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FOCUS ON...                                         the regs



Looking at the Recent
FDA Biosimilar Guidelines
Immunogenicity Concerns and
Extension to Other Classes of Drugs

by Vera Weinstein




S
        mall-molecule treatments are                                                  (www.photos.com)
        invaluable in providing
        symptomatic benefits for an
        array of illnesses. However,
many serious conditions — ranging
from cancer to autoimmune disorders
— respond better to more
sophisticated complex drugs such as
therapeutic biologics and nonbiologic
complex drugs (NBCDs). The latter
are medicinal, nonbiological products
in which the active substance is not a
homomolecular structure, but rather
consists of a number of different
(closely related) structures that cannot
be fully characterized. The US Food
and Drug Administration (FDA)
defines a therapeutic biologic as “a
protein derived from living material
(such as cells or tissues) used to treat             outlining necessary steps for             for biosimilars two years ago, when
or cure disease” (1).                                submitting biosimilar drug                President Barack Obama signed the
   Until recently, pharmaceutical                    applications. The agency’s attention to   Patient Protection and Affordable
companies in the United States had                   detail came about as a result of past     Care Act (PPAC Act) into law on 23
no procedure to follow when                          issues seen with complex therapies        March 2010, amending the Public
submitting applications for “generic”                such as interferons, which produced       Health Service Act (PHS Act) .The
or follow-on versions of biologic drugs              immunogenicity issues (neutralizing       relevant statutory provisions are also
(now called biosimilars). And still, no              antibodies) in multiple sclerosis (MS)    referred to as the Biologics Price
clear guidelines are available for                   patients (2). The guidelines address      Competition and Innovation Act
NBCDs. Despite expiring patents on                   issues often associated with complex      (BPCI Act) of 2009 (3). Similar to the
biologics, this was a complicated issue              products — such as immunogenicity         Hatch–Waxman Act, which defined
because even slight changes in protein               concerns — by defining specific safety    an approval pathway for small-
structure (such as small differences in              and efficacy testing requirements that    molecule generics, the BPCI Act was
amino-acid sequence) could cause                     will be expected with submissions.        aimed at a parallel objective for
serious side effects (e.g., immunogenic                                                        biosimilars.
reactions) in patients.                              Pathway to a Biosimilar Guidance             In one recently released draft
   On 9 February 2012, the FDA                       The FDA began its process of              guidance, the FDA defines biosimilars
released three draft guidelines                      developing regulatory requirements        or biosimilarity as “highly similar to
10	 BioProcess International   10(6)   J une 2012
the reference product, notwithstanding              Alliance Urges a Cautious Approach for Patient Safety
minor differences in clinically inactive            In response to the US Food and Drug          when it comes to the requirement of
components . . . and there are no                   Administration’s (FDA) draft guidance on     clinical studies and pharmacovigilance.
clinically meaningful differences                   approving biosimilar medicines, the          There can be no grey area when it comes
between the biological product and the              Alliance for Safe Biologic Medicines         to patient safety.
reference product in terms of the                   (ASBM, www.safebiologics.org)                “Unwanted immunogenicity is the
safety, purity, and potency of the                  submitted comments to the agency in          preeminent safety challenge associated
product” (4). The FDA notes the                     April 2012 outlining recommendations         with biological therapeutics and can
importance of ensuring similarity                   for ensuring that patient safety is at the   result in unexpected or sometimes
between a reference product and a                   forefront of the biosimilars pathway.        severe adverse effects. The predictive
                                                    ASBM states that effective                   value of animal studies is often
biosimilar by taking into account the
                                                    implementation must incorporate              insufficient to characterize
“structure, function, animal toxicity,              prudent measures, including
and human pharmacokinetics and                                                                   immunogenicity in humans. Clinical
                                                    • analytical data and clinical studies to    studies, in addition to analytical
pharmacodynamics” of the reference
                                                    fully characterize biosimilarity and         methods, are necessary to weed out
product (4). Additionally, “the nature              immunogenicity                               ineffective and unsafe drugs —
and complexity of the reference                                                                  innovator biologics and biosimilars —
                                                    • traceability measures including unique
product will be considered along with                                                            before they are ever a risk to patients.
                                                    nonproprietary names for all biologic
the degree of characterization of the               therapies, transparent product labels,       “In the unfortunate situation that
mechanism of action (MOA) of the                    and notification to patients and             problems arise, measures must be in
reference product, the extent to which              physicians for clinical assessment and       place to accurately and promptly connect
pharmacokinetic and                                 adverse event reporting.                     a specific patient to a specific product.
pharmacodynamic tests predict clinical              Before designating a biosimilar to be        Our current pharmacovigilance system is
outcomes, the extent of clinical                    “interchangeable” with its reference         not equipped to distinguish a biologic
experience and appropriate endpoints                product, ASBM says, US regulators must       reference product from its biosimilars.
and biomarkers, and the extent of any               recognize and address that the similarity    Unique nonproprietary names for
clinical experience with the proposed               between reference and biolosimilar           biosimilar and innovator compounds
product” (4).                                       products may change over time due to         ensure we will be able to effectively track
                                                    manufacturing or environmental               and trace a product to an adverse event.
   Similar criteria are seen in the
                                                    variations.                                  This must be implemented prior to
European Union’s regulatory pathway                                                              biosimilar market entry.
for biosimilars, which was released by              The organization outlined clear, concrete,
                                                    and achievable ways to manage risk and       The Alliance for Safe Biologic Medicines
the European Medicines Agency
                                                    thereby prioritize patient safety. Richard   (ASBM) is an organization composed of
(EMA) in 2005. In Europe,                                                                        diverse healthcare groups and
companies submitting applications for               Dolinar (ASBM chair) released the
                                                    following statement as he submitted the      individuals from patients to physicians,
biosimilars must show that their                                                                 innovative medical biotechnology
                                                    coalition’s comments to the docket:
generic products are closely related to                                                          companies, and others working together
reference medicines and do not have                 “We are pleased with the FDA biosimilar
                                                                                                 to ensure that patient safety is at the
                                                    draft guidance, but it leaves a lot of
any meaningful differences in quality,                                                           forefront of biosimilar policy discussions.
                                                    questions unanswered — particularly
safety, or efficacy (5).
   Additional guidelines are needed
for NBCDs that fall outside the realm               of the reference products being              generic manufacturers could not
of both small molecules and biologics,              reproduced. Such highly complex              demonstrate that their products
but the FDA biosimilar guidelines are               drugs will require research into the         contained the same active ingredient as
an important first step in defining                 specificities of their make-up — e.g.,       the reference product. Although
regulatory considerations for ensuring              characterizing method of action              sodium estrone sulfate and sodium
affordable patient access to safe and               (MoA) — and proper testing needed            equilin sulfate were thought to be the
effective therapies.                                to demonstrate similarity to their           only active Premarin ingredients,
   Because biosimilars are projected to             reference products.                          laboratory and clinical studies
be a multibillion dollar industry, they                                                          suggested that other active ingredients
will have implications for the                      Expanding the Guidelines                     could not be identified. In the FDA
pharmaceutical industry and patients                to Other Complex Drugs                       statement, Center for Drug Evaluation
overall. Integrating affordable                     Although they are not biological drugs,      and Research (CDER) director Janet
biologics into the market will provide              NBCDs can be just as complicated to          Woodcock stated, “Based on currently
more patients with access to life-                  characterize as biologics, warranting        available data, there is at this time no
saving drugs, and companies will be                 the need for their own generic               way to assure that synthetic generic
competing to supply them as soon as                 guidelines (6). For example, in 1997 the     forms of Premarin have the same active
possible. Additional data may need to               FDA refused to approve generic               ingredients as the brand-name drug.
be provided with biosimilar                         versions of Premarin tablets (an NBCD        This is essential for determining they
applications, depending on the nature               used for estrogen replacement) because       are equivalent to the brand drug, and is
12	 BioProcess International   10(6)   J une 2012
•
                                                                                                           3	 Implementation of the Biologics Price
also a legal requirement for their                                                                    Competition and Innovation Act of 2009. US
approval” (7).                                                                                        Food and Drug Administration: Rockville,
    Fortunately, a lot of groundwork for                                                              MD, 10 March 2011; www.fda.gov/Drugs/
the NBCD guidelines now has been                                                                      GuidanceComplianceRegulatoryInformation/
                                                                All classes of                        ucm215089.htm.
established by the biosimilar pathway
                                                                                                           4	 CDER. Guidance for Industry: Scientific
— including the need for a stepwise                             complex drugs must                    Considerations for Demonstrating Biosimilarity to
approach to address immunogenicity                              be held to at                         a Reference Product. US Food and Drug
issues that can arise with these drugs.                                                               Administration: 9 February 2012; www.fda.
NBCDs would also need to be                                     least the same                        gov/downloads/Drugs/GuidanceCompliance
evaluated case by case to determine                             strict standards as                   RegulatoryInformation/Guidances/
                                                                                                      UCM291128.pdf.
whether clinical trials are necessary if                        biosimilars to ensure
                                                                                                           5	 Guideline on Similar Biological Medicinal
inadvertent chemical and physical                               that the follow-on                    Products. European Medicines Agency:
changes (such as aggregation) can                                                                     London, UK, 30 October 2005; www.emea.
greatly affect their immunogenicity                             versions are safe for
                                                                                                      europa.eu/docs/en_GB/document_library/
profile. Already, a generic version of                          patient consumption.                  Scientific_guideline/2009/09/WC500003517.
one NBCD has caused                                                                                   pdf.
immunogenicity effects that were seen                                                                      6	 Immunogenicity of biosimilar Low
                                                                                                      Molecular Weight Heparins. Generics and
only in longer-term clinical trials.
                                                                                                      Biosimilars Initiative: Mol, Belgium, 22 April
    Copaxone injection is an                                                                          2011; www.gabionline.net/Biosimilars/
glatiramoid-class NBCD therapy for                  changes to biologics and NBCDs can                Research/Immunogenicity-of-biosimilar-low-
multiple sclerosis that produces extreme            cause for patients. In a 2009 article,            molecular-weight-heparins.
immunogenicity effects when altered. It             Eva-Maria Jahn of the University of                    7	 CDER. FDA Statement on Generic
is a safe and efficacious MS drug                   Duisburg-Essen and Christian                      Premarin. US Food and Drug Administration:
                                                                                                      Rockville, MD, 25 June 2009; www.fda.gov/
produced by Teva Pharmaceuticals as a               Schneider of the Max Planck Institute
                                                                                                      Drugs/DrugSafety/PostmarketDrugSafety
mixture of polypeptide sequences with               noted that “as the consequences of                InformationforPatientsandProviders/
immunomodulating activity. Teva                     such immune reactions to a bio-                   DrugSafetyInformationforHeathcare
pursued development of a follow-on                  therapeutic drug may lead to                      Professionals/PublicHealthAdvisories/
glatiramoid (Protiramer) by introducing             potentially serious side effects and/or           ucm169045.htm.
slight changes to the Copaxone                      loss of efficacy, it is essential to adopt             8	 Data on File. Teva Neuroscience, Inc.:
                                                                                                      Petach Tikva, Israel.
downstream synthesis procedure.                     an appropriate strategy for the
                                                                                                           9	 Jahn E, Schneider C. How to
Despite similarity in the basic                     assessment of immunogenicity that
                                                                                                      Systematically Evaluate Immunogenicity of
polypeptide characteristics, and                    involves assay development, and                   Therapeutic Proteins: Regulatory
although Teva did not initially detect              bridging of results to and from clinical
                                                                                                      280–286. •
                                                                                                      Considerations. New Biotechnol. 25(5) 2009:
those in short-term preclinical testing,            development from early on” (9).
chronic Protiramer treatment in animal                 Immunogenicity is clearly an
trials over time led to a number of                 important component for
                                                                                                      Vera Weinstein, PhD, is director of
severe side effects: systemic toxicity,             consideration, and all complex drug
                                                                                                      scientific affairs, CMC Israel, and Europe
extensive fibrosis, organ damage, and               applications should be assessed case by           GBP R&D at Teva Pharmaceuticals,
eosinophilia. Those results were                    case. All classes of complex drugs                5 Basel Street, Petach Tikva, 49131 Israel;
drastically different from what was seen            must be held to at least the same strict          972-3-9267267, fax 972-3-9234050;
with the original drug, which has over              standards as biosimilars to ensure that           vera.weinstein@teva.co.il.
one million patient years of success (8).           the follow-on versions are safe for
No tests exist that can characterize and            patient consumption. By forming
quantitate the active ingredients of                regulatory pathways based on a                     To order reprints of this article, contact
glatiramer (the drug’s generic name).               totality-of-the-evidence approach for              Rhonda Brown (rhondab@fosterprinting.com)
                                                                                                       1-800-382-0808. Download a low-resolution
Because of that — and Teva’s inability              highly complex drugs, the FDA and                  PDF online at www.bioprocessintl.com.
to characterize the product’s MoA —                 EMA will ensure that patients get
creating a safe and effective follow-on             access to the best care possible while
version could prove to be extremely                 continuing to ensure that safety
difficult. A lack of similarity in                  remains a top priority.
complex drugs can lead to severe
consequences, evident only when tested              References
in long-term nonclinical or adequate                    1	 Drugs@FDA Glossary of Terms. US Food
                                                    and Drug Administration: Rockville, MD, 2
clinical trials.
                                                    February 2012; www.fda.gov/Drugs/
                                                    informationondrugs/ucm079436.htm.
Safety Cannot Be Compromised                            2	 Immunogenicity of Therapeutic Biological
The above examples illustrate                       Products, Volume 112. Brown F, Mire-Sluis
significant consequences that minor                 AR, Eds. S Karger: Basel, Switzerland, April
                                                    2003: 3–11.
14	 BioProcess International   10(6)   J une 2012

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Fda biosimilar guidelines review

  • 1. FOCUS ON... the regs Looking at the Recent FDA Biosimilar Guidelines Immunogenicity Concerns and Extension to Other Classes of Drugs by Vera Weinstein S mall-molecule treatments are (www.photos.com) invaluable in providing symptomatic benefits for an array of illnesses. However, many serious conditions — ranging from cancer to autoimmune disorders — respond better to more sophisticated complex drugs such as therapeutic biologics and nonbiologic complex drugs (NBCDs). The latter are medicinal, nonbiological products in which the active substance is not a homomolecular structure, but rather consists of a number of different (closely related) structures that cannot be fully characterized. The US Food and Drug Administration (FDA) defines a therapeutic biologic as “a protein derived from living material (such as cells or tissues) used to treat outlining necessary steps for for biosimilars two years ago, when or cure disease” (1). submitting biosimilar drug President Barack Obama signed the Until recently, pharmaceutical applications. The agency’s attention to Patient Protection and Affordable companies in the United States had detail came about as a result of past Care Act (PPAC Act) into law on 23 no procedure to follow when issues seen with complex therapies March 2010, amending the Public submitting applications for “generic” such as interferons, which produced Health Service Act (PHS Act) .The or follow-on versions of biologic drugs immunogenicity issues (neutralizing relevant statutory provisions are also (now called biosimilars). And still, no antibodies) in multiple sclerosis (MS) referred to as the Biologics Price clear guidelines are available for patients (2). The guidelines address Competition and Innovation Act NBCDs. Despite expiring patents on issues often associated with complex (BPCI Act) of 2009 (3). Similar to the biologics, this was a complicated issue products — such as immunogenicity Hatch–Waxman Act, which defined because even slight changes in protein concerns — by defining specific safety an approval pathway for small- structure (such as small differences in and efficacy testing requirements that molecule generics, the BPCI Act was amino-acid sequence) could cause will be expected with submissions. aimed at a parallel objective for serious side effects (e.g., immunogenic biosimilars. reactions) in patients. Pathway to a Biosimilar Guidance In one recently released draft On 9 February 2012, the FDA The FDA began its process of guidance, the FDA defines biosimilars released three draft guidelines developing regulatory requirements or biosimilarity as “highly similar to 10 BioProcess International 10(6) J une 2012
  • 2. the reference product, notwithstanding Alliance Urges a Cautious Approach for Patient Safety minor differences in clinically inactive In response to the US Food and Drug when it comes to the requirement of components . . . and there are no Administration’s (FDA) draft guidance on clinical studies and pharmacovigilance. clinically meaningful differences approving biosimilar medicines, the There can be no grey area when it comes between the biological product and the Alliance for Safe Biologic Medicines to patient safety. reference product in terms of the (ASBM, www.safebiologics.org) “Unwanted immunogenicity is the safety, purity, and potency of the submitted comments to the agency in preeminent safety challenge associated product” (4). The FDA notes the April 2012 outlining recommendations with biological therapeutics and can importance of ensuring similarity for ensuring that patient safety is at the result in unexpected or sometimes between a reference product and a forefront of the biosimilars pathway. severe adverse effects. The predictive ASBM states that effective value of animal studies is often biosimilar by taking into account the implementation must incorporate insufficient to characterize “structure, function, animal toxicity, prudent measures, including and human pharmacokinetics and immunogenicity in humans. Clinical • analytical data and clinical studies to studies, in addition to analytical pharmacodynamics” of the reference fully characterize biosimilarity and methods, are necessary to weed out product (4). Additionally, “the nature immunogenicity ineffective and unsafe drugs — and complexity of the reference innovator biologics and biosimilars — • traceability measures including unique product will be considered along with before they are ever a risk to patients. nonproprietary names for all biologic the degree of characterization of the therapies, transparent product labels, “In the unfortunate situation that mechanism of action (MOA) of the and notification to patients and problems arise, measures must be in reference product, the extent to which physicians for clinical assessment and place to accurately and promptly connect pharmacokinetic and adverse event reporting. a specific patient to a specific product. pharmacodynamic tests predict clinical Before designating a biosimilar to be Our current pharmacovigilance system is outcomes, the extent of clinical “interchangeable” with its reference not equipped to distinguish a biologic experience and appropriate endpoints product, ASBM says, US regulators must reference product from its biosimilars. and biomarkers, and the extent of any recognize and address that the similarity Unique nonproprietary names for clinical experience with the proposed between reference and biolosimilar biosimilar and innovator compounds product” (4). products may change over time due to ensure we will be able to effectively track manufacturing or environmental and trace a product to an adverse event. Similar criteria are seen in the variations. This must be implemented prior to European Union’s regulatory pathway biosimilar market entry. for biosimilars, which was released by The organization outlined clear, concrete, and achievable ways to manage risk and The Alliance for Safe Biologic Medicines the European Medicines Agency thereby prioritize patient safety. Richard (ASBM) is an organization composed of (EMA) in 2005. In Europe, diverse healthcare groups and companies submitting applications for Dolinar (ASBM chair) released the following statement as he submitted the individuals from patients to physicians, biosimilars must show that their innovative medical biotechnology coalition’s comments to the docket: generic products are closely related to companies, and others working together reference medicines and do not have “We are pleased with the FDA biosimilar to ensure that patient safety is at the draft guidance, but it leaves a lot of any meaningful differences in quality, forefront of biosimilar policy discussions. questions unanswered — particularly safety, or efficacy (5). Additional guidelines are needed for NBCDs that fall outside the realm of the reference products being generic manufacturers could not of both small molecules and biologics, reproduced. Such highly complex demonstrate that their products but the FDA biosimilar guidelines are drugs will require research into the contained the same active ingredient as an important first step in defining specificities of their make-up — e.g., the reference product. Although regulatory considerations for ensuring characterizing method of action sodium estrone sulfate and sodium affordable patient access to safe and (MoA) — and proper testing needed equilin sulfate were thought to be the effective therapies. to demonstrate similarity to their only active Premarin ingredients, Because biosimilars are projected to reference products. laboratory and clinical studies be a multibillion dollar industry, they suggested that other active ingredients will have implications for the Expanding the Guidelines could not be identified. In the FDA pharmaceutical industry and patients to Other Complex Drugs statement, Center for Drug Evaluation overall. Integrating affordable Although they are not biological drugs, and Research (CDER) director Janet biologics into the market will provide NBCDs can be just as complicated to Woodcock stated, “Based on currently more patients with access to life- characterize as biologics, warranting available data, there is at this time no saving drugs, and companies will be the need for their own generic way to assure that synthetic generic competing to supply them as soon as guidelines (6). For example, in 1997 the forms of Premarin have the same active possible. Additional data may need to FDA refused to approve generic ingredients as the brand-name drug. be provided with biosimilar versions of Premarin tablets (an NBCD This is essential for determining they applications, depending on the nature used for estrogen replacement) because are equivalent to the brand drug, and is 12 BioProcess International 10(6) J une 2012
  • 3. 3 Implementation of the Biologics Price also a legal requirement for their Competition and Innovation Act of 2009. US approval” (7). Food and Drug Administration: Rockville, Fortunately, a lot of groundwork for MD, 10 March 2011; www.fda.gov/Drugs/ the NBCD guidelines now has been GuidanceComplianceRegulatoryInformation/ All classes of ucm215089.htm. established by the biosimilar pathway 4 CDER. Guidance for Industry: Scientific — including the need for a stepwise complex drugs must Considerations for Demonstrating Biosimilarity to approach to address immunogenicity be held to at a Reference Product. US Food and Drug issues that can arise with these drugs. Administration: 9 February 2012; www.fda. NBCDs would also need to be least the same gov/downloads/Drugs/GuidanceCompliance evaluated case by case to determine strict standards as RegulatoryInformation/Guidances/ UCM291128.pdf. whether clinical trials are necessary if biosimilars to ensure 5 Guideline on Similar Biological Medicinal inadvertent chemical and physical that the follow-on Products. European Medicines Agency: changes (such as aggregation) can London, UK, 30 October 2005; www.emea. greatly affect their immunogenicity versions are safe for europa.eu/docs/en_GB/document_library/ profile. Already, a generic version of patient consumption. Scientific_guideline/2009/09/WC500003517. one NBCD has caused pdf. immunogenicity effects that were seen 6 Immunogenicity of biosimilar Low Molecular Weight Heparins. Generics and only in longer-term clinical trials. Biosimilars Initiative: Mol, Belgium, 22 April Copaxone injection is an 2011; www.gabionline.net/Biosimilars/ glatiramoid-class NBCD therapy for changes to biologics and NBCDs can Research/Immunogenicity-of-biosimilar-low- multiple sclerosis that produces extreme cause for patients. In a 2009 article, molecular-weight-heparins. immunogenicity effects when altered. It Eva-Maria Jahn of the University of 7 CDER. FDA Statement on Generic is a safe and efficacious MS drug Duisburg-Essen and Christian Premarin. US Food and Drug Administration: Rockville, MD, 25 June 2009; www.fda.gov/ produced by Teva Pharmaceuticals as a Schneider of the Max Planck Institute Drugs/DrugSafety/PostmarketDrugSafety mixture of polypeptide sequences with noted that “as the consequences of InformationforPatientsandProviders/ immunomodulating activity. Teva such immune reactions to a bio- DrugSafetyInformationforHeathcare pursued development of a follow-on therapeutic drug may lead to Professionals/PublicHealthAdvisories/ glatiramoid (Protiramer) by introducing potentially serious side effects and/or ucm169045.htm. slight changes to the Copaxone loss of efficacy, it is essential to adopt 8 Data on File. Teva Neuroscience, Inc.: Petach Tikva, Israel. downstream synthesis procedure. an appropriate strategy for the 9 Jahn E, Schneider C. How to Despite similarity in the basic assessment of immunogenicity that Systematically Evaluate Immunogenicity of polypeptide characteristics, and involves assay development, and Therapeutic Proteins: Regulatory although Teva did not initially detect bridging of results to and from clinical 280–286. • Considerations. New Biotechnol. 25(5) 2009: those in short-term preclinical testing, development from early on” (9). chronic Protiramer treatment in animal Immunogenicity is clearly an trials over time led to a number of important component for Vera Weinstein, PhD, is director of severe side effects: systemic toxicity, consideration, and all complex drug scientific affairs, CMC Israel, and Europe extensive fibrosis, organ damage, and applications should be assessed case by GBP R&D at Teva Pharmaceuticals, eosinophilia. Those results were case. All classes of complex drugs 5 Basel Street, Petach Tikva, 49131 Israel; drastically different from what was seen must be held to at least the same strict 972-3-9267267, fax 972-3-9234050; with the original drug, which has over standards as biosimilars to ensure that vera.weinstein@teva.co.il. one million patient years of success (8). the follow-on versions are safe for No tests exist that can characterize and patient consumption. By forming quantitate the active ingredients of regulatory pathways based on a To order reprints of this article, contact glatiramer (the drug’s generic name). totality-of-the-evidence approach for Rhonda Brown (rhondab@fosterprinting.com) 1-800-382-0808. Download a low-resolution Because of that — and Teva’s inability highly complex drugs, the FDA and PDF online at www.bioprocessintl.com. to characterize the product’s MoA — EMA will ensure that patients get creating a safe and effective follow-on access to the best care possible while version could prove to be extremely continuing to ensure that safety difficult. A lack of similarity in remains a top priority. complex drugs can lead to severe consequences, evident only when tested References in long-term nonclinical or adequate 1 Drugs@FDA Glossary of Terms. US Food and Drug Administration: Rockville, MD, 2 clinical trials. February 2012; www.fda.gov/Drugs/ informationondrugs/ucm079436.htm. Safety Cannot Be Compromised 2 Immunogenicity of Therapeutic Biological The above examples illustrate Products, Volume 112. Brown F, Mire-Sluis significant consequences that minor AR, Eds. S Karger: Basel, Switzerland, April 2003: 3–11. 14 BioProcess International 10(6) J une 2012