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Heng JE, Raman S, Wong ZY, Beh VJN. Cost minimization analysis of subcutaneous trastuzumab versus intravenous biosimilar trastuzumab: policy recommendations for breast cancer treatment in Malaysia. Daru 2024; 32:67-76. [PMID: 37903943 PMCID: PMC11087381 DOI: 10.1007/s40199-023-00485-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Current clinical practice recommends switching innovator intravenous trastuzumab (IV-TZMi) to subcutaneous trastuzumab (SC-TZM) to save healthcare resources. However, with the availability of biosimilar intravenous trastuzumab (IV-TZMb), there is a need to re-evaluate the recommendation. Hence, this study aims to compare the cost and resource use of SC-TZM and IV-TZMb in a Malaysian public healthcare facility. METHODS This activity-based costing study consists of (1) a retrospective medical record abstraction to determine patient details to estimate drug costs and (2) a time-motion study to quantify personnel time, patient time, and consumables used. The total cost of both SC-TZM and IV-TZMb were then compared using a cost-minimization approach, while differences were explored using an independent t-test. A sensitivity analysis was also conducted to determine the impact of uncertainties in the analysis. RESULTS The mean total cost of SC-TZM and IV-TZMb was USD 13,693 and USD 5,624 per patient respectively. The cost difference was primarily contributed by savings in drug cost of IV-TZMb, a reduction of USD 8,546 (SD = 134), p < 0.001 compared to SC-TZM. Interestingly, SC-TZM had a significantly lower cost than IV-TZMb for both the consumable and personnel cost, a reduction by USD 300 (SD = 17.6); p < 0.001 and USD 176 (SD = 7.3); p < 0.001 respectively. The sensitivity analysis demonstrated that the total cost difference between the formulation was mainly driven by drug costs. CONCLUSION The study evidenced that IV-TZMb was a more economically viable option in Malaysian public healthcare currently compared to SC-TZM.
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Affiliation(s)
- Jin Ee Heng
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia.
| | - Sivaraj Raman
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Shah Alam, Malaysia
| | - Zhi Yen Wong
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Valerine Jen Nin Beh
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
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Stevenson J, Poker R, Schoss J, Campbell M, Everitt C, Holly B, Stones N, Pettis RJ, Sanchez-Felix M. Pharmaceutical and biotech industry perspectives on optimizing patient experience and treatment adherence through subcutaneous drug delivery design. Adv Drug Deliv Rev 2024; 209:115322. [PMID: 38677443 DOI: 10.1016/j.addr.2024.115322] [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: 02/02/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
Subcutaneous (SC) drug delivery can be a safe, effective alternative to the traditional intravenous route of administration, potentially offering notable advantages for both patients and healthcare providers. The SC Drug Development & Delivery Consortium convened in 2018 to raise awareness of industry challenges to advance the development of patient-centric SC drug delivery strategies. The SC Consortium identified better understanding of patient preferences and perspectives as necessary to optimize SC product design attributes and help guide design decisions during SC product development. This manuscript provides a comprehensive overview of patient-centric factors for consideration in the SC drug delivery design and development process with the aim of establishing a foundation of existing knowledge for patient experiences related to SC drug delivery. This overview is informed by the outcomes of a multi-step survey of Consortium members and key pharmaceutical stakeholders. Framed in the context of the patient's treatment journey, the survey findings offer future perspectives to fill data gaps to advance patient-centric SC drug delivery.
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Affiliation(s)
| | - Rachel Poker
- AstraZeneca, Human Factors Engineering, BioPharmaceutical Development, Biopharmaceuticals R&D, 121 Oyster Point Blvd, South San Francisco, CA 94080, USA
| | | | | | - Claire Everitt
- Pfizer, Granta Park, Great Abington, Cambridge CB21 6GP, UK
| | - Brian Holly
- Pfizer, Granta Park, Great Abington, Cambridge CB21 6GP, UK
| | - Nicholas Stones
- Novartis Pharma AG, Lichtstrasse 35, CH-4056 Basel, Switzerland
| | - Ronald J Pettis
- Becton-Dickinson, 21 Davis Drive, Research Triangle Park, NC 27513, USA
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Delgado SR, Faissner S, Linker RA, Rammohan K. Key characteristics of anti-CD20 monoclonal antibodies and clinical implications for multiple sclerosis treatment. J Neurol 2024; 271:1515-1535. [PMID: 37906325 PMCID: PMC10973056 DOI: 10.1007/s00415-023-12007-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023]
Abstract
The recent success of anti-CD20 monoclonal antibody therapies in the treatment of multiple sclerosis (MS) has highlighted the role of B cells in the pathogenesis of MS. In people with MS, the inflammatory characteristics of B-cell activity are elevated, leading to increased pro-inflammatory cytokine release, diminished anti-inflammatory cytokine production and an accumulation of pathogenic B cells in the cerebrospinal fluid. Rituximab, ocrelizumab, ofatumumab, ublituximab and BCD-132 are anti-CD20 therapies that are either undergoing clinical development, or have been approved, for the treatment of MS. Despite CD20 being a common target for these therapies, differences have been reported in their mechanistic, pharmacological and clinical characteristics, which may have substantial clinical implications. This narrative review explores key characteristics of these therapies. By using clinical trial data and real-world evidence, we discuss their mechanisms of action, routes of administration, efficacy (in relation to B-cell kinetics), safety, tolerability and convenience of use. Clinicians, alongside patients and their families, should consider the aspects discussed in this review as part of shared decision-making discussions to improve outcomes and health-related quality of life for people living with MS.
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Affiliation(s)
- Silvia R Delgado
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Simon Faissner
- Department of Neurology, Ruhr-University Bochum, St Josef-Hospital, Bochum, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Kottil Rammohan
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
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Parra A, Hernández C, Prieto-Pinto L. Evaluation of the economic benefits, administration times, and patient preferences associated with the use of biotechnological drugs administered subcutaneously and intravenously in patients with cancer: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1017-1026. [PMID: 37665685 DOI: 10.1080/14737167.2023.2249232] [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: 10/03/2022] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Cancer imposes a high economic burden with medical care and medication costs. We evaluate the costs, the use of resources, the administration time, and the patient preferences associated with the use of biotechnological drugs in SC and IV presentations. METHODOLOGY A systematic literature search was conducted in PubMed, Embase, and seven additional databases. The search was carried out in September 2021 and included only studies directly comparing SC and IV presentations. Evidence was synthesized narratively. RESULTS 34 references were included, which only analyzed bortezomib, daratumumab, rituximab, and trastuzumab. Reduction in preparation costs of SC compared to IV presentations ranged from 6.6% to 50.1%, and in administration costs from 4.5% to 95.3%. SC administration of rituximab and trastuzumab resulted in less productivity loss. More than 68% of patients reported greater satisfaction with the SC route. A reduction of time in the infusion chair, lower costs of resources for preparation, and health personnel for the administration process were identified with SC administration. CONCLUSIONS The use of SC daratumumab, rituximab, and trastuzumab in patients with cancer reduces direct and indirect costs and adverse events compared to IV use. Patients prefer the SC administration, perceiving more comfort, and less pain at the administration site.
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Affiliation(s)
- Ana Parra
- Evidence-Based Medicine Department, NeuroEconomix, Bogotá, Colombia
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McCloskey C, Ortega MT, Nair S, Garcia MJ, Manevy F. A Systematic Review of Time and Resource Use Costs of Subcutaneous Versus Intravenous Administration of Oncology Biologics in a Hospital Setting. Pharmacoecon Open 2023; 7:3-36. [PMID: 35996066 PMCID: PMC9395845 DOI: 10.1007/s41669-022-00361-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND The introduction of human epidermal growth factor receptor 2 (HER2)-targeted treatment options, including dual HER2 blockade, has improved the prognosis for patients with HER2-positive breast cancer (BC) substantially. However, most of these treatments are administered via the intravenous (IV) route, which can present many challenges, such as long infusion and observation times, issues associated with repeated IV access, and increased strain on time and resources of medical centers and healthcare professionals. A fixed-dose combination of pertuzumab and trastuzumab for subcutaneous (SC) injection (pertuzumab, trastuzumab, and hyaluronidase-zzxf (PHESGO®, F. Hoffmann-La Roche Ltd, Basel, Switzerland; PH FDC SC)) has been approved for use alongside chemotherapy for early-stage and metastatic HER2-positive BC. OBJECTIVES This systematic literature review was performed to identify evidence relating to time/resource use and resulting cost differences between SC and IV administration of oncology biologics in a hospital setting, and, ultimately, to inform economic modeling and associated health technology assessment of PH FDC SC. METHODS Electronic databases (Embase, MEDLINE, and EconLit) were searched on 9 April 2020. Additional hand searches were performed to identify publications not captured in the electronic database search. Publication screening and data extraction (study characteristics, participants, interventions, costs, and time/resource use) were carried out per the standard Cochrane review methodology. The quality of economic evidence of cost analyses was assessed using the 36-item checklist of the National Institute for Health and Care Excellence Single Technology Appraisal Specification for submission of evidence (January 2015). RESULTS The database search identified 2,740 records, of which 237 underwent full text screening. Full text screening, prioritization of publications about patients with a cancer diagnosis, and the addition of four citations identified during the hand search resulted in 72 final included publications, relating to 71 unique studies. This included 40 publications that described the time/resource use and/or costs associated with SC versus IV trastuzumab administration for the treatment of HER2-positive BC, and 28 publications that described time/resource use and/or costs associated with rituximab SC versus IV administration for the treatment of non-Hodgkin's lymphoma/follicular lymphoma and diffuse large B-cell lymphoma. The majority of publications showed substantial time savings for preparation and administration of SC versus IV therapy, and cost savings associated with reductions in healthcare professional time and resource use for SC administration. LIMITATIONS There was a lack of consensus between publications regarding time and cost measurements. In addition, the search was limited to publications related to anticancer drugs; the majority of the studies included were performed in European countries. CONCLUSIONS AND IMPLICATIONS This review indicated a substantial body of evidence showing time/resource and cost savings of SC versus IV administration of oncology biologics in a hospital setting, which can be used to inform economic evaluations of PH FDC SC.
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Affiliation(s)
| | | | | | - Maria João Garcia
- Pharmaceuticals Division, Global Access-Evidence Chapter, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland.
| | - Federico Manevy
- Pharmaceuticals Division, Global Access-Evidence Chapter, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
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Hsieh P, Kacew AJ, Dreyer M, Serritella AV, Knoebel RW, Strohbehn GW, Ratain MJ. Alternative trastuzumab dosing strategies in HER2-positive early breast cancer are associated with patient out-of-pocket savings. NPJ Breast Cancer 2022; 8. [PMID: 35288585 PMCID: PMC8921207 DOI: 10.1038/s41523-022-00393-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractPatients with breast cancer frequently experience financial hardship, often due to the high costs of anti-cancer drugs. We sought to develop alternative trastuzumab dosing strategies, compare their pharmacokinetic effectiveness to standard dosing, and assess the expected financial implications of transitioning to them. We extracted clinical data from the records of 135 retrospectively identified patients with HER2-positive early breast cancer at a single, urban comprehensive cancer center who were treated with trastuzumab between 2017 and 2019. We performed pharmacokinetic simulations on a range of trastuzumab dose levels and frequencies, assessing efficacy by trough trastuzumab concentration (Ctrough) and population and individual likelihoods of Ctrough exceeding trastuzumab minimum effective concentration (MEC). We performed deterministic financial modeling to estimate the treatment-associated financial savings from alternative dosing strategies. Trastuzumab maintenance doses of 4 mg/kg every 3 weeks (Q3W) and 6 mg/kg every 4 weeks (Q4W) had nearly identical probabilities of Ctrough being above MEC as standard of care 6 mg/kg every 3 weeks. In the primary financial analysis, both trastuzumab 4 mg/kg Q3W and 6 mg/kg Q4W were associated with significant drug- and administration-related out-of-pocket cost savings over the duration of therapy, ranging from $765 (neoadjuvant, Q4W) to $2791 (adjuvant, Q4W). In particular, Q4W trastuzumab increased savings related to lost wages and travel cost avoidance. Low-dose and reduced frequency trastuzumab in appropriately selected patients may significantly reduce total drug utilization and meaningfully reduce patient financial toxicity. Prospective clinical trials evaluating low-dose or reduced-frequency administration of therapeutic monoclonal antibodies are warranted and needed.
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Jackisch C, Manevy F, Frank S, Roberts N, Shafrin J. White Paper on the Value of Time Savings for Patients and Healthcare Providers of Breast Cancer Therapy: The Fixed-Dose Combination of Pertuzumab and Trastuzumab for Subcutaneous Injection as an Example. Adv Ther 2022; 39:833-844. [PMID: 34988876 PMCID: PMC8730478 DOI: 10.1007/s12325-021-01996-0] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022]
Abstract
Health technology assessments and value frameworks are becoming increasingly important for clinical decision-making. Most of these frameworks, however, focus on value to payers rather than patients and healthcare providers and may ignore other sources of economic value such as patient and physician time cost, impact on productivity, and direct health system costs. This article focusses on fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) in the treatment of HER2-positive breast cancer. We review relevant clinical evidence, examine data on time and resource use of the subcutaneous administration of trastuzumab compared with intravenous treatment and how it can be extrapolated to PH FDC SC, and discuss the value PH FDC SC can bring to patients and healthcare providers. We will also provide our own experiences of PH FDC SC from the healthcare (oncologist, healthcare economist, pharmacist) and patient point of view. The data, combined with our personal experiences, suggest that switching from intravenous pertuzumab and trastuzumab to PH FDC SC could reduce non-drug costs for healthcare providers treating patients with HER2-positive breast cancer through time savings and other economic benefits. Furthermore, PH FDC SC could also save patient time given its shorter administration and post-injection observation time versus intravenous infusions, potentially resulting in reduced productivity loss. These benefits could be applied to other subcutaneous formulations, either currently available or in development. New therapies are increasingly assessed by looking at their value to those who pay for them rather than their value to patients and healthcare providers. Value assessments conducted from the payers’ perspective often ignore such things as patient and healthcare system time and costs. The fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (also known as pertuzumab, trastuzumab, and hyaluronidase-zzxf, abbreviated to PH FDC SC), is injected under the skin to treat a subtype of breast cancer called HER2-positive breast cancer. PH FDC SC is as effective as pertuzumab and trastuzumab, which are infused separately into a vein, but takes a lot less time to administer to patients. This transition is similar to what was seen when a subcutaneous version of trastuzumab was developed and compared to the intravenous original. Also, subcutaneous trastuzumab reduced costs associated with treating patients compared with intravenous infusions. The same benefits of PH FDC SC to patients and healthcare providers can be expected, and our personal experiences as an oncologist, healthcare economist, patient, and pharmacist agree. PH FDC SC could save patient and healthcare provider time given its shorter injection and observation times versus intravenous infusions, potentially resulting in better productivity for these people and a smaller cost to healthcare providers. These benefits could be applied to other subcutaneous formulations, either currently available or in development.
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Affiliation(s)
| | | | | | | | - Jason Shafrin
- Center for Healthcare Economics and Policy, FTI Consulting, Los Angeles, CA, USA
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Lageat C, Combedazou A, Ramus C, Guerrero K, Frolet C, Glezer S. Formative and Validation Human Factors studies of a new disposable autoinjector for subcutaneous delivery of chronic disease therapies. Expert Opin Drug Deliv 2021; 18:1761-1775. [PMID: 34448423 DOI: 10.1080/17425247.2021.1954906] [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: 10/20/2022]
Abstract
BACKGROUND Use-related risks related to autoinjector devices have been previously identified. To minimize these problems, the identification of potential use errors is a critical task during device development. METHODS This article presents iterative human factor studies, which aim to assess user interaction with the tested push-on-skin BD Intevia™ 1 mL Disposable Autoinjector, across a wide range of indications, and a broad user population. RESULTS Through the different human factor studies, use errors were recorded when the participants completed the critical tasks, but their occurrence continuously decreased. First, the incidence of use errors was reduced when the participants read the IFU. In addition, the IFU updates and design change implemented contributed to improve the usability performance. During the validation study, some use errors were still observed, mainly during the first uses. Nevertheless, providing a training to the participants almost fully eliminated the remaining use errors. CONCLUSION Thus, these results demonstrated that this new autoinjector can be safely and efficiently used for its intended uses and under the expected use conditions by all tested user groups.
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Affiliation(s)
- Claire Lageat
- BD Medical - Pharmaceutical Systems, Becton Dickinson and Company, Le Pont-de-Claix, France
| | - Anne Combedazou
- BD Medical - Pharmaceutical Systems, Becton Dickinson and Company, Le Pont-de-Claix, France
| | - Claire Ramus
- BD Medical - Pharmaceutical Systems, Becton Dickinson and Company, Le Pont-de-Claix, France
| | - Karen Guerrero
- BD Medical - Pharmaceutical Systems, Becton Dickinson and Company, Le Pont-de-Claix, France
| | - Cecile Frolet
- BD Medical - Pharmaceutical Systems, Becton Dickinson and Company, Le Pont-de-Claix, France
| | - Stanislav Glezer
- Diabetes Care, Becton Dickinson and Company, Franklin Lakes, NJ, USA
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Solitano V, Vuitton L, Peyrin-Biroulet L, Danese S. The Evolution of Biologics Administration From Intravenous to Subcutaneous: Treatments for Inflammatory Bowel Disease Go Home. Gastroenterology 2021; 160:2244-2247. [PMID: 33773995 DOI: 10.1053/j.gastro.2021.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Bourgogne-Franche-Comté University, Besançon, France
| | - 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; IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
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D'Amico F, Solitano V, Aletaha D, Hart A, Magro F, Selmi C, Ng SC, Al Awadhi S, Choy E, Schulze-Koops H, Bossuyt P, Olivera PA, Kotze PG, Ghosh S, Peyrin-Biroulet L, Danese S. Biobetters in patients with immune-mediated inflammatory disorders: An international Delphi consensus. Autoimmun Rev 2021; 20:102849. [PMID: 33974946 DOI: 10.1016/j.autrev.2021.102849] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/03/2021] [Accepted: 03/12/2021] [Indexed: 12/27/2022]
Abstract
Several efforts have been made to improve the available therapeutic armamentarium of patients with immune-mediated inflammatory disorders (IMIDs) leading to the development of biobetters. To date, there is no commonly accepted definition of biobetters. Sixteen physicians with expertise in the field of IMIDs from eleven countries attended a virtual international consensus meeting to provide for the first time a definition of biobetter and to identify unmet needs on this topic. Improvements in clinical outcomes and drug pharmacology were considered crucial for the definition of biobetters, while safety profile and patient acceptability were not. In addition, an appropriate balance between clinical outcomes and costs and a shared decision between physicians and patients should guide the decision to use a biobetter. Clinical studies are required to validate the biobetter definition and to investigate their role in the management of patients with IMIDs.
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Shi GH, Pisupati K, Parker JG, Corvari VJ, Payne CD, Xu W, Collins DS, De Felippis MR. Subcutaneous Injection Site Pain of Formulation Matrices. Pharm Res 2021; 38:779-793. [PMID: 33942212 DOI: 10.1007/s11095-021-03047-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/05/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The objective of this work was to systematically evaluate the effects of formulation composition on subcutaneous injection site pain (ISP) using matrices comprising of common pharmaceutical excipients. METHODS Two randomized, blinded, crossover studies in healthy subjects were conducted at a single site, where subjects received 1 mL SC injections of the buffer matrices. ISP intensity was measured using a 100 mm visual analogue scale (VAS), which was then analyzed via heatmap, categorical grouping, subgroup analysis, and paired delta analysis. RESULTS Buffer type, buffer concentration and tonicity agent showed a substantial impact on ISP. Citrate buffer demonstrated a higher ISP than acetate buffer or saline). The 20 mM citrate buffer was more painful than 10 or 5 mM citrate buffers. NaCl and propylene glycol were significantly more painful than sugar alcohols (mannitol, sucrose, trehalose or glycerol). Histidine buffers exhibited ISP in the descending order of 150 mM > 75 mM > 25 mM > 0 mM NaCl, while histidine buffers containing Arginine-HCl at 0, 50, or 150 mM all showed very low ISP. Histidine buffer at pH 6.5 showed a lower ISP than pH 5.7. CONCLUSIONS This systematic study via orthogonal analyses demonstrated that subcutaneous ISP is significantly influenced by solution composition.
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Affiliation(s)
- Galen H Shi
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Karthik Pisupati
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Jonathan G Parker
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Vincent J Corvari
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA.
| | - Christopher D Payne
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - Wen Xu
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
| | - David S Collins
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, 46285, USA
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12
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Allmendinger A. Opportunities in an Evolving Pharmaceutical Development Landscape: Product Differentiation of Biopharmaceutical Drug Products. Pharm Res 2021; 38:739-57. [PMID: 33903976 DOI: 10.1007/s11095-021-03037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
The current perspective reviews the biopharmaceutical market until end of 2020 and highlights the transforming biopharmaceutical landscape during the recent decade. In particular, the rise of biosimilars and the development of new therapeutic modalities through recent advancement in molecular biology research sustainably change the product scenery. The present manuscript describes opportunities for pharmaceutical technical development, highlighting concepts such as product differentiation to succeed in a competitive product landscape. Product differentiation offers the opportunity for numerous life-cycle options and market exclusivity through incremental improvements in standard of care treatment. In particular, different formulation options and formulation-device combinations are described, focusing on systemic delivery of monoclonal antibody products and patient-centered development. The concept of product differentiation is exemplified in a case study about HER2+ breast cancer therapy, underlining pharmaceutical technical solutions and major improvements for the patient.
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Abstract
Over the past 3 decades, monoclonal antibodies and their related derivatives, including recently approved antibody-drug conjugates, conquered a central role in cancer therapy because of their contribution to improve survival, time to progression and quality of life of patients compared to chemotherapy protocols. This review summarizes information on approved original and biosimilar products, as well as investigational antibody-based therapeutics, targeting ErbB2. This target has been selected as a paradigmatic example because of its relevant role in sustaining the malignancy of major cancer diseases including, breast, gastric and other chemotherapy-resistant solid tumors. This work analyzes the drivers affecting research and development of next-generation anti-ErbB2 immunotherapeutics, taking into account unmet medical needs and pharmacoeconomic issues related to sustainability. The analysis may help with the design of future research and development strategies.
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Affiliation(s)
- Rita De Santis
- Biotechnology Research and Development, Alfasigma SpA, Rome, Italy
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Kim H, Alten R, Cummings F, Danese S, D'Haens G, Emery P, Ghosh S, Gilletta de Saint Joseph C, Lee J, Lindsay JO, Nikiphorou E, Parker B, Schreiber S, Simoens S, Westhovens R, Jeong JH, Peyrin-Biroulet L. Innovative approaches to biologic development on the trail of CT-P13: biosimilars, value-added medicines, and biobetters. MAbs 2021; 13:1868078. [PMID: 33557682 PMCID: PMC7889098 DOI: 10.1080/19420862.2020.1868078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/18/2022] Open
Abstract
The biosimilar concept is now well established. Clinical data accumulated pre- and post-approval have supported biosimilar uptake, in turn stimulating competition in the biologics market and increasing patient access to biologics. Following technological advances, other innovative biologics, such as “biobetters” or “value-added medicines,” are now reaching the market. These innovative biologics differ from the reference product by offering additional clinical or non-clinical benefits. We discuss these innovative biologics with reference to CT-P13, initially available as an intravenous (IV) biosimilar of reference infliximab. A subcutaneous (SC) formulation, CT-P13 SC, has now been developed. Relative to CT-P13 IV, CT-P13 SC offers clinical benefits in terms of pharmacokinetics, with comparable efficacy, safety, and immunogenicity, as well as increased convenience for patients and reduced demands on healthcare system resources. As was once the case for biosimilars, nomenclature and regulatory pathways for innovative biologics require clarification to support their uptake and ultimately benefit patients.
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Affiliation(s)
- HoUng Kim
- Celltrion Healthcare , Incheon, Republic of Korea.,Department of Pharmacology, College of Medicine, Chung-Ang University , Seoul, Republic of Korea
| | - Rieke Alten
- Rheumatology Research Center, Schlosspark-Klinik Charité, University Medicine Berlin , Berlin, Germany
| | - Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust , Southampton, UK
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS and Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Geert D'Haens
- Department of Inflammatory Bowel Disease, Amsterdam University Medical Centers , Amsterdam, The Netherlands
| | - Paul Emery
- Leeds NIHR Biomedical Research Centre, The Leeds Teaching Hospital Trust, and Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds , UK
| | - Subrata Ghosh
- The Institute of Translational Medicine, Immunology and Immunotherapy, NIHR BRC, University of Birmingham , Birmingham, UK
| | | | - JongHyuk Lee
- Department of Pharmaceutical Engineering, College of Life and Health Science, Hoseo University , Asan, Republic of Korea
| | - James O Lindsay
- Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust , London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College, London, and Rheumatology Department, King's College Hospital , London, UK
| | - Ben Parker
- Kellgren Centre for Rheumatology, Manchester Royal Infirmary, NIHR Manchester Biomedical Research Centre , Manchester, UK
| | - Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein , Kiel, Germany
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven , Leuven, Belgium
| | - Rene Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center , Leuven, Belgium
| | - Ji Hoon Jeong
- Department of Global Innovative Drugs, Graduate School of Chung-Ang University and Department of Pharmacology, College of Medicine, Chung-Ang University , Seoul, Republic of Korea
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital , Vandoeuvre-Les-Nancy, France.,Inserm U1256 NGERE, Lorraine University , Vandoeuvre-Les-Nancy, France
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15
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Badkar AV, Gandhi RB, Davis SP, LaBarre MJ. Subcutaneous Delivery of High-Dose/Volume Biologics: Current Status and Prospect for Future Advancements. Drug Des Devel Ther 2021; 15:159-170. [PMID: 33469268 PMCID: PMC7812053 DOI: 10.2147/dddt.s287323] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022]
Abstract
Subcutaneous (SC) delivery of biologics has traditionally been limited to fluid volumes of 1-2 mL, with recent increases to volumes of about 3 mL. This injection volume limitation poses challenges for high-dose biologics, as these formulations may also require increased solution concentration in many cases, resulting in high viscosities which can affect the stability, manufacturability, and delivery/administration of therapeutic drugs. Currently, there are technologies that can help to overcome these challenges and facilitate the delivery of larger amounts of drug through the SC route. This can be achieved either by enabling biologic molecules to be formulated or delivered as high-concentration injectables (>100 mg/mL for antibodies) or through facilitating the delivery of larger volumes of fluid (>3 mL). The SC Drug Delivery and Development Consortium, which was established in 2018, aims to identify and address critical gaps and issues in the SC delivery of high-dose/volume products to help expand this delivery landscape. Identified as a high priority out of the Consortium's eight problem statements, it highlights the need to shift perceptions of the capabilities of technologies that enable the SC delivery of large-volume (>3 mL) and/or high-dose biologics. The Consortium emphasizes a patient-focused approach towards the adoption of SC delivery of large-volume/high-concentration dosing products to facilitate the continued expansion of the capabilities of novel SC technologies. To raise awareness of the critical issues and gaps in high-dose/volume SC drug development, this review article provides a generalized overview of currently available and emerging technologies and devices that could facilitate SC delivery of high-dose/volume drug formulations. In addition, it discusses the challenges, gaps, and future outlook in high-dose/volume SC delivery as well as potential solutions to exploit the full value of the SC route of administration.
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Affiliation(s)
- Advait V Badkar
- Pharmaceutical Research & Development, Pfizer Inc., Andover, MA, USA
| | - Rajesh B Gandhi
- Drug Product Science & Technology, Bristol-Myers Squibb, Co., New Brunswick, NJ, USA
| | - Shawn P Davis
- BioPharmaceuticals Development, Research & Development, AstraZeneca, Cambridge, MA, UK
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16
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Elsamany S, Elsisi GH, Hassanin F, Jafal M. Budget impact analysis of subcutaneous trastuzumab compared to intravenous trastuzumab in Saudi HER2-positive breast cancer patients. Expert Rev Pharmacoecon Outcomes Res 2020; 21:511-518. [PMID: 33275459 DOI: 10.1080/14737167.2021.1860024] [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: 01/03/2023]
Abstract
Background: This study was aimed to assess the budget impact of SC trastuzumab compared to IV trastuzumab in patients with HER2-positive breast cancer (BC) from the perspective of the governmental health sector in Saudi Arabia, over a 3-year time horizon.Methods: A model was developed to calculate the direct medical and indirect costs for 394 incidents HER2-positive BC patients per year who would receive SC trastuzumab compared to IV formulation. We calculated drug acquisition costs for fixed, loading, and subsequent doses of trastuzumab. One-way sensitivity analysis was conducted.Results: Two scenarios were modeled: the first scenario evaluated the impact of gradual replacement of IV formulation by SC, the second scenario, evaluated impact of totally replacing IV formulation. The total annual costs in the first scenario were estimated to be SAR 177 million (USD 98 million) for IV trastuzumab compared to SAR 143 million (USD 79 million) for SC formulation, leading to a total budget saving of SAR 34,527,346 (USD 19,181,858). In the second scenario, the total annual costs were estimated to be SAR 108 million (USD 60 million) for SC trastuzumab compared to SAR 177 million (USD 98 million) for IV formulation, leading to budget savings of SAR 69,054,692 (USD 36,363,717).Conclusion: Benefits of the SC formulation over IV infusions are being converted to realistic monetary benefits for all providers and payers.
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Affiliation(s)
- Shereef Elsamany
- Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia.,Oncology Center, Mansoura University, Mansoura, Egypt
| | - Gihan Hamdy Elsisi
- HEOR Department, Cairo University, HTA Office, LLC, Cairo, Egypt.,Faculty of Economics and Political Science, Cairo University, Giza, Egypt
| | - Fayza Hassanin
- Oncology Nursing, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Mohamed Jafal
- Clinical Pharmacy, King Abdullah Medical City, Makkah, Saudi Arabia
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17
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Collins DS, Sánchez-félix M, Badkar AV, Mrsny R. Accelerating the development of novel technologies and tools for the subcutaneous delivery of biotherapeutics. J Control Release 2020; 321:475-82. [DOI: 10.1016/j.jconrel.2020.02.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 01/04/2023]
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18
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