New biopharmaceuticals in the USA: trends in development and marketing approvals 1995-1999

The Tufts Center for the Study of Drug Development has collected data on the clinical and approval phases of the 26 new biopharmaceuticals approved by the US Food and Drug Administration between 1980 and 1999. Here, the data for biopharmaceuticals approved between 1995 and 1999 are presented grouped by product category, review status, orphan-drug designation and therapeutic indication, and the mean phase lengths are compared. They are also compared with the data for approvals during the periods 1982-1989, 1990-1994 and 1996-1998.     

Production of biopharmaceuticals and vaccines in plants via the chloroplast genome

Transgenic plants offer many advantages, including low cost of production (by elimination of fermenters), storage and transportation; heat stability; and absence of human pathogens. When therapeutic proteins are orally delivered, plant cells protect antigens in the stomach through bioencapsulation and eliminate the need for expensive purification and sterile injections, in addition to development of both systemic and mucosal immunity. Chloroplast genetic engineering offers several advantages, including high levels of transgene expression, transgene containment via maternal inheritance and multi-gene expression in a single transformation event. Hyper-expression of vaccine antigens against cholera, tetanus, anthrax, plague or canine parvovirus (4-31% of total soluble protein, tsp) in transgenic chloroplasts (leaves) or non-green plastids (carrots, tomato), as well as the availability of antibiotic-free selectable markers or the ability to excise selectable marker genes, facilitate oral delivery. Hyper-expression of several therapeutic proteins, including human serum albumin (11.1% tsp), somatotropin (7% tsp), interferon-gamma (6% tsp), anti-microbial peptide (21.5% tsp), facilitates efficient and economic purification. Also, the presence of chaperones and enzymes in chloroplasts facilitate assembly of complex multi-subunit proteins and correct folding of human blood proteins with proper disulfide bonds. Functionality of chloroplast-derived vaccine antigens and therapeutic proteins has been demonstrated by several assays, including the macrophage lysis assay, GM1-ganglioside binding assay, protection of HeLa cells or human lung carcinoma cells against encephalomyocarditis virus, systemic immune response, protection against pathogen challenge, and growth or inhibition of cell cultures. Thus, transgenic chloroplasts are ideal bioreactors for production of functional human and animal therapeutic proteins in an environmentally friendly manner.     

Medical molecular farming: production of antibodies, biopharmaceuticals and edible vaccines in plants

The use of plants for medicinal purposes dates back thousands of years but genetic engineering of plants to produce desired biopharmaceuticals is much more recent. As the demand for biopharmaceuticals is expected to increase, it would be wise to ensure that they will be available in significantly larger amounts, on a cost-effective basis. Currently, the cost of biopharmaceuticals limits their availability. Plant-derived biopharmaceuticals are cheap to produce and store, easy to scale up for mass production, and safer than those derived from animals. Here, we discuss recent developments in this field and possible environmental concerns.     

The effect of new drug approvals on HIV mortality in the US, 1987–1998

After increasing steadily from 1987 to 1995, the number of US deaths caused by human immunodeficiency virus (HIV) declined sharply from 1995 to 1998. We analyse aggregate data to consider the hypothesis that this decline was due to a rapid increase in the number of drugs available to treat HIV. The evidence suggests that new drugs played a key role in the post-1995 decline in HIV mortality. The annual number of HIV deaths is estimated to have been reduced by over 6000, on average, by an additional HIV drug approval. The social return to HIV drug innovation appears to be extremely large.     

Leishmania vaccines: old and new

The approach to the development of a Leishmania vaccine has undergone a revolution since its early beginnings with the ancient practice of leishmazation: the inoculation of infectious parasites from an active lesion in order to produce a self-healing lesion in a healthy individual. Controlled infection has been followed by injection of killed parasites and has now progressed to subunit and naked DNA vaccines. Emanuela Handman here discusses the current studies and the future prospects for a Leishmania vaccine with a focus on cutaneous leishmaniasis. Unfortunately, what J.F. Williams said about antiparasite vaccines in 1987 (Ref. 1) is still true in 1997: 'the reasons for optimism are less evident than the reasons for enthusiasm'.     

Oral vaccines: new needs, new possibilities

Vaccination is an important tool for handling healthcare programs both in developed and developing countries. The current global scenario calls for a more-efficacious, acceptable, cost-effective and reliable method of immunization for many fatal diseases. It is hoped that the adoption of oral vaccines will help to provide an effective vaccination strategy, especially in developing countries. Mucosal immunity generated by oral vaccines can serve as a strong first line of defense against most of the pathogens infecting through the mucosal lining. Advances in elucidating the mechanism of action of oral vaccines will facilitate the design of more effective, new generation vaccines. There are promising developments in the use of different agents to effectively deliver the vaccine candidate. It is hoped that ongoing research may be able to set another cardinal point, after polio vaccine, in eradicating infectious diseases.     

Biopharmaceuticals: recent approvals and likely directions

Some 160 biopharmaceuticals have now gained medical approval and several hundred are in the pipeline. Most are protein-based, although two nucleic acid-based products are now on the US/European market. An increasing proportion of approvals are engineered in some way and advances in alternative production systems and delivery methods will also likely impact upon the approvals profile over the remainder of this decade.     

Biosurfactants in cosmetics and biopharmaceuticals

Biosurfactants are surface‐active biomolecules that are produced by various micro‐organisms. They show unique properties i.e. lower toxicity, higher biodegradability and environmental compatibility compared to their chemical counterparts. Glycolipids and lipopeptides have prompted application in biotechnology and cosmetics due to their multi‐functional profile i.e. detergency, emulsifying, foaming and skin hydrating properties. Additionally, some of them can be served as antimicrobials. In this study the current status of research and development on rhamnolipids, sophorolipids, mannosyloerythritol lipids, trehalipids, xylolipids and lipopeptides particularly their commercial application in cosmetics and biopharmaceuticals, is described.     

Placebo Trends across the Border: US versus Canada

Background

Physicians around the world report to using placebos in a variety of situations and with varying degrees of frequency. Inconsistent methodologies, however, complicate interpretation and prevent direct comparisons across studies. While US- and Canada-based physicians share similar professional standards, Canada harbours a less-litigious universal healthcare model with no formal placebo-related policy—factors that may impact how physicians view and use placebos.

Methods

To compare American and Canadian data, we circulated an online survey to academic physicians practicing in Canada, collected anonymous responses, and extracted those of internists and rheumatologists for comparison to US data obtained through parallel methodologies.

Results

Whereas our data show overall concordance across the border—from definitions to ethical limitations and therapeutic potential—differences between American- and Canadian-based placebo practices merit acknowledgement. For example, compared to 45%-80% among US-based respondents, only 23±7% of Canada-based respondents reported using placebos in clinical practice. However, 79±7% of Canada-respondents—a figure comparable to US data—professed to prescribing at least one form of treatment without proven or expected efficacy. Placebo interventions including unwarranted vitamins and herbal supplements (impure placebos) as well as sugar pills and saline injections (pure placebos) appear more common in Canada, where more doctors described placebos as “placebos” (rather than “medications”) and used them as a “diagnostic” tool (rather than a means of placating patient demands for treatment).

Interpretation

Cross-border variation in the use of clinical placebos appears minor despite substantial differences in health care delivery system, malpractice climate, and placebo-related policy. The prevalence of impure placebos in both Canadian and US clinics raises ethical and practical questions currently unaddressed by policy and warranting investigation.     

A new large‐scale manufacturing platform for complex biopharmaceuticals

Complex biopharmaceuticals, such as recombinant blood coagulation factors, are addressing critical medical needs and represent a growing multibillion‐dollar market. For commercial manufacturing of such, sometimes inherently unstable, molecules it is important to minimize product residence time in non‐ideal milieu in order to obtain acceptable yields and consistently high product quality. Continuous perfusion cell culture allows minimization of residence time in the bioreactor, but also brings unique challenges in product recovery, which requires innovative solutions. In order to maximize yield, process efficiency, facility and equipment utilization, we have developed, scaled‐up and successfully implemented a new integrated manufacturing platform in commercial scale. This platform consists of a (semi‐)continuous cell separation process based on a disposable flow path and integrated with the upstream perfusion operation, followed by membrane chromatography on large‐scale adsorber capsules in rapid cycling mode. Implementation of the platform at commercial scale for a new product candidate led to a yield improvement of 40% compared to the conventional process technology, while product quality has been shown to be more consistently high. Over 1,000,000 L of cell culture harvest have been processed with 100% success rate to date, demonstrating the robustness of the new platform process in GMP manufacturing. While membrane chromatography is well established for polishing in flow‐through mode, this is its first commercial‐scale application for bind/elute chromatography in the biopharmaceutical industry and demonstrates its potential in particular for manufacturing of potent, low‐dose biopharmaceuticals. Biotechnol. Bioeng. 2012; 109: 3049–3058. © 2012 Wiley Periodicals, Inc.     

Preventing papillomavirus infectious and herpes zoster: new vaccines

Two new vaccines have been recently licensed : a quadrivalent vaccine against Human papillomavirus infections (HPV) 6, 11, 16 and 18, recommended to children from 9 years old and to young adults under the age of 26 years, and a vaccine against herpes zoster for adults from 60 years old onwards. A bivalent vaccine against HPV 16 and 18 will be shortly available. HPV vaccines are composed of the L1 structural proteins of 2 or 4 HPV genotypes, produced by genetic engineering and self-assembled. These inert vaccines are devoid of genetic materials and mimic the viral particle (virus-like particle, VLP). They allow, as suggested by the 4.5 to 5 years follow-up, to prevent HPV infections and the onset of pre-cancerous lesions associated with genotypes contained within the vaccine. They represent a major overhang in the vaccinology field, and, as anti-hepatitis B vaccine, will probably be effective in cancer prevention. Their use must be associated with the continued detection of cervix cancer by smears and also with the prevention of other sexually transmitted diseases. The herpes zoster vaccine is a living attenuated vaccine produced from the OKA/Merck strain already used in the vaccine against varicella. Its safety is good among persons 50 years old and over and its efficiency on lowering herpes zoster incidence, on the burden of illness and on post-herpetic neuralgia has been demonstrated in persons over 60 years old.     

Mutation detection in plasmid-based biopharmaceuticals

As the number of applications involving therapeutic plasmid DNA (pDNA) increases worldwide, there is a growing concern over maintaining rigorous quality control through a panel of high-quality assays. For this reason, efficient, cost-effective and sensitive technologies enabling the identification of genetic variants and unwanted side products are needed to successfully establish the identity and stability of a plasmid-based biopharmaceutical. This review highlights several bioinformatic tools for ab initio detection of potentially unstable DNA regions, as well as techniques used for mutation detection in nucleic acids, with particular emphasis on pDNA.     

On risk and plant-based biopharmaceuticals

Research into plant-based expression of pharmaceutical proteins is proceeding at a blistering pace. Indeed, plants expressing pharmaceutical proteins are currently being grown in field environments throughout the USA. But how are these plants and proteins being assessed for environmental risk and how are they being regulated? Here, we examine the applicability of the risk assessment paradigm for assessing human and ecological risks from field-grown transgenic plants that express pharmaceutical proteins.     

Fusion protein technologies for biopharmaceuticals: Applications and challenges

Stefan R. Schmidt consolidates the hugely diverse field of fusion proteins and their application in the creation of biopharmaceuticals. The text is replete with case studies and clinical data that inform and intrigue the reader as to the myriad possibilities available when considering the creation of a fusion protein. This valuable text will serve the novice as a broad introduction or the seasoned professional as a thorough review of the state of the art. The first marketed therapeutic recombinant protein was human insulin (Humulin® R). Its approval in 1982 was followed by other such products, including erythropoietin (EPO), interferon (IFN), and tissue plasminogen activator (tPa). Since the 1980s, the number and general availability of recombinant products that replace natural proteins harvested from animal or human sources has increased considerably. Following the initial success, researchers started de novo designs of therapeutic proteins that do not occur in nature. The first of these new drugs to be approved was etanercept (Enbrel®), a fusion portion containing a section of the tumor necrosis factor (TNF) receptor fused to the Fc portion of human IgG1.