Serum concentrations after switching from originator infliximab to the biosimilar CT-P13 in patients with quiescent inflammatory bowel disease (SECURE): an open-label, multicentre, phase 4 non-inferiority trial

Loss of efficacy and safety of the switch from infliximab original to infliximab biosimilar (CT-P13) in patients with inflammatory bowel disease

BACKGROUND

Infliximab original has changed the natural history of inflammatory bowel diseases (IBD) over the past two decades. However, the recent expiration of its patent has allowed the entry of the first Infliximab biosimilar into the European and Spanish markets. Currently switching drugs data in IBD are limited.

AIM

To compare the efficacy of infliximab biosimilar, CT-P13, against infliximab original, analyzing the loss of response of both at the 12 mo follow-up in patients with IBD.

METHODS

An observational study of two cohorts has been conducted. One retrospective cohort that included patients with IBD treated with Infliximab original, and a prospective cohort of patients who were switching from infliximab original to infliximab biosimilar (CT-P13). We had analyzed the overall efficacy and loss of efficacy in patients in remission at the end of one year after treatment with the original drug compared to the results of the year of treatment with the biosimilar.

RESULTS

98 patients (CD 67, CU 31) were included in both cohorts. The overall efficacy for infliximab original per year of treatment was 71% vs 68.2% for infliximab biosimilar (P = 0.80). The loss of overall efficacy at 12 mo for infliximab original was 6.6% vs 14.5% for infliximab biosimilar (P = 0.806). The loss of efficacy in patients who were in basal remission was 16.3% for infliximab original vs 27.1% for infliximab biosimilar. Adverse events were 9.2% for infliximab original vs 11.2% for infliximab biosimilar.

CONCLUSION

The overall efficacy and loss of treatment response with infliximab biosimilar (CT-P13) is similar to that observed with infliximab original in patients who were switching at the 12 mo follow-up. There is no difference in the rate of adverse events.

The nocebo effect: a clinical challenge in the era of biosimilars

INTRODUCTION

The nocebo effect is defined as a negative effect of a pharmacological or non-pharmacological medical treatment that is induced by patients' expectations, and that is unrelated to the physiological action of the treatment. The nocebo effect is an important clinical challenge in the current era of biosimilars. Areas covered: This review aims to answer five key questions about the nocebo effect, namely to reveal its definition, pathophysiology, clinical relevance, contributing factors, and management. Expert commentary: The nocebo effect lowers patients' quality of life and negatively affects treatment adherence rates in biosimilar-treated patients. It may negatively impact on the cost-savings of biosimilars. Health-care providers in charge of biosimilar-treated patients need to be aware of the nocebo effect and adopt strategies to minimize it. They have to be well-informed and confident about the existing evidence about biosimilars. A good patient-physician relationship will improve patients' acceptance of biosimilars, and limits the risk of inappropriate negative bias and the nocebo effect.

Anti-Tumour Necrosis Factor in Inflammatory Bowel Disease: Inventory and Outlook

Biosimilars have contributed substantially to the evolving therapeutic landscape for inflammatory bowel disease (IBD), enabling healthcare systems to offer access to a broader range of therapies at an affordable price. Despite the increasing confidence healthcare practitioners (HCP) place in the safety and efficacy of biosimilars, uncertainty remains around best practice when switching a patient from a reference product to a biosimilar. This symposium aimed to uncover the importance of a managed switch programme by exploring real-world data from the University Hospital Southampton NHS Foundation Trust, Southampton, UK, and University Hospital Erlangen, Erlangen, Germany. The roles of therapeutic drug monitoring and predictive outcome scoring were discussed based on evidence from the SECURE and the CREOLE studies, respectively. Finally, in light of the recent European Union (EU) approval of adalimumab biosimilars, the future therapeutic landscape and how physicians and patients can make well-informed decisions when multiple versions of the same biologic are available were discussed.