Primary Adenocarcinoma Arising at a Colostomy Site

Taylor, C.; Agarwal, Shreya; Haubert, Lisa

doi:10.1016/j.cgh.2017.12.012

Cited by 1 publication

(1 citation statement)

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“…Although data from randomized controlled trials were generally positive [ 44 – 49 ], real-world data indicated that discontinuation rates were higher in patients switched to a biosimilar for non-medical reasons than in historical cohorts maintained on innovator TNF inhibitors [ 8 , 50 – 54 ]. Limited real-world data exist on NMS from a biosimilar to an innovator [ 55 ], but as a biosimilar would have been approved only if it was shown not to yield clinically meaningful differences relative to its innovator, it is reasonable to assume that the act of switching in and of itself—rather than the direction of the switch (innovator to biosimilar or vice versa)—is responsible for the increased discontinuation rates reported in the real-world setting.…”

Section: Issues With Non-medical Switchingmentioning

confidence: 99%

The Automatic Substitution of Biosimilars: Definitions of Interchangeability are not Interchangeable

et al. 2021

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In the USA, an interchangeability designation provides biosimilar sponsors with a pathway for achieving what is standard for small-molecule generics: pharmacy-level auto-substitution for an innovator. No other major health authority links interchangeability to automatic substitution, as all require the involvement of the prescriber or patient in a medication change. This editorial considers the clinical impact and practicality of auto-substitution. First, interchangeability is linked to non-medical switching (NMS), the practice of switching treatment in patients with stable disease for non-clinical reasons. NMS may generate negative sentiment in those unwilling or reluctant to switch, which can adversely impact treatment outcomes (i.e., nocebo effect). Indeed, in real-world studies of tumor necrosis factor inhibitors, discontinuation rates have been shown to be higher in patients switched to biosimilars for non-medical reasons than in historical cohorts maintained on innovators. Second, interchangeability may impede pharmacovigilance and traceability, as not all jurisdictions require innovators and biosimilars to have distinct biologic names. Third, an interchangeability designation from the US Food and Drug Administration only permits a biosimilar to be automatically substituted for its innovator, not other biosimilars (if available). Pharmacist education would be needed to avoid off-label, automatic substitution among biosimilars of a single innovator. Last, once granted, an interchangeability designation exists in perpetuity under current US federal law. However, the supply chains of innovators and biosimilars are maintained independently, with no requirement for reconfirmation of biosimilarity or interchangeability. We feel that additional guidance is needed for the auto-substitution of biosimilars and innovators to become a reality.

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