Meta-analysis of efficacy ，safety and immunogenicity of bevacizumab biosimilars and original drugs for patients with non-small cell lung cancer / 中国药房

OBJECTIVE To compare the efficacy ，safety and immunogenicity of bevacizumab biosimilars and original drugs for non-small cell lung cancer （NSCLC），and to provide evidence-based reference for clinical use. METHODS PubMed，Embase， Web of Science ，Cochrane Library ，CBM，CNKI，VIP，Wanfang database ，ClinicalTrials.gov，and Clinical Trial Center of China were searched from the establishment of the database to September 25，2021，randomized controlled trials （RCTs）about bevacizumab biosimilars（trial group ）versus bevacizumab original drugs （control group ）for NSCLC were collected. After literature screening ， data extraction and quality evaluation of included RCTs with bias risk assessment tool recommended by Cochrane Handbook 5.1.0， meta-analysis，sensitivity analysis and publication bias analysis were performed by using RevMan 5.3 software. RESULTS A total of 11 RCTs were included ，involving 6 596 patients in total. Meta-analysis showed that there was no statistical significance in the difference of overall response rate [RR＝0.97，95％CI（0.92，1.02），P＝0.22]，the total incidence of adverse reaction [RR＝1.00， 95％CI（0.99，1.01），P＝0.79]，the incidence of severe adverse reaction [RR＝1.04，95％CI（0.96，1.13），P＝0.38]，positive rate of anti-drug antibody [RR ＝1.10，95％CI（0.88，1.36，P＝0.41] and the incidence of common adverse reactions （except for vomiting）among 2 groups（P＞0.05）. The sensitivity analysis results showed that the obtained results were robust. The results of publication bias analysis showed that there was little possibility of publication bias. CONCLUSIONS The efficacy ，safety and immunogenicity of bevacizumab biosimilars used for NSCLC are equivalent to those of bevacizumab original drugs.

Comparative Study on Regulatory Measures of Biosimilars in China ，the United States ，Japan and Europe / 中国药房

OBJECTIVE：To provi de reference for drug admini stration supervision of biosimilars in China. METHODS ： Referring to the authoritative documents of the official websites of National Medical Products Administration of China ，FDA of the United States ，European Drug A dministration and Japan ’s D rug and M edical Devices Agency ，and comparing their regulatory measures on the definition ，effectiveness，safety and clinical application of biosimilars，the suggestions were put forward for the improvement of regulatory measures of biosimilars in China. RESULTS & CONCLUSIONS ：Although the definitions biosimilars in different countries/regions were different ，they all required that biosimilars should have the same drug quality ，safety and effectiveness as their corresponding reference drugs. The United States ，the European Union and Japan required enterprises to provide studies on the similarity of early pharmacy ，non-clinical studies such as pharmacology and toxicology ，and clinical studies on immunogenicity ，pharmacokinetics and pharmacodynamics of biosimilars and reference drugs. However ，the similarity between biosimilars and reference drugs had not been required in China. All countries/regions supported the extrapolation of indications of biosimilars. Among which the United States and the European Union required manufacturers to provide detailed data ；Japan only mentioned the relevant concepts of indications extrapolation of biosimilars，but did not mention the specific data requirements. The relevant description of the conditions for the extrapolation of biosimilars in China was not clear enough ，and its application in China was still facing great challenges. In terms of drug interchangeability ，although the United States allowed the use of interchangeable biosimilars to replace reference drugs under the conditions permitted by state laws ，no relevant biosimilars had been approved；European countries had different regulations on the interchangeability of biosimilars；but there was no document explicitly mentioned in China and Japan on the interchangeability of biosimilars. It is suggested that the principle of comparison should be further improved and strict requirements should be appropriately enforced in ensuring the effectiveness and safety of biosimilars；in the field of indication extrapolation ，more detailed data requirements should be put forward ，and the possible risks after extrapolation should be evaluated scientifically ；in terms of the interchangeability of biosimilars ，it is suggested to try to implement the principle of conversion of biosimilars ，but it should be used after consultation among doctors ，pharmacists and patients，and drug use safety should be monitored timely. Meanwhile ，a sound traceability system should be established to ensure drug safety of patients.

Analysis on the Policy Measures of Clinical Use Incentives and Risk Control for Biosimilars in the European Union / 中国药学杂志

OBJECTIVE: The supervision of biosimilars in EU is based on scientific and reasonable principles. It not only had lots of laws, regulations and policy guidelines on marketing approval, but also made great efforts in clinical use and risk monitoring. To provide reference for the supervision and management of biosimilars in China. METHODS: Through the data summary and system comparison, the article described and analyzed the clinical use incentives and post-marketing risk control policies of biosimilars in EU countries. RESULTS: It is found that under the background of perfecting the regulatory systems and policies, EU countries encourage the vigorous development of the biosimilar industry and strictly control the drugs' safety, effectiveness and clinical risks. CONCLUSION: China could learn from the EU experience, encourage the development of biosimilars by improving pricing, reimbursement, clinical substitution and other policies. At the same time, we should also pay attention to the specificity of biosimilars, ensure that clinical risks are controllable and drugs are safe and effective.

Biosimilares en enfermedad inflamatoria intestinal: ¿será una alternativa útil en Chile? / Biosimilars for Inflammatory Bowel disease: would be an option in Chile?

Biological therapies have been essential for the management of inflammatory bowel disease; however, their high cost results in many patients being unable to access them. With time, commercial patents of many "original" biologics are reaching or almost in the point of reaching the expiration date of their licenses, which has allowed for the development of new agents known as biosimilars leading to a reduction of the cost of these therapies. The objective of this review is to explain what biosimilars are and show evidence of their effectiveness and safety.

Las terapias biológicas son parte fundamental en el manejo de la enfermedad inflamatoria intestinal, sin embargo los costos de éstas han hecho que muchos de los pacientes que tienen indicación de su uso, no puedan utilizarlas. Con el paso del tiempo, muchos biológicos "originales" están alcanzando o a punto de alcanzar el vencimiento de sus patentes, lo que ha llevado al desarrollo de nuevos agentes conocidos como biosimilares, determinando una disminución en los costos de estas terapias. Esta revisión tiene como objetivo explicar en qué consisten los biosimilares y la evidencia actual con respecto a su eficacia y seguridad.

Impacto orçamentário para o Sistema Único de Saúde da incorporação do infliximabe biossimilar no tratamento de artrite reumatóide / Budgetary impact of the incorporation of biosimilar infliximab in the treatment of rheumatoid arthritis from the perspective of the Brazilian Public Health System

A artrite reumatoide (AR) é uma doença inflamatória crônica, autoimune, que afeta as articulações, podendo produzir sintomas sistêmicos. O infliximabe é um medicamento biológico incorporado no Sistema Único de Saúde (SUS) para o tratamento da AR, que teve um biossimilar aprovado em 2015. Além do biossimilar, existe um produto derivado de uma Parceria de Desenvolvimento Produtivo (PDP). Este estudo estimou o impacto orçamentário da incorporação do infliximabe biossimilar no tratamento da AR no SUS. O impacto orçamentário da incorporação do produto da PDP foi contemplado como um dos objetivos secundários. As estimativas foram calculadas pelo método de demanda aferida para um horizonte temporal de cinco anos. Foram estimadas duas estratégias de uso: (A) apenas casos novos de AR recebendo o infliximabe inovador utilizarão o biossimilar (ou o produto da PDP) e (B) tanto os casos novos como 50% daqueles já em uso do infliximabe inovador utilizarão o biossimilar (idem). As projeções da população com AR foram realizadas a partir dos dados presentes no Datasus e da "quota de mercado"1 do infliximabe. Adicionalmente, foram realizadas análises de sensibilidade univariadas, considerando uma difusão progressiva dos dois produtos e de pior e melhor cenário. A incorporação do infliximabe biossimilar e do produto de PDP para casos novos (estratégia A) implicariam em economias de -R$ 284.430.468,79 e -R$ 366.194.377,69, respectivamente, em cinco anos. Esses valores representariam reduções de 19% e 24%, respectivamente, nos gastos em saúde de infliximabe para o tratamento de AR. Na estratégia B, onde também são considerados parte dos pacientes em terapia de manutenção as economias geradas seriam de -R$ 419.006.071,14 para o biossimilar e -R$ 539.455.804,86 para o produto da PDP. Na análise de sensibilidade por difusão progressiva, as economias reduzem se a -R$ 178.544.332,95 (estratégia A) e -R$ 263.639.280,49 (estratégia B) para o biossimilar e -R$ 229.869.645,03 (estratégia A) e -R$ 339.426.443 (estratégia B). Na análise de melhor cenário, os resultados apontaram para economias de -R$ 1.011.789.713,83 e -R$ 1.222.955.301,30 para o biossimilar e produto da PDP, respectivamente. Já no pior cenário, as estimativas mostram que a introdução das tecnologias analisadas produziria um ônus ao sistema de saúde de R$ 8.552.019,91 (para o biossimilar) e R$ 5.366.519,91 para o produto da PDP. A incorporação do produto biossimilar no tratamento da AR proporcionaria redução dos gastos, tornando possível uma alocação de recursos mais eficiente para o tratamento dessa doença.

Rheumatoid arthritis (AR) is a chronic, autoimmune, inflammatory disease that affects the joints, but also may produce systemic symptoms. Infliximab is a biologic drug incorporated into the Brazilian Public Health System (SUS) for the treatment of AR, which had a biosimilar approved in 2015. In Brazil, in addition to biosimilar, there is a product derived from a public-private partnership (PDP). This study aimed to estimate the budgetary impact of the incorporation of biosimilar infliximab in the treatment of AR in SUS. The budgetary impact of the incorporation of the PDP product was considered as one of the secondary objectives. Estimates were calculated using a measured demand approach over a five-year time horizon. Two strategies of utilization was estimated for the biosimilar product or PDP: (A) only new cases that would receive the innovative infliximab will use the biosimilar (or the PDP product) and (B) both new cases and 50% of those already in use of the innovative infliximab will use biosimilar (idem). The projections of the AR population were based on data from Datasus and the "market share" of infliximab. In addition, univariate sensitivity analyzes were performed, considering the progressive diffusion and analyses of "best-case scenario" and "worst-case scenario". The incorporation of biosimilar infliximab and PDP product for new cases (strategy A) would save -R$ 284,430,468.79 and -R$ 366,194,377.69, respectively, in five years. These values would represent reductions of 19% and 24%, respectively, in the health expenditures of infliximab for the treatment of AR. In strategy B, where part of the maintenance therapy patients were also considered, the savings would be -R$ 419,006,071.14 for biosimilar and -R$ 539,455,804.86 for the PDP product. For both drugs, the practiced price was the parameter with the greatest impact on the cost savings estimates, both in strategy A and B. In the sensitivity analysis by progressive diffusion the savings would decrease to -R$ 178,544,332.95 (strategy A) and -R $ 263,639,280.49 (strategy B) for biosimilar and -R $ 229,869,645.03 (strategy A) and -R$ 339,426,443 (Strategy B). In the analysis of best-case scenario, the results showed savings of -R$ 1,011,789,713.83 and -R$ 1,222,955,301.30 for biosimilar and PDP products, respectively. On the other hand, in the worst-case scenario the introduction of the analyzed technologies would result in a health system burden of R$ 8,552,019.91 for the biosimilar and R$ 5,366,519.91 for the PDP product. The incorporation of the biosimilar product in the treatment of AR would reduce the health care expenditures for this treatment, allowing the budget manger to allocate resources more efficiently for the treatment of AR.

Desafios ao controle da qualidade de medicamentos no Brasil / Challenges to the drug quality control in Brazil

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.

Abstract Introduction Scientific and technological development, as well as the adoption of public policies aiming drugs cost reduction, has broadened the population's access to therapeutic alternatives. These alternatives include generic drugs, biosimilars, nanomedicines and non-biological complexes. Already marketed categories require their own procedures to guarantee their quality, therapeutic efficacy and safety. This article assesses the current Brazilian scenario in this regard, pointing to situations that will surely have to be addressed in a near future. Methodology Data was obtained in the electronic databases MEDLINE, PubMed and SCIELO, searching for original articles, both Portuguese and English, retrospectively indexed back to 1999 using relevant search terms, both in English and in Portuguese. More than 50 scientific articles were found. Results and Discussion Most of the evaluated articles point to problems both in the manufacture and in the control of generic and biosimilar drugs. In fact, scientific publications have proven these problems in the most varied markets including Brazilian. On the other hand, new drug forms are being created and need the development of legislation and specific methodologies to guarantee the quality of these products. An evaluation of the current Brazilian system of registration and quality control points out some flaws and especially the lack of a better structured and active pharmacovigilance in the country. Conclusion The current scenario demonstrates the need of the responsible organs in the country to review the current system and improve it, as well as to prepare for the confrontation with other, even more complex, demands that are already under development.

Biosimilars In Medicine

Biopharmaceutical drugs or biologicals have become an essential part of modern pharmacotherapy. Biosimilars or similar biologics have been defined as drugs that have shown to have comparable quality, safety and efficacy to the original biopharmaceutical drugs. The past decade has seen a significant increase in interest in these products from the biotechnology industry. Major developments in order to establish a regulatory path for approval of these products have taken place . In order to understand how the different quality attributes of a biosimilar impact its safety and efficacy we need further efforts. India is globally regarded to have great potential for development and commercialization of biosimilars.

The development of biosimilars in oncology / 中华肿瘤杂志

With the extensive application in clinical practice, biological medicine plays a significant role in both treatment and supportive care in oncology. With the expiration of original drug patents, biosimilars emerge. The biosimilars are defined as biological drugs that are be highly similar but not identical to the biological reference. Their development and evaluation procedure are different from those of small molecular chemical generics. Biosimilars are expected to reduce the health care costs worldwide. The booming developments of biosimilars, such as rituximab, trastuzumab and bevacizumab in medical oncology can optimize the clinical strategies, offer patients more treatment options and reduce the medical expenditure. In this article, we review the advances in the field of biosimilars, especially focus on the challenges and opportunities of biosimilars in clinical oncology.

Characterization and comparability of biosimilars: a filgrastim case of study and regulatory perspectives for Latin America

Background: Developing countries have an estimate of ten times more approved biosimilars than developed countries. This disparity demands the need of an objective regulation that incorporates health policies according to the technological and economical capabilities of each country. One of the challenges lies on the establishment of comparability principles based on a physicochemical and biological characterization that should determine the extent of additional non-clinical and clinical studies. This is particularly relevant for licensed biosimilars in developing countries, which have an extensive clinical experience since their approval as generics' in some cases more than a decade. To exemplify the current status of biosimilars in Mexico' a characterization exercise was conducted on licensed filgrastim biosimilars using pharmacopeial and extended characterization methodologies. Results: Most of the evaluated products complied with the pharmacopeial criteria and showed comparability in their Critical Quality Attributes (CQAs) towards the reference product. These results were expected in accordance with their equivalent performance during their licensing as generics. Accordingly' a rational approval and registration renewal scheme for biosimilars is proposed, that considers the proper identification of CQAs and its thoroughly evaluation using selected techniques. Conclusions: This approach provides support to diminish uncertainty of exhibiting different pharmacological profiles and narrows or even avoids the necessity of comparative clinical studies. Ultimately, this proposal is intended to improve the accessibility to high quality biosimilars in Latin America and other developing countries.

Analysis of the Regulatory Policies Progress of Biosimilars in Foreign Countries and Its Enlightenment to China / 中国药房

OBJECTIVE:To explore the development status of regulatory policies of biosimilars in foreign countries,and to provide reference for perfecting biosimilars regulatory policies in China. METHODS:Comparative analysis was conducted,con-cerning biosimilar regulations and directories which had been issued by WHO,EMA and FDA,in aspects of biosimilars definition, the choice of reference drug,quality studies,non-clinical studies,clinical studies. RESULTS & CONCLUSIONS:Three common points found in foreign regulatory policies were that:firstly,discrepancies were allowed between biosimilars and reference drugs;secondly,the comparison was itemized between biosimilars and reference drugs on safety and effectiveness,in order to guarantee the reliability of quality research;thirdly,clinical and non-clinical studies were reduced with a premise that similarity is confirmed. Given China's current situation,several parts of policies should be improved,including stressing pertinence of reference drug selec-tion,refining preclinical and clinical study directories and establishing supporting system after listing.

Biologics and Biosimilars: Differences and Clinical Implications.

Biologics or biopharmaceuticals are drugs derived from living organisms by recombinant technology. Biologics have made a significant contribution to the management of certain chronic diseases such as cancer, rheumatoid, arthritis, ankylosing spondylitis, psoriasis and other immune mediated disorders. Biologics are produced by genetically modifying cells and, are highly complex and expensive to manufacture. Many of them are now facing patent expiry which has paved the way for the development of biosimilars. Biosimilars are biologic medicine that is similar in terms of quality, safety and efficacy but not the same as a registered innovator biologic. The manufacturing of biosimilars has many complexities, such as consistency of manufacturing process, conformation of manufacturing standards and demonstration of product consistency Also, powered clinical trials have to be executed to demonstrate similarity to the innovator biologic. Registration of biosimilars requires a more stringent evaluation than that is required for conventional generics. Biosimilars have the potential to be the molecules of the future as long as they are developed strictly in accordance with comparative procedures mandated by regulatory authorities such as EMA and USFDA. It is believed that the advent of biosimilars will improve patient access to expensive biologics for chronic illnesses. However, it is important that clinicians distinguish between innovator biologics and biosimilars. Physicians should avoid substituting biosimilars for innovators as well as avoid interchangeability as biosimilars are not generics. In addition, pharmacovigilance will be the need of the hour to track down any safety and efficacy problems arising from the use of biosimilars.

Terapias biológicas en enfermedad inflamatoria intestinal: puesta al día / Biologics therapies in inflammatory bowel disease: an update

Inflammatory bowel disease (IBD) is a chronic condition that significantly compromises the quality of life of patients. Biologicals have improved the course of the disease and its prognosis; however, not all patients have access to these treatments due to its high cost. Biosimilars seem to be a safe and effective option in the treatment of IBD. Because of its lower cost, the number of patients who have been treated increases every day. It is important to consider that not all patients respond to anti-TNF so alternatives have emerged within biological therapies that have demonstrated efficacy, and others are being tested. Antiintegrins emerge strongly as a new therapeutic model of IBD. With all these options probably the future treatment will be more personalized and less protocolized according to the characteristics of each patient.

La enfermedad inflamatoria intestinal (EII) es crónica y determina un notable compromiso de la calidad de vida de los pacientes que lo padecen. Los biológicos han mejorado el curso de la enfermedad y su pronóstico, sin embargo, no todos los pacientes tienen acceso a estos tratamientos debido a su alto costo. Los biosimilares parecen ser una opción segura y eficiente en el tratamiento de la EII. Debido a su menor costo cada día aumenta el número de pacientes que han sido tratados. Es importante considerar que no todos los pacientes responden a los anti TNF por lo que han surgido otras alternativas dentro de los biológicos que han demostrado eficacia y otros que se encuentran en evaluación. Los biológicos antiintegrinas surgen con fuerza como nuevo modelo terapéutico de las EII. Con todas estas alternativas es planteable que el tratamiento a futuro sea más personalizado y menos protocolizado según las características de cada paciente.

Controversias en el manejo de la de colitis ulcerosa grave en Chile / Controversies in the management of severe ulcerative colitis in Chile

Ulcerative colitis is a chronic inflammation in the mucosa layer of the colon characterized by activity and remitting episodes of varying severity and extension. Most of the flares are mild to moderate. They require outpatient treatment and have a good prognosis. The severe crises can have a high mortality if not treated on time. The success of the therapy depends on a multidisciplinary team.

La colitis ulcerosa en una inflamación crónica de la mucosa del intestino grueso que se caracteriza por episodios de actividad y remisiones de gravedad y extensión variable. La mayoría de las crisis son leves a moderadas, requieren tratamiento ambulatorio y son de buen pronóstico. Las crisis graves pueden llegar a tener una alta mortalidad si no son tratadas a tiempo. El éxito de la terapia depende de un equipo multidisciplinario.

Therapeutic potential of biosimilars in dermatology.

The introduction of biologic therapy has revolutionized the treatment of many chronic diseases, including several dermatological disorders. Biological agents promise to satisfy medical needs previously unmet by conventional medicines. Unfortunately, these agents are expensive and out of reach for the majority of patients who need them. Biosimilars are copies of the innovator biological agents and represent an important advance in the field of biological therapeutics. Although they are similar to the original biologic, differences in terms of structure, efficacy, safety and immunogenicity remain a concern. Thus, biosimilars cannot be regarded as bio‑generics. Awareness of the key differences between a biosimilar and its reference biological agent is essential for optimal treatment and safety of patients. The increasing availability of biosimilars provides patients and doctors with less expensive alternatives and increases the accessibility of biologic therapy to needy patients. In this review, we discuss the concept of biosimilars, the need for appropriate regulatory pathways and their current status in dermatology.

Biologics and biosimilars: role in modern pharmacotherapy and importance of pharmacovigilance.

Biologics are highly sensitive large molecules with complex structure, difficult to characterize and reproduce, derived from living cells; used for treatment, diagnosis or prevention of disease. Examples are therapeutic hormones, vaccines, monoclonal antibodies etc. Biologicals are beneficial in the management of several health conditions which were once upon a time difficult to manage like cancer, multiple sclerosis, Alzheimer’s disease, rheumatoid arthritis, diabetes etc. Biosimilars are proteins that are similar to innovator biologics but not the same as they differ slightly in structure however with no clinically significant difference. Biosimilars are not the exact replicas of originator biologic and are therefore not generics. Biosimilars for their approval are not required to undergo intense clinical trials as innovator biologic but are required to produce data that demonstrates its similarity to an original biologic in terms of clinical efficacy and safety. However, manufactures of both the biologics and biosimilars are required to submit pharmacovigilance and risk management plans as part of their application. Marketing authorization for biosimilars was for the first time framed by EMA along with the guidelines for developing them. As biologics and biosimilars are derived proteins they have immunogenic potential and risk of adverse events which cautions their use. Pharmacovigilance is needed to ensure that adverse events are quickly detected, reported and attributed to the correct product and manufacturer. Regulations are implemented to improve identification and traceability of biologics. Automatic substitution should not be permitted for biologicals.

Review of biosimilar regulatory guidelines and scientific principles:Experiences from Europe-an Medicines Agency (EMA) guidelines / 中国卫生政策研究

In this study, a literature review was adopted to specify terminology of biosimilars and demonstrate the basic characteristic of biologics and relevant research and development ( R&D) procedures. The regulatory frame-work of the European Medicines Agency ( EMA ) guidelines on biosimilars was introduced. Explicitly, regulatory guidelines and scientific principles, regarding biosimilarity, safety and immunogenicity, extrapolation, labels and names, data protection, were systematically introduced, as well as interchangeability and pharmacovigilance, respec-tively. The purpose of the study is to provide regulatory references for Chinese legislators and recommendations on the R&D of biosimilars in the biopharmaceutical industry.

Perspective of biosimilars: A brief comment on immunogenicity of human insulin biosimilars based on viewing of severe adverse events of epoetin α and roferon A / 中华内分泌代谢杂志

A number of biosimilars will be soon marketing due to the expiration of patent protection of their originators.Unlike classical chemical drugs,biotherapeutics are proteins with large and complex molecules produced by biological high-tech with sophisticated manufactural procedures.This leads to the difficulties of the copy of biosimilars from their originators,and the almost inevitable distinctions between the two products.Thus biosimilars are only similar but not identical to their reference drugs in terms of stracture,action,and safety.It is important for physicians to understand these differences before using biosimilars.Optimal management by a national regulatory authority with rigorous standards is very important in all aspects of authorization of the development,production,marketing,and postmarketing surveillances for biosimilars.

Biosimilarity: resemble or not? The diffirence between biosimilarity and low molecule medicine

Studies of 11 biosimilarities. Result: in vitro bioactive was from 71-226% compared to Eprex. 9/11 biosilmilars had different isome from standard. Among 12 samples from 5 producers, the effectiveness was from 67.6% to 119.4% differently from European stardard. In three samples, toxic level was 15 higher than maximum accepted starndard. Isomeric samples also varied among producers. The study showed Epoetin produced outside of The United States and Europe had very different elements not in conformity with full process. The content on label was often lower or exceeded the limit.