Biosimilar vs originator insulins: Systematic review and meta-analysis.

Biosimilar insulins have expanded the treatment options for diabetes. We compared the clinical efficacy and safety of biosimilar insulins with those of originator insulins by conducting a meta-analysis. A random-effects meta-analysis was performed on randomized controlled trials comparing biosimilar and originator insulins in adults with diabetes. Studies were obtained by searching electronic databases up to December 2017. Ten trials, in a total of 4935 patients, were assessed (2 trials each on LY2963016, MK-1293, Mylan's insulin glargine and SAR342434, and 1 trial each on FFP-112 and Basalog). The meta-analysis found no differences between long-acting biosimilar and originator insulins with regard to reduction in glycated haemoglobin at 24 weeks (0.04%, 95% confidence interval [CI] -0.01, 0.08; P for efficacy = .14, I2 = 0%) or at 52 weeks (0.03%, 95% CI -0.04, 0.1), or reduction in fasting plasma glucose (0.08 mmol/L, 95% CI 0.36, 0.53), hypoglycaemia (odds ratio 0.99, 95% CI 0.96, 1.03), mortality, injection site reactions, insulin antibodies and allergic reactions. Analyses stratified by type of diabetes and prior insulin use yielded similar findings. Similarly, no significant differences were found between short-acting biosimilar and originator insulins. In summary, our meta-analysis showed no significant differences in clinical efficacy and safety, including immune reactions, between biosimilar and originator insulins. Biosimilar insulins can increase access to modern insulin therapy and reduce medical costs.

Horizontal sliding of kilometre-scale hot spring area during the 2016 Kumamoto earthquake.

We report horizontal sliding of the kilometre-scale geologic block under the Aso hot springs (Uchinomaki area) caused by vibrations from the 2016 Kumamoto earthquake (Mw 7.0). Direct borehole observations demonstrate the sliding along the horizontal geological formation at ~50 m depth, which is where the shallowest hydrothermal reservoir developed. Owing to >1 m northwest movement of the geologic block, as shown by differential interferometric synthetic aperture radar (DInSAR), extensional open fissures were generated at the southeastern edge of the horizontal sliding block, and compressional deformation and spontaneous fluid emission from wells were observed at the northwestern edge of the block. The temporal and spatial variation of the hot spring supply during the earthquake can be explained by the horizontal sliding and borehole failures. Because there was no strain accumulation around the hot spring area prior to the earthquake and gravitational instability could be ignored, the horizontal sliding along the low-frictional formation was likely caused by seismic forces from the remote earthquake. The insights derived from our field-scale observations may assist further research into geologic block sliding in horizontal geological formations.