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Biosimilar Development EPTM 2015

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Sharing my learning in dealing with complexity and uncertainty and shed some light on:
(a) Understanding the ‘biosimilar paradox’
(b) Accelerating our “QbD” Journey – focusing on ‘from Generics to Biosimilars’
(c) In preparing this talk, collect my thoughts to help NIPTE consider ways for developing its program on Biosimilars to help the Nation improve assurance of quality with confidence and lower costs
(D) Invite the audience to get to know NIPTE and provide us ways to collaborate with industry

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Biosimilar Development EPTM 2015

  1. 1. Biosimilar Development Our “QbD” Journey from Generics to Biosimilars Ajaz S. Hussain, Ph.D. The National Institute of Pharmaceutical Technology & Education, Inc. & Insight Advice and Solutions LLC. Celebrating 54 Years September 25, 2015, Basking Ridge, NJ 9/24/2015 ajaz@nipte.org 1
  2. 2. Biosimilars @ US FDA: Current state 57 products in review, 16 reference products • New Review paradigm; totality of evidence – putting analytics first • Advisory committee process (Zarxio®; ‘totality of evidence’ making the case to clinicians poses challenges) • Final Guidance documents • Scientific Considerations in Demonstrating Biosimilarity to a Reference Product (2012) • Quality Considerations in Demonstrating Biosimilarity to a Reference Protein Product (2012) • Biosimilars: Questions and Answers Regarding Implementation of the Biologics Price Competition and Innovation Act of 2009 (2012) • Formal Meetings Between the FDA and Biosimilar Biological Product Sponsors or Applicants (2013) • Clinical Pharmacology Data to Support a Demonstration of Biosimilarity to a Reference Product (2014) • Other documents • Purple book • Draft guidance Naming, labeling • Planned guidance Statistical approaches to analytical similarity • Planned guidance Interchangeability • Building confidence – education? • 30 years of Generics; still we have confidence challenges • How will we build confidence in ‘biosimilars’? 9/24/2015 ajaz@nipte.org 2
  3. 3. 9/24/2015 ajaz@nipte.org 3 generics are for minor but not serious illnesses;… and poor people are forced to ‘settle’ for generics. What do people really think of generic medicines? A systematic review and critical appraisal of literature on stakeholder perceptions of generic drugs. BMC Medicine 2015, 13:173 36 % of the patients reported negative experiences after medication substitution 89 % of pharmacists reported receiving patient complaints regarding use of generic medicine, although 64 % suggested that this was due to a nocebo effect Only 50.2 % of the surveyed pharmacists agreed that all products that were approved as generic equivalents can be considered therapeutically equivalent. Just 6 % of pharmacists considered that dry powder inhalers were interchangeable. While acceptance of generic medications is improving, substantial mistrust and lack of confidence remains, particularly within the patient and, to a lesser extent, physician groups. Nearly half the patients stated they would refuse generic substitution when it became available if this was just to save the health authority money. Generic medicines were considered to be poor quality and treated with suspicion.
  4. 4. Zarzio® (EU) & Zarxio® (US) EP2006 Zarzio® Zarxio® US‐NeupogenEU‐Neupogen 9/24/2015 ajaz@nipte.org 4 Highly similar Interchangeable?Highly similar Highly similar Extrapolation of indications; easier Extrapolation of indications; difficult Finger-print like similarity; statistical confidence Products and Trade-marks of Sandoz
  5. 5. This talk: My objectives • To share my learning in dealing with complexity and uncertainty and shed some light on • Understanding the ‘biosimilar paradox’ • Accelerating our “QbD” Journey – focusing on ‘from Generics to Biosimilars’ • In preparing this talk, collect my thoughts to help NIPTE consider ways for developing its program on Biosimilars to help the Nation improve assurance of quality with confidence and lower costs • Invite the audience to get to know NIPTE and provide us ways to collaborate with industry 9/24/2015 ajaz@nipte.org 5
  6. 6. 9/24/2015 ajaz@nipte.org 6 A unique, non-profit consortium of pharmaceutical science and engineering programs across 14 major research universities. Lowering cost & enhancing confidence…… Biosimilars Group Analytical Comparison of Parent and Follow-On Biologics to Aid Biosimilars Regulatory Guidelines Development •Lead: Anna Schwendeman •Institution: University of Michigan Physiochemical and Biological Evaluations of Different IgG1Fc Glycoforms as a Model of Biosimilar Comparability Analysis •Lead: Thomas Tolbert •Institution: University of Kansas http://www.nipte.org/
  7. 7. My viewpoints and interests Viewpoints • US FDA • SUPACs, BCS,….PAT, QbD, Integrations of Office of Biotechnology within CDER • Sandoz • Omnitrope®, Binocrit®, Zarzio®, generic enoxaparin, generic glatiramer acetate • Philip Morris International • Plant based vaccines and modified-risk tobacco products • Reconnecting with India • Wockhardt and current advisory practice in India – Culture of Pharmaceutical Quality Interests • NIPTE consider ways for developing its program on Biosimilars to help the Nation improve assurance of quality with confidence and lower costs • Insight Advice and Solutions LLC., Allocated time filled-up; not accepting new clients until the end of 2016 9/24/2015 ajaz@nipte.org 7
  8. 8. In the news; past few days Sept. 24, 2015 Novartis in biosimilar push to cut US drug prices: The introduction of biosimilar drugs in the US, which kicked off this month with Novartis’s version of an Amgen blockbuster, hands healthcare payers a new weapon against rising drug prices. Sept. 23, 2015 Amgen, Allergan Biosimilar Lung-Cancer Therapy Shows Positive Results: ABP 215 is being developed as a biosimilar to Roche’s Avastin Sept. 22, 2015 Lack of regulatory clarity dominates US biosimilar debates post Zarxio®: Sandoz has reiterated its call for US FDA guidance on biosimilar interchangeability arguing that the lack of clarity makes it hard to gauge what impact switching rules will have on pricing. 9/24/2015 ajaz@nipte.org 8
  9. 9. First Biosimilar Medicine Launches; Price Disappoints Those Hoping For Deeper Discount Forbes | Opinion Sept. 15, 2015 Chart using 2014 data. Retrieved from Rand Corporation, September 14, 2015. “..could reduce spending on biologics in the United States by $44 billion over the next decade..” Chart using 2013 data. Retrieved from Express Scripts, September 14, 2015. Another biosimilar is coming along that could actually cost taxpayers a higher price!!! 9/24/2015 ajaz@nipte.org 9
  10. 10. ‘Biosimilar Paradox’ 9/24/2015 ajaz@nipte.org 10 http://invivoblog.blogspot.com/2007/08/are-these-large-molecule-twins.html •Not Similar; Similar; Highly Similar; Highly similar; fingerprint-like similarity ; Interchangeable •Barriers to Market Entry - Commercial Success Disappointing •(Will) there will be significant savings for the U.S. Medicare and Medicaid programs? •US is not Europe! Zarzio® (EU) & Zarxio® (US)•
  11. 11. Biosimilar Paradox: EU Aug., 10 2007 • But despite Europe's pioneering regulatory pathway for biosimilars, and reluctant grunts of acceptance from originator companies, most of which have realized that it’s pointless and counterproductive to keep resisting the biosimilar movement, the going’s tough, according to Ajaz Hussain, Sandoz’s VP and Global Head of Biopharmaceutical Development. • One might expect a drug that sells at a 20-30% discount—he did confirm this much--to fly off the shelves, given all the fuss around Amgen’s monopoly over EPO supply…..and the noise that most European governments and US payors are making about drug costs. But education and perception are blocking widespread uptake…. 9/24/2015 ajaz@nipte.org 11
  12. 12. Biosimilar Paradox: Promises & Perils Steep discounts help biotech drug copies gain ground in Europe: Biosimilar antibody drug prices fall faster than expected ( Sept. 23, 2015, Reuters). But US is not Europe! Zarzio® (EU) & Zarxio® (US) There will be significant savings for the U.S. Medicare and Medicaid programs? CBO estimates savings of ~$25 billion between 2013 and 2020. How to build confidence, cost savings, and commercial success? Assessing Valuation Risk of Big Pharma Companies: Forbes | Investing (Sept. 21, 2015) J&J’s Remicade Revenues May See Significant Decline Merck May Actually Be Well Off In The Near Term Pfizer Seems To Have Upside Possibility Bristol-Myers Squibb’s Risk Lies A Few Years Ahead Roche Might Be Vulnerable, But Will Fiercely Defend Barriers to Market Entry: It takes 7 to 8 years to develop a biosimilar, at a cost of between $100 million and $250 million: Commercial Success (Currently) Disappointing ? ? 9/24/2015 ajaz@nipte.org 12
  13. 13. FDA's Woodcock to Senators: Need to First Get the Science Right on Biosimilars • Sept., 17 2015 • "We have to get the science right. We can't have problems with the first biosimilars out of the block" • One of the most important parts of launching a robust US biosimilar market and setting up the regulations to support it is to make sure the scientific framework is "bulletproof” • Key issues remaining - FDA guidance on interchangeability and the difficulties behind developing, naming and labeling • "We've laid out a plan of education campaigns and still need to determine what people need to know“ • It's a complicated issue so we have a menu of educational activities for the next several years“ • Does this mean the EU didn’t get its “science right”? No! 9/24/2015 ajaz@nipte.org 13
  14. 14. Essentially taken for granted  paying attention is the critical factor......... To understand this Paradox: Understand our “QbD” Journey from Generics to Biosimilars The Hatch-Waxman Act of 1984: Successfully contained the cost of small-molecule drugs; based on the [PE + BE = TE] paradigm [PE + BE = TE] paradigm struggles to deal with complexity; including Complex Generics The Biologics Price Competition & Innovation Act 2009: pathway for Biosimilars; recognizing the complexity; a high bar! PE = Pharmaceutical equivalence: BE = Bioequivalence TE = Therapeutic equivalence 9/24/2015 ajaz@nipte.org 14
  15. 15. Our “generic” paradigm: Interchangeability with confidence 9/24/2015 ajaz@nipte.org 15 Pharmaceutical Equivalence Bio-equivalence Practices > Confidence Therapeutic Equivalence
  16. 16. Generic paradigm has been tested and “knocked on its head” • “It still is solid” but in need for attention – particularly in the realm of complex generics • “Knocks on the head” • Generic Drug Scandal • Failures to detect obvious errors/flaws • Recent failures and manufacturing challenges • Tested – numerous prospective studies to assess therapeutic equivalence 9/24/2015 ajaz@nipte.org 16
  17. 17. “Knocks on the head” erode confidence and increase nocebo effects! • “Knocks on the head” have occurred • When we failed to appreciate a systems approach to development, review, process validation, and inspections (GLP/GCP/CGMPs) • When we ignored to ask the ‘right question’ and in the ‘right sequence’ • When we did not question assumptions we take for granted • Most of these relate to Pharmaceutical Equivalence • PE = dosage form (irrespective of color, shape, mechanism of release,….); • A clear liquid in a bottle is a “solution”: e.g., cyclosporine micro emulsion, and low- permeability excipients (e.g., sorbitol) • Consider current examples….ER failures and AB to BX downgrades • Our incorrect thinking – “BE is the pivotal evidence”; instead of integrating PE,BE, Practices – as in a system 9/24/2015 ajaz@nipte.org 17
  18. 18. “Pharmaceutical Equivalence” that is the ‘Elephant in the Dark’ • Q1/Q2 • Q1/Q2/Q3, …… • Today … Color, Shape,…..moving towards same mechanism of release? • Today we are back to “subjectXformulation” interaction – once again in healthy subjects? • Isn't this just an assumption? Which, politely, is not a part of “our elephant” but what comes out of it when we don’t pay attention to PE! • We lack consensus on a set of principles to integrate across multiple, orthogonal, analytical characterization tools for physical attributes and physical performance (e.g., size, shape, charge, flow, plume, …) • This is a “billion dollar” opportunity; but only for certain companies 9/24/2015 ajaz@nipte.org 18
  19. 19. 9/24/2015 ajaz@nipte.org 19 Ajaz Hussain. Reducing technical and regulatory uncertainty in biosimilar development (2014) Value of extensive analytical characterization Leveraging variability to reduce uncertainty in interchangeability
  20. 20. The “how” is very difficult because of “culture” and “mind-set” 9/24/2015 ajaz@nipte.org 20 Characterization of Brand Copaxone Thorough understanding of reference listed drug (Copaxone) required. Review available scientific, patent, and regulatory literature on Copaxone. Characterizationby more than 60 physicochemical, biological, and immunological methods. Multiple lots (up to 50 for some attributes) were studied over several years probing the range and diversity of the commercial lots, as well as evaluating the effects of lot aging. Four-Point Criteria for Demonstration of Equivalence of Glatopa and Copaxone Equivalenceof starting materials and basic chemistry. Equivalenceof structural signatures for polymerization, depolymerization, and purification. Equivalenceof physicochemicalproperties. Equivalenceof biologicaland immunological properties. Example: Equivalence considerations for Glatopa® and Copaxone® http://www.momentapharma.com/AAN-Equivalence-Glatopa-Poster-6x4-PRESS.pdf (accessed 16 September 2015)
  21. 21. 9/24/2015 ajaz@nipte.org 21 Ajaz Hussain. Reducing technical and regulatory uncertainty in biosimilar development (2014)
  22. 22. 9/24/2015 ajaz@nipte.org 22 Residual uncertainty; perhaps reserved for uncertainty in extrapolation to some indications Ajaz Hussain. Reducing technical and regulatory uncertainty in biosimilar development (2014)
  23. 23. Biosimilar: Totality of Evidence • New Review Paradigm – meeting format • Focus first on analytical characterization and comparability • Totality of evidence evolves – based on residual uncertainty • Is this a better – formalized- approach than for complex generics? • For Complex Generics OGD has been willing to meet with sponsors more often • However, time for complex generic approval is very protracted 9/24/2015 ajaz@nipte.org 23
  24. 24. Complex Generics & Biosimilars: What we need? • Put R back in R&D & recognize It is a “complex” product and process! • Invest smartly in analytics, mathematics & statistics, and large sample sizes; and in systems/integrative thinking and data integration • Get to know the RLD – multiple lots; open the door with large sample size • Build capability to justify measured RLD variability is relevant to development of the proposed generic/biosimilar • Exquisite regulatory communication strategy • This is not a ‘complicated process’ for which typical “good practices” will work seamlessly (e.g., typical project management approach); this is a complex process – with multiple interactions and “emergent properties” • Treat it as it is - a complex process and plan; anticipate and address “emergent issues” - in technical, regulatory and legal dimensions; at a certain point be prepared for stakeholder (payers, patient groups,..) communications 9/24/2015 ajaz@nipte.org 24
  25. 25. NIPTE: The Nation Needs • Seamless scientific logic bridging different legal and regulatory pathways • Accelerate achieving consensus on a set of generalizable principles for integrating information across multiple, orthogonal, analytical characterization tools for chemical, biological and physical attributes; to predict product performance, and estimate and describe residual uncertainty • Consider categories such as peptides (synthetic and recombinant) as a bridge between Generics and Biosimilars to achieve a ‘seamless scientific logic’ • The Nation needs the scientific & regulatory community to achieve this quickly – so that efforts to educate to build confidence, in the health care community and with patients, can begin 9/24/2015 ajaz@nipte.org 25

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