Cameron Santoro is an associate editor for The Center for Biosimilars

Cameron Santoro

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Among patients with rheumatoid arthritis (RA) registered with the British Society for Rheumatology Biologics Register in Rheumatoid Arthritis (BSRBR-RA), those treated with etanercept biosimilar showed similar treatment responses and drug survival rates vs those treated with etanercept originator. The findings were published in 

In the early 2000s, etanercept was one of the first biologic therapies licensed as a treatment method for patients with RA. The observational BSRBR-RA study monitors the long-term safety of biologics in routine practice, and for the current study, patients enrolled from 2010 were included. The authors aimed to compare outcomes of the originator vs the biosimilar after 6 and 12 months of therapy.

Patient characteristics included age, gender, disease duration, disease activity using core outcome variables, patient global visual analogue scale, erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) and the 28-joint DAS, functional ability using the health assessment questionnaire (HAQ), and the current or previous anti-rheumatic therapies they received. The observational prospective cohort study operated from January 1, 2010, to June 16, 2022, where every patient had at least 1 year of follow-up.

The core outcome variables of disease activity, DAS28, and HAQ were reviewed at baseline, 6 months, and 1 year. Statistics were calculated using the proportion of patients who achieved DAS28 remission (DAS28 < 2.6), European Alliance of Associations for Rheumatology (EULAR) response (good: 6-month DAS28 ≤ 3.2 and improvement > 1.2 units; no response: 6-month DAS28 ≤ 5.1 and > 3.2 with improvement ≤ 0.6 units; moderate all others), and minimal clinically important difference (MCID) in HAQ (reduction in HAQ score ≥.22 units). Primary outcome statistics were DAS28 remission, any EULAR response (moderate and good vs no response), good EULAR response (vs moderate/no response) and MCID in HAQ. Ethnicity, joint surgery history, anti-CCP positivity, rheumatoid factor (RF) positivity, smoking status, disease duration, and body mass index were among additional variables included to offset any missing data.

Drug survival was calculated using the Kaplan-Meier method amongst cohorts, adjusted by propensity deciles. The study utilized the Cox proportional hazards model to compute the regression of patients on etanercept originator who halted therapy after time in comparison to patients on the biosimilar, modified by propensity deciles. Analyses were determined using Stata version 14, a multilevel survey model.

Results demonstrated similar disease activity between the cohorts starting etanercept as their first biologic of the originator vs the biosimilar. Each cohort had a median improvement of DAS28 from baseline to 6 months, with a median improvement of 2.4 units at 6 months and a median of 2.5 units at 1 year. Patients with RA reached DAS28 remission at 6 months of therapy in 26% of the originator group and 31% of the biosimilar participants. The classification of a good EULAR response was met by 38% of the originator cohort after 6 months while the biosimilar group achieved 45%. After 6 months, 41% of the originator cohort attained MCID in HAQ while the biosimilar cohort was at 47% (95% CI, 0.57-0.97). Both the etanercept originator and biosimilar cohorts had 35% of patients achieve MCID in HAQ from baseline to 1 year. The Cox proportional hazards model proved etanercept originator group versus the biosimilar group were no more likely to stop therapy than the other one (95% CI, 0.99-1.33).

Study limitations were mainly the large gap of time between the approval of the originator drug to the earlier approval of the 2016 biosimilar. This could likely lead to bias since the biosimilar patients had less follow-up in comparison to the originator participants. The study focused on patients from 2010 and beyond because patients with RA may be vastly different to those of more recent.

The national cohort study proved the etanercept originator had closely similar treatment effects on the patients beginning the biosimilar regarding disease activity and drug survival. Neither group was more likely to halt etanercept therapy after 1 year with 71% on the originator and 76% on the biosimilar. The authors conclude, “These data are reassuring to both patients and clinical teams when considering starting etanercept originator or biosimilar therapy as their first biologic”.

Kearsley-Fleet L, Rokad A, Tsoi MF, et al. Etanercept originator versus etanercept biosimilar for the treatment of rheumatoid arthritis as a first biologic: results from the BSRBR-RA. 

. 2023;62(12):3849-3857. doi:10.1093/rheumatology/kead127

Articles

A national study on patients with rheumatoid arthritis (RA) compares the disease activity and drug survival rate between an etanercept biosimilar and the originator (Enbrel).

Study Shows Similar Efficacy, Drug Survival Rates for Etanercept Biosimilar vs Originator in RA

Here are the top 5 biosimilar articles for the week of December 4, 2023. 

The Top 5 Biosimilar Articles for the week of December 4, 2023

 noted that Europe could miss out on €15 billion in cost savings by not having biosimilars for medications about to lose market exclusivity, shedding light on the implications for overall health care savings and ultimately, patient access.

 where data were collected from patients with inflammatory bowel disease (IBD) showed safety and efficacy of the adalimumab biosimilar HS016.

Number 3: Several companies make moves to further their 

, Regeneron sues Celltrion over biosimilar for Eylea (aflibercept), and Health Canada grants marketing authorization for biosimilar referencing Stelara (ustekinumab). 

Number 2: Sarfaraz K. Niazi, PhD, offers hope for the end of 

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Number 1: With numerous adalimumab biosimilars launched in the United States in 2023, the impact of an 

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Videos

The Top 5 Biosimilar Articles for the Week of December 4

A study confirmed the effectiveness and safety of GP2017in patients with inflammatory bowel disease (IBD) who were naïve to adalimumab or switched from the originator (Humira) or another adalimumab biosimilar.

The observational, multi-centric, retrospective 

 was conducted in 2 IBD centers in Northern Italy by analyzing patients with IBD, an umbrella term for Crohn disease (CD) and ulcerative colitis (UC). Data surrounding GP2017 has been scarce, especially in patients with IBD, since its July 2018 European Medicines Agency (EMA) approval was supported by data testing the product in plaque psoriasis. GP2017 (Hyrimoz/Hefiya) 1 of 10 EMA-approved adalimumab biosimilar.

Participants included patients with a diagnosis of CD or UC, ongoing or previous therapy for GP2017, and at least 6 months of follow up after beginning the GP2017. The patients were administered subcutaneous injections of 160 mg at baseline, 80 mg at 2 weeks, followed by 40 mg maintenance doses every 2 weeks for patients naïve to adalimumab. However, patients who switched from the originator or from another biosimilar received a standard maintenance dose of 40 mg every 2 weeks.

Overall, the study included a total of 72 patients with an IBD diagnosis. GP2017 was administered to 29 patients (40.3%) as the first form of adalimumab therapy. There were 33 patients that were first treated with the adalimumab originator (45.8%) and 10 who were initially treated with a different adalimumab biosimilar (13.8%).

Prior to GP2017 treatment, 5 patients reported clinical remission (17.2%), 16 had mild disease activity (55.1%), and 8 communicated moderate-to-severe activity (27.6%). After 6 months, 10 of the 29 treated with GP2017 were considered in remission (34.5%), 17 had mild activity (58.6%), and 8 had moderate-to-severe activity (27.6%). Following 12 months, 17 patients concluded remission (58.6%), 9 reported mild activity (31%), and only 1 patient had moderate-to-severe activity present (3.5%). There were 5 patients in remission at baseline, 10 patients after 6 months (P = .0005) and 17 patients noted remission after 12 months (P = .001).

Overall, 33 patients were switched from the originator to GP2017. When first administered, 25 patients reported clinical remission (75.8%), 6 were in mild activity (18.2%), and 2 had moderate-to-severe activity present (6%). The following 6 months included 26 patients reaching remission (78.8%), 4 with mild activity (12.1%), and only 1 out of 33 had moderate-to-severe activity (3%). After the 12-month follow-up period ,26 patients were in clinical remission (78.8%), 2 had mild activity (6.1%), and 0 patients had moderate-to-severe activity. 

Regarding the 10 participants who switched from another adalimumab biosimilar to GP2017, at baseline, 6 patients were in clinical remission, 3 had mild activity present, and only 1 had moderate-to-severe activity. At 6-months ,7 patients were in remission, 2 had mild activity, and 1 patient had moderate-to-severe activity. At month 12, 7 patients were in remission, 2 had mild activity, and 0 patients had moderate-to-severe activity.

Only 11 patients experienced nonserious side effects, including headache, allergic reactions, arthralgia, and cutaneous manifestations, in line with those identified for the originator. Additionally, 9 patients discontinued treatment, mainly due to adverse events or secondary failure.Study limitations surrounded the observational data collection potentially influenced by missing information or demographics, absence of certain procedures, lack of control groups, and smaller sample sizes for UC compared to patients with CD. Statistics could be affected regarding the subgroup sample size of patients who switched from other adalimumab biosimilars.

The author stated, “Moreover, the retention rate and safety profile are comparable to those present in the literature regarding the originator, justifying the feasibility to switch from the originator to a biosimilar or from biosimilar to biosimilar.”

Vernero M, Bezzio C, Ribaldone DG, et al. Efficacy and safety of adalimumab biosimilar GP2017 in patients with inflammatory bowel disease. J. ClinMed. 2023; 12(21):6839. doi:0.3390/jcm12216839

Patients with inflammatory bowel disease (IBD) receive additional evidence on the safety and efficacy of adalimumab biosimilar GP2017 treatment.  

Adalimumab Biosimilar GP2017 Shows Similar Safety, Efficacy to Originator in Patients With IBD 

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biosimilars of tumor necrosis factor (TNF)

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A real-world study from China, published in 

, concluded the use of adalimumab biosimilar HS016 is as safe and effective as reference adalimumab (Humira) in patients with inflammatory bowel disease (IBD).

Existing studies compare infliximab to adalimumab, proving the benefits patients with IBD receive. Additionally, traditional treatment methods such as 5-aminosalicylic acid, glucocorticoids, and immunosuppressants have not been entirely successful among patients.

This analysis is the first to be conducted in China for patients with IBD based on the efficacy of HS016, confirming the safety, effectiveness, and similarities to the original adalimumab. The study results could aid in the expansion of biosimilar treatment options for Chinese patients diagnosed with IBD.

Biological therapy medications such as monoclonal antibodies or inhibitors, tumor necrosis factor (TNF)-α, interleukin (IL)-12/23, adhesion molecules, and Janus kinase (JAK)inhibitors are considered forms of treatment for patients with IBD. TNF-α is an important treatment in developing the inflammatory responding process as anti–(TNF)-α modifies diseases, heals the mucosal, while reducing risk of hospitalization, colectomy, and colorectal cancer in IBD patients.

(TNF)-αinhibitors bind with serum (sTNF-α) or on immune cell membranes (mTNF-α) to function as a biological agent. Anti–(TNF)-α products have become standard among all biologics, along with infliximab and the subcutaneous injection of adalimumab.

Researchers utilized therapeutic drug monitoring (TDM) to assess the safety and efficacy of HS016. TDM is a reliable tool for the management and optimization of anti–(TNF)-α agents, as well as measuring serum and anti-drug antibody concentrations. The adalimumab biosimilar HS016 acts as a biological agent with similar effects to adalimumabregarding quality, efficacy, and safety while allowing widespread accessibility with the potential of cost effectiveness.

The study included91patients with IBD (CD: n = 75; UC, n = 16), who were treated with HS016 atXijing Hospitalin China to be treated from October 2020 to April 2022. A total of 77 (CD: n = 61; UC: n = 16) patients completed the 52-week follow-up.

Of those in the CD group, 14 patients were in clinical remission at baseline and 61 had active disease. The mean age of the cohort was 30.5 years in the remission CD group, 33 years in the active CD group, and 40.5 yearsin the UC group. Most participants in all groups were male (remission CD: 71.4%; active CD: 67.2%; UC: 68.8%).Considerable factors in patients included disease duration, previous medications, disease typing, extraintestinal manifestations, complications of IBD, and previous surgical history.

Patients treated with the adalimumab biosimilar HS016 were administered a 160 mg dose at baseline, 80 mg dose at week 2, 40 mg dose every other week, and in the event of insufficient efficacy, the dose was increased to 40 mg per week based on the physicians’ judgement.

The efficacy assessment of HS016 is determined using the Harvey-Bradshaw Index (HBI) and Simplified Endoscopic Score for Crohn Disease while UC is determined by partial Mayo score (pMS). Patients with CD aimed for a score of less than or equal to 4 points, marking remission based on HBI while the pMS defines a score of less than or equal to 2 as remission.

Study results conveyed the patients with CD achieved the clinical response of 75.4% (n = 46) at 12 weeks, 73.8% (n = 45) at 26 weeks, and 50.8% (n = 31) at 52 weeks. Data of patients with CD reaching clinical remission was at 55.7% (n = 34) at 12 weeks, 65.6% (n = 40) at 26 weeks, and 45.9% (n = 28) at 52 weeks. Remission rates were maintained for 100% of patients at 12 weeks, 78.6% at 26 weeks, and 63.6% at 52 weeks (n = 14, 11, and 7, respectively). The clinical response of patients with UC achieved 37.5% (n = 6) at 12 weeks and 50% (n = 8) at 26 weeks.

Regarding safety, 3 participants experienced psoriasis-like rashes and 2 cases of fungal otitis externa. A large rash on the forehead and back developed in 1 patient afterinitial treatment. Following the 12 and 52-week mark, 2 patients presented symptoms of scattered rashes on their extremities. The researchers noted that the occurrence of adverse events was in line with previous data on the use of Humira in a similar patient population.

The authors concluded, “As research continues, we are confident that increasing biological agents will appear for IBD therapy. Additionally, biosimilars will stimulate competition in the market and have incredible potential to expand patient exposure to biologics in the context of treatment recommendations. Appropriate use of TDM will provide physicians with a more significant basis for selecting and optimizing treatment.”

Wang F, Li X, Shi Y, et al. Efficacy and safety of adalimumab biosimilar (HS016) in inflammatory bowel disease from the real-world study. Front Pharmacol. 2023;14:1259183. doi:10.3389/fphar.2023.1259183