Introducing New Biosimilars Into Current Treatment Algorithms

Summary of a Biogen-sponsored symposium, held at the European League Against Rheumatism (EULAR) Congress 2016 in London, UK, on 9th June 2016

Moderator: John D. Isaacs1
Faculty: Thomas Dörner,2 Tore K. Kvien,3 Arnold Vulto4

1. Institute of Cellular Medicine, Newcastle University, Newcastle, UK
2. Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
3. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
4. Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands

Disclosure: Prof Isaacs has received honoraria, research grants, or consulting fees from AbbVie Inc., Baxalta, Biogen Inc., Boehringer Ingelheim GmbH, Bristol-Myers-Squibb, Celltrion Healthcare, Chugai Pharmaceutical Co. Ltd., Eli Lilly and Company, Epirus Biopharmaceuticals Inc., Hospira Inc., Janssen Pharmaceuticals Inc., Merck Serono S.A., Pfizer Inc., and Roche Laboratories, Inc. Prof Dörner has received research grants from Merck, UCB, Roche/Chugai and Janssen, and honoraria for consulting or lecture fees from Roche, Eli Lilly, Hospira, Sanofi, Pfizer, Abbvie, Biogen, and Samsung Bioepis (each below $10,000). Prof Kvien has received fees for speaking and/or consulting from Biogen, Bristol-Myers-Squibb, Boehringer Ingelheim, Celltrion Healthcare, Eli Lilly and Company, Epirus Biopharmaceuticals Inc., Hospira, Merck-Serono, Novartis, Orion Pharma, Pfizer, Sandoz, and UCB. Prof Vulto has received consultancy and speaker bureau fees from AbbVie, Amgen, Biogen, Boehringer-Ingelheim, Medicines for Europe (EGA), Pfizer/Hospira, Mundipharma, Roche, and Sandoz.
Acknowledgements: Writing assistance was provided by Juliette Allport of Ashfield Healthcare Communications Ltd.
Support: Biogen provided funding for medical writing support in the development of this article. Biogen reviewed the article for medical accuracy and provided feedback to the authors. All named authors had full editorial control of the paper, and provided their final approval of all the content.
Citation: EMJ Rheumatol. 2016;3[1]:28-35.

Meeting Summary

Three biosimilar products are now licensed for the treatment of rheumatic diseases in Europe. The European Medicines Agency (EMA) requires that similarity between a biosimilar and its reference product is demonstrated using a rigorous, stepwise process that includes extensive physicochemical and biological analytical testing, non-clinical pharmacology, clinical evaluations, and pharmacovigilance plans. Each step is highly sensitive to any differences between products and progressively reduces any uncertainty over similarity; all steps must be satisfied to demonstrate biosimilarity. The US Food and Drug Administration (FDA) requires a similar stringent biosimilar development process.

The etanercept biosimilar SB4 (Benepali®), recently approved for the treatment of rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis (ankylosing spondylitis, non-radiographic axial spondyloarthritis), and plaque psoriasis, is herein used to demonstrate the detailed analytical characterisation and clinical testing that are required by the EMA before biosimilars are approved for use. A comprehensive characterisation study involving >55 physiochemical and >25 biological assays demonstrated that SB4 has highly similar structural, physicochemical, and biological quality attributes to reference etanercept. A Phase I study demonstrated pharmacokinetic equivalence between SB4 and reference etanercept in healthy male subjects. Furthermore, a Phase III, randomised, controlled trial performed in patients with moderate-to-severe rheumatoid arthritis despite treatment with methotrexate (MTX) showed that SB4 was equivalent to etanercept in terms of efficacy, safety, and immunogenicity.

In conclusion, the biosimilar development process performed according to EMA or FDA guidelines is highly rigorous and comprehensive. Biosimilars such as SB4 are now available in clinical practice and are likely to improve access, reduce costs, and ultimately, improve health outcomes.

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