A biosimilar (also known as follow-on biologic or subsequent entry biologic) is a biologic medical product that is almost an identical copy of an original product that is manufactured by a different company. [1] Biosimilars are officially approved versions of original "innovator" products and can be manufactured when the original product's patent expires. [2] Reference to the innovator product is an integral component of the approval. [3]
Unlike with generic drugs of the more common small-molecule type, biosimilar drugs generally exhibit high molecular complexity and may be quite sensitive to changes in manufacturing processes. Despite this heterogeneity, all biopharmaceuticals, including biosimilars, must maintain consistent quality and clinical performance throughout their lifecycle. [4]
Drug-related authorities such as the European Medicines Agency (EMA) of the European Union, the United States Food and Drug Administration (FDA), and the Health Products and Food Branch of Health Canada hold their own guidance on requirements for demonstration of the similar nature of two biological products in terms of safety and efficacy. According to them, analytical studies demonstrate that the biological product is highly similar to the reference product, despite minor differences in clinically inactive components, animal studies (including the assessment of toxicity), and a clinical study or studies (including the assessment of immunogenicity and pharmacokinetics or pharmacodynamics). They are sufficient to demonstrate safety, purity, and potency in one or more appropriate conditions of use for which the reference product is licensed and is intended to be used and for which licensure is sought for the biological product.[ citation needed ]
The World Health Organization (WHO) published its "Guidelines for the evaluation of similar biotherapeutic products (SBPs)" in 2009. The purpose of this guideline is to provide an international norm for evaluating biosimilars. [5] [6] [7] [8]
The EMA has granted marketing authorizations for more than 50 biosimilars since 2006. The first biosimilar of a monoclonal antibody to be approved worldwide was a biosimilar of infliximab in the EU in 2013. [9] On March 6, 2015, the FDA approved the United States' first biosimilar product, the biosimilar of filgrastim called filgrastim-sndz (trade name Zarxio) by Sandoz.
In the United States, the Food and Drug Administration (FDA) held that new legislation was required to enable them to approve biosimilars to those biologics originally approved through the PHS Act pathway. [10] Additional Congressional hearings have been held. [11] On March 17, 2009, the Pathway for Biosimilars Act was introduced in the House. [2] Since 2004 the FDA has held a series of public meetings on biosimilars. [12] [13]
The FDA gained the authority to approve biosimilars (including interchangeables that are substitutable with their reference product) as part of the Patient Protection and Affordable Care Act signed into law by President Obama on March 23, 2010.[ citation needed ]
The FDA has previously approved biologic products using comparability, for example, Omnitrope in May 2006, but this like Enoxaparin was also to a reference product, Genotropin, originally approved as a biologic under the FD&C Act. [14]
On March 6, 2015, Zarxio obtained the first approval of FDA. [15] Sandoz's Zarxio is biosimilar to Amgen's Neupogen (filgrastim), which was originally licensed in 1991. This is the first product to be passed under the Biologics Price Competition and Innovation Act of 2009 (BPCI Act), which was passed as part of the Affordable Healthcare Act. But Zarxio was approved as a biosimilar, not as an interchangeable product, the FDA notes. And under the BPCI Act, only a biologic that has been approved as an "interchangeable" may be substituted for the reference product without the intervention of the health care provider who prescribed the reference product. The FDA said its approval of Zarxio is based on review of evidence that included structural and functional characterization, animal study data, human pharmacokinetic and pharmacodynamics data, clinical immunogenicity data and other clinical safety and effectiveness data that demonstrates Zarxio is biosimilar to Neupogen.[ citation needed ]
In March 2020, most protein products that were approved as drug products (including every insulin currently on the market as of December 2019 [update] ) are scheduled to open up to biosimilar and interchangeable competition in the United States. [16] However, "chemically synthesized polypeptides" are excluded from this transition, which means that a product that falls within this category won't be able to come to market as a biosimilar or interchangeable product, but will have to come to the market under a different pathway. [16]
Cloning of human genetic material and development of in vitro biological production systems has allowed the production of virtually any recombinant DNA based biological substance for eventual development of a drug. Monoclonal antibody technology combined with recombinant DNA technology has paved the way for tailor-made and targeted medicines. Gene- and cell-based therapies are emerging as new approaches.
Recombinant therapeutic proteins are of a complex nature (composed of a long chain of amino acids, modified amino acids, derivatized by sugar moieties, folded by complex mechanisms). These proteins are made in living cells (bacteria, yeast, animal or human cell lines). The ultimate characteristics of a drug containing a recombinant therapeutic protein are to a large part determined by the process through which they are produced: choice of the cell type, development of the genetically modified cell for production, production process, purification process, formulation of the therapeutic protein into a drug.
After the expiry of the patent of approved recombinant drugs (e.g., insulin, human growth hormone, interferons, erythropoietin, monoclonal antibodies and more) any other biotech company can develop and market these biologics (thus called biosimilars).
The typical reference product has undergone numerous changes in its manufacturing processes, and such changes in the manufacturing process (ranging from a change in the supplier of cell culture media to new purification methods or new manufacturing sites) was substantiated with appropriate data and was approved by the EMA.
The current concept of development of biosimilar monoclonal antibodies follows the principle that an extensive state of the art physicochemical, analytical and functional comparison of the molecules is complemented by comparative non-clinical and clinical data that establish equivalent efficacy and safety in a clinical "model" indication that is most sensitive to detect any minor differences (if these exist) between the biosimilar and its reference monoclonal antibody also at the clinical level.
The EMA has recognized this fact, which has resulted in the establishment of the term "biosimilar" in recognition that, whilst biosimilar products are similar to the original product, they are not exactly the same. [17]
Originally the complexity of biological molecules led to requests for substantial efficacy and safety data for a biosimilar approval. This has been progressively replaced with a greater dependence on assays, from quality through to clinical, that show assay sensitivity sufficient to detect any significant difference in dose. [18] However, the safe application of biologics depends on an informed and appropriate use by healthcare professionals and patients. Introduction of biosimilars also requires a specifically designed pharmacovigilance plan. It is difficult and costly to recreate biologics because the complex proteins are derived from living organisms that are genetically modified. In contrast, small molecule drugs made up of a chemically based compound can be easily replicated and are considerably less expensive to reproduce. In order to be released to the public, biosimilars must be shown to be as close to identical to the parent innovator biologic product based on data compiled through clinical, animal, analytical studies and conformational status. [19] [20]
Generally, once a drug is released in the market by the FDA, it has to be re-evaluated for its safety and efficacy once every six months for the first and second years. Afterward, re-evaluations are conducted yearly, and the result of the assessment should be reported to authorities such as FDA. Biosimilars are required to undergo pharmacovigilance (PVG) regulations as its reference product. Thus biosimilars approved by the EMA are required to submit a risk management plan (RMP) along with the marketing application and have to provide regular safety update reports after the product is in the market. The RMP includes the safety profile of the drug and proposes the prospective pharmacovigilance studies.
Several PK studies, such as studies conducted by Committee for Medicinal Products for Human Use (CHMP), have been conducted under various ranges of conditions; Antibodies from an originator's product versus antibodies from a biosimilar; combination therapy and monotherapy; various diseases, etc. on the purpose to verify comparability in pharmacokinetics of the biosimilar with the reference medicinal product in a sufficiently sensitive and homogeneous population.
In the European Union, no unique identifier of a biosimilar medicine product is required, as the same rules are followed as for all biologics.[ citation needed ]
The US decided on a different approach, requiring the assignment of a four-letter suffix to the nonproprietary name of the original product to distinguish between innovator drugs and their biosimilars. [21] Japan has similar requirements. [22] The suffix approach has been criticized on the grounds of compromising the INN system and delaying the marketing of biosimilars. [22] Australia decided not to use a 4-letter suffix. [23] [24] [25]
A version of the four-letter suffix has been proposed to the WHO as the biological qualifier (BQ). It is not part of the international nonproprietary name (INN), but is proposed to be managed under the same registry. [26] The report 1 of the May 2017 WHO Expert Consultation on Improving Access to and Use of Similar Biotherapeutic Products, published in October 2017, revealed on page 4, that following the outcome arising from the meeting: "No consensus was reached on whether WHO should continue with the BQ... WHO will not be proceeding with this at present." [27]
Biosimilars available in Australia include adalimumab, bevacizumab, enoxaparin, epoetin lambda, etanercept, filgrastim, follitropin alfa, infliximab, insulin aspart, insulin glargine, pegfilgrastim, rituximab, teriparatide, and trastuzumab. [28]
A research article about "Maximizing the benefits of using biosimilars in Egypt" proposed a regulatory framework for biosimilars in Egypt. The article summarized the recommendations of a number of stakeholders. [29]
Biosimilar medicines approved in the European Union (EU) are interchangeable with their reference medicine or with an equivalent biosimilar. [30]
Active substance | Reference product | Biosimilar medicines |
---|---|---|
Adalimumab | Humira [32] | Amgevita, [33] Amsparity, [34] Cyltezo, [35] Halimatoz, [36] Hefiya, [37] Hukyndra, [38] Hulio, [39] Hyrimoz, [40] Idacio, [41] Imraldi, [42] Kromeya, [43] Libmyris, [44] Solymbic, [45] Trudexa, [46] Yuflyma [47] |
Bevacizumab | Avastin [48] | Abevmy, [49] Alymsys, [50] Aybintio, [51] Equidacent, [52] Mvasi, [53] Onbevzi, [54] Oyavas, [55] Vegzelma, [56] Zirabev [57] |
Enoxaparin sodium | Clexane [58] | Inhixa, [58] Thorinane [59] |
Epoetin alfa | Eprex/Erypo | Abseamed, [60] Binocrit, [61] Epoetin Alfa Hexal, [62] Retacrit, [63] Silapo [64] |
Etanercept | Enbrel [65] | Benepali, [66] Erelzi, [67] Lifmior, [68] Nepexto [69] |
Filgrastim | Neupogen [70] | Accofil, [71] Biograstim, [72] Filgrastim Hexal, [73] Filgrastim ratiopharm, [74] Grastofil, [75] Nivestim, [70] Ratiograstim, [76] Tevagrastim, [77] Zarzio [78] |
Follitropin alfa | Gonal-F [79] | Bemfola, [80] Ovaleap [81] |
Infliximab | Remicade [82] | Flixabi, [83] Inflectra, [84] Remsima, [85] Zessly [86] |
Insulin aspart | NovoRapid [87] | Fiasp, [88] Insulin aspart Sanofi, [89] Kirsty, [90] NovoMix, [91] Ryzodeg [92] |
Insulin glargine | Lantus [93] | Abasaglar, [94] Semglee [95] |
Insulin lispro | Humalog [96] | Insulin lispro Sanofi [97] |
Pegfilgrastim | Neulasta [98] | Cegfila, [99] Fulphila, [100] Grasustek, [101] Pelgraz, [102] Pelmeg, [103] Udenyca, [104] Stimufend, [105] Ziextenzo [106] |
Ranibizumab | Lucentis [107] | Byooviz, [108] Ranivisio, [109] Ximluci [110] |
Rituximab | MabThera [111] | Blitzima, [112] Ritemvia, [113] Rituzena, [114] Rixathon, [115] Riximyo, [116] Ruxience, [117] Truxima [118] |
Somatropin | Genotropin [119] | Omnitrope [119] |
Teriparatide | Forsteo [120] | Movymia, [121] Terrosa [122] |
Tocilizumab | RoActemra [123] | Tyenne [124] |
Trastuzumab | Herceptin [125] | Herzuma, [126] Kanjinti, [127] Ogivri, [128] Ontruzant, [129] Trazimera, [130] Zercepac [131] |
As of October 2024, the US FDA has approved 60 biosimilars. [132] [133]
The Biologics Price Competition and Innovation Act of 2009 (BPCI Act) was originally sponsored and introduced on June 26, 2007, by Senator Edward Kennedy (D-MA). It was formally passed under the Patient Protection and Affordable Care Act (PPAC Act), signed into law by President Barack Obama on March 23, 2010. The BPCI Act was an amendment to the Public Health Service Act (PHS Act) to create an abbreviated approval pathway for biological products that are demonstrated to be highly similar (biosimilar) to a Food and Drug Administration (FDA) approved biological product. [134] The BPCI Act is similar, conceptually, to the Drug Price Competition and Patent Term Restoration Act of 1984 (also referred to as the "Hatch-Waxman Act") which created biological drug approval through the Federal Food, Drug, and Cosmetic Act (FFD&C Act). The BPCI Act aligns with the FDA's longstanding policy of permitting appropriate reliance on what is already known about a drug, thereby saving time and resources and avoiding unnecessary duplication of human or animal testing. The FDA has released a total of four draft guidelines related to biosimilar or follow-on biologics development. Upon the release of the first three guidance documents the FDA held a public hearing on May 11, 2012. [135]
In 2018, the FDA released a Biosimilars Action Plan to implement regulations from the BPCI, including limiting the abuse of the Risk Evaluation and Mitigation Strategy (REMS) system for evergreening and transitioning insulin and human growth hormone to regulation as biologics rather than drugs. [136]
Date of Biosimilar FDA Approval | Biosimilar Product [132] | Original Product [132] |
---|---|---|
March 2015 [137] | filgrastim-sndz/Zarxio | filgrastim/Neupogen |
April 2016 [138] | infliximab-dyyb/Inflectra | infliximab/Remicade |
August 2016 [139] [140] | etanercept-szzs/Erelzi | etanercept/Enbrel |
September 2016 [141] [142] | adalimumab-atto/Amjevita | adalimumab/Humira |
April 2017 [143] | infliximab-abda/Renflexis | infliximab/Remicade |
August 2017 [144] | adalimumab-adbm/Cyltezo | adalimumab/Humira |
September 2017 [145] [146] | bevacizumab-awwb/Mvasi | bevacizumab/Avastin |
December 2017 [147] [148] | trastuzumab-dkst/Ogivri | trastuzumab/Herceptin |
December 2017 [149] | infliximab-qbtx/Ixifi | infliximab/Remicade |
May 2018 [150] [151] | epoetin alfa-epbx/Retacrit | epoetin alfa/Procrit |
June 2018 [152] [153] | pegfilgrastim-jmdb/Fulphila | pegfilgrastim/Neulasta |
July 2018 [154] | filgrastim-aafi/Nivestym | filgrastim/Neupogen |
October 2018 [155] | adalimumab-adaz/Hyrimoz | adalimumab/Humira |
November 2018 [156] | pegfilgrastim-cbqv/Udenyca | pegfilgrastim/Neulasta |
November 2018 [157] | rituximab-abbs/Truxima | rituximab/Rituxan |
December 2018 [158] | trastuzumab-pkrb/Herzuma | trastuzumab/Herceptin |
January 2019 [159] | trastuzumab-dttb/Ontruzant | trastuzumab/Herceptin |
March 2019 [160] | trastuzumab-qyyp/Trazimera | trastuzumab/Herceptin |
April 2019 [161] | etanercept-ykro/Eticovo | etanercept/Enbrel |
June 2019 [162] | trastuzumab-anns/Kanjinti | trastuzumab/Herceptin |
June 2019 [163] | bevacizumab-bvzr/Zirabev | bevacizumab/Avastin |
July 2019 [164] | rituximab-pvvr/Ruxience | rituximab/Rituxan |
July 2019 [165] | adalimumab-bwwd/Hadlima | adalimumab/Humira |
November 2019 [166] | pegfilgrastim-bmez/Ziextenzo | pegfilgrastim/Neulasta |
November 2019 [167] | adalimumab-afzb/Abrilada | adalimumab/Humira |
December 2019 [168] | infliximab-axxq/Avsola | infliximab/Remicade |
June 2020 [169] | pegfilgrastim-apgf/Nyvepria | pegfilgrastim/Neulasta |
July 2020 [170] | adalimumab-fkjp/Hulio | adalimumab/Humira |
December 2020 [171] | rituximab-arrx/Riabni | rituximab/Rituxan |
July 2021 [172] | insulin glargine-yfgn/Semglee | insulin glargine/Lantus |
September 2021 [173] | ranibizumab-nuna/Byooviz | ranibizumab/Lucentis |
December 2021 [174] | insulin glargine-aglr/Rezvoglar | insulin glargine/Lantus |
December 2021 [175] | adalimumab-aqvh/Yusimry | adalimumab/Humira |
February 2022 [176] | filgrastim-ayow/Releuko | filgrastim/Neupogen |
April 2022 [177] | bevacizumab-maly/Alymsys | bevacizumab/Avastin |
May 2022 [178] | pegfilgrastim-pbbk/Fylnetra | pegfilgrastim/Neulasta |
August 2022 [179] | ranibizumab-eqrn/Cimerli | ranibizumab/Lucentis |
September 2022 [180] | pegfilgrastim-fpgk/Stimufend | pegfilgrastim/Neulasta |
September 2022 [181] | bevacizumab-adcd/Vegzelma | bevacizumab/Avastin |
December 2022 [182] | adalimumab-aacf/Idacio | adalimumab/Humira |
May 2023 [183] | adalimumab-aaty/Yuflyma | adalimumab/Humira |
August 2023 [184] | natalizumab-sztn/Tyruko | natalizumab/Tysabri |
September 2023 [185] | tocilizumab-bavi/Tofidence | tocilizumab/Actemra |
October 2023 [186] | ustekinumab-auub/Wezlana | ustekinumab/Stelara |
December 2023 [132] | bevacizumab-tnjn/Avzivi | bevacizumab/Avastin |
February 2024 [132] | adalimumab-ryvk/Simlandi | adalimumab/Humira |
March 2024 [132] | denosumab-bbdz/Jubbonti | denosumab/Prolia |
March 2024 [132] | denosumab-bbdz/Wyost | denosumab/Xgeva |
March 2024 [132] | tocilizumab-aazg/Tyenne | tocilizumab/Actemra |
April 2024 [132] | ustekinumab-aekn/Selarsdi | ustekinumab/Stelara |
April 2024 [132] | trastuzumab-strf/Hercessi | trastuzumab/Herceptin |
May 2024 [132] | aflibercept-yszy/Opuviz | aflibercept/Eylea |
May 2024 [132] | aflibercept-jbvf/Yesafili | aflibercept/Eylea |
May 2024 [132] | eculizumab-aeeb/Bkemv | eculizumab/Soliris |
June 2024 [132] | ustekinumab-ttwe/Pyzchiva | ustekinumab/Stelara |
June 2024 [132] | filgrastim-txid/Nypozi | filgrastim/Neupogen |
June 2024 [132] | aflibercept-mrbb/Ahzantive | aflibercept/Eylea |
July 2024 [132] | eculizumab-aagh/Epysqli | eculizumab/Soliris |
August 2024 [132] | aflibercept-abzv/Enzeevu | aflibercept/Eylea |
August 2024 [132] | aflibercept-ayyh/Pavblu | aflibercept/Eylea |
September 2024 [132] | ustekinumab-aauz/Otulfi | ustekinumab/Stelara |
Infliximab, a chimeric monoclonal antibody, sold under the brand name Remicade among others, is a medication used to treat a number of autoimmune diseases. This includes Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, and Behçet's disease. It is given by slow injection into a vein, typically at six- to eight-week intervals.
Filgrastim, sold under the brand name Neupogen among others, is a medication used to treat low neutrophil count. Low neutrophil counts may occur with HIV/AIDS, following chemotherapy or radiation poisoning, or be of an unknown cause. It may also be used to increase white blood cells for gathering during leukapheresis. It is given either by injection into a vein or under the skin. Filgrastim is a leukocyte growth factor.
Trastuzumab, sold under the brand name Herceptin among others, is a monoclonal antibody used to treat breast cancer and stomach cancer. It is specifically used for cancer that is HER2 receptor positive. It may be used by itself or together with other chemotherapy medication. Trastuzumab is given by slow injection into a vein and injection just under the skin.
Etanercept, sold under the brand name Enbrel among others, is a biologic medical product that is used to treat autoimmune diseases by interfering with tumor necrosis factor (TNF), a soluble inflammatory cytokine, by acting as a TNF inhibitor. It has US Food and Drug Administration (FDA) approval to treat rheumatoid arthritis, juvenile idiopathic arthritis and psoriatic arthritis, plaque psoriasis and ankylosing spondylitis. Tumor necrosis factor alpha (TNFα) is the "master regulator" of the inflammatory (immune) response in many organ systems. Autoimmune diseases are caused by an overactive immune response. Etanercept has the potential to treat these diseases by inhibiting TNF-alpha.
Teriparatide, sold under the brand name Forteo, is a form of parathyroid hormone (PTH) consisting of the first (N-terminus) 34 amino acids, which is the bioactive portion of the hormone. It is an effective anabolic agent used in the treatment of some forms of osteoporosis. Teriparatide is a recombinant human parathyroid hormone analog. It has an identical sequence to the 34 N-terminal amino acids of the 84-amino acid human parathyroid hormone.
Bevacizumab, sold under the brand name Avastin among others, is a monoclonal antibody medication used to treat a number of types of cancers and a specific eye disease. For cancer, it is given by slow injection into a vein (intravenous) and used for colon cancer, lung cancer, ovarian cancer, glioblastoma, hepatocellular carcinoma, and renal-cell carcinoma. In many of these diseases it is used as a first-line therapy. For age-related macular degeneration it is given by injection into the eye (intravitreal).
Insulin glargine sold under the brand name Lantus among others is a long-acting modified form of medical insulin, used in the management of type I and type II diabetes. It is injected just under the skin. Effects generally begin an hour after use.
Adalimumab, sold under the brand name Humira and others, is a disease-modifying antirheumatic drug and monoclonal antibody used to treat rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, plaque psoriasis, hidradenitis suppurativa, and uveitis. It is administered by subcutaneous injection. It works by inactivating tumor necrosis factor-alpha (TNFα).
Pegfilgrastim, sold under the brand name Neulasta among others, is a PEGylated form of the recombinant human granulocyte colony-stimulating factor (GCSF) analog filgrastim. It serves to stimulate the production of white blood cells (neutrophils). Pegfilgrastim was developed by Amgen.
Ranibizumab, sold under the brand name Lucentis among others, is a monoclonal antibody fragment (Fab) created from the same parent mouse antibody as bevacizumab. It is an anti-angiogenic that is approved to treat the "wet" type of age-related macular degeneration, diabetic retinopathy, and macular edema due to branch retinal vein occlusion or central retinal vein occlusion.
Tolvaptan, sold under the brand name Samsca among others, is an aquaretic drug that functions as a selective, competitive vasopressin receptor 2 (V2) antagonist used to treat hyponatremia (low blood sodium levels) associated with congestive heart failure, cirrhosis, and the syndrome of inappropriate antidiuretic hormone (SIADH). Tolvaptan was approved by the U.S. Food and Drug Administration (FDA) on May 19, 2009, and is sold by Otsuka Pharmaceutical Co. under the trade name Samsca. Tolvaptan, as Jynarque, was granted approval for medical use in the United States in April 2018.
Ustekinumab, sold under the brand name Stelara among others, is a monoclonal antibody medication developed by Janssen Pharmaceuticals, for the treatment of Crohn's disease, ulcerative colitis, plaque psoriasis and psoriatic arthritis, targeting both IL-12 and IL-23.
Denosumab, sold under the brand names Prolia and Xgeva among others, is a human monoclonal antibody used for the treatment of osteoporosis, treatment-induced bone loss, metastases to bone, and giant cell tumor of bone.
Tocilizumab, sold under the brand name Actemra among others, is an immunosuppressive drug, used for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis, polyarticular juvenile idiopathic arthritis, giant cell arteritis, cytokine release syndrome, COVID‑19, and systemic sclerosis-associated interstitial lung disease (SSc-ILD). It is a humanized monoclonal antibody against the interleukin-6 receptor (IL-6R). Interleukin 6 (IL-6) is a cytokine that plays an important role in immune response and is implicated in the pathogenesis of many diseases, such as autoimmune diseases, multiple myeloma and prostate cancer. Tocilizumab was jointly developed by Osaka University and Chugai, and was licensed in 2003 by Hoffmann-La Roche.
Ofatumumab is a fully human monoclonal antibody to CD20, which appears to provide rapid B-cell depletion. Under the brand name Kesimpta, it is approved for the treatment of multiple sclerosis in the United States as well as in the European Union and other regions. Under the brand name Arzerra, it is approved for the treatment of certain types of chronic lymphocytic leukemia (CLL) in the United States. It is sold by Novartis under license from Genmab.
Insulin lispro, sold under the brand name Humalog among others, is a modified type of medical insulin used to treat type 1 and type 2 diabetes. It is delivered subcutaneously either by injection or from an insulin pump. Onset of effects typically occurs within 30 minutes and lasts about 5 hours. Often a longer-acting insulin like insulin NPH is also needed.
Aflibercept, sold under the brand names Eylea and Zaltrap among others, is a medication used to treat wet macular degeneration and metastatic colorectal cancer. It was developed by Regeneron Pharmaceuticals.
Pasireotide, sold under the brand name Signifor, is an orphan drug approved in the United States and the European Union for the treatment of Cushing's disease in patients who fail or are ineligible for surgical therapy. It was developed by Novartis. Pasireotide is a somatostatin analog with a 40-fold increased affinity to somatostatin receptor 5 compared to other somatostatin analogs.
Tenofovir alafenamide, sold under the brand name Vemlidy, is an antiviral medication used against hepatitis B and HIV. It is used for the treatment of chronic hepatitis B virus (HBV) infection in adults with compensated liver disease and is given in combination with other medications for the prevention and treatment of HIV. It is taken by mouth.
Tirbanibulin, sold under the brand name Klisyri, is a medication used for the treatment of actinic keratosis (AK) on the face or scalp. It functions by inhibiting both tubulin polymerization and Src kinase signaling. It is potentially effective in impeding the development of squamous cell carcinoma in situ.