Biological agents show significant clinical benefits, but their high cost limits their accessibility. The demand for cost-effective options and the patent expiry of biologics have propelled the development of biosimilars or similar biologics.
This article covers the key takeaways from the Indian regulatory guidelines for the approval of similar biologics in India.
The guideline for similar biologics in India was released in 2016 by the Central Drugs Standard Control Organization (CDSCO) and the Department of Biotechnology (DBT).
The 2016 guideline are an update to previous guidelines published in 2012. The authorities revised the guidelines to provide a clear regulatory pathway at par with international regulations for the approval of similar biologics in India.
As per the guideline, a similar biologic product is that which is similar in terms of quality, safety and efficacy to an approved reference biological product based on comparability.
The guideline enumerates the various regulatory requirements for the manufacturing, preclinical studies, clinical studies and post-marketing requirements for similar biologics.
The approval of similar biologics follows a sequential process and involves the following authorities:
A product can only be considered similar biologic if proven similar using extensive quality characterization against the reference biologic. The dose, strength, dosage form and mode of administration of similar biologics need to be similar to that of the reference product.
Companies planning to develop similar biologics are required to submit the rationale for selecting the reference product to the regulatory authorities. The reference product should have been approved in India using a complete data package. When the reference product is not authorized in India, it should be approved/licensed and marketed in an ICH (The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use) country.
Similar biologics should be manufactured following good manufacturing practices. The manufacturing process should be robust, consistent and reproducible.
Companies need to provide a complete description of the manufacturing process, including details regarding the host cell cultures, vectors and gene sequence. The post-translational modifications, if any, should also be enumerated.
Analytic characterization is required to demonstrate similarity between the similar biologic and the reference drug. Indian guidelines recommend characterization studies to evaluate immunological and biological activities, physical/chemical properties, content, purity, contamination and content.
Real-time stability studies, accelerated studies, and stress studies should be conducted to evaluate the product's shelf life, storage conditions, and degradation profile.
Variability between the similar biologic and the reference product should be evaluated to assess the potential impact on the safety and efficacy of similar biologic. Additional characterization studies may be necessary in such cases.
Once the analytical studies characterize the similarity between similar biologic and the reference product, companies need to conduct preclinical and clinical studies to test the safety and efficacy of the similar biologic.
Comparative pharmacokinetic (PK)/ pharmacodynamics (PD) studies are required to establish similarities in PK/PD characteristics between the similar biologic and the reference product. The type may vary case by case - Drug developers can combine PD and PK studies, or PD study can also be conducted together with phase III studies as appropriate.
A phase III comparative clinical trial is required to establish the similarity in efficacy and safety between the similar biologic candidate and the reference product. In recombinant human-soluble insulin products, only a comparative safety study is required.
Equivalence or non-inferiority studies may also need to be conducted. Before study initiation, the manufacturer must consult the CDSCO and justify the rationale for the sample size estimation and define the comparability limits.
The confirmatory safety and efficacy study can be waived if the similar biologic demonstrates high similarity with the reference biologic regarding the structural and functional characteristics, preclinical and PK/PD outcomes. However, confirmatory phase 3 clinical studies cannot be waived for large molecular weight biologics like monoclonal antibodies.
To ensure the absence of any unexpected safety concerns, clinical studies to evaluate the immunogenicity and adverse events are mandatory. The immunogenicity profile of the similar biologic should be compared to the reference biologic. Pre-approval comparative safety data should be based on adequate patient exposure and presented along with published data on the reference biologic.
Extrapolation of indication can be considered if similarity has been established between the similar biologic and the reference product with respect to the quality or preclinical assessment. Additionally, demonstration of efficacy and safety in one indication allows extrapolation for other indications if the exact mechanism of action or receptor is involved. It should be noted that new indications that are not specified by the innovator require a separate application.
With the new virus variant causing a surge in infections, India has been crippled by the pandemic. Apart from the shortage of medicines, oxygen and healthcare staff, several states in India face a shortage of vaccines – one of the most effective tools to end the pandemic.
COVID-19 has caused a massive shift in how we manage clinical trials. Due to inadequate resources and restrictions placed due to the pandemic, companies are struggling to maintain the safety of study participants and staff while ensuring the continuity of ongoing trials.
Biological agents show significant clinical benefits, but their high cost limits their accessibility. The demand for cost-effective options and the patent expiry of biologics have propelled the development of biosimilars or similar biologics.
