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Safety of biological preparations. Report 1. Terminology and classification issues

Abstract

Adverse drug reactions (ADR) are injuries caused by taking a medication. For the purpose of an objective analysis of the reasons and mechanisms of ADR, with a view to developing the methods for their relief and prevention, one should use standard criteria for the characterization of ADR. Typically, the description of ADR includes information about the damaged organ or tissue and the frequency of ADR occurrence. To characterize ADRs caused by low molecular weight chemicals proposed, an A/B classification and its modifications have been proposed, based on the possible mechanisms of ADR. Biological preparations differ from chemicals by a number of characteristics, including the mechanism of action. Considering the nature of biological/biotechnological preparations, several types of ADR classifications, related to the mentioned drug group, have been suggested. The most popular classification for ADR related to biological preparations have been suggested by W. J. Pichler. It is based on the involvement of immunological mechanisms in ADR occurrence. This classification divides ADR related to biologicals into 5 types: type α (reactions caused by high level of cytokines), type β (hypersensitivity reaction), type γ (reactions caused by the imbalance of immune factors), type δ (cross-reactivity reactions) and type ε (reactions caused by non-immunological mechanisms). The mentioned classification method has certain disadvantages: it does not cover all biological preparations, but only drugs, containing cytokines, hormones and monoclonal antibodies preparations; and it does not consider ADR occurring without immune mechanisms (such as increased blood pressure when administering preparations of recombinant erythropoietins).

About the Authors

A. A. Soldatov
Scientific Centre for Expert Evaluation of Medicinal Products
Russian Federation
Chief expert of Office of expertise allergens, cytokines and other immunomodulators of Center for examination and control of medical immunobiological preparations. Doctor of Medical Sciences


Zh. I. Avdeeva
Scientific Centre for Expert Evaluation of Medicinal Products
Russian Federation
Chief expert of Office of expertise allergens, cytokines and other immunomodulators of Center for examination and control of medical immunobiological preparations. Doctor of Medical Sciences, professor


Yu. V. Olefir
Scientific Centre for Expert Evaluation of Medicinal Products
Russian Federation
Director General. Doctor of Medical Sciences


V. A. Merkulov
Scientific Centre for Expert Evaluation of Medicinal Products
Russian Federation
Deputy Director General for the expertise of drugs. Doctor of Medical Sciences, professor


V. P. Bondarev
Scientific Centre for Expert Evaluation of Medicinal Products
Russian Federation
Director of Center for examination and control of medical immunobiological preparations. Doctor of Medical Sciences, professor


References

1. Public Health Services Act 42 U. S. C. § 262(i).

2. Directive 2001/83/EC of the European parliament and of the council of 6 November 2001 on the Community code relating to medicinal products for human use (OJ L 311, 28.11.2001, p. 67).

3. Pichler WJ. Adverse side-effects to biological agents. Allergy; 2006; 61: 912–20.

4. Leader B, Baca QJ, Golan DE. Protein therapeutics: a summary and pharmacological classification. Nat Rev Drug Discov. 2008; 7(1): 21 – 39.

5. International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use, Q5C: Quality of biotechnological products: Stability testing of biotechnological / biological products, Nov. 30, 1995.

6. Soldatov AA, Avdeeva ZhI, Alpatova NA, Medunitsyn NV, Kiselevsky MV, Lysikova SL, Bondarev VP, Mironov AN, Merkulov VA, Sakaeva IV. The aspects of biosimilar marketing approval process. Biopreparaty 2014; (4): 24–36 (in Russian).

7. Wax PM. Elixirs, diluents, and the passage of the 1938 Federal Food, Drug and Cosmetic Act. Ann Intern Med. 1995; 122(6): 456–61.

8. Stephens T, Brynner R. Dark Remedy. The Impact of Thalidomide and its Revival as a Vital Medicine. Cambridge, Massachusetts: Perseus Publishing; 2001.

9. Dukes MNG. The seven pillars of foolishness. In: Dukes MNG, editor. Side Effects of Drugs. Annual 8. Amsterdam: Elsevier; 1984. P. xvii–xxiii.

10. Shah RR. Drug-induced prolongation of the QT interval: why the regulatory concern? Fundam Clin Pharmacol. 2002; 16(2): 119–24.

11. World Health Organization. The Importance of Pharmacovigilance. Safety Monitoring of Medicinal Products. Chapter 2. A Short History of Involvement in Drug Safety Monitoring by WHO. Available from: http://apps.who.int/medicinedocs/en/d/Js4893e/3.html.

12. Available from: evs.nci.gov/ftp1/CTCAE v 4.03.

13. Ferner RE, Butt TF. Adverse drug reactions. Med. 2012; 40: 366–70.

14. Rawlins M, Thompson W. Mechanisms of adverse drug reactions. In: Davies D, ed. Textbook of adverse drug reactions. New York: Oxford University Press; 1991. P. 18–45.

15. Ebbers HC, Al-Temimi E, Moors EHM, Mantel-Teeuwisse AK, Schellekens H, Leufkens HGM. Differences Between Post-Authorization Adverse Drug Reactions of Biopharmaceuticals and Small Molecules. BioDrugs 2013; 27(2): 167–74.

16. Giezen TJ, Mantel-Teeuwisse AK, Straus SMJM, et al. Safety-related regulatory actions for biologicals approved in the United States and the European Union. JAMA 2008; 300: 1887–96.

17. Pichler WJ. Delayed drug hypersensitivity reactions. Ann Intern Med. 2003; 139: 683–93.

18. Perez-Soler R, Saltz L. Cutaneous adverse effects with HER1/ EGFR-targeted agents: is there a silver lining? J Clin Oncol. 2005; 23: 5235–46.

19. Danese S, Fiocchi C. Platelet activation and the CD40 / CD40 ligand pathway: mechanisms and implications for human disease. Crit Rev Immunol 2005; 25: 103–21.

20. Kwon HJ, Cote TR, Cuffe MS, Kramer JM, Braun MM. Case reports of heart failure after therapy with a tumor necrosis factor antagonist. Ann Intern Med. 2003; 138: 807–11.

21. Kasahara A, Hiraide A, Tomita N, Iwahashi H, Imagawa A, Ohguro N, et al. Vogt-Koyanagi-Harada disease occurring during interferon alpha therapy for chronic hepatitis C. J Gastroenterol. 2004; 39: 1106–09.

22. Sherer K, Spoerl D, Bircher AJ. Adverse drug reactions to biologics. JDDG 2010; (8): 411–26.

23. Clarke JB. Mechanisms of adverse drug reactions to biologics. In: Uetrecht J, ed. Adverse Drug Reactions. Handbook of Experimental Pharmacology. New York: Springer; 2010. P. 453–74.

24. Aronson JK, Ferner RE. Joining the DoTS: new approach to classify adverse drug reactions. BMJ 2003; 327: 1222–25.

25. Napoleone E. Children and ADRs (Adverse Drug Reactions). Ital. J. Pediat. 2011; 36: e1–e5.

26. Horen B, Montastruc JL. Adverse drug reactions and off-label drug use in pediatric outpatients. Br J Clin Pharmacol. 2002; 5(4): 665–70.

27. Pichler WJ, Adam J, Daubner B, Gentinetta T, Keller M, Yerly D. Drug Hypersensitivity Reactions: Pathomechanism and Clinical Symptoms. Med Clin ¹ Am. 2010; 94: 645–64.

28. Nassif A, Bensussan A, Dorothee G, et al. Drug specific cytotoxic T-cells in the skin lesions of a patient with toxic epidermal necrolysis. J Invest Dermatol. 2002; 118: 728–33.

29. Britschgi M, Steiner UC, Schmid S, et al. T-cell involvement in drug-induced acute generalized exanthematous pustulosis. J Clin Invest. 2001; 107: 1433–41.

30. Pichler WJ. Pharmacological interaction of drugs with antigen-specific immune receptors: the p-i concept. Curr Opin Allergy Clin Immunol. 2002; 2: 301–5.

31. National Cancer Institute. Common Terminology Criteria for Adverse Events v3.0 (CTCAE). 9 August, 2006. Available from: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf.

32. Barbaud A., Granel F., Waton J., Poreaux C. How to manage hypersensitivity reactions to biological agents? Eur J Dermatol. 2011; 21 (5): 667–74.


Review

For citations:


Soldatov A.A., Avdeeva Zh.I., Olefir Yu.V., Merkulov V.A., Bondarev V.P. Safety of biological preparations. Report 1. Terminology and classification issues. BIOpreparations. Prevention, Diagnosis, Treatment. 2016;16(1):14-26. (In Russ.)

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