Biologic medical product
A biologic medical product, also known as a biological product or more simply as a biologic or biological, is a medicinal product such as a vaccine, blood or blood component, allergenic, somatic cell, gene therapy, tissue, recombinant therapeutic protein or living cells that are used as therapeutics to treat diseases.  Biologics are created by biological processes, rather than being chemically synthesized. Biologics are technically a subset of biopharmaceuticals, though the latter term is more likely to be used to refer to macromolecular products like protein-based and nucleic-acid-based drugs, while the term biologic is used more often when the medical product consists of cellular or tissue based products (e.g. stored packed Red Blood Cell units).
Biologics can be composed of sugars, proteins or nucleic acids or complex combinations of these substances, or may be living entities such as cells and tissues. Biologics are isolated from a variety of natural sources — human, animal or microorganism — and may be produced by biotechnology methods and other technologies. Gene-based and cellular biologics, for example, often are at the forefront of biomedical research, and may be used to treat a variety of medical conditions for which no other treatments are available.
In some jurisdictions, biologics are regulated through varied regulatory pathway other than small molecule drugs and medical devices.
Extracted from living systems
Some of the oldest forms of biologics are extracted from the bodies of animals, and other humans especially. Important biologics include:
- Whole blood and other blood components.
- Organs and tissue transplants.
- Stem cell therapy.
- Antibodies for passive immunization, e.g. to treat a virus infection.
Some biologics that were previously extracted from animals, such as insulin, are now more commonly produced by recombinant DNA.
Produced by recombinant DNA
As indicated the term "biologics" can be used to refer to a wide range of biological products in medicine. However, in most cases, the term "biologics" is used more restrictively for a class of therapeutics (either approved or in development) that are produced by means of biological processes involving recombinant DNA technology. These medications are usually one of three types:
- Substances that are (nearly) identical to the body's own key signalling proteins. Examples are the blood-production stimulating protein erythropoetin, or the growth-stimulating hormone named (simply) "growth hormone" or biosynthetic human insulin and its analogues.
- Monoclonal antibodies. These are similar to the antibodies that the human immune system uses to fight off bacteria and viruses, but they are "custom-designed" (using hybridoma technology or other methods) and can therefore be made specifically to counteract or block any given substance in the body, or to target any specific cell type; examples of such monoclonal antibodies for use in various diseases are given in the table below.
- Receptor constructs (fusion proteins), usually based on a naturally-occurring receptor linked to the immunoglobulin frame. In this case, the receptor provides the construct with detailed specificity, whereas the immunoglobulin-structure imparts stability and other useful features in terms of pharmacology. Some examples are listed in the table below.
Biologics as a class of medications in this narrower sense have had a profound impact on many medical fields, primarily rheumatology and oncology, but also cardiology, dermatology, gastroenterology, neurology, and others. In most of these disciplines, biologics have added major therapeutic options for the treatment of many diseases, including some for which no effective therapies were available, and others where previously existing therapies were clearly inadequate. However, the advent of biologic therapeutics has also raised complex regulatory issues (see below), and significant pharmacoeconomic concerns, because the cost for biologic therapies has been dramatically higher than for conventional (pharmacological) medications. This factor has been particularly relevant since many biological medications are used for the treatment of chronic diseases, such as rheumatoid arthritis or inflammatory bowel disease, or for the treatment of otherwise untreatable cancer during the remainder of life. The cost of treatment with a typical monoclonal antibody therapy for relatively common indications is generally in the range of € 7,000-14,000 per patient per year.
Older patients who receive biologic therapy for diseases such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis are at increased risk for life-threatening infection, adverse cardiovascular events, and malignancy. However, because other therapies are often ineffective, biologic therapy should be considered for some of these patients.
A few examples of biologics made with recombinant DNA technology include:
|USAN/INN||Trade Name||Indication||Technology||Mechanism of Action|
|abatacept||Orencia||rheumatoid arthritis||immunoglobin CTLA-4 fusion protein||T-cell deactivation|
|adalimumab||Humira||rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis, Crohn's disease||monoclonal antibody||TNF antagonist|
|alefacept||Amevive||chronic plaque psoriasis||immunoglobin G1 fusion protein||incompletely characterized|
|erythropoietin||Epogen||anemia arising from cancer chemotherapy, chronic renal failure, etc.||recombinant protein||stimulation of red blood cell production|
|etanercept||Enbrel||rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis||recombinant human TNF-receptor fusion protein||TNF antagonist|
|infliximab||Remicade||rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis, Crohn's disease||monoclonal antibody||TNF antagonist|
|trastuzumab||Herceptin||breast cancer||humanized monoclonal antibody||HER2/neu (erbB2) antagonist|
|ustekinumab||Stelara||psoriasis||humanized monoclonal antibody||IL-12 and IL-23 antagonist|
|denileukin diftitox||Ontak||cutaneous T-cell lymphoma (CTCL)||Diphtheria toxin engineered protein combining Interleukin-2 and Diphtheria toxin||Interleukin-2 receptor binder|
Many vaccines are grown in tissue cultures.
With the more common small-molecule drugs, an exactly identical generic drug can be reliably produced and marketed. Because biologics are vastly more complex, other manufacturers cannot guarantee that their version is exactly identical to the original manufacturer's version, although it is similar to the original biologic. The subsequent manufacturer may use a slightly different manufacturing process, which can occasionally produce significantly different effects. The follow-on manufacturer does not have access to the originator's molecular clone bank and original cell bank. Finally, nearly undetectable differences in impurities and/or breakdown products are known to have serious health implications.
Because different manufacturers may produce slightly different products, they consequently cannot guarantee that their version is exactly as safe and effective as the original manufacturer's version. So, unlike most drugs, generic versions of biologics were not authorized in the United States or the European Union through the simplified procedures allowed for small-molecule generics. As a result, nearly all biologics have been brand-name therapeutics and required very extensive testing. Notable exceptions to this rule include several of the earliest biopharmaceuticals made via recombinant DNA technology, including biosynthetic 'human' insulin and human growth hormone.
Legislation in the 21st century has attempted to address this by recognizing an intermediate ground of testing, which is more testing than for small-molecule drugs proven to be identical to each other, but less testing than for completely new therapeutics.
In the European Union a specially adapted approval procedure has been authorized for certain protein drugs, termed similar biological medicinal products. This procedure is based on a thorough demonstration of "comparability" of the "similar" product to an existing approved product.
Within the U.S., the Patient Protection and Affordable Care Act of 2010 created an abbreviated approval pathway for biological products shown to be biosimilar to, or interchangeable with, an FDA licensed reference biological product.
The acceptance of biosimilars may reduce the profitability of biologics and the cost to the patients and healthcare systems. This acceptance may, in turn, be driven by lobbying with public institutions and opinion leaders, particularly during the upcoming 2012-2019 biologics patent cliff.
In the European Union, a biological medicinal product is one of the active substance(s) produced from or extracted from a biological (living) system, and requires, in addition to physico-chemical testing, biological testing for full characterisation. The characterisation of a biological medicinal product is a combination of testing the active substance and the final medicinal product together with the production process and its control.
- With regard to the production process, a biological medicinal product can be derived from biotechnology or derived from other new technologies. It may be prepared using more conventional techniques, as well, as is the case for blood or plasma-derived products and a number of vaccines.
- With regard to the nature of its active substance, a biological medicinal product can consist of entire microorganisms or mammalian cells or of nucleic acids or proteinaceous or polysaccharide component(s) originating from a microbial, animal, human or plant source.
- With regard to its mode of action, a biological medicinal product can be a therapeutic medicinal product, an immunological medicinal product, gene transfer materials, or cell therapy materials.
Within the United States, biologics are regulated by the FDA's Center for Biologics Evaluation and Research (CBER). Drugs, by contrast, are regulated by the Center for Drug Evaluation and Research (CDER).
- antibody-drug conjugate
- Center for Biologics Evaluation and Research (CBER)
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- United States Food and Drug Administration (August 2008). "Supplemental applications proposing labeling changes for approved drugs, biologics, and medical devices. Final rule". Fed Regist 73 (164): 49603–10. PMID 18958946.
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- Committee for Medicinal Products for Human Use (CHMP) (2005-10-30). "Guideline on Similar Biological Medicinal Products". European Medicines Agency. Retrieved 2007-12-17.
- 75 F.R. 61497; United States Food and Drug Administration (2010-10-05). "Approval Pathway for Biosimilar and Interchangeable Biological Products". Public Hearing; Request for Comments.
- Calo-Fernández B, Martínez-Hurtado J (December 2012). "Biosimilars: Company Strategies to Capture Value from the Biologics Market". Pharmaceuticals 5 (12): 1393–1408. doi:10.3390/ph5121393.
- The Commission of the European Communities (2003-06-25). "Commission Directive 2003/63/EC amending Directive 2001/83/EC of the European Parliament and of the Council on the Community code relating to medicinal products for human use". Official Journal of the European Union. p. L 159/62.
- Biological Products at the US National Library of Medicine Medical Subject Headings (MeSH)
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