Uptake of rheumatology biosimilars in the absence of forced switching

Research output: Contribution to journalArticle


Background: To describe the uptake and system-level effects of the introduction of biosimilars in a setting without forced switching. Research design and methods: We used data from the Swedish Rheumatology Quality register from start of marketing of infliximab (Remsima® and Inflectra®) and etanercept (Benepali®) biosimilars until 31 December 2016. We compared users of each originator-product and its biosimilar(s) by line of treatment: bDMARD-naïve patients, non-medical switchers (vs. matched patients remaining on originator), and patients switching from a previous bDMARD of another type. Results: From the start of marketing 1343 patients started an infliximab biosimilar (22 months) and 2691 started etanercept (9 months). Overall, the introduction of these biosimilars resulted in an increase of the total number of ongoing infliximab and etanercept treatments (originator + biosimilar) . At the end of the study period, biosimilars accounted for 31% of all infliximab treatments and 31% of all etanercept-treated patients. For each line of therapy, we noted only small differences in patient characteristics between those starting the originator product vs. its biosimilar(s). Conclusions: Introduction of biosimilars have effects beyond replacement of the originator product, in terms of an increased rate of bDMARD initiation. Selection to non-medical switching displayed no particular disease- or patient-characteristics.


  • Daniela Di Giuseppe
  • Thomas Frisell
  • Sofia Ernestam
  • Helena Forsblad-D’Elia
  • Elisabet Lindqvist
  • Ulf Lindström
  • Christopher Sjöwall
  • Johan Askling
External organisations
  • Karolinska Institutet
  • Karolinska University Hospital
  • Umeå University
  • Sahlgrenska Academy
  • Linköping University
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Rheumatology and Autoimmunity


  • bDMARD, biosimilar, rheumatology, uptake
Original languageEnglish
Pages (from-to)499-504
JournalExpert Opinion on Biological Therapy
Issue number5
Early online date2018 Apr 8
Publication statusPublished - 2018 May 4
Publication categoryResearch