Therapeutic equivalents

This page is very much under construction at the moment. It is possible that information here may be of assistance related to drug shortages.

Introduction

Generally speaking, prospective clinical trials are very specific in the drugs that they use in their evaluation. In clinical practice, one drug is often substituted for another, using the clinical concept of therapeutic equivalence. The purpose of this page is to gather various categories of therapeutic equivalence for general reference, and also to inform the HemOnc ontology. Please keep checking back as the page develops!

Categories of therapeutically similar drugs

Recombinant proteins

These are identical products to a parent natural protein, which are created through synthetic methods.

Parent compound	Recombinant protein
Asparaginase Erwinia chrysanthemi (Erwinaze)	Asparaginase erwinia chrysanthemi-rywn (Rylaze)
Pegfilgrastim (Neulasta)	Lipefilgrastim (Lonquex)

Biosimilars

These are "nearly identical" products to a parent compound, with what is considered interchangeable efficacy and toxicity. Note that EMA approvals do not include the four-letter suffix at this time, which we have added to distinguish the generic ingredient from the parent compound.

Class of agent	Parent compound	Biosimilar(s)
Anti-C5 antibody	Eculizumab (Soliris)	Eculizumab-beke (Bekemv) Eculizumab-epys (Epysqli)
Anti-VEGF antibody	Bevacizumab (Avastin)	Bevacizumab-adcd (Vegzelga) Bevacizumab-awwb (Mvasi) Bevacizumab-bvzr (Zirabev) Bevacizumab-maly (Alymsys) Bevacizumab-aybi (Aybintio) Bevacizumab-equi (Equidacent) Bevacizumab-onbe (Onbevzi)
Anticoagulant	Enoxaparin (Lovenox)	Enoxaparin-inhi (Inhixa)
Red cell growth factor	Epoetin alfa (Procrit)	Epoetin alfa-epbx (Retacrit) Epoetin alfa-abse (Abseamed) Epoetin alfa-bino (Binocrit) Epoetin alfa-hexa (Epoetin Alfa Hexal)
Red cell growth factor	Epoetin zeta (Eprex)	Epoetin zeta-reta (Retacrit) Epoetin zeta-sila (Silapo)
Myeloid growth factor	Filgrastim (Neupogen)	Filgrastim-aafi (Nivestym) Filgrastim-sndz (Zarxio) Filgrastim-acco (Accofil) Filgrastim-ayow (Releuko) Filgrastim-hexa (Filgrastim Hexal) Filgrastim-gras (Grastofil) Filgrastim-rati (Ratiograstim) Filgrastim-teva (Tevagrastim)
Myeloid growth factor	Pegfilgrastim (Neulasta)	Pegfilgrastim-apgf (Nyvepria) Pegfilgrastim-bmez (Ziextenzo) Pegfilgrastim-cbqv (Udenyca) Pegfilgrastim-jmdb (Fulphila) Pegfilgrastim-cegf (Cegfila) Pegfilgrastim-fpgk (Stimufend) Pegfilgrastim-gras (Grasustek) Pegfilgrastim-pbbk (Fylnetra) Pegfilgrastim-pelg (Pelgraz) Pegfilgrastim-pelm (Pelmeg) Pegfilgrastim-stim (Stimufend)
Anti-CD20 antibody	Rituximab (Rituxan)	Rituximab-abbs (Truxima) Rituximab-arrx (Riabni) Rituximab-pvvr (Ruxience) Rituximab-blit (Blitzima) Rituximab-rite (Ritemvia) Rituximab-rixa (Rixathon) Rituximab-rixi (Riximyo)
Anti-HER2 antibody	Trastuzumab (Herceptin)	Trastuzumab-anns (Kanjinti) Trastuzumab-dkst (Ogivri) Trastuzumab-dttb (Ontruzant) Trastuzumab-herw (Herwenda) Trastuzumab-pkrb (Herzuma) Trastuzumab-qyyp (Trazimera) Trastuzumab-zerc (Zercepac)

Same drug, different route

These agents generally are first approved as IV formulations, and then are approved for a more convenient route, usually with a different vehicle. Efficacy is considered to be equivalent, but toxicity may differ.

Class of agent	Original formulation	Alternative formulation
Anti-CD38 antibody	Daratumumab (Darzalex)	Daratumumab and hyaluronidase (Darzalex Faspro)
Hypomethylating agent	Azacitidine (Vidaza)	Azacitidine oral (Onureg)
Hypomethylating agent	Decitabine (Dacogen)	Decitabine and cedazuridine (Inqovi)
Anti-CD20 antibody	Rituximab (Rituxan)	Rituximab and hyaluronidase human (Rituximab Hycela)
Anti-HER antibody	Trastuzumab (Herceptin)	Trastuzumab and hyaluronidase (Herceptin Hylecta)

Combinations of agents

(e.g., Phesgo is combined pertuzumab & trastuzumab)

Pro-drugs

(e.g., capecitabine & 5-FU, although this is tricky because of LCV...)

Same class

(e.g., possibly cisplatin and carboplatin; definitely prednisone and prednisolone)

References

1. Nahleh Z, Lyman GH, Schilsky RL, Peterson DE, Tagawa ST, Chavez-MacGregor M, Rumble RB, Gupta S. Use of Biosimilar Medications in Oncology. JCO Oncol Pract. 2022 Mar;18(3):177-186. Epub 2022 Jan 18. link to original article PubMed
2. Rodriguez G, Mancuso J, Lyman GH, Cardoso F, Nahleh Z, Vose JM, Gralow JR, Francisco M, Sherwood S. ASCO Policy Statement on Biosimilar and Interchangeable Products in Oncology. JCO Oncol Pract. 2023 Jul;19(7):411-419. Epub 2023 Apr 7. link to original article PubMed