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      Biosimilar drugs: Current status

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          Abstract

          Biologic products are being developed over the past three decades. The expiry of patent protection for many biological medicines has led to the development of biosimilars in UK or follow on biologics in USA. This article reviews the literature on biosimilar drugs that covers the therapeutic status and regulatory guidelines. Appraisal of published articles from peer reviewed journals for English language publications, search from PubMed, and guidelines from European Medicines Agency, US Food Drug Administration (FDA) and India were used to identify data for review. Literature suggest that biosimilars are similar biological products, i.e., comparable but not identical to the reference product, are not generic version of innovator product and do not ensure therapeutic equivalence. Biosimilars present more challenges than conventional generics and marketing approval is also more complicated. To improve access, US Congress passed the Biologics Price Competition and Innovation act 2009 and US FDA allowed “abbreviated pathway” for their approval. U.S law has defined new standards and terms and EMA scientific guidelines have also set detailed approval standards. India being one of the most preferred manufacturing destinations of biosimilars, there is a need for stringent safety and regulatory guidelines. The New India Guidelines “Draft Guidelines on Similar Biologics were announced in June 2012, by Department of Biotechnology at Boston bio and available online.

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          Thrombocytopenia caused by the development of antibodies to thrombopoietin.

          Thrombocytopenia developed in some individuals treated with a recombinant thrombopoietin (TPO), pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMGDF). Three of the subjects who developed severe thrombocytopenia were analyzed in detail to determine the cause of their thrombocytopenia. Except for easy bruising and heavy menses, none of these subjects had major bleeding episodes; none responded to intravenous immunoglobulin or prednisone. Bone marrow examination revealed a marked reduction in megakaryocytes. All 3 thrombocytopenic subjects had antibody to PEG-rHuMGDF that cross-reacted with endogenous TPO and neutralized its biological activity. All anti-TPO antibodies were immunoglobulin G (IgG), with increased amounts of IgG4; no IgM antibodies to TPO were detected at any time. A quantitative assay for IgG antibody to TPO was developed and showed that the antibody concentration varied inversely with the platelet count. Anti-TPO antibody recognized epitopes located in the first 163 amino acids of TPO and prevented TPO from binding to its receptor. In 2 subjects, endogenous TPO levels were elevated, but the TPO circulated as a biologically inactive immune complex with anti-TPO IgG; the endogenous TPO in these complexes had an apparent molecular weight of 95 000, slightly larger than the full-length recombinant TPO. None of the subjects had atypical HLA or platelet antigens, and the TPO cDNA was normal in both that were sequenced. Treatment of one subject with cyclosporine eliminated the antibody and normalized the platelet count. These data demonstrate a new mechanism for thrombocytopenia in which antibody develops to TPO; because endogenous TPO is produced constitutively, thrombocytopenia ensues.
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            Biosimilars-why terminology matters.

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              EMPHYSEMATOUS PYELONEPHRITIS

              Dear Editor, A 48-year-old female with poorly controlled diabetes mellitus (DM) presented herself with a five-day history of fever, chills, left flank pain and dysuria. On admission, her abdomen was mildly distended and tender over the left lumbar region. Laboratory data showed white blood cell count of 18.6×109/L with 91.7% neutrophils, serum creatinine at 223 μmol/L, C-reactive protein at 168 mg/L and glycosylated hemoglobin (HbA1c) at 14.1%. Urine analysis showed turbid appearance with obvious pyuria, hematuria and proteinuria. A renal ultrasound scan revealed potential signs of gas in the parenchyma of the left kidney. A non-contrast computed tomography (CT) scan of the abdomen demonstrated swelling of the left kidney with visible gas in the renal parenchyma (Fig. 1), radiologically associated with emphysematous pyelonephritis (EPN, Class 2). The patient underwent CT-guided percutaneous catheter drainage (PCD) and was treated with broad-spectrum intravenous antibiotics and rigorous blood sugar control. The urine and pus cultures showed significant growth of Escherichia coli (E. coli). From the above medical procedures, the patient improved significantly and was discharged with an excellent prognosis. EPN is an uncommon, but acutely severe and life-threatening necrotizing kidney infection, which is characterized by gas accumulation in the renal parenchyma, collecting system, or perinephric tissue1 , 2 , 4. The disease usually occurs in female patients with poorly controlled DM, with or without urinary tract obstruction1 , 2 , 4. E. coli is the most common pathogen, which has been extracted from urine or pus cultures in almost 70% of the patients4. EPN is a radiological diagnosis, with CT scan currently being the imaging procedure of choice for early diagnosis and assessment of the disease1 , 2 , 4. Importantly, PCD is now the most appropriate strategy and the gold standard in management of EPN2 , 3. Over the last two decades, improvements in management techniques have drastically reduced the mortality rate of EPN to 21%3 , 4. Fig. 1 Computed tomography (CT) scan of the abdomen showing a mottled gas collection within the parenchyma of the swelling left kidney
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                Author and article information

                Journal
                Int J Appl Basic Med Res
                Int J Appl Basic Med Res
                IJABMR
                International Journal of Applied and Basic Medical Research
                Medknow Publications & Media Pvt Ltd (India )
                2229-516X
                2248-9606
                Jul-Dec 2014
                : 4
                : 2
                : 63-66
                Affiliations
                [1]Department of Pharmacology, GMCH, Chandigarh, India
                Author notes
                Address for correspondence: Dr. Rajiv Kumar, H. No - 1156 B, Sector 32 B, Chandigarh - 160 030, India. E-mail: drrajiv.08@ 123456gmail.com
                Article
                IJABMR-4-63
                10.4103/2229-516X.136774
                4137643
                25143877
                6551574a-f09f-4141-a966-ae89b8dfc61c
                Copyright: © International Journal of Applied and Basic Medical Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 October 2013
                : 28 February 2014
                Categories
                Review Article

                biologicals,biosimilars,european medicines agency,food drug administration,guidelines,india

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