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Kurizky PS, Marianelli FF, Cesetti MV, Damiani G, Sampaio RNR, Gonçalves LMT, de Sousa CAF, Martins SS, Vernal S, da Mota LMH, Gomes CM. A comprehensive systematic review of leishmaniasis in patients undergoing drug-induced immunosuppression for the treatment of dermatological, rheumatological and gastroenterological diseases. Rev Inst Med Trop Sao Paulo 2020; 62:e28. [PMID: 32401957 PMCID: PMC7232954 DOI: 10.1590/s1678-9946202062028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/17/2020] [Indexed: 04/06/2023] Open
Abstract
Immunosuppression is an important risk factor for leishmaniasis. We assessed the clinical profile, geographic distribution and prevalence of leishmaniasis in patients undergoing immunosuppressive therapy for dermatological, rheumatological or gastroenterological autoimmune diseases. We identified relevant studies in PubMed, EMBASE, Scopus, Web of Science and LILACS on July 3rd, 2018. We included articles that reported at least one case of leishmaniasis in patients undergoing immunosuppressive treatment for dermatological, rheumatological or gastroenterological diseases. Our protocol was registered in PROSPERO (CRD42018103050). We assessed the quality of the included studies with the Joanna Briggs Institute Critical Appraisal Tool. After the removal of duplicates, 5,431 articles were collected and screened. We included 138 articles; the prevalence of leishmaniasis in six methodologically similar studies varied from three to 1,282 cases per 100,000 patients using anti-TNFα drugs, but the results were significantly heterogeneous . Leishmaniasis in patients treated with immunosuppressive drugs is a health problem mostly reported in European countries bordering the Mediterranean Sea; sporadic activities, such as travelling, seem not to be associated with a significant risk of leishmaniasis, although effective control measures must always be observed.
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Affiliation(s)
- Patrícia Shu Kurizky
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Brasília, Brazil
- Hospital Universitário de Brasília, Brasília, Brazil
- Universidade de Brasília, Faculdade de Medicina, Grupo de Diagnóstico Dermatológico, Brasília, Brazil
- Universidade de Brasília, Faculdade de Medicina, Laboratório de Dermatomicologia, Brasília, Brazil
| | | | - Mariana Vicente Cesetti
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Brasília, Brazil
| | - Giovanni Damiani
- Case Western Reserve University, Department of Dermatology, Cleveland, Ohio, USA
- IRCCS Istituto Ortopedico Galeazzi, Dermatologia Clinica, Milan, Italy
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Milan, Italy
| | - Raimunda Nonata Ribeiro Sampaio
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Brasília, Brazil
- Universidade de Brasília, Faculdade de Medicina, Grupo de Diagnóstico Dermatológico, Brasília, Brazil
- Universidade de Brasília, Faculdade de Medicina, Laboratório de Dermatomicologia, Brasília, Brazil
- Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, Brasília, Brazil
| | | | | | - Sofia Sales Martins
- Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, Brasília, Brazil
| | - Sebastian Vernal
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Programa de Pós-Graduação em Clínica Médica, Ribeirão Preto, São Paulo, Brazil
| | - Licia Maria Henrique da Mota
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Brasília, Brazil
- Hospital Universitário de Brasília, Brasília, Brazil
| | - Ciro Martins Gomes
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Brasília, Brazil
- Hospital Universitário de Brasília, Brasília, Brazil
- Universidade de Brasília, Faculdade de Medicina, Grupo de Diagnóstico Dermatológico, Brasília, Brazil
- Universidade de Brasília, Faculdade de Medicina, Laboratório de Dermatomicologia, Brasília, Brazil
- Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Brasília, Brazil
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Numan S, Faccin F. Non-medical Switching from Originator Tumor Necrosis Factor Inhibitors to Their Biosimilars: Systematic Review of Randomized Controlled Trials and Real-World Studies. Adv Ther 2018; 35:1295-1332. [PMID: 30084060 PMCID: PMC6133136 DOI: 10.1007/s12325-018-0742-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/06/2023]
Abstract
Tumor necrosis factor (TNF) inhibitors are widely used biologics for the treatment of several chronic inflammatory diseases. The launch of anti-TNF biosimilars has introduced the possibility of non-medical switching between originator biologics and their biosimilars. However, the potential clinical and patient-reported consequences of non-medical switching remain largely unknown, as much of the evidence comes from poorly or uncontrolled real-world evidence (RWE) studies that often have an element of bias and nonstandardized outcome measures. To appropriately evaluate the safety, efficacy, and immunogenicity of non-medical switching from an originator to its biosimilar, we propose that seven key study design elements should be considered when assessing the existing evidence: studies should be (1) randomized and double-blind, (2) adequately controlled, and (3) adequately powered; include (4) multiple switching, (5) an assessment of immunogenicity, and (6) adequate follow-up duration; and (7) report individual patient-level outcomes. This systematic review assessed the robustness and consistency of the current non-medical switching evidence, with a focus on TNF inhibitors. A comprehensive literature search (January 2012-February 2018) identified 98 publications corresponding to 91 studies (17 randomized controlled trials and 74 RWE studies) describing non-medical switching from a TNF inhibitor originator to its biosimilar. When assessing the totality of this evidence, none of the non-medical switching studies conducted to date were found to use all seven of the key design elements, and the absence of these elements dilutes the robustness of the data. Furthermore, discontinuation rates varied widely among studies (0-87%), suggesting heterogeneity and inconclusiveness of the current efficacy, safety, and immunogenicity evidence, particularly at an individual patient level. Therefore, patients should not be indiscriminately switched from an originator TNF inhibitor to its biosimilar for non-medical reasons. Switching decisions should remain between the treating physicians and their patients and be made on a case-by-case basis, relying upon robust scientific evidence. FUNDING AbbVie.Plain Language Summary: Plain language summary available for this article.
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McKinnon RA, Cook M, Liauw W, Marabani M, Marschner IC, Packer NH, Prins JB. Biosimilarity and Interchangeability: Principles and Evidence: A Systematic Review. BioDrugs 2018; 32:27-52. [PMID: 29344876 PMCID: PMC5814534 DOI: 10.1007/s40259-017-0256-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The efficacy, safety and immunogenicity risk of switching between an originator biologic and a biosimilar or from one biosimilar to another are of potential concern. OBJECTIVES The aim was to conduct a systematic literature review of the outcomes of switching between biologics and their biosimilars and identify any evidence gaps. METHODS A systematic literature search was conducted in PubMed, EMBASE and Cochrane Library from inception to June 2017. Relevant societal meetings were also checked. Peer-reviewed studies reporting efficacy and/or safety data on switching between originator and biosimilar products or from one biosimilar to another were selected. Studies with fewer than 20 switched patients were excluded. Data were extracted on interventions, study population, reason for treatment switching, efficacy outcomes, safety and anti-drug antibodies. RESULTS The systematic literature search identified 63 primary publications covering 57 switching studies. The reason for switching was reported as non-medical in 50 studies (23 clinical, 27 observational). Seven studies (all observational) did not report whether the reasons for switching were medical or non-medical. In 38 of the 57 studies, fewer than 100 patients were switched. Follow-up after switching went beyond 1 year in eight of the 57 studies. Of the 57 studies, 33 included statistical analysis of disease activity or patient outcomes; the majority of these studies found no statistically significant differences between groups for main efficacy parameters (based on P < 0.05 or predefined acceptance ranges), although some studies observed changes for some parameters. Most studies reported similar safety profiles between groups. CONCLUSIONS There are important evidence gaps around the safety of switching between biologics and their biosimilars. Sufficiently powered and appropriately statistically analysed clinical trials and pharmacovigilance studies, with long-term follow-ups and multiple switches, are needed to support decision-making around biosimilar switching.
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Affiliation(s)
- Ross A McKinnon
- School of Medicine, Flinders University, Bedford Park, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Matthew Cook
- John Curtin School of Medical Research, Australian National University and Canberra Hospital, Canberra, ACT, Australia
| | - Winston Liauw
- Cancer Care Centre, St George Hospital, Kogarah, Australia
- University of New South Wales, Kensington, NSW, Australia
| | | | - Ian C Marschner
- Department of Statistics, Macquarie University, North Ryde, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Nicolle H Packer
- Department of Chemistry and Biomolecular Sciences and ARC Centre of Nanoscale Biophotonics, Macquarie University, North Ryde, Australia
- Institute for Glycomics,, Griffith University, Southport, QLD, Australia
| | - Johannes B Prins
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
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