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Pohl C, Polimeni M, Indrakumar S, Streicher W, Peters GHJ, Nørgaard A, Lund M, Harris P. Electrostatics Drive Oligomerization and Aggregation of Human Interferon Alpha-2a. J Phys Chem B 2021; 125:13657-13669. [PMID: 34898211 PMCID: PMC8713289 DOI: 10.1021/acs.jpcb.1c07090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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Aggregation is a
common phenomenon in the field of protein therapeutics
and can lead to function loss or immunogenic patient responses. Two
strategies are currently used to reduce aggregation: (1) finding a
suitable formulation, which is labor-intensive and requires large
protein quantities, or (2) engineering the protein, which requires
extensive knowledge about the protein aggregation pathway. We present
a biophysical characterization of the oligomerization and aggregation
processes by Interferon alpha-2a (IFNα-2a), a protein drug with
antiviral and immunomodulatory properties. This study combines experimental
high throughput screening with detailed investigations by small-angle
X-ray scattering and analytical ultracentrifugation. Metropolis Monte
Carlo simulations are used to gain insight into the underlying intermolecular
interactions. IFNα-2a forms soluble oligomers that are controlled
by a fast pH and concentration-dependent equilibrium. Close to the
isoelectric point of 6, IFNα-2a forms insoluble aggregates which
can be prevented by adding salt. We show that monomer attraction is driven mainly by molecular anisotropic dipole–dipole interactions
that increase with increasing pH. Repulsion is due
to monopole–monopole interactions and depends on the charge
of IFNα-2a. The study highlights how combining multiple methods
helps to systematically dissect the molecular mechanisms driving oligomer
formation and to design ultimately efficient strategies for preventing
detrimental protein aggregation.
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Affiliation(s)
- Christin Pohl
- Novozymes A/S, Bagsvaerd, 2880, Denmark.,Department of Chemistry, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
| | - Marco Polimeni
- Division of Theoretical Chemistry, Department of Chemistry, Lund University, 221 00, Lund, Sweden
| | - Sowmya Indrakumar
- Department of Chemistry, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
| | | | - Günther H J Peters
- Department of Chemistry, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
| | | | - Mikael Lund
- Division of Theoretical Chemistry, Department of Chemistry, Lund University, 221 00, Lund, Sweden
| | - Pernille Harris
- Department of Chemistry, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
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Hanna N, Silverberg OM, Reaume M, Gladman D, Davis MDP, Piguet V, Alavi A. Incidence, prevalence, and predictors of inflammatory arthritis in patients with hidradenitis suppurativa: a systematic review and meta-analysis. Int J Dermatol 2021; 61:1069-1079. [PMID: 34432308 DOI: 10.1111/ijd.15860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/17/2022]
Abstract
An increasing amount of evidence has emerged suggesting that hidradenitis suppurativa (HS) is associated with inflammatory arthritis. This study reviewed the incidence, prevalence, and predictors of inflammatory arthritis in patients with HS. A comprehensive literature search was conducted in CINAHL, Embase, and Medline from inception to February 14, 2020. Articles were included in the review if they provided data on disease epidemiology or predictors of adult or pediatric HS patients with comorbid inflammatory arthritis. There are no validated diagnostic criteria for HS, thus we considered patients as having HS if they had at least one diagnostic code in a hospital or claims database or a diagnosis of HS/inflammatory arthritis in a medical record. The same criteria were used to confirm presence of inflammatory arthritis. We identified an increased incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) in HS patients when compared with estimates in the general population. We identified a relatively high prevalence of RA, spondyloarthritis (SpA), and PsA in HS patients when compared with estimates in the general population. There was evidence to suggest that patients who are younger than 30, male, have severe HS, or are taking infliximab or adalimumab (which may also be confounded by HS disease severity) may be at greater risk for specific subtypes of inflammatory arthritis. However, further data are needed to confirm these associations. The increased incidence and prevalence of inflammatory arthritis within HS patients underscore the need for increased awareness and interdisciplinary partnership within rheumatology and dermatology.
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Affiliation(s)
- Nardin Hanna
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Michael Reaume
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dafna Gladman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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3
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Novel formulations and drug delivery systems to administer biological solids. Adv Drug Deliv Rev 2021; 172:183-210. [PMID: 33705873 DOI: 10.1016/j.addr.2021.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
Recent advances in formulation sciences have expanded the previously limited design space for biological modalities, including peptide, protein, and vaccine products. At the same time, the discovery and application of new modalities, such as cellular therapies and gene therapies, have presented formidable challenges to formulation scientists. We explore these challenges and highlight the opportunities to overcome them through the development of novel formulations and drug delivery systems as biological solids. We review the current progress in both industry and academic laboratories, and we provide expert perspectives in those settings. Formulation scientists have made a tremendous effort to accommodate the needs of these novel delivery routes. These include stability-preserving formulations and dehydration processes as well as dosing regimes and dosage forms that improve patient compliance.
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5
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Tyo KM, Lasnik AB, Zhang L, Mahmoud M, Jenson AB, Fuqua JL, Palmer KE, Steinbach-Rankins JM. Sustained-release Griffithsin nanoparticle-fiber composites against HIV-1 and HSV-2 infections. J Control Release 2020; 321:84-99. [PMID: 32035194 DOI: 10.1016/j.jconrel.2020.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Human immunodeficiency virus (HIV-1) and herpes simplex virus 2 (HSV-2) affect hundreds of millions of people worldwide. The antiviral lectin, Griffithsin (GRFT), has been shown to be both safe and efficacious against HSV-2 and HIV-1 infections in vivo. The goal of this work was to develop a multilayered nanoparticle (NP)-electrospun fiber (EF) composite to provide sustained-release of GRFT, and to examine its safety and efficacy in a murine model of lethal HSV-2 infection. Composites were fabricated from polycaprolactone (PCL) fibers surrounding polyethylene oxide (PEO) fibers that incorporated methoxy poly(ethylene glycol)-b-poly(lactide-co-glycolide) (mPEG-PLGA) GRFT NPs. GRFT loading and release were determined via ELISA, showing that NP-EF composites achieved high GRFT loading, and provided sustained-release of GRFT for up to 90 d. The in vitro efficacy of GRFT NP-EFs was assessed using HIV-1 pseudovirus assays, demonstrating complete in vitro protection against HIV-1 infection. Additionally, sustained-release NP-EFs, administered 24 h prior to infection, prevented against a lethal dose of HSV-2 infection in a murine model. In parallel, histology and cytokine expression from murine reproductive tracts and vaginal lavages collected 24 and 72 h post-administration were similar to untreated mice, suggesting that NP-EF composites may be a promising and safe sustained-delivery platform to prevent HSV-2 infection. Future work will evaluate the ability to provide prolonged protection against multiple virus challenges, and different administration times with respect to infection.
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Affiliation(s)
- Kevin M Tyo
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Amanda B Lasnik
- Center for Predictive Medicine, Louisville, KY, United States
| | - Longyun Zhang
- Center for Predictive Medicine, Louisville, KY, United States; Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, United States
| | - Mohamed Mahmoud
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Alfred B Jenson
- James Graham Brown Cancer Center, University of Louisville School of Medicine, University of Louisville, Louisville, KY, United States
| | - Joshua L Fuqua
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States
| | - Kenneth E Palmer
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville School of Medicine, University of Louisville, Louisville, KY, United States; Department of Microbiology and Immunology, School of Medicine, University of Louisville, KY, United States
| | - Jill M Steinbach-Rankins
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, KY, United States; Center for Predictive Medicine, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville School of Medicine, University of Louisville, Louisville, KY, United States; Department of Bioengineering, Speed School of Engineering, University of Louisville, Louisville, KY, United States; Department of Microbiology and Immunology, School of Medicine, University of Louisville, KY, United States.
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6
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Mansell K, Bhimji H, Eurich D, Mansell H. Potential cost-savings from the use of the biosimilars filgrastim, infliximab and insulin glargine in Canada: a retrospective analysis. BMC Health Serv Res 2019; 19:827. [PMID: 31718624 PMCID: PMC6852752 DOI: 10.1186/s12913-019-4680-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In 2014 and 2015, biosimilars for the drugs filgrastim, infliximab, and insulin glargine were approved for use in Canada. The introduction of biosimilars in Canada could provide significant cost savings for the Canadian healthcare system over originator biologic drugs, however it is known that the use of biosimilars varies widely across the world. The aim of this study was to estimate the use of biosimilars in Canada and potential cost-savings from their use. METHODS We performed a retrospective analysis of Canadian drug purchases for filgrastim, infliximab, and insulin glargine from July 2016 to June 2018. This was a cross-sectional study and the time horizon was limited to the study period. As a result, no discounting of effects over time was included. Canadian drugstore and hospital purchases data, obtained from IQVIA™, were used to estimate the costs per unit and unit volume for biosimilars and originator biologic drugs within each province. Potential cost-savings were calculated as a product of the units of reference originator product purchased and the cost difference between the originator biologic and its corresponding biosimilar. RESULTS The purchase of biosimilars varied by each province in Canada, ranging from a low of 0.1% to a high of 81.6% of purchases. In total, $1,048,663,876 Canadian dollars in savings could have been realized with 100% use of biosimilars over the originator products during this 2 year time period. The potential savings are highest in the province of Ontario ($349 million); however, even in smaller markets (PEI and Newfoundland), $28 million could have potentially been saved. Infliximab accounted for the vast majority of the potential cost-savings, whereas the purchases of the biosimilar filgrastim outpaced that of the originator drug in some provinces. In sensitivity analyses assuming only 80% of originator units would be eligible for use as a biosimilar, $838 million dollars in cost savings over this two-year time period would still have been realized. CONCLUSIONS The overall use of biosimilar drugs in Canada is low. Policy makers, healthcare providers, and patients need to be informed of potential savings by increased use of biosimilars, particularly in an increasingly costly healthcare system.
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Affiliation(s)
- Kerry Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 2Z4, Canada.
| | - Hishaam Bhimji
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 2Z4, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 2Z4, Canada
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Esteban E, Bustos RH, García JC, Jáuregui E. Biosimilars: An Approach to some Current Worldwide Regulation Frameworks. ACTA ACUST UNITED AC 2019; 14:16-40. [DOI: 10.2174/1574884713666181025142928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 12/26/2022]
Abstract
Developing new biologics has led to regulations and norms aimed at guaranteeing their
safety, quality and effectiveness, in terms of marketing, prescription, use, interchangeability and
switching. Biologics are of great importance in treating patients suffering from rheumatic, autoimmune,
inflammatory and neoplastic diseases. The expiry/lapse of reference biologics or originators’
patents has meant that developing biosimilars involves accompanying legal requirements for their
approval in countries worldwide. This paper has thus approached the situation of biosimilar regulation
worldwide, the pertinent technical concepts and regulatory differences in some countries of
interest.
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Affiliation(s)
- Efraín Esteban
- Evidence-Based Therapeutic Group, Clinical Pharmacology, Universidad de la Sabana, Chia, Colombia
| | - Rosa-Helena Bustos
- Evidence-Based Therapeutic Group, Clinical Pharmacology, Universidad de la Sabana, Chia, Colombia
| | - Julio-César García
- Evidence-Based Therapeutic Group, Clinical Pharmacology, Universidad de la Sabana, Chia, Colombia
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Rohrer J, Lupo N, Bernkop-Schnürch A. Advanced formulations for intranasal delivery of biologics. Int J Pharm 2018; 553:8-20. [PMID: 30316796 DOI: 10.1016/j.ijpharm.2018.10.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The global biologics market has been ever increasing over the last decades and is predicted to top Euro 350 by 2020. Facing this scenario, the parenteral route of biologics administration as hitherto standard route is inconvenient for the future. Among the alternatives, the intranasal delivery of therapeutic biologicals seems to be most promising but researchers are still facing challenges as indicated by the scarce number of successfully marketed peptide drugs. AREAS COVERED This review article is a compilation of current research focusing on achievements in the field of auxiliary agents for biologics delivery. First, the key benefits of the nose as most promising alternative route of drug administration are highlighted. Then, the potential of the different auxiliary agents in preclinical research is in detail discussed. Moreover, the most used permeation enhancing agents, mucolytic agents, mucoadhesive agents, in situ gelling agents and enzyme inhibiting agents in the formulation of nasal drug delivery systems are described. Thus, the overall purpose of this review is to highlight recent achievements in nasal delivery of biologics and to encourage researchers to work in the direction of needle-free nasal administration of biologics. EXPERT OPINION The nasal epithelium is a promising route for biologics administration, which is reflected in a number of well-established products on the market treating chronic diseases as well as a large number of clinical trials currently in progress. The nasal route of drug administration might be a chance to improve therapy of biologics however break-through advances, especially for very complex molecules, such as antibodies, are still needed.
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Affiliation(s)
- Julia Rohrer
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Innsbruck, Innrain 80/82, Innsbruck, Austria
| | - Noemi Lupo
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Innsbruck, Innrain 80/82, Innsbruck, Austria
| | - Andreas Bernkop-Schnürch
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Innsbruck, Innrain 80/82, Innsbruck, Austria.
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9
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Rheumatoid Arthritis. JOURNAL OF INFUSION NURSING 2017; 40:364-366. [DOI: 10.1097/nan.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Barata-Silva C, Hauser-Davis RA, Silva ALOD, Moreira JC. Desafios ao controle da qualidade de medicamentos no Brasil. ACTA ACUST UNITED AC 2017. [DOI: 10.1590/1414-462x201700030075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Resumo Introdução O desenvolvimento científico e tecnológico, assim como a adoção de políticas públicas voltadas à redução do custo dos medicamentos, tem ampliado o acesso da população a alternativas terapêuticas, as quais incluem medicamentos genéricos, biossimilares, nanomedicamentos e complexos não biológicos. As categorias já comercializadas exigem procedimentos próprios para a garantia de sua qualidade, eficácia terapêutica e segurança. Nesse contexto, o presente estudo procura realizar uma avaliação do cenário atual no Brasil sobre esse tema, apontando para situações que certamente terão de ser enfrentadas em um futuro próximo. Metodologia Foi realizado um levantamento de dados nas bases eletrônicas MEDLINE, PubMed e SCIELO, buscando artigos originais, tanto em português quanto em inglês, indexados retrospectivamente até 1999. Foram utilizados termos de busca relevantes em língua portuguesa e inglesa. Mais de 50 artigos científicos foram encontrados. Resultados e Discussão A maioria dos artigos avaliados aponta problemas tanto na fabricação quanto no controle de medicamentos genéricos e biossimilares, seja no mercado internacional, seja no nacional. No entanto, novas formas medicamentosas estão sendo criadas e necessitam do desenvolvimento de legislação e de metodologias específicas para a garantia da qualidade desses produtos. Uma avaliação do atual sistema brasileiro de registro e controle da qualidade aponta falhas e, especialmente, falta de uma farmacovigilância mais bem estruturada e ativa no país. Conclusão O atual cenário demonstra que os órgãos responsáveis no país necessitam rever a atual sistemática utilizada na fabricação e controle de medicamentos e aprimorá-la, bem como se preparar para o enfrentamento de outras demandas, algumas ainda mais complexas, que já se encontram em desenvolvimento.
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Zheng MK, Shih DQ, Chen GC. Insights on the use of biosimilars in the treatment of inflammatory bowel disease. World J Gastroenterol 2017; 23:1932-1943. [PMID: 28373759 PMCID: PMC5360634 DOI: 10.3748/wjg.v23.i11.1932] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/05/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
Biologic therapy, such as those that target tumor necrosis factor (TNF) signaling, has proven to be an efficacious method of treatment for patients with inflammatory bowel disease (IBD) with regards to symptom management and mucosal healing. However, the rising prevalence of IBD worldwide and the ever-increasing burden of biologic pharmaceuticals in the health care industry is alarming for insurance companies, clinicians, and patients. The impending patent expiry and the relatively high costs of biologics, particularly anti-TNF agents, have paved the way for biosimilar development for IBD. The United States Food and Drug Administration defines a biosimilar as a biological product that is highly similar to its reference medicinal product, with no clinically meaningful differences in terms of safety, purity, and potency. The hope with biosimilars is that their entry into the market will be able to drive competition between pharmaceutical companies to reduce prices like that of the generic market, and that access to appropriate biologic treatments for IBD patients is increased in the long-term. Yet, there are challenging issues such as indication extrapolation and interchangeability that are still being debated in the field of IBD and must be addressed in future issued guidance. This review will discuss the issues and implications concerning the use of biosimilar therapy for IBD.
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Goncalves J, Matos de Brito P, Batista A, Feio J, Machado F, Aperta J, Ascensão I, Pires V, Oliveira C, Armandina Pontes R, Alcobia A, Paulo Cruz J, Lampreia Guerreiro S, Farinha H, Margarida Freitas A, Caetano M, Almeida P, Costa B, Oliveira C, Campos C, Madureira B, Cavaco M, Catarino H. Position Paper from the Portuguese Association of Hospital Pharmacists for biosimilar therapeutic antibodies. J Clin Pharm Ther 2016; 42:239-243. [PMID: 27859438 DOI: 10.1111/jcpt.12477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/10/2016] [Indexed: 12/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Biopharmaceuticals are an important class of drugs for the treatment of autoimmune/inflammatory and oncologic diseases. With patent expiries, biotechnological manufacturers can now develop biosimilar drugs. Due to timeliness of introducing new and more complex biosimilars, the Portuguese Association of Hospital Pharmacists gathered to develop a common positioning on the use of biosimilar monoclonal antibodies. MAIN ISSUES The European pathway to biosimilar approval was developed to improve affordability and access to biological therapies, but it remains a work in progress because unresolved issues remain. Due to the present reality of biosimilar monoclonal antibodies, hospital pharmacists must play an important role in ensuring the safe, effective and cost-effective use of biosimilars in health systems; and educating healthcare administrators, providers, legislators, policymakers, payors and patients about these products. WHAT IS NEW AND CONCLUSION The conclusions presented in this work focused on the proposal for optimal biosimilar prescription criteria, the preparation of original biologics and biosimilars in the pharmacy, the management and selection of suppliers, extrapolation issues, the specific role of pharmacovigilance and risk management for the optimal use of biosimilar monoclonal antibodies.
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Affiliation(s)
- J Goncalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - P Matos de Brito
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | | | - J Feio
- CHUC, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - F Machado
- CHUC, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | | | - I Ascensão
- Hospital Beatriz Angelo, Loures, Portugal
| | | | - C Oliveira
- Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | | | - A Alcobia
- Hospital Garcia de Orta, Almada, Portugal
| | | | | | - H Farinha
- Hospital Egas Moniz, Lisboa, Portugal
| | | | - M Caetano
- CHUC, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - P Almeida
- Hospital Garcia de Orta, Almada, Portugal
| | | | | | - C Campos
- Hospital Pedro Hispano, Sra. da Hora, Portugal
| | - B Madureira
- Hospital São Francisco Xavier, Lisboa, Portugal
| | - M Cavaco
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - H Catarino
- British Hospital Lisbon XXI, Lisboa, Portugal
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Abstract
As patents of the first introduced biologic therapeutics in oncology have begun to expire, competing pharmaceutical companies are allowed to produce and market the same protein as the original agent. These products are called biosimilars. Upon patent expiration, biosimilars would hopefully be a cheaper alternative to the original agent and that is the main reason for their existence. Although the financial aspect is similar to generics, the complex nature of these products generates the need for a distinct regulatory environment. Biosimilars are produced by DNA technology in bacteria, plant cells, or animal cells, while generics are produced by chemical synthesis. Details in the process of synthesis, selection of the microorganism, protein extraction, purification and manufacturing, affect the precise nature of the end product. Monoclonal antibodies are large proteins with four polypeptide chains and interact variably with each other and with the environment. It is important for payors to realize that biosimilars are different from generics; therefore, they need to develop different set of rules for approving, registering, and dispensing biosimilars. Regulators ought to respect the physicians’ request for non-interchangeability and facilitate in any possible way of traceability. Such regulations along with a rigorous pharmacovigilance program will satisfy the concerns for true equivalence in activity and long-term safety. This is the only way to accumulate over time reliable safety information for new biosimilars. In conclusion, the wish born by the medical community and the society for a more affordable health system triggers the emergence of biosimilars, which could meet that goal if properly regulated.
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Affiliation(s)
| | - Maria I Karampola
- Department of Oncology, Interbalkan Medical Center, Thessaloniki, Greece
| | - Maria Beredima
- Department of Oncology, Interbalkan Medical Center, Thessaloniki, Greece
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Abstract
Biosimilar agents are approximate copies of branded biologic therapies. Since the first biosimilar was authorized in the European Union in 2006, fifteen additional agents have been approved by the European Medicines Agency, including two biosimilar monoclonal antibodies (mAbs). Biosimilar mAbs represent a distinct class given their large molecular size, complex protein structure, and post-translational modifications. While guidelines have been established for the development, approval, and use of biosimilars, further scrutiny and discussion is necessary to fully understand their potential impact on clinical outcomes. This review takes a critical look at the structural complexity of biosimilar mABs, the feasibility of indication extrapolation, the impact of product variability on immunogenicity, the importance of comprehensive pharmacovigilance, and the potential for ongoing pharmacoeconomic impact.
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Affiliation(s)
- Håkan Mellstedt
- Professor of Oncological Biotherapy, Department of Oncology-Pathology, Karolinska Institute, SE-171 76 Stockholm, Sweden
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15
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Immunogenicity to biologics: mechanisms, prediction and reduction. Arch Immunol Ther Exp (Warsz) 2012; 60:331-44. [PMID: 22930363 DOI: 10.1007/s00005-012-0189-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 05/11/2012] [Indexed: 01/06/2023]
Abstract
Currently, there is a significant rise in the development and clinical use of a unique class of pharmaceuticals termed as Biopharmaceuticals or Biologics, in the management of a range of disease conditions with, remarkable therapeutic benefits. However, there is an equally growing concern regarding development of adverse effects like immunogenicity in the form of anti-drug antibodies (ADA) production and hypersensitivity. Immunogenicity to biologics represents a significant hurdle in the continuing therapy of patients in a number of disease settings. Efforts focussed on the identification of factors that contribute towards the onset of immunogenic response to biologics have led to reductions in the incidence of immunogenicity. An in-depth understanding of the cellular and molecular mechanism underpinning immunogenic responses will likely improve the safety profile of biologics. This review addresses the mechanistic basis of ADA generation to biologics, with emphasis on the role of antigen processing and presentation in this process. The article also addresses the potential contribution of complement system in augmenting or modulating this response. Identifying specific factors that influences processing and presentation of biologic-derived antigens in different genotype and disease background may offer additional options for intervention in the immunogenic process and consequently, the management of immunogenicity to biologics.
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