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Comparative Study
. 2017 Mar 10;7(3):e011637.
doi: 10.1136/bmjopen-2016-011637.

Comparative effectiveness and safety of erythropoiesis-stimulating agents (biosimilars vs originators) in clinical practice: a population-based cohort study in Italy

Francesco Trotta  1 , Valeria Belleudi  1 , Danilo Fusco  1 , Laura Amato  1 , Alessandra Mecozzi  2 , Flavia Mayer  1 , Massimo Sansone  2 , Marina Davoli  1 , Antonio Addis  1
Affiliations
Comparative Study

Comparative effectiveness and safety of erythropoiesis-stimulating agents (biosimilars vs originators) in clinical practice: a population-based cohort study in Italy

Francesco Trotta et al. BMJ Open. .

Abstract

Objectives: To evaluate the benefit/risk profile of epoetin α biosimilar with the erythropoiesis-stimulating agents (ESAs) originators when administered to naïve patients from clinical practice.

Design: Population-based observational cohort study.

Setting: All residents in the Lazio Region, Italy, with chronic kidney disease (CKD) or cancer retrieved from the Electronic Therapeutic Plan (ETP) Register for ESA between 2012 and 2014.

Participants: Overall, 13 470 incident ESA users were available for the analysis, 8161 in the CKD and 5309 in the oncology setting, respectively.

Interventions: ESAs identified through the ATC B03XA were divided into 3 groups: (1) biosimilars; (2) epoetin α originator and (3) other originators. Patients were exposed to ESAs from the date of activation of the ETP, until the end of a 6-month follow-up period.

Outcome measures: Effectiveness (all-cause mortality and blood transfusion) and safety (major cardiovascular events, blood dyscrasia). A composite outcome including all-cause mortality, blood transfusion and major cardiovascular events was predefined. HRs of any outcome were estimated through Cox regression.

Results: We found no differences between patients on biosimilars or all originators with regard to the risk estimates of all-cause mortality, blood transfusion, major cardiovascular events and blood dyscrasia in the CKD setting. The composite outcome confirmed these results (biosimilars vs epoetin α originators: adjusted HR=1.02, 95% CI 0.78 to 1.33; biosimilars vs other originators: adjusted HR=1.09, 95% CI 0.85 to 1.41). Comparable risk estimates were observed between biosimilars and all originators in the oncology setting.

Conclusions: In both settings, our findings are suggestive of no difference between biosimilars and originators on relevant effectiveness and safety outcomes. This study may contribute to settling future drug policy for the health services and provides reassurance on the approval pathway for biosimilars. The oncology setting merits further research, taking into account tumour types, tumour stage and anticancer chemotherapy administered.

Keywords: Comparative effectiveness; biosimilar; cohort study; erythropoiesis-stimulating agents; real life data.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of patients included in the study cohort. ESA, erythropoiesis-stimulating agent.
Figure 2
Figure 2
(A–D) HRs for the effectiveness and safety outcomes by settings. Green dots were the value of the HR estimate and the line represented the lower and upper values of the CIs. CKD, chronic kidney disease; MACE,major cardiovascular events.
See this image and copyright information in PMC

References

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