Safety of Marketed Cancer Supportive Care Biosimilars in the US: A Disproportionality Analysis Using the Food and Drug Administration Adverse Event Reporting System (FAERS) Database

Comparative Analysis of Adverse Events Linked to PEG-rhG-CSF and rhG-CSF in Real-World Settings: Disproportionate Examination of the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) Database

PURPOSE

Granulocyte-colony stimulating factor (G-CSF) is widely acknowledged for its efficacy in managing chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN), albeit accompanied by a spectrum of potential adverse effects. This study conducted a comprehensive analysis utilizing real-world data sourced from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database, spanning the years 2004 to 2023, to assess and compare adverse events (AEs) associated with recombinant human G-CSF (rhG-CSF) and its polyethylene glycol-modified form (PEG-rhG-CSF).

METHODS

A comprehensive analysis was conducted using FAERS data to evaluate the reporting proportion of AEs, gender-based disparities, and specific AEs such as bone pain. Statistical analyses included Reporting Odds Ratio (ROR) calculations and comparisons of median time to AE onset between PEG-rhG-CSF and rhG-CSF.

FINDINGS

The study revealed that PEG-rhG-CSF was associated with a significantly higher number of adverse events (AEs) compared to rhG-CSF (76,155 vs. 10,953 cases). Female patients experienced a higher reporting proportion of AEs than males for both treatments, with PEG-rhG-CSF showing 54.2% of cases in females and rhG-CSF showing 46.1%, compared to 27.1% and 34.7% in males, respectively. Bone pain emerged as the most common AE, with PEG-rhG-CSF linked to 2,473 cases and rhG-CSF to 581 cases, and a higher reporting odds ratio (ROR = 1.17, 95% CI: 1.07-1.29) for PEG-rhG-CSF. Additionally, the median time to onset of AEs was shorter for PEG-rhG-CSF (3 days, IQR: 1-9) than for rhG-CSF (9 days, IQR: 2-42). Delayed AEs, such as splenomegaly, capillary leak syndrome, interstitial lung disease, and lung infiltration, were also identified, emphasizing the importance of close patient follow-up.

IMPLICATIONS

The study highlights significant differences in AE reporting proportion, gender disparities, and onset timing between PEG-rhG-CSF and rhG-CSF. These findings emphasize the need for close patient monitoring, especially for delayed AEs that may manifest after discharge. Further assessment of real-world data is warranted.

Model driven method for exploring individual and confounding effects in spontaneous adverse event reporting databases

BACKGROUND

Spontaneous Adverse Event Reporting (SAER) databases play a crucial role in post-marketing drug surveillance. However, the traditional model-free disproportionality analysis has been challenged by the insufficiency in investigating subgroup and confounders. These issues result in significant low-precision and biases in data mining for SAER.

METHODS

The Model-Driven Reporting Odds Ratio (MD-ROR) was proposed to bridge the gap between SAER database and explainable models for exploring individual and confounding effects. MD-ROR is grounded in a well-designed model, rather than a 2 × 2 cross table, for estimating AE-drug signals. Consequently, individual and confounding effects can be parameterized based on these models. We employed simulation data and the FDA Adverse Event Reporting System (FAERS) database.

RESULT

The simulated data indicated the subgroup effects estimated by MD-ROR were unbiased and efficient. Moreover, the adjusted-MD-ROR demonstrated greater robustness against confounding biases than the crude ROR. Applying our method to the FAERS database suggested higher occurrences of drug interactions and cardiac adverse events induced by Midazolam in females compared to males.

CONCLUSION

The study underscored that MD-ROR holds promise as a method for investigating individual and confounding effects in SAER databases.

Adverse event reporting of marketed biosimilar and biological monoclonal antibody cancer treatments in the United States

BACKGROUND

By 8 September 2022, 10 biological monoclonal antibody (mAb) biosimilar products for cancer treatment had been approved and marketed in the United States (US). This study examined adverse event (AE) reporting patterns and disproportionate reporting signals for mAb biosimilars in the US compared to their originator biologics.

RESEARCH DESIGN AND METHODS

The US Food and Drug Adverse Event Reporting System database was used to identify AE reports for biological rituximab, bevacizumab, trastuzumab, and their marketed biosimilars. Proportions of patient age, sex and type of reporters of AEs were described for these reports. Reporting odds ratios (RORs) with 95% confidence intervals were calculated to compare reporting disproportionality in serious, death, and specific AEs between mAb biologics/biosimilars (index) and all other drugs. Breslow-Day statistic was used to determine homogeneity in RORs between each mAb biologic-biosimilar pair at p < 0.05.

RESULTS

We observed no risk signals of serious or death AE reporting for all three mAb biosimilars. A signal of disproportionate reporting of death was detected between biological and biosimilar bevacizumab (p < 0.05).

CONCLUSIONS

Our findings support the similarity in signals of disproportionate AE reporting between mAb originator biologics and biosimilars, except for death between biological and biosimilar bevacizumab.