The biosimilar Enoxa (enoxaparin), marketed in Tunisia, demonstrated equivalence in preventing subclinical postoperative thrombotic events in patients with digestive cancers to Sanofi’s Lovenox, in a randomized controlled trial.
Image credit: olegganko - stock.adobe.com
The biosimilar Enoxa (enoxapain biosimilar, Medis Pharmaceuticals), marketed in Tunisia, demonstrated equivalence in preventing subclinical postoperative thrombotic events in patients with digestive cancers to Sanofi’s Lovenox, in a randomized controlled trial published in PLOS ONE.
Both cancer and major surgery increase the risk of venous thromboembolic disease (VTED), including deep vein thrombosis and pulmonary embolism: cancer induces hypercoagulability, and surgery causes vascular injury that is often followed by a period of immobilization. VTED is the second leading cause of death in patients with cancer, the authors noted.
Thromboprophylaxis reduces the risk of VTED following surgery, and several molecules for this purpose are available, including enoxaparin, a low-molecular weight heparin (LMWH). Multiple biosimilar enoxaparin products are available, including Inhixa and Thorinane in the EU, Fragmin and Innohep in the US, and Cloti-Xa in India. Enoxa has been available in Tunisia since 2007.
This randomized controlled trial in a single center in Tunisia evaluated equivalence of Enoxa to the reference product in patients following surgery for digestive cancers. Patients received one injection of either originator or biosimilar enoxaparin daily for 30 days starting 8-12 hours after surgery. The primary outcome of the study was asymptomatic thromboembolic events assessed by Doppler ultrasound of the lower limbs 7-10 days following surgery, and secondary endpoints included symptomatic thrombotic events, heparin-induced thrombocytopenia, bleeding events, and deaths. A total of 168 patients were enrolled, and 145 patients were evaluated by Doppler ultrasound, 74 in the biosimilar group and 71 in the reference product group.
There were no statistically significant differences between groups for demographics and thrombosis-associated factors, such as history of cardiovascular disease and stroke, or use of hormone replacement therapy.
Six (4.1%) of the 168 enrolled patients had subclinical venous thrombosis following surgery, 2 (2.7%) in the biosimilar group and 4 (5.6%) in the originator group. The 95% CI of the difference in means between groups (-0.095 to 0.036) fell within the margins of equivalence (-0.20 to 0.20).
Clinical and subclinical events combined occurred in 6 (6.9%) and 7 (8.6%) patients in the biosimilar and reference product groups, also with no significant difference between groups. There were also no significant differences in other secondary outcomes, such as postoperative bleeding, heparin-induced thrombocytopenia, post-operative complications, and deaths. The authors noted the overall mortality rate (10.1%) was high. However, it was not significantly different between groups. Deaths occurred in 12.6% of patients who received the biosimilar and 7.4% in those who received the reference product.
The authors concluded Enoxa met equivalence criteria, and noted their results are consistent with 2 non-comparative studies that found Enoxa was safe and effective for preventing thrombotic events in patients undergoing total hip replacement. To their knowledge, theirs is the first trial to compare Enoxa to the reference product for preventing post-operative, subclinical thrombotic events.
Reference
Dziri C, Ben Hmida W, Dougaz W, Khalfallah M, Samaali I, Jerraya H, Bouasker I, Nouira R. Biosimilar versus branded enoxaparin to prevent postoperative venous thromboembolism after surgery for digestive tract cancer: Randomized trial. PLoS One. 2023;18(11):e0293269. doi:10.1371/journal.pone.0293269
BioRationality: EMA Accepts Waiver of Clinical Efficacy Testing of Biosimilars
April 21st 2025Sarfaraz K. Niazi, PhD, shares his latest citizen's petition to the FDA, calling on the agency to waive clinical efficacy testing in response to the European Medicines Agency's (EMA) efforts towards the same goal.
Biosimilars Development Roundup for October 2024—Podcast Edition
November 3rd 2024On this episode of Not So Different, we discuss the GRx+Biosims conference, which included discussions on data transparency, artificial intelligence (AI), and collaboration to enhance the global supply chain for biosimilars and generic drugs, as well as the evolving requirements for biosimilar devices.
Latest Biosimilar Deals Signal Growth Across Immunology, Oncology Markets
April 14th 2025During Q1 2025, pharmaceutical companies accelerated biosimilar expansion through strategic acquisitions and partnerships in hopes of boosting patient access to lower-cost treatments in immunology and oncology.
Biosimilars Oncology Roundup for June 2024—Podcast Edition
July 7th 2024On this episode of Not So Different, we review biosimilar news coming out of June, with clinical trial results from conferences and a study showcasing how to overcome economic and noneconomic barriers to oncology biosimilars.
BioRationality: Commemorating the 15th Anniversary of the BPCIA
April 8th 2025Affirming that analytical characterization is often sufficient for biosimilar approval, minimizing unnecessary clinical testing, and enhancing FDA-led education to counter stakeholder misconceptions are key recommendations put forth in this opinion piece by Sarfaraz K. Niazi, PhD.