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Comparability Study (for Biosimilar) Wisit Tangkeangsirisin, PhD Faculty of Pharmacy, Silpakorn University Content: • • • • • Biosimilar Definition and Concept Regulations Quality Assessment of Biosimilar Example and Cases Assignment Biologics Biopharmaceuticals Recombinant Proteins Monoclonal Antibodies Etc. Blood & Blood Products Others Gene therapy Cell therapies Tissue therapy Allergens Vaccines & Toxoids Required only for Biosimilarity Major Biopharmaceuticals Recombinant Proteins • Insulin, Epoetins, Interferons, Somatropin , Filgrastim Monoclonal Antibodies • Trastuzumab, Rituximab, Infliximab Immunoglobulin Fusion Proteins • Etanercept Biopharmaceuticals First generation Second generation (biobetter) • Native Proteins, Unengineered • murin antibodies, simple replacement proteins • Frequent Injection • Engineered, modified, alteration of amino acid sequence, alteration of glycosylation, PEGylation • Suitable PK 7 Monoclonal Antibodies Structurally much more complex than other proteins Complexity • More complex than currently developed biosimilars Biological Activity • glycosylation patterns are critical-smalll differences correlate to changes in biological activity Predictability • multi-functionlity (binding and immuneffector functions) coupled with an often limited understanding of structurefunction relationship will limit predictability of in vitro data Extrapolation • complexity and diversity of the mechanisms of action will be of particular challenge for indications and line extensions 9 Quality Attributes to Consider - Mab Functional characteristics Physico-chemical characteristics N-terminal heterogeneity pyroglutamate formation Other modifications AA modifications deamidation, oxidation, glycation, isomerization Fab Fragmentation Cleavage in hinge region, Asp-Pro Oligosaccharides Fucosylation, sialyation, galactosylation… Fc Effector functions Disulfide bonds complement interaction Fc recepter interaction Free thiols, disulfide shuffling, thioether C-terminal heterogeneity Lysine processing, proline amidation 10 Biologics are hard to copy Significance and Needs WHY BIOSIMILAR?? Why Biosimilar? • Ensuring safety and effectiveness • Accessibility of high cost medicine Definition Global Approval Pathways Key Issues BIOSIMILARS NDA vs. ANDA Review Process New Drug NDA Requirements Generic Drug ANDA Requirements • • • • • • • • • • • • • Chemistry Manufacturing Controls Labeling Testing Animal Studies Clinical Studies Bioavailability Chemistry Manufacturing Controls Labeling Testing • Bioequivalence Generics vs. Biosimilars Generics Patent Biosimilars Expired Active Pharmaceutical Ingredients Identical Proof Needed Bioequivalence Comparability Never identical (Highly Similar) What Biosimilar are…. And are not? • They are similar …… They are not the same • They are different from innovator’s product. • They are not generic biologics Which biologics are in the scope of Biosimilar? Vaccines Blood Products Recombinant Proteins Monoclonal Antibodies Transgenic cells/ Cell therapy EMA guidelines – can be adapted to all biologics including blood products, vaccines WHO guidelines and others – adapted only well established and well characterized biotherapeutic products BioMarket Trends Jun 15, 2012 (Vol. 32, No. 12) Biosimilar Market Posts Steady Gains Actual Performance Varies between Regulated and Semi- and Unregulated Environments. Biosimilarity requirements 21 Same Approval Pathway as Generics for Biologics? • For Blood Products and Vaccines – No, the approval pathway treats them as New biologics. • For Recombinant Proteins – Yes and No • Yes • No • Somewhat between Generic Approval New biologics Approval Biosimilar Biosimilarity is built on five indispensible pillars. Modified from lecture of Dr. Thomas Schreitmueller Approval of Biosimilar vs. Originator Biologics Pharmacovigilance Clinical (PI,II,III for each indication) Clinical (with extrapolation) Non-clinical Non-Clinical Chemistry, Manufacturing and Control Originator Biologics 24 Comparability exercise in Quality Chemistry, Manufacturing and Control Biosimilars Establishment of biosimilar guidelines increased, driven by WHO But: Variability in adoption by National Regulatory Authorities 2010 2015 Biosimilar pathways in place Biosimilar pathways under development 25 Global regulatory environment • In general, regulators require: – Comparative analytical program – Clinical program – Post-approval commitment to Pharmacovigilance – High degree of analytical similarity – High degree of pre-clinical and clinical similarity • Regulators may permit extrapolation when scientifically justified. 26 Key Issues in Biosimilar Dossier • Quality Comparisons – The most critical and extensive step – Cell culture, impurities, glycosylations …….. • Non-clinical Comparisons – In vitro receptor binding & cell based assay are fundamental • Clinical Comparative Studies – Most sensitive population and endpoints – 6-12 months safety data – Extrapolation of indications 27 28 Current Thailand Biosimilar Guidelines คู่มือ และหลักเกณฑ์ การขึน้ ทะเบียนตารั บยาชีววัตถุคล้ ายคลึง 2556 Biotechnology-derived proteins Defines philosophy and principles General guidelines Quality NonClinical EPO Review Unorthodox Pathway ???? Epoetin Clinical 2557 IFN-α Somatropin NonClinical NonClinical NonClinical Clinical Clinical Clinical 2559 2558 IFN-β FSH NonClinical NonClinical NonClinical Clinical Clinical Clinical GCSF mAbs NonClinical Clinical Immunogenicity Guideline for biosimilars Annex guidelinesspecific data requirements ประเภทของยาชีววัตถุในประเทศไทย • Previous • New Regulations • ยาชีววัตถุใหม่ • ยาชีววัตถุท่ ไี ม่ ใช่ ยา ใหม่ • ยาชีววัตถุใหม่ • ยาชีววัตถุคล้ ายคลึง 30 EXTRAPOLATION OF INDICATIONS key to the biosimilar concept needs to be justified in all cases Extrapolation of Indications • The Key Consequence of Biosimilar is the EXTRAPOLATION of INDICATIONS • Justification of the extrapolated indication is on a case-by-case basis. • Decision based upon mechanism of action, type of receptors, Affinity etc. Interchangeability • In EU, the biosimilar approval do not automatically allow interchangeability • Interchangeability/switching remains a national decision. • Later, after 10 yrs experience of biosimilar in the market, several countries change regulations. Dossier requirements for a biosimilar vs. an originator The State of the Art in the Development of Biosimilars Mark McCamish and Gillian Woollett Nature Biotechnology 30, 1179–1185 (2012) Manufacturing Process (1) • Demonstrate the Consistency and Robustness of manufacturing process – – – – cGMP implementation Modern QA/QC procedures In-process controls Process validation • Minimize Differences b/w SBP vs. RBP – Reduction clinical testing requirements of SBP – Minimize any predictable impact on clinical safety and efficacy of SBP • Differences are expected and may acceptable – Appropriate justification lack of impact on clinical performance 37 Manufacturing Process (2) • Current manufacturing process following current guidelines (ICHs) and extensive quality control is encourage • Potential impact of Changing of on Quality Safety and Efficacy should be identified. • Some Differences are expected and may acceptable – Appropriate justification (based on scientific and clinical experience lack of impact on clinical performance Comparability Exercises in Quality of Drug substance General Principles Manufacturing Processes • To ensure the similarity of drug substance in SBP vs. RBP (vs. Reference standard) • Products should be expressed and produced in the same host cell type • • • • • • • • • Expression vectors Cell banks Cell culture/ Fermentation Harvest Purification Modification reaction Filling / Storage Dosage form Container closure system Analytical Techniques • Using appropriate, state-of-the-art in Biochemical, Biophysical, Biological • Provided on – Primary and higher-order structures – Post translational modifications – Biological activity – Purity – Impurities – Product-related substance – Immunochemical properties Justification of Analytical Methods • Suitability – State-of-the-art (Current and upto-date) – Able to detect any difference between SBP vs. RBP • Method Validations Physicochemical Assessment • A comprehensive understanding and description of the RBP vs. SBP to support development throughout the manufacturing process to – Understand impact of manufacturing changes – Ensure continued and consistent biosimilar properties to the reference product – Build a database to support the Quality by Design (QbD) program • Orthogonal methods/multiple techniques employed to fully elucidate structure (as far as possible) including microheterogeneities Physicochemical Assessment Extensive enough to fully characterize primary and higher order structure including post translational modifications • Primary structure, sequence and bridging (disulphide, thioether) • Higher (secondary, tertiary and quaternary) order structure • C and N terminal variants • • • • • • • Post translational modifications Protein concentration Surface charge Protein size Aggregation Bioassay, potency Purity and impurities Biosimilar filgrastim compared to reference product (Neupogen) using three state-of-theart analytical techniques The State of the Art in the Development of Biosimilars 2/22/2013 Wisit Tangkeangsirisin, Biosimilars Mark McCamish and Gillian Woollett Guideline Public Hearing 44 Biological Activity Assessment • Biological activity based on clinically relevant assays are required • The extent is, to some degree, predicated by the physicochemical data • All clinically relevant functional attributes to be assessed where possible – E.g., for a mAb it may be necessary to test for both antigen binding and effector binding in appropriate in-vitro bioassays • Relevance may determine extent of further nonclinical (and clinical studies) – Animal toxicity studies not useful if no suitable model – Studies should be comparative and provide a meaningful toxicological comparison – Stand-alone toxicology study can be justified – Safety pharm, repro toxicity, and carc studies not generally warranted – Single-dose PK and PD study in animals can be useful Specifications • ICH Q6B : Specifications: Test Procedures and Acceptance Criteria for Biotechnological/Biological Products – Data from batch-to-batch consistency, pharmaceutical development, comparability exercise in quality, safety and efficacy profile • Range of acceptance should not wider than RBP No significant differences Significant differences Significant differences Significant differences Significant differences No significant differences No detectable difference No significant differences Clinical Results Biophysical Comparison Full Comparability Studies for Safety and Efficacy Bioequivalence Based Approach Possible biophysical and clinical outcomes for biosimilars Biosimilar Development Understand a Reference Product • Characterization • Identify Critical Quality Attributes (CQA) Creating and Producing a Biosimilar • Identify the suitable clones • Production process development Throughout Comparison of the Reference Product vs Biosimilar • Analytical testing and Clinical study • Totality of Evidence for similarity 48 Biosimilar Development 49 Data requirements for comparability exercises for a moderate risk and a high risk manufacturing change by the same manufacturer compared with a biosimilar manufacturing process. 50 http://www.amgenbiosimilars.com/manufacturing/comparability-vs-biosimilarity/ Therapeutic Mab Critical Quality Attributes Charge Variants Glycolysation Immunogenicity Aggregation & Degradation Primary & High Order Structures 52 WHY DO WE NEED STATE OF THE ART ANALYTICS? 55 Quality: Analytical • Analytical comparison is more than “Just Meets Specs” • Possible Analytical Comparison Outcomes – Analytical Methods Alone Confirm High Similarity – Analytical Methods Not Sufficient or Adequately Discerning – Analytical Methods Confirm Differences, but Differences Are Shown to Be Not Practically Significant • Eg. HX575-higher phosphorylated mannose type glycan – Analytical Methods Confirm Differences, but Significance of Differences on Safety and Efficacy Cannot Be Ruled out – Analytical Methods Confirm Not Comparable – Analytical Methods is better 56 Changes in Process: Changes in Products Quality Attributes ARANESP 57 State of the Art Analytics 58 http://www.amgenbiosimilars.com/the-science/state-of-the-art-analytics/ RITUXAN 59 ENBREL 60 CASE STUDIES ON BIOSIMILAR APPROVAL IN EU Omnitrope (somatropin) • RBP = Genotropin • During development, changes by increase complexity of comparability demonstration • Esp. Additional steps to reduce Host Cell Protein • V. high level of non-neutralizing antibodies (about 60%, during clinical trials (old process)) Binocrit (Epoetin alpha) • RBP = Eprex • Extensive characterization and comparability exercise in quality • Structure comparisons – Qualitative similar – Quantitative differences found (increase in high mannose-6-phosphate, Decrease in N-glycolylneuraminic acid (NGNA) – Differences was justified • PRCA concerns – SC route contraindication in CKD Silapo (epoetin zeta) • RBP = Eprex • Extensive characterization and comparability exercise in quality • Structure comparisons – Qualitative similar – Quantitative differences found (increase in des Oglycan forms, Decrease in NGNA – Differences was justified • SC route initially contraindicated • SC indications added post-authorization upon further clinical data Zarzio (filgrastim) • RBP = Neupogen • Extensive characterization and comparability exercise in quality • Clinical data – Phase I: Comparative PK/PD studies in healthy volunteers. Efficacy endpoints: neutrophil and CD34 cell counts – Phase III: Non-comparative (single arm) clinical trial in cancer patients undergoing chemotherapy. Safety focus • G-CSF Guideline states: – “The recommended clinical model for the demonstration of comparability of the test and the reference medicinal product is the prophylaxis of severe neutropenia after cytotoxic chemotherapy in a homogenous patient group (…). Alternative models, including pharmacodynamic studies in healthy volunteers, may be pursued for the demonstration of comparability if justified” Valtropin (somatropin) • RBP = Humatrope • Different expression system compared to reference medicinal product (S. cerevisiae vs. E.coli). Process specific HCP (yeast) assay required • Changes during development subject to additional comparability • Clinical trial: – Initially calculated to demonstrate non-inferiority – US sourced RBP used (supportive data) • Indication differ from Omnitrope – Pediatric indication for Omnitrope only: Small gestational Age, Prader-Willi Syndrome • May 2012 Voluntarily withdrawn for commercial reasons Insulin Marvel (Withdrawal) • RBP = Humulin S • Three forms (Short, Intermediate (30/70), Long acting) • Quality Concerns – – – – Incomplete comparability exercise, esp Drug Product Inadequate process validation Missing batch traceability More data required for extended release forms • Clinical issues – Comparative PK/PD: euglycaemic clamp – most sensitive model – Similar PK Parameters, but not similar PD profiles (faster glucose absorption – Applicant resorted to efficacy trial with HbA1C end-point, not sufficiently sensitive – Limit Immunogenicity data Alpheon (rhIFNalpha-2a; Negative) • RBP = Roferon-A • Quality concerns – Stability and impurities for drug substance and drug product profile also not matching RBP – Inadequate process validation in DP – No comparability studies between clinical trial batches and commercial batches • Non-clinical studies were inadequate and indicated differences • Clinical issues – – – – Difference in virological relapse rates Inconclusive data in response rate for Genotype 1 patients Different rate of adverse events Inadequate immunogenicity documentation Some Concerns About Biosimilars • Route of Administration for approved indications of biosimilar may not be the same as Reference Biological Product – Eg. Binocrit initially contraindicated in CRF by SC route Different glycan pattern--Not biosimilar REALLY???????? HX575 has different glycan profiles from RBP. But the differences are acceptable and justified. EPO Isoforms among Biosimilar vs. RBP are similar. Not Identical “ More recently, two cases of neutralizing antibodies were reported during a pre-marketing clinical trial of a biosimilar epoetin (HX575) in subcutaneous administration in chronic renal failure subjects (9). In this paper, we present data showing that contamination by tungsten during the manufacture of the syringes used for primary packaging is the most likely cause of protein denaturation and aggregation, which may have led to the occurrence of two cases of neutralizing antibodies in the investigational clinical trial. Conclusion • Quality assessment is the primary and major part of biosimilar registrations. • Comparability studies with RBP determine the degree of intensity in non-clinic and clinical assessment. • State-of-the-Art technology should be used to detect any potential differences. • How to demonstrate product comparability is challenging • Case studies about EU biosimilar approval confirmed case-by-case varies Thank you Any questions, comments and suggestions are welcomes 74