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      Registro sanitario de medicamentos biológicos y biotecnológicos en América Latina Translated title: Marketing authorization of biologic and biotechnological products in Latin America

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          Abstract

          Resumen Introducción: los medicamentos biológicos se definen como productos cuyos ingredientes activos son producidos por una fuente biológica, mientras que un producto biotecnológico se desarrolla a partir del aislamiento de un gen de interés y su clonación. Método: se realizó un estudio comparativo de las regulaciones vigentes a julio de 2020 relacionadas con medicamentos biológicos y biotecnológicos de los países de Centroamérica y el Caribe que actualmente disponen de un marco regulatorio para su registro, con respecto a aquellas de Chile y Brasil. Resultados: existen diferencias relevantes en diversos aspectos. Dentro de la información general solicitada se encontraron variaciones para las definiciones de autoridad reguladora de referencia, producto biotecnológico, producto de referencia y producto innovador. También se hallaron divergencias para la información no clínica y clínica solicitada, y los programas de farmacovigilancia. Para productos biosimilares se distinguieron particularidades referentes a su definición y la de ejercicio de biosimilitud, así como para aspectos propios de su utilización como lo son la extrapolación de indicaciones y la sustitución automática o intercambiabilidad. Finalmente, para su etiquetado se requiere mayor estudio por parte de las autoridades sanitarias. Conclusiones: una vez realizada la revisión de la normativa respecto al registro sanitario de productos biológicos y biotecnológicos en nueve países de América Latina, se encontró que la información solicitada no se halla homologada.

          Translated abstract

          Abstract Introduction: biological products are defined as products whose active ingredients are produced by a biological source, while biotechnological medicine is developed from the isolation of a gene of interest and its cloning. Method: a comparative study was carried out of the regulations in force as of July 2020 related to biological and biotechnological drugs of the countries of Central America and the Caribbean that currently have a regulatory framework for their registration, with respect to those of Chile and Brazil. Results: there are relevant differences in various aspects. Within the general information requested, variations were found for the definitions of Stringent Regulatory Authority, biotechnological product, reference product, and innovative product. Also, divergences were found for the non-clinical and clinical information requested and the Pharmacovigilance programs. For biosimilar products, particularities were distinguished regarding their definition and the exercise of biosimilarity, as well as for aspects of their use, such as the extrapolation of indications and automatic substitution or interchangeability. Finally, their labeling requires further study by the health regulatory authorities. Conclusions: after reviewing the regulations for the marketing authorization of biological and biotechnological products in nine Latin American countries, it was found that the requested information is not homologated.

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          An overview of FDA-approved biologics medicines.

          Recombinant DNA technologies revolutionized medicine. Herein, the approvals and mechanistic basis of biologics-based medicines are analyzed. The overall and relative rate of FDA approvals for recombinant proteins grew from the 1980s through the first half-decade of the new millennium. Over time, the number of biologics gaining approval for an orphan indication has climbed to more than 50% in the current decade. The field has been dynamic in terms of the types of biologics, indications targeted and the mechanistic basis of drug activity. Despite impressive increases in recombinant-protein-based medicine, the rate of new biologics approvals could have leveled out.
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            Immunogenicity of Innovative and Biosimilar Monoclonal Antibodies

            The development of hybridoma technology for producing monoclonal antibodies (mAbs) by Kohler and Milstein (1975) counts as one of the major medical breakthroughs, opening up endless possibilities for research, diagnosis and for treatment of a whole variety of diseases. Therapeutic mAbs were introduced three decades ago. The first generation of therapeutic mAbs of murine origin showed high immunogenicity, which limited efficacy and was associated with severe infusion reactions. Subsequently chimeric, humanized, and fully human antibodies were introduced as therapeutics, these mAbs were considerably less immunogenic. Unexpectedly humanized mAbs generally show similar immunogenicity as chimeric antibodies; based on sequence homology chimeric mAbs are sometimes more “human” than humanized mAbs. With the introduction of the regulatory concept of similar biological medicines (biosimilars) a key concern is the similarity in terms of immunogenicity of these biosimilars with their originators. This review focuses briefly on the mechanisms of induction of immunogenicity by biopharmaceuticals, mAbs in particular, in relation to the target of the immune system.
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              The Immunogenicity of Biologic Therapies.

              Virtually all therapeutic proteins (biologics) elicit an immune response with the consequent production of anti-drug antibodies (ADA). The majority of ADA to therapeutic monoclonal antibodies (mAbs) are directed against the antigen-binding site of the therapeutic mAb, and hence are neutralizing. This nature of the ADA response explains why fully human antibodies can still be highly immunogenic. The detection of ADA is technically challenging and all assays have limitations, namely a limited capacity in detecting ADA in the presence of a drug due to immune complex (IC) formation, which may underestimate the ADA incidence. Refined assays, able to disrupt drug-ADA ICs, have revealed the presence of ADA in a higher proportion of patients. The great heterogeneity among ADA assays prevents a direct comparison of immunogenicity between different molecules and across studies. The formation of drug-ADA ICs can significantly alter pharmacokinetics and directly reduce drug efficacy if the ADA titer (i.e., concentration) is sufficiently high and persistent. In patients with low ADA titer, free drug concentrations may remain high enough to be effective, while in patients developing high ADA titer a substantial part of the drug will be neutralized and clinical non-response is likely to occur. ADA can also increase the risk of adverse events, namely hypersensitivity reactions. Several studies have revealed the presence of ADA before a clinically overt adverse reaction, highlighting their predictive value. Algorithms integrating therapeutic drug monitoring and immunogenicity information in the current clinical evaluation of patients receiving biologics are today available to guide therapeutic decisions in clinical practice, helping us to design safer and more cost-effective therapeutic strategies.
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                Author and article information

                Journal
                ars
                Ars Pharmaceutica (Internet)
                Ars Pharm
                Universidad de Granada (Granada, Granada, Spain )
                2340-9894
                June 2021
                : 62
                : 2
                : 131-143
                Affiliations
                [1] Heredia orgnameRoche Servicios S. A. orgdiv1Área de Asuntos Regulatorios orgdiv2Departamento de Asuntos Médicos Costa Rica
                [2] San José orgnameUniversidad de Costa Rica orgdiv1Facultad de Farmacia orgdiv2Departamento de Farmacia Industrial Costa Rica
                Article
                S2340-98942021000200131 S2340-9894(21)06200200131
                10.30827/ars.v62i2.15862
                fd25b9d6-f629-4cf4-8b1d-29d1e9116d27

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 30 August 2020
                : 24 November 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 36, Pages: 13
                Product

                SciELO Spain

                Categories
                Artículos Originales

                legislación farmacéutica,biological products,biosimilar pharmaceuticals,products registration,pharmacy legislation,medicamentos biológicos,medicamentos biosimilares,registro de medicamentos

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