Biosimilars in IBD: Will it Benefit to Patients, Physicians or the Health Care System?

Infliximab therapy intensification based on endoscopic activity is related to suppress treatment discontinuation in patients with Crohn disease: A retrospective cohort study

ABSTRACT

Administering double doses of infliximab or shortening its dosing interval for patients with Crohn disease who experience a loss of response to treatment is an accepted treatment method; however, the effectiveness and appropriate timing of treatment intensification remain unclear. We examined the treatment outcomes of patients with Crohn disease receiving infliximab therapy intensification.Among 430 patients with Crohn disease who were seen at our related facilities from July 2002 to July 2018, 46 patients (30 men and 16 women) who were followed up for diminished infliximab effects for >1 year after therapy intensification were included in this study. The relationship between patient background and continuation of therapy intensification was retrospectively examined through a logistic regression analysis.Among the 46 patients, 67.4% (31 cases) continued therapy intensification for 12 months. The treatment discontinuation rate after 12 months (7.1% vs 43.8%, P = .015) and the C-reactive protein levels at the start of therapy intensification (P = .0050) were significantly lower in the group in which treatment was strengthened due to remaining endoscopic findings (n = 14) than that due to clinical symptoms (n = 32). There was no significant difference in the rates of treatment discontinuation after 12 months of treatment strengthening between patients receiving double doses (n = 34) and those with shortened dosing intervals (n = 12).Infliximab treatment discontinuation seems to be less likely to occur in patients with Crohn disease who are receiving infliximab treatment intensification based on endoscopic findings of exacerbations than in patients whose treatment is based on clinical symptoms.

Assays used to assess biosimilarity of therapies for inflammatory bowel disease

Introduction: Biological drugs have revolutionized the treatment of various medical conditions. Recently, upon expiration of patents of a few biological agents, biosimilars are being rapidly developed as an affordable substitute for more expensive biologic drugs, which may serve as a therapeutic alternative for biologics reference medical product (RMP). Prior to approval for use of the biosimilar drug for treatment of RMP indications, a process involving several different assays is required, in which the biosimilar must prove to posses no meaningful differences from an existing approved RMP in terms of purity, safety and potency.Areas covered: This report describes the different assays which are used to assess biosimilar drugs using CT-P13 infliximab biosimilar as a case-in-point. It covers the assays of physicochemical characterization, biological activity, and immunogenicity and examines their rational along with methodological and conceptual caveats clinicians should be cognizant of.Expert opinion: The approval of a biosimilar is a complex process that requires several assays, specifically tailored to the characteristics of the RMP. Determining the required assays and the allowable margin of confidence are of great importance but are not sufficient in order to prove that the biosimilar is indeed not inferior in its clinical potency and safety to the RMP.