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Biopharmaceuticals
Transforming proteins and genes into drugs




                           By-

                           Kuldeep Dabasby:
                                        Prepared



                           XIIIth Batch
Flow of presentation


      I. Biopharmaceutical

        1.Definition
        2 Structure
        3.Type
        4. Manufacturing
        5. Top 10 Biopharmaceuticals(2008)
        6. Top 10 Biopharmaceutical companies

       II. Biosimilars
         1.Definition
         2.Regulation
         3.Strategies

       III. Challenges for Biologics

       IV. Future

       V. Conclusion




2
Terminology used


     Biologics

     Biopharmaceuticals

     Biosimilars

     Follow-on Biologics

     Biogenerics




3   Note- Following terms are used in different organization in different places
Cornerstones in biotechnology history which have influenced the
    production of Biopharmceuticals




    1953: Discovery of DNA structure

    1973: Discovery of DNA restriction enzymes

    1977: Genentech, first biotech-enterprise founded

    1982: First biopharmaceutical approved by FDA: recombinant human insulin

    1986: First recombinant vaccine (HepB) is approved for human use, first
    recombinant anti-cancer drug (Interferon) is produced

    2003: Human genome sequenced




4
Traditional Vs Biopharmceuticals

          Traditional                   Biopharmceuticals
        Multiple effect               Specific effect

        Short Acting                  Long acting

        Non-Immunogenic               Immunogenic

        Species independent           Species dependent

        Small molecules               Large molecules

        Stable                        Heat sensitive

        Oral administration           Parenteral

        General practice              Hospital




5
Definitions of BiologicsBiopharmaceuticals



       A biologic can be any therapeutic serum, toxin, antitoxin, vaccine, virus, blood, blood component or derivative,
       allergenic product, or analogous product, or derivatives applicable to the prevention, treatment, or cure of
       injuries or disease of human

                                Source – FDA

       “A biological substance is a substance that is produced by or extracted from a biological source and for which a
       combination of physico-chemical-biological testing and the production process and its control is needed for its
       characterisation and the determination of its quality

       Source – EMEA


      “a substance which cannot be completely characterized by physicochemical means alone and which therefore
      requires the use of some form of bioassay”.

      Source – WHO




6   Note: Sources mentioned in the notes section of slide
Complexity of Biopharmceuticals




                                          Structure
     Epoetin              Size

                Aspirin
                          M



                                          Stability
                           od
                             ifi
                                 ca
                                   tio
                                      n




7
Types of Biologics


     Peptides

     Non-glycosylated proteins

     Glycosylated proteins

     Monoclonal antibodies




8
Manufacturing Process



                            Cell Bank




                            UPSTREAM
                      •Cell expansion
                      •Fermentation
        Raw                                      In
                      •Clarification
       materials                              process
                         DOWNSTREAM
                      •Centrifugation
                      •Chromatography
                      •Ultra filtration


                                          Drug substances
                              Drug            release
                            substances
9
Biotech Process




                A typical fermentation based biotech
                             process flow




10
FDA Approvals (2005-2009) Synthetic V/s Biopharmceuticals



                             25

                                                                                 21

                             20                                                                 19
                                  18       18
                                                            16
       Number of Approvals




                             15



                             10

                                                                                                     6
                              5                 4
                                                                                       3
                                       2                            2

                              0
                                   2005     2006              2007                 2008          2009

                                           New molecular entities       New biologic entities




11
EMEA Approvals (2005-2009) Synthetic V/s Biopharmceuticals



                             25
                                                                                                           23

                                                                                                                20
                             20                                         19

                                                      16
       Number of Approvals




                             15
                                                                                             13

                                                           10
                             10
                                                                               8
                                                                                                   6
                                        5
                              5             4



                              0
                                        2005            2006             2007                 2008          2009

                                                      New molecular entities       New biologic entities

                                  More number of Biopharmceuticals were approved by EMEA as compared to FDA in 2009


12
Benefits of Biopharmaceuticals


      Highly effective and potent action

      Fewer side effects

      Potential to actually cure diseases rather than merely treat the symptoms

      Longer half life




13
Top 10 Biopharmceuticals in 2008


     #Rank   Biopharmceuticals    Brands          Company                  Sales(08)(US$ million)             Therapeutic area

       1        Etanercept        Enbrel        Amgen, Wyeth                       $6,580                    Rheumatoid Arthritis

                                             J&J, Schering Plough,
       2         Infliximab      Remicade                                          $5,934                    Rheumatoid Arthritis
                                                   Mitsubishi

       3       Bevacizumab        Avastin           Roche                          $5,777                     Colorectal cancer.

       4        Rituximab        Rituxan            Roche                          $5,653                  Head and Neck Cancer

       5       Adalimumab         Humira            Abbott                         $5,488                    Rheumatoid Arthritis

       6        Epoetin alfa     Epogen             Amgen                          $5,033                       Renal anemia

       7       Trastuzumab       Herceptin          Roche                          $4,890                       Breast cancer

       8          Insulin         Lantus        Sanofi Aventis                     $4,180                          Diabetes

       9       Pegfilgrastim     Neulasta           Amgen                          $3,355                        Neutropenia

      10       Darbepoetin       Aranesp            Amgen                          $2,871                          Anemia




14                                                                   Source- La Merie Business intelligence (R&D Pipeline news 10 March 2010)
Top 10 companies in Biopharmceuticals


                                 Sales/Revenues     R & D spending
     # Rank       Company                                                                        Therapeutic area
                                  In US$ Million)   (In US$ Million)

     1.       Amgen                        14,687              $2,900   Oncology, kidney disease, rheumatoid arthritis

                                                                        Oncology, Immunology, Tissue Repair, Neuroscience, Ophthalmology
     2.       Genentech                    10,531              2,800

                                                                        Diabetes care , Haemostatic management , Growth hormone
     3.       Novo Nordisk                  8,989               1,550
                                                                        therapy , Hormone replacement therapy

                                                                        Neurodegenerative Diseases, Oncology, Fertility, Endocrinology,
     4.       Merck Serono                  7,338              1,580
                                                                        Autoimmune and Inflammatory, Cardio metabolic care

              Baxter biopharma
     5.                                     5,308                868    Hemophilia, Biotherapeutics, Regenerative Medicine, Vaccines
              solutions

     6.       Biogen Idec                   3,968              1,072    Neurology, Oncology, Immunology, Hemophilia, Cardiopulmonary

                                                                        Genetics Diseases, Cardio metabolic and Renal, Oncology,
     7.       Genzyme                       3,751                750    Orthopaedics/Biosurgical Specialties, Transplant,
                                                                        Genetics/Diagnostics

                                                                        Dermatology, Urology, Cardiovascular, Antibiotics, Anaphylaxis,
     8.       CSL ltd                       2,961                202    Central nervous system, Analgesia, Emergency Care, Obstetrics and
                                                                        Gynecology

                                                                        Neurosciences, Medical Dermatology and Urology, Eye Care,
     9.       Allergan                      1,311                 798
                                                                        Medical Aesthetics, Obesity Intervention

     10.      Alexion Pharma                  259                  63   Hematology



15                                                                               Source-Contract Pharma Articles » 2009 » July/August 2009
Cost of Biopharmceuticals


                       Drug                                      Indication                   Cost                    Duration

     Cerezyme                                  Life-threatening enzyme deficiency   $200,000 to $500,000   12 Month

     Trastuzumab (Herceptin)                   Breast Cancer                        $36,000                6 Month

     Rituximab (Rituxan)                       Non-hodgkin’s lymphoma               $32,500                2 Month

     Bevacizumab (Avastin)/ Cetuximab
                                               Metastatic Colorectal Cancer         $28,500                2 Month
     (Erbitux)

     Infliximab (Remicade),                    Rheumatoid arthritis                 $18,000                -

     Infliximab                                Crohn’s disease                      $16,500                -




     Cost for indication listed are for 2005                                                                   Source- MONROE 2006
16
Biosimilar
Definitions and Terminologies



      A biosimilar medicine is a medicine which is similar to a biological medicine that has already been authorised (the
      ‘biological reference medicine’)1
                                                                                                           Source – EMEA


      “A follow-on biologic (FOB) is “a protein product which is intended to be a similar version or duplicate of an already
      approved or licensed protein product”.4
                                                                                                              Source – FDA


      A new biological medicinal product claimed to be “similar” with regard to quality, safety and efficacy to an already
      approved reference medicinal product3
                                                                                                                Source – WHO


      “A drug to be developed by a different marketing approval holder as a drug that is bio-equivalent/quality-equivalent to
      biotechnology-derived drug already approved domestically” 2
                                                                                                      Source – PMDA ,Japan


                                                           Commonly used
                                                           terminologies/synonyms
                                                           • Biosimilars
                                                           • Biogenerics
                                                           • Follow on Biopharmceuticals
                                                           • Follow on Protein

18 Note: Sources mentioned in the notes section of slide
Biosimilars -
       Scientific basis for abbreviated pathway



                     Demonstrate Quality, Safety, Efficacy




                                                                              Surveillance
                                                                 Regulatory
                          Extensive




                                                                 Approval
     New Biologic                             Clinical
                        Characterization


                                   Pre-Clinical




                                              Clinical
                        Extensive




                                                                 Regulatory




                                                                              Surveillance
                      Characterization




                                                                 Approval
                                                      Clinical
      Biosimilar
                        Extensive           Pre-Clinical
                      Comparison to               Pre-Clinical
                        Reference

                    Allows for abbreviated
19                   pre-clinical & clinical
Regulation of Biosimilars
No Harmonized Worldwide Regulatory Framework for
      Biosimilars

      Small molecule generics model is inappropriate

      In many regions limited or no regulatory processes exist

      Lack of minimum regulatory standards presents a risk for patients
       because of the potential issues relating to the quality, efficacy and safety
       of biosimilars developed and approved without defined requirements




21
Biosimilars – Regulatory Perspective



         Well Defined Framework                               Under process of Development                     No or Minimal Framework


                         EUROPEAN5                                                 USA5                                        INDIA2
                           UNION                             Currently there is no clear guidelines
      Comparability studies are required                     and authority for approval of biosimilars    Requires only Phase III clinical
       to substantiate evidence for safety,                                                                 trials for 100 patients
                                                             No equivalent of ANDA under PH&S act
       efficacy and quality5
                                                              for approval of biosimilars6
      Guidelines, including specific clinical                                                                                CHINA 4
                                                             A biosimilar could not be approved until
       and non-clinical data requirements
                                                              12 years after the date on which the
       for four product types:
                                                              reference product was first licensed5
        Recombinant insulin, human
       growth factor, erythropoietin and
       CSFs 6

      10-year period for innovator
       exclusivity, with the opportunity for
                                                                                    JAPAN 1
       an additional year for new
                                                            Pharmaceuticals and medical device
       indications5
                                                             Agency (PMDA )
                                                             Japan's regulator, expects to finalize a
                                                             new guideline for the regulation of
                                                             follow-on Biopharmceuticals this year,

                                                            First draft put out for public comment
                                                             last September


                                                                                     CANADA 4
22 Note: Sources mentioned in the notes section of slide
Biosimilars In the Market Today


      Europe - Sandoz –Omnitrope (hGH), Binocrit (“EPO” or erythropoietin);
       Biopartners -Valtropin (hGH);
       Hexal –EPO version;

      U.S. –Sandoz -Omnitrope

      China –EPO versions, Interferons, IL-2, IL-11, GM-CSF, hGHs

      India –hGH. EPO, Interferon alpha 2b, insulin

      Australia –Omnitrope (Sandoz)

      Cuba, Egypt, Africa –EPO versions




23
Strategic Options to Tap Biosimilar Market

      Generics firms enter successfully into the biosimilars
                             market




        Pharmaceutical companies expand their Biopharmceuticals
          business and enter biosimilars market opportunistically




                  New types of cooperation between Pharma, Biotech
                                     or Generics



24
Biosimilars successful if all hurdles passed




25
The other side of the Biopharmceuticals…….


     Safety issue …………??????????



      Biologic drugs are orders of magnitude more complex than small
       molecule drugs

      Safety & efficacy of final product is exceptionally sensitive to small
       changes in manufacturing process

      It is difficult to impossible to predict the effect of these small changes—
       experience counts

      Potential for dramatic negative health consequences




26
Key Success Factors for Biosimilars


       1.   Consistent long term strategy

       2.   Healthy financial structure

       3.   Comprehensive competitive intelligence

       4.   Core competencies for manufacturing process

       5.   Deep clinical development and regulatory expertise

       6.   Effective marketing & sales skills




27
Regulation of Biologics
Challenges in front of Biopharmceuticals


        From Industry perspective



      Long and costly clinical trials

      Efficacy

      Difference in Sero – Prevalence (Virus etc) and Genetic makeup (Human
       beings)

      Low cost advantage (due to costly raw materials, equipments and labor)

      Difficult to copy (Standardization process)




29
Continue…


          From Govt. perspective



      No guidelines (Since Biopharmceuticals are in Nascent stage)




       From Patients perspective



      Adverse - effects




30
Future of Biopharmceuticals


      More diseases will come under the treatment

      Effective manufacturing




31
Conclusion


      Biopharmceuticals or PERISH!!!!!!!



      Traditional drug1st generation Biopharmceuticals (small
       molecules)2nd Generation Biopharmceuticals (large molecules)
       Follow on Biopharmceuticals Biobetters ….….What next???




32
33

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Biopharmaceuticals (Transforming proteins and genes into drugs)

  • 1. Biopharmaceuticals Transforming proteins and genes into drugs By- Kuldeep Dabasby: Prepared XIIIth Batch
  • 2. Flow of presentation I. Biopharmaceutical 1.Definition 2 Structure 3.Type 4. Manufacturing 5. Top 10 Biopharmaceuticals(2008) 6. Top 10 Biopharmaceutical companies II. Biosimilars 1.Definition 2.Regulation 3.Strategies III. Challenges for Biologics IV. Future V. Conclusion 2
  • 3. Terminology used  Biologics  Biopharmaceuticals  Biosimilars  Follow-on Biologics  Biogenerics 3 Note- Following terms are used in different organization in different places
  • 4. Cornerstones in biotechnology history which have influenced the production of Biopharmceuticals 1953: Discovery of DNA structure 1973: Discovery of DNA restriction enzymes 1977: Genentech, first biotech-enterprise founded 1982: First biopharmaceutical approved by FDA: recombinant human insulin 1986: First recombinant vaccine (HepB) is approved for human use, first recombinant anti-cancer drug (Interferon) is produced 2003: Human genome sequenced 4
  • 5. Traditional Vs Biopharmceuticals Traditional Biopharmceuticals Multiple effect Specific effect Short Acting Long acting Non-Immunogenic Immunogenic Species independent Species dependent Small molecules Large molecules Stable Heat sensitive Oral administration Parenteral General practice Hospital 5
  • 6. Definitions of BiologicsBiopharmaceuticals A biologic can be any therapeutic serum, toxin, antitoxin, vaccine, virus, blood, blood component or derivative, allergenic product, or analogous product, or derivatives applicable to the prevention, treatment, or cure of injuries or disease of human Source – FDA “A biological substance is a substance that is produced by or extracted from a biological source and for which a combination of physico-chemical-biological testing and the production process and its control is needed for its characterisation and the determination of its quality Source – EMEA “a substance which cannot be completely characterized by physicochemical means alone and which therefore requires the use of some form of bioassay”. Source – WHO 6 Note: Sources mentioned in the notes section of slide
  • 7. Complexity of Biopharmceuticals Structure Epoetin Size Aspirin M Stability od ifi ca tio n 7
  • 8. Types of Biologics  Peptides  Non-glycosylated proteins  Glycosylated proteins  Monoclonal antibodies 8
  • 9. Manufacturing Process Cell Bank UPSTREAM •Cell expansion •Fermentation Raw In •Clarification materials process DOWNSTREAM •Centrifugation •Chromatography •Ultra filtration Drug substances Drug release substances 9
  • 10. Biotech Process A typical fermentation based biotech process flow 10
  • 11. FDA Approvals (2005-2009) Synthetic V/s Biopharmceuticals 25 21 20 19 18 18 16 Number of Approvals 15 10 6 5 4 3 2 2 0 2005 2006 2007 2008 2009 New molecular entities New biologic entities 11
  • 12. EMEA Approvals (2005-2009) Synthetic V/s Biopharmceuticals 25 23 20 20 19 16 Number of Approvals 15 13 10 10 8 6 5 5 4 0 2005 2006 2007 2008 2009 New molecular entities New biologic entities More number of Biopharmceuticals were approved by EMEA as compared to FDA in 2009 12
  • 13. Benefits of Biopharmaceuticals  Highly effective and potent action  Fewer side effects  Potential to actually cure diseases rather than merely treat the symptoms  Longer half life 13
  • 14. Top 10 Biopharmceuticals in 2008 #Rank Biopharmceuticals Brands Company Sales(08)(US$ million) Therapeutic area 1 Etanercept Enbrel Amgen, Wyeth $6,580 Rheumatoid Arthritis J&J, Schering Plough, 2 Infliximab Remicade $5,934 Rheumatoid Arthritis Mitsubishi 3 Bevacizumab Avastin Roche $5,777 Colorectal cancer. 4 Rituximab Rituxan Roche $5,653 Head and Neck Cancer 5 Adalimumab Humira Abbott $5,488 Rheumatoid Arthritis 6 Epoetin alfa Epogen Amgen $5,033 Renal anemia 7 Trastuzumab Herceptin Roche $4,890 Breast cancer 8 Insulin Lantus Sanofi Aventis $4,180 Diabetes 9 Pegfilgrastim Neulasta Amgen $3,355 Neutropenia 10 Darbepoetin Aranesp Amgen $2,871 Anemia 14 Source- La Merie Business intelligence (R&D Pipeline news 10 March 2010)
  • 15. Top 10 companies in Biopharmceuticals Sales/Revenues R & D spending # Rank Company Therapeutic area In US$ Million) (In US$ Million) 1. Amgen 14,687 $2,900 Oncology, kidney disease, rheumatoid arthritis Oncology, Immunology, Tissue Repair, Neuroscience, Ophthalmology 2. Genentech 10,531 2,800 Diabetes care , Haemostatic management , Growth hormone 3. Novo Nordisk 8,989 1,550 therapy , Hormone replacement therapy Neurodegenerative Diseases, Oncology, Fertility, Endocrinology, 4. Merck Serono 7,338 1,580 Autoimmune and Inflammatory, Cardio metabolic care Baxter biopharma 5. 5,308 868 Hemophilia, Biotherapeutics, Regenerative Medicine, Vaccines solutions 6. Biogen Idec 3,968 1,072 Neurology, Oncology, Immunology, Hemophilia, Cardiopulmonary Genetics Diseases, Cardio metabolic and Renal, Oncology, 7. Genzyme 3,751 750 Orthopaedics/Biosurgical Specialties, Transplant, Genetics/Diagnostics Dermatology, Urology, Cardiovascular, Antibiotics, Anaphylaxis, 8. CSL ltd 2,961 202 Central nervous system, Analgesia, Emergency Care, Obstetrics and Gynecology Neurosciences, Medical Dermatology and Urology, Eye Care, 9. Allergan 1,311 798 Medical Aesthetics, Obesity Intervention 10. Alexion Pharma 259 63 Hematology 15 Source-Contract Pharma Articles » 2009 » July/August 2009
  • 16. Cost of Biopharmceuticals Drug Indication Cost Duration Cerezyme Life-threatening enzyme deficiency $200,000 to $500,000 12 Month Trastuzumab (Herceptin) Breast Cancer $36,000 6 Month Rituximab (Rituxan) Non-hodgkin’s lymphoma $32,500 2 Month Bevacizumab (Avastin)/ Cetuximab Metastatic Colorectal Cancer $28,500 2 Month (Erbitux) Infliximab (Remicade), Rheumatoid arthritis $18,000 - Infliximab Crohn’s disease $16,500 - Cost for indication listed are for 2005 Source- MONROE 2006 16
  • 18. Definitions and Terminologies A biosimilar medicine is a medicine which is similar to a biological medicine that has already been authorised (the ‘biological reference medicine’)1 Source – EMEA “A follow-on biologic (FOB) is “a protein product which is intended to be a similar version or duplicate of an already approved or licensed protein product”.4 Source – FDA A new biological medicinal product claimed to be “similar” with regard to quality, safety and efficacy to an already approved reference medicinal product3 Source – WHO “A drug to be developed by a different marketing approval holder as a drug that is bio-equivalent/quality-equivalent to biotechnology-derived drug already approved domestically” 2 Source – PMDA ,Japan Commonly used terminologies/synonyms • Biosimilars • Biogenerics • Follow on Biopharmceuticals • Follow on Protein 18 Note: Sources mentioned in the notes section of slide
  • 19. Biosimilars - Scientific basis for abbreviated pathway Demonstrate Quality, Safety, Efficacy Surveillance Regulatory Extensive Approval New Biologic Clinical Characterization Pre-Clinical Clinical Extensive Regulatory Surveillance Characterization Approval Clinical Biosimilar Extensive Pre-Clinical Comparison to Pre-Clinical Reference Allows for abbreviated 19 pre-clinical & clinical
  • 21. No Harmonized Worldwide Regulatory Framework for Biosimilars  Small molecule generics model is inappropriate  In many regions limited or no regulatory processes exist  Lack of minimum regulatory standards presents a risk for patients because of the potential issues relating to the quality, efficacy and safety of biosimilars developed and approved without defined requirements 21
  • 22. Biosimilars – Regulatory Perspective Well Defined Framework Under process of Development No or Minimal Framework EUROPEAN5 USA5 INDIA2 UNION  Currently there is no clear guidelines  Comparability studies are required and authority for approval of biosimilars  Requires only Phase III clinical to substantiate evidence for safety, trials for 100 patients  No equivalent of ANDA under PH&S act efficacy and quality5 for approval of biosimilars6  Guidelines, including specific clinical CHINA 4  A biosimilar could not be approved until and non-clinical data requirements 12 years after the date on which the for four product types: reference product was first licensed5 Recombinant insulin, human growth factor, erythropoietin and CSFs 6  10-year period for innovator exclusivity, with the opportunity for JAPAN 1 an additional year for new  Pharmaceuticals and medical device indications5 Agency (PMDA ) Japan's regulator, expects to finalize a new guideline for the regulation of follow-on Biopharmceuticals this year,  First draft put out for public comment last September CANADA 4 22 Note: Sources mentioned in the notes section of slide
  • 23. Biosimilars In the Market Today  Europe - Sandoz –Omnitrope (hGH), Binocrit (“EPO” or erythropoietin); Biopartners -Valtropin (hGH); Hexal –EPO version;  U.S. –Sandoz -Omnitrope  China –EPO versions, Interferons, IL-2, IL-11, GM-CSF, hGHs  India –hGH. EPO, Interferon alpha 2b, insulin  Australia –Omnitrope (Sandoz)  Cuba, Egypt, Africa –EPO versions 23
  • 24. Strategic Options to Tap Biosimilar Market Generics firms enter successfully into the biosimilars market Pharmaceutical companies expand their Biopharmceuticals business and enter biosimilars market opportunistically New types of cooperation between Pharma, Biotech or Generics 24
  • 25. Biosimilars successful if all hurdles passed 25
  • 26. The other side of the Biopharmceuticals……. Safety issue …………??????????  Biologic drugs are orders of magnitude more complex than small molecule drugs  Safety & efficacy of final product is exceptionally sensitive to small changes in manufacturing process  It is difficult to impossible to predict the effect of these small changes— experience counts  Potential for dramatic negative health consequences 26
  • 27. Key Success Factors for Biosimilars 1. Consistent long term strategy 2. Healthy financial structure 3. Comprehensive competitive intelligence 4. Core competencies for manufacturing process 5. Deep clinical development and regulatory expertise 6. Effective marketing & sales skills 27
  • 29. Challenges in front of Biopharmceuticals From Industry perspective  Long and costly clinical trials  Efficacy  Difference in Sero – Prevalence (Virus etc) and Genetic makeup (Human beings)  Low cost advantage (due to costly raw materials, equipments and labor)  Difficult to copy (Standardization process) 29
  • 30. Continue… From Govt. perspective  No guidelines (Since Biopharmceuticals are in Nascent stage) From Patients perspective  Adverse - effects 30
  • 31. Future of Biopharmceuticals  More diseases will come under the treatment  Effective manufacturing 31
  • 32. Conclusion  Biopharmceuticals or PERISH!!!!!!!  Traditional drug1st generation Biopharmceuticals (small molecules)2nd Generation Biopharmceuticals (large molecules) Follow on Biopharmceuticals Biobetters ….….What next??? 32
  • 33. 33

Notas do Editor

  1. Source: http://www.egagenerics.com/doc/biosimilars_helsinki_2008-10-31.pdf http://www.pmda.go.jp/english/past/2009bio_sympo/file/I-2_Nomura(JPMA).pdf http://www.diahome.org/product/16920/Kim_18430_852.pdf http://www.slideshare.net/m_a_staples/MStaplesBioGenerics-HandoutMAR08
  2. http://www.fda.gov/BiopharmceuticalsBloodVaccines/DevelopmentApprovalProcess/BiologicalApprovalsbyYear/default.htm http://www.fda.gov/BiopharmceuticalsBloodVaccines/DevelopmentApprovalProcess/BiologicalApprovalsbyYear/default.htm
  3. http://www.ema.europa.eu/htms/human/epar/a.htm Thomson Partners; IDDB3 IMS Health
  4. Source- http://www.contractpharma.com/articles/2009/07/2009-top-10-biopharmaceutical-companies-report
  5. http://www.managedcaremag.com/supplements/0803_bfac/BFAC_monograph_MC.pdf http://www.law.duke.edu/journals/dltr/articles/2008dltr0009.html
  6. Source: http://www.egagenerics.com/doc/biosimilars_helsinki_2008-10-31.pdf http://www.pmda.go.jp/english/past/2009bio_sympo/file/I-2_Nomura(JPMA).pdf http://www.diahome.org/product/16920/Kim_18430_852.pdf http://www.slideshare.net/m_a_staples/MStaplesBioGenerics-HandoutMAR08
  7. http://www.scripnews.com/home/Japans-biosimilar-guidelines-edge-forward-115782 http://www.genengnews.com/articles/chitem.aspx?aid=2099&chid=4 Evaluation of Medicines for Human Use http://www.prlog.org/10273398-negotiating-the-emerging-biosimilars-landscape-key-developments-in-the-regulatory-environment.html 5. http://www.pjbpubs.com/uploads/RycPYX13U757v7h2kpec.pdf ( page 17-20) 6. http://www.scribd.com/doc/2068017/Biosimilars-Overview-18012007-v2
  8. http://www.biosimilarstoday.com/2008/King.pdf
  9. http://www.accenture.com/NR/rdonlyres/B5765AC2-4B74-4512-9034-BB4420A6BC5D/0/Accenture_HLS_PMP_Biosimilars.pdf