Changing trends in the use of anti-vascular endothelial growth factor (anti-VEGF) biosimilars: Insights from the Vitreoretinal Society of India Biosimilars of Anti-VEGF Survey

Abstract

Purpose: The aim of this study was to present the outcomes of the 2018 and 2020 Vitreo-retinal Society of India (VRSI) biosimilars of anti-vascular endothelial growth factor (VEGF) (VIBE) surveys.

Methods: An online survey of members of VRSI was conducted in July 2018 and January 2020 regarding their practice-patterns on anti-VEGF biosimilars pertaining to safety, efficacy, pricing, and need for enhanced clinical trials before regulatory approval.

Results: In 2018, 112 VRSI members participated, whereas in 2020, 98 society members participated. In both surveys, majority of respondents were aware of biosimilars (96%, 2018 vs. 100%, 2020; P = 0.9) and felt that approval of biosimilar drugs should be made more stringent with larger clinical trials (89%, 2018 vs. 91%, 2020; P = 0.93). An increase in use of ranibizumab-biosimilar (41%, 2018 to 56%, 2020; P = 0.2) and a simultaneous significant decline in use of bevacizumab-biosimilar (9%, 2018 to 2%, 2020; P = 0.04) was noted from 2018 to 2020. From 2018 to 2020, the proportion of respondents satisfied with safety (61% to 68%; P = 0.59) and efficacy (65% to 81%; P = 0.32) of ranibizumab-biosimilar increased. However, during the same period, we noted in reduction in satisfaction levels with safety of bevacizumab-biosimilar (30% to 25%; P = 0.54), whereas satisfaction with its efficacy was stable (29% vs 30%; P = 0.99). A substantial proportion of retina specialists considered that current cost of ranibizumab-biosimilar ($130) was sufficiently low for it to be used as a substitute for Avastin (37%, 2018 and 40%, 2020; P = 0.82).

Conclusion: The VRSI surveys reveal that Indian vitreoretinal specialists are familiar with anti-VEGF biosimilars. There was a progressive trend favoring ranibizumab-biosimilar over bevacizumab-biosimilar. One-third of the participants deem the current price of ranibizumab-biosimilar as appropriate to replace Avastin. Simultaneously, the need for enhanced pharmacovigilance and larger clinical trials are warranted for regulatory approval of these agents.

Keywords: Bevacizumab; Razumab; Vitreoretinal Society of India; biosimilars; ranibizumab.

Figure 1

Economics of anti-VEGF biosimilars. (a). Price of anti-VEGF injection in India (US dollars; $); (b). Graph showing ewillingness to payf price of ranibizumab biosimilar (Razumab) at which the respondents would switch from Avastin. (c). Graph showing similar proportion of respondents in 2018 and 2020 who are of the opinion that the current price of the ranibizumab biosimilar warranted a switch from Avastin. (d). Graph showing that a majority of respondents believe that biosimilars have made anti-VEGF treatment more affordable

Figure 2

Outlook towards anti-VEGF biosimilars. Bulk of the respondents in the VIBE surveys were aware regarding biosimilars (a) and feel that they require more stringent procedure for approval (b). From 2018 to 2020, there was a rise in proportion of respondents using ranibizumab biosimilar, while simultaneously, the usage of bevacizumab biosimilars declined (c). Similar trend was also noted when the respondents favored use ranibizumab biosimilar (d)

Figure 3

Safety and efficacy of anti-VEGF biosimilars. From 2018 to 2020, we noted an increase in satisfaction levels with the safety (61% to 68%) and efficacy (65% to 81%) of ranibizumab biosimilar amongst the participants (a and c). Yet, during the same period, the number of respondents satisfied with the safety of bevacizumab biosimilar (30% to 25%) reduced, whereas satisfaction with its efficacy remained almost identical (29% vs 30%) (b and d)

Figure 4

Graph showing annual growth in sales of ranibizumab biosimilar (Razumab