An Introduction to Biosimilars for the Treatment of Retinal Diseases: A Narrative Review

Abstract

Biological therapies have revolutionized the treatment of disease across a number of therapeutic areas including retinal diseases. However, on occasion, such treatments may be relatively more expensive compared to small molecule therapies. This can restrict patient access and treatment length leading to suboptimal clinical outcomes. Several biosimilar candidates of ranibizumab and aflibercept are currently in development and the first biosimilar of ranibizumab received EMA approval in August and FDA approval in September 2021. Biosimilars are biological medicines that are highly similar to an already-approved biological medicine (reference product). The physicochemical and clinical similarity of a biosimilar is determined by a rigorous analytical and clinical program, including extensive pharmacokinetic and pharmacodynamic analysis with phase III equivalence studies where appropriate. These phase III studies are carried out in a patient population that is representative of all of the potential approved therapeutic indications of the originator product and the most sensitive for detecting potential differences between the biosimilar and the reference product. Biosimilars have been used successfully across a wide range of therapeutic areas for the past 15 years where they have achieved substantial cost savings that can be reinvested into healthcare systems without affecting the quality of patient care. The current review provides an introduction to biosimilars with the aim of preparing retinal specialists for discussing these products with their patients.

Keywords: Biologics; Biosimilars; Development; Extrapolation; Interchangeability; Retinal disease.

Fig. 1

Key biosimilar legislation and guidance development and biosimilar cumulative approvals in the EU and USA

Fig. 2

Methods used to determine the quality attribute “fingerprint” of the biosimilar

Fig. 3

Comparison of the development pathways for reference biologics and biosimilars (Reproduced from Future Oncol. (2021) 17(19), 2529–2544 with permission of Future Medicine Ltd.) [65]