Journal of Bioequivalence & Bioavailability

Abstract

Generic and Branded Enoxaparin Bioequivalence: A Clinical and Experimental Study

Hamdi Boubaker MD, Mohamed Habib Grissa MD, Mouna Sassi MD, Taher Chakroun MD, Kaouthar Beltaief MD, Mohsen Hassine MD, Grigoris T Gerotziafas MD, Rabie Razgallah MD, Wahid Bouida MD, Riadh Boukef MD, Ismail Elalamy MD and Semir Nouira MD

Our aim is to compare a new generic version of enoxaparin (Enoxa®) with the parent brand (Lovenox®). We included patients with acute coronary syndrome (ACS) for the clinical study and healthy volunteers for the experimental study. ACS patients randomly assigned to receive a bolus of Enoxa® (n=86) or Lovenox® (n=83) and serum anti-Xa activity was measured 4 hours thereafter. For experimental study, blood from healthy volunteers was used to compare the effect of both formulations on thrombin generation in citrated platelet-poor plasma (PPP). The half maximal inhibitory concentration of the drug (IC50) that is required to inhibit 50% in-vitro thrombin generation parameters, mean rate index (MRI) and endogenous thrombin potential (ETP). Both IC50 MRI and IC50 ETP were calculated in PPP. In ACS patients, serum anti-Xa activity was found not different between Enoxa® and Lovenox®. Median anti Xa activity measured 4 hours after the initial bolus was 0.39 IU anti-Xa/ml [95 % CI 0.31-0.53] and 0.34 IU anti-Xa/ml [95% CI 0.27-0.53], for the Enoxa® group and Lovenox® group respectively. No difference in major cardiovascular events was observed during hospital stay. In healthy volunteers, IC50 MRI and IC50 ETP were similar between Lovenox® and Enoxa® in PPP [(2.5 μg/ml ± 0.2 μg/ml) versus (2.3 μg/ml ± 0.1μg/ml) respectively for IC50 MRI; (p=0.2)] and [(4.8 μg/ml ± 0.8 μg/ml) versus (4.1 μg/ml ± 0.1 μg/ml) respectively for IC50 ETP; (p=0.2)]. With both formulations, anti-Xa activity and anti-Xa/anti-IIa ratio were similar. The generic enoxaparin Enoxa® met the main regulatory criteria of bioequivalence with the branded product.