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Dr Ivo Abraham: Biosimilar Pegfilgrastims vs Neulasta Onpro Utilization


Ivo Abraham, PhD, RN, a professor with the University of Arizona Health Sciences in the Department of Pharmacy Practice, talks about the role that the pandemic has played in the struggle between biosimilar pegfilgrastims and the on-body injector version of the reference product.

Ivo Abraham, PhD, RN, is a professor with the University of Arizona Health Sciences in the Department of Pharmacy Practice. Abraham is also a health care consultant and co-founder at Matrix45.


Do you think the evidence produced from your research is enough to convince stakeholders to put a bigger emphasis on pegfilgrastim biosimilars?

I think there's little question among clinicians, payers, patients, and policy makers that prophylaxis for febrile neutropenia is standard of care. So, yes, a proportion of patients need to be on a prophylactic. Of all cancer patients diagnosed in a certain year, about 20% of them will end up needing chemotherapy and prophylaxis for a G-CSF [granulocyte-colony stimulating factor]. So, there's no question about whether to do it; it's about how to do it. It's an expensive drug and it's not comparable to what we see with some of the very new anticancer treatments, but still in itself is an expensive drug for something that really doesn't treat the cancer. It makes the cancer treatment perhaps better or more effective by not having it interrupted.

So, the issue is not as much do we need to convince the stakeholders. Ultimately, what we're seeing right now in clinic practice and what my pharmacy colleagues are telling us is that we're using a lot of biosimilar pegfilgrastim. The problem is that one payer will say, "Use this biosimilar pegfilgrastim," and another payer will say, "No, we don't like those people. This is the contract that we have with that manufacturer." I'm making light of it, but that is what is happening. All the payers—certainly commercial payers—are negotiating contracts. So, pharmacies have to stock several pegfilgrastim products, including Neulasta [reference pegfilgrastim] because there are some payers that struck a deal with Amgen for Neulasta to keep the biosimilar pegfilgrastims at bay.

Although doctors will likely switch patients to biosimilar pegfilgrastim, do you think there’s a durable practical advantage for the Onpro?

Yeah, I think that the Onpro device is an ingenious device. We have to be careful about it malfunctioning. I'm sure Amgen is working on that because there's the additional cost to the payers. There's also the image of course. Is this really safe? Do I trust it as a patient? Do I trust it as a clinician? And COVID-19 helped Onpro enormously, rightfully so, because everybody was saying, let’s not bring immunocompromised people, which is what most cancer patients are, back to the clinic just to get an injection the next day. So, we want to keep people at home. From that point of view Onpro has a very important role.

The concern is, first of all, payers. Will they cover it? The other element is also that there is an enormous convenience factor. The NCCN [National Comprehensive Cancer Network] and ASCO [American Society of Community Oncology] COVID-19–related guidelines did not directly advocate for Onpro, but certainly pointed out that this is potentially a very, very good solution. So, I think from that point of view, yes, people will continue using it and sooner or later there will be another device on the market. People are working on that, also something that allows for time-defined, delayed administration of the medication.

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