-P13, in 3112 patients with ulcerative colitis. Aliment Pharmacol Ther 2019; 50:269-277. [PMID: 31115919 PMCID: PMC6767082 DOI: 10.1111/apt.15323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/20/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND CT-P13, a biosimilar of the reference product infliximab, has been approved for the treatment of ulcerative colitis on the basis of the results of trials conducted in patients with spondyloarthritis and rheumatoid arthritis. AIM To compare the effectiveness and safety of CT-P13 and the reference product in infliximab-naive patients with ulcerative colitis METHODS: A comparative real-life equivalence cohort study was conducted using the French nationwide health administrative database. Infliximab-naive patients with ulcerative colitis over 15 years of age who started infliximab with no other indications for infliximab were included. The primary outcome was a composite endpoint (death, ulcerative colitis-related surgery, all-cause hospitalisation and reimbursement for other biologics). Equivalence was defined as a 95% CI of the hazard ratio (HR) of CT-P13 vs the reference product, in a multivariable marginal Cox model situated within prespecified margins of (0.80-1.25). RESULTS A total of 3112 patients were included between 1 January 2015 and 30 June 2017: 1434 received the reference product, 1678 received CT-P13. Overall, 710 patients in the reference product group and 743 patients in the CT-P13 group met the composite endpoint. In multivariable analysis of the primary outcome, CT-P13 was equivalent to the reference product (HR 1.04; 95% CI: 0.94-1.15). The number of serious infections was lower in the CT-P13 group (HR 0.65; 95% CI: 0.48-0.88). There was no difference in the incidence of solid or haematologic malignancy (HR 0.81; 95% CI: 0.41-1.60). CONCLUSIONS The effectiveness of CT-P13 is equivalent and the risk of serious infections could be lower than that of the reference product for infliximab-naive patients with ulcerative colitis.
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Affiliation(s)
- Antoine Meyer
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance,Service de gastroentérologie, BicêtreAssistance Publique-Hôpitaux de ParisLe Kremlin BicêtreFrance,Université Paris SudLe Kremlin BicêtreFrance
| | - Jérémie Rudant
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
| | - Jérôme Drouin
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
| | - Joël Coste
- Biostatistique et EpidémiologieHôtel-Dieu, Assistance Publique-Hôpitaux de ParisParisFrance
| | - Franck Carbonnel
- Service de gastroentérologie, BicêtreAssistance Publique-Hôpitaux de ParisLe Kremlin BicêtreFrance,Université Paris SudLe Kremlin BicêtreFrance
| | - Alain Weill
- Caisse Nationale de l’Assurance Maladie (CNAM)ParisFrance
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Guiotto C, Italia A, Lavagna A, Rigazio C, Cosimato M, Ercole E, Mendolaro M, Rocca R, Daperno M. Switching from infliximab originator to a first biosimilar is safe and effective. Results of a case-control study with drug levels and antibodies evaluation. Dig Liver Dis 2019; 51:1117-22. [PMID: 31272935 DOI: 10.1016/j.dld.2019.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inflammatory bowel disease is treated with anti-TNF agents such as infliximab and its biosimilars, but use of biosimilars is limited due to perceived risks of adverse events. AIM To explore safety and effectiveness of switching from the infliximab originator to a first biosimilar. PATIENTS AND METHODS Clinical and biological outcomes were compared between 53 patients who switched from the infliximab originator to the biosimilar CT-P13 (Switched group) and 13 patients treated with CT-P13 from the beginning (Naïve group). Infliximab trough levels and antidrug antibodies were measured. RESULTS At enrolment, patients in the Switched group had a longer median duration of infliximab treatment than Naïve (4.0 vs. 0.6 years, p < 0.0001) but similar proportions of patients were in remission (77% and 62%, respectively). Infliximab discontinuation due to adverse events or loss of efficacy was less common in the Switched (26%) than Naïve group (62%, p = 0.017). Variables independently associated with time to discontinuation were disease activity (p < 0.0001) and immunomodulating treatment (p = 0.019) at enrolment. Trough levels and antidrug antibodies were similar between groups during observation. CONCLUSION This study confirms that switching from infliximab originator to a first biosimilar is safe and effective. Patients at highest risk of losing treatment efficacy are those with active disease, irrespective of the therapeutic switch.
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Ooi CJ, Hilmi I, Banerjee R, Chuah SW, Ng SC, Wei SC, Makharia GK, Pisespongsa P, Chen MH, Ran ZH, Ye BD, Park DI, Ling KL, Ong D, Ahuja V, Goh KL, Sollano J, Lim WC, Leung WK, Ali RAR, Wu DC, Ong E, Mustaffa N, Limsrivilai J, Hisamatsu T, Yang SK, Ouyang Q, Geary R, De Silva JH, Rerknimitr R, Simadibrata M, Abdullah M, Leong RWL. Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia. J Gastroenterol Hepatol 2019; 34:1296-1315. [PMID: 30848854 DOI: 10.1111/jgh.14648] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/05/2019] [Accepted: 03/02/2019] [Indexed: 02/05/2023]
Abstract
The Asia-Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, under the auspices of the Asia-Pacific Association of Gastroenterology with the goal of improving inflammatory bowel disease care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in conjunction with conventional treatments for ulcerative colitis and Crohn's disease in Asia. These statements also address how pharmacogenetics influences the treatments of ulcerative colitis and Crohn's disease and provides guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of inflammatory bowel disease workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing, and future revisions are likely as new data continue to emerge.
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Affiliation(s)
- Choon Jin Ooi
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Ida Hilmi
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rupa Banerjee
- Asian Institute of Gastroenterology, New Delhi, India
| | | | - Siew Chien Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Shu Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | | | - Min Hu Chen
- Division of Gastroenterology, The First University Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhi Hua Ran
- Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Byong Duk Ye
- Department of Gastroenterology and IBD Center, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - David Ong
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital of Singapore, Singapore
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Khean Lee Goh
- University of Malaya Specialist Centre, Kuala Lumpur, Malaysia
| | - Jose Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Wee Chian Lim
- Department of Gastroenterology & Hepatology, Tan Tock Seng Hospital, Singapore
| | - Wai Keung Leung
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Hong Kong, Hong Kong
| | | | - Deng Chyang Wu
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Evan Ong
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Nazri Mustaffa
- Department of Internal Medicine, School of Medical Sciences, Health Campus, Universiti Sains, George Town, Malaysia
| | - Julajak Limsrivilai
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tadakazu Hisamatsu
- The Third Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Suk Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Qin Ouyang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Richard Geary
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | | | | | - Marcellus Simadibrata
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Dr Cipto Mangankusumo National Hospital, Central Jakarta, Indonesia
| | - Rupert W L Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
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Ingrasciotta Y, Sultana J, Kirchmayer U, Trifirò G. Challenges in Post-marketing Studies of Biological Drugs in the Era of Biosimilars: A Report of the International Society for Pharmacoepidemiology 2019 Mid-Year Meeting in Rome, Italy. BioDrugs 2019; 33:345-352. [PMID: 31313085 DOI: 10.1007/s40259-019-00365-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Several controversial issues related to challenges in the post-marketing studies of biological drugs, including biosimilars, were discussed at the International Society for Pharmacoepidemiology (ISPE) 2019 Mid-Year Meeting in Rome (Italy) in April. In recent years, the marketing of biosimilars has been growing, thus offering opportunities for wider access by patients to high-cost biological drugs as well as ensuring the economic sustainability of national healthcare systems. Through the comparability exercise required for marketing approval, the similarity of biosimilars to the reference products in terms of efficacy, safety and quality has to be demonstrated in pre-marketing studies. In Europe, the 15 years of experience of marketing of biosimilars has allowed the accumulation of a significant amount of scientific evidence confirming the comparability of the benefit-risk profile of biosimilars and originators. However, some aspects remain to be addressed both from a scientific and regulatory perspective, such as interchangeability and the automatic substitution of originators and biosimilars. The (long-term) monitoring of all biological drugs, including biosimilars, in real-world settings is warranted, with the ultimate goal of integrating pre- and post-marketing evidence relating to the aforementioned open questions. This conference report describes priorities, data sources and methodological strategies for the post-marketing surveillance of biological drugs in the era of biosimilars.
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Affiliation(s)
- Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy. .,Unit of Clinical Pharmacology, A.O.U. Policlinico "G. Martino", Messina, Italy.
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50
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Guerra Veloz MF, Belvis Jiménez M, Valdes Delgado T, Castro Laria L, Maldonado Pérez B, Perea Amarillo R, Merino Bohórquez V, Caunedo Álvarez Á, Vilches Arenas Á, Argüelles-Arias F. Long-term follow up after switching from original infliximab to an infliximab biosimilar: real-world data. Therap Adv Gastroenterol 2019; 12:1756284819858052. [PMID: 31258621 PMCID: PMC6585238 DOI: 10.1177/1756284819858052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/23/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several studies have reported positive efficacy outcomes for patients with inflammatory bowel disease treated with CT-P13, an infliximab biosimilar. Data from follow-up periods longer than 1 year are still scarce. Here, we assessed the long-term efficacy data, loss of response and safety after switching from infliximab to CT-P13 in patients with inflammatory bowel disease. METHODS This was a prospective single-center observational study involving patients with moderate-to-severe Crohn's disease and ulcerative colitis switched from infliximab to CT-P13 treatment and reviewed up to 24 months. Efficacy and loss of response were measured using the Harvey-Bradshaw (HB) index and partial Mayo score for patients with Crohn's disease and ulcerative colitis respectively. C-reactive protein, infliximab drug levels, adverse events and antidrug antibodies were also monitored throughout the study. RESULTS A total of 64 patients with Crohn's disease and 36 patients with ulcerative colitis were included. Most of them (72%) remained on CT-P13. Overall, 28% of patients discontinued the therapy due to loss of response, adverse events or long-lasting clinical remission. Remission at 18 and 24 months occurred in 69.9% and 68.5% of patients, respectively. Dose increase was performed in 22% of patients, with remission being reached in 60% of them. HB index, partial Mayo score, C-reactive protein and infliximab drug levels did not show significant changes. Serious adverse events were reported in 14% of patients. Overall, two patients developed low levels of antidrug antibodies. CONCLUSIONS Most of the patients switching from original infliximab were maintained on CT-P13 at 2 years of follow up with a good profile of efficacy and safety.
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Affiliation(s)
| | - María Belvis Jiménez
- Gastroenterology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | - Luisa Castro Laria
- Gastroenterology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | - Raúl Perea Amarillo
- Gastroenterology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | | | - Ángel Vilches Arenas
- Preventive Medicine and Public Health, University Hospital Virgen Macarena, Seville, Spain
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