1
|
Deakin CT, Littlejohn GO, Griffiths H, Ciciriello S, O'Sullivan C, Smith T, Youssef P, Bird P. Comparative effectiveness of etanercept originator and biosimilar for treating rheumatoid arthritis: implications for cost-savings. Intern Med J 2024; 54:795-801. [PMID: 38009675 DOI: 10.1111/imj.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIMS This study aimed to assess the comparative effectiveness of the etanercept (ETN) originator (Enbrel) and ETN biosimilar SB4 (Brenzys) as first-line treatment in patients with rheumatoid arthritis (RA), while also exploring the potential cost-savings associated with this approach in Australia. METHODS Clinical data were obtained from the Optimising Patient outcomes in rheumatoLogy Australian real-world data set. Adult patients with RA who had initiated treatment with the ETN originator or biosimilar as their first-recorded biologic or targeted synthetic disease-modifying antirheumatic drug between 1 April 2017 and 31 December 2020 were included. Treatment persistence was analysed using survival analysis. Cost-savings were estimated based on data reported by the Australian National Prescribing Service MedicineWise. RESULTS Propensity score matching followed by inverse probability of treatment weighting selected patients taking originator (n = 209) or biosimilar (n = 141) with similar baseline characteristics and eliminated small differences in baseline disease activity. The median time for 50% of the patients to stop treatment was 19.4 months (95% confidence interval [CI], 14.7-36.4 months) for the originator and 22.4 months (95% CI, 15.0-33.1 months) for the biosimilar (P = 0.95). As a result of pricing policies established by the Australian Government, introduction of the ETN biosimilar would have resulted in a cost-savings of over AU$9.5 million for 1 year of treatment for the patients reported in this study. CONCLUSION Treatment persistence using either ETN originator or biosimilar was similar. The cost of all brands of ETN markedly reduced upon listing of the ETN biosimilar, resulting in significant savings for the Australian Government.
Collapse
Affiliation(s)
- Claire T Deakin
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Centre for Adolescent Rheumatology at University College London, University College London Hospitals and Great Ormond Street Hospital, London, UK
- National Institute of Health Research Biomedical Centre at Great Ormond Street Hospital, London, UK
| | - Geoffrey O Littlejohn
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hedley Griffiths
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Barwon Rheumatology Service, Geelong, Victoria, Australia
| | - Sabina Ciciriello
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Tegan Smith
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
| | - Peter Youssef
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul Bird
- OPAL Rheumatology Ltd, Sydney, New South Wales, Australia
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Ørnbjerg LM, Rugbjerg K, Georgiadis S, Rasmussen SH, Jacobsson L, Loft AG, Iannone F, Fagerli KM, Vencovsky J, Santos MJ, Möller B, Pombo-Suarez M, Rotar Z, Gudbjornsson B, Cefle A, Eklund K, Codreanu C, Jones G, van der Sande M, Wallman JK, Sebastiani M, Michelsen B, Závada J, Nissen MJ, Sanchez-Piedra C, Tomšič M, Love TJ, Relas H, Mogosan C, Hetland ML, Østergaard M. Patient-Reported Outcomes (PROs) and PRO Remission Rates in 12,262 Biologic-Naïve Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitors in Routine Care. J Rheumatol 2024; 51:378-389. [PMID: 38224992 DOI: 10.3899/jrheum.2023-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To evaluate patient-reported outcomes (PROs) after initiation of tumor necrosis factor inhibitor (TNFi) treatment in European real-world patients with psoriatic arthritis (PsA). Further, to investigate PRO remission rates across treatment courses, registries, disease duration, sex, and age at disease onset. METHODS Visual analog scale or numerical rating scale scores for pain, fatigue, patient global assessment (PtGA), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) from 12,262 patients with PsA initiating a TNFi in 13 registries were pooled. PRO remission rates (pain ≤ 1, fatigue ≤ 2, PtGA ≤ 2, and HAQ-DI ≤ 0.5) were calculated for patients still on the treatment. RESULTS For the first TNFi, median pain score was reduced by approximately 50%, from 6 to 3, 3, and 2; as were fatigue scores, from 6 to 4, 4, and 3; PtGA scores, from 6 to 3, 3, and 2; and HAQ-DI scores, from 0.9 to 0.5, 0.5, and 0.4 at baseline, 6, 12, and 24 months, respectively. Six-month Lund Efficacy Index (LUNDEX)-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 24%, 31%, 36%, and 43% (first TNFi); 14%, 19%, 23%, and 29% (second TNFi); and 9%, 14%, 17%, and 20% (third TNFi), respectively. For biologic-naïve patients with disease duration < 5 years, 6-month LUNDEX-adjusted remission rates for pain, fatigue, PtGA, and HAQ-DI scores were 22%, 28%, 33%, and 42%, respectively. Corresponding rates for patients with disease duration > 10 years were 27%, 32%, 41%, and 43%, respectively. Remission rates were 33%, 40%, 45%, and 56% for men and 17%, 23%, 24%, and 32% for women, respectively. For patients aged < 45 years at diagnosis, 6-month LUNDEX-adjusted remission rate for pain was 29% vs 18% for patients ≥ 45 years. CONCLUSION In 12,262 biologic-naïve patients with PsA, 6 months of treatment with a TNFi reduced pain by approximately 50%. Marked differences in PRO remission rates across treatment courses, registries, disease duration, sex, and age at onset of disease were observed, emphasizing the potential influence of factors other than disease activity on PROs.
Collapse
Affiliation(s)
- Lykke M Ørnbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark;
| | - Kathrine Rugbjerg
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- L.M. Ørnbjerg, MD, PhD, K. Rugbjerg, MSc, PhD, S. Georgiadis, MSc, PhD, S.H. Rasmussen, MSc, PhD, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lennart Jacobsson
- L. Jacobsson, MD, PhD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne G Loft
- A.G. Loft, MD, PhD, The DANBIO registry and Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Florenzo Iannone
- F. Iannone, MD, PhD, DETO - Rheumatology Unit, University of Bari, Bari, Italy
| | - Karen M Fagerli
- K.M. Fagerli, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Jiri Vencovsky
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria J Santos
- M.J. Santos, MD, PhD, Rheumatology Department, Hospital Garcia de Orta, Rheumatology Research Unit, Faculdade de Medicina, Lisboa, and Reuma.pt, Portugal
| | - Burkhard Möller
- B. Möller, MD, Department for Rheumatology and Immunology, Inselspital - University Hospital Bern, University of Bern, Bern, Switzerland
| | - Manuel Pombo-Suarez
- M. Pombo-Suarez, MD, PhD, Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ziga Rotar
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- B. Gudbjornsson, MD, PhD, Centre for Rheumatology Research, Landspitali University Hospital (ICEBIO), and the Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Ayse Cefle
- A. Cefle, MD, TURKBIO Registry and Division of Rheumatology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kari Eklund
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Catalin Codreanu
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Gareth Jones
- G. Jones, PhD, BSRBR-AS and Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marleen van der Sande
- M. van der Sande, MD, PhD, Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology, and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, the Netherlands
| | - Johan K Wallman
- J.K. Wallman, MD, PhD, Department of Clinical Sciences Lund, Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marco Sebastiani
- M. Sebastiani, MD, PhD, Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Brigitte Michelsen
- B. Michelsen, MD, PhD, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, and Research Unit, Sørlandet Hospital, Kristiansand, Norway, and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Jakub Závada
- J. Vencovsky, MD, DSc, J. Závada, MD, PhD, Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael J Nissen
- M.J. Nissen, MD, PhD, Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Carlos Sanchez-Piedra
- C. Sanchez-Piedra, MD, PhD, Spanish Agency of Health Technology Assessment, Instituto de Salud Carlos III, Madrid, Spain
| | - Matija Tomšič
- Z. Rotar, MD, PhD, M. Tomšič, MD, PhD, Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thorvardur J Love
- T.J. Love, MD, PhD, Faculty of Medicine, University of Iceland, and Department of Science, Landspitali University Hospital, Reykjavík, Iceland
| | - Heikki Relas
- K. Eklund, MD, PhD, H. Relas, MD, PhD, ROB-FIN, Division of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Corina Mogosan
- C. Codreanu, MD, PhD, RRBR, C. Mogosan, MD, PhD, RRBR, Center for Rheumatic Diseases, University of Medicine Bucharest, Bucharest, Romania
| | - Merete L Hetland
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- M.L. Hetland, MD, PhD, DMSc, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Kawakami T, Masui S, Onishi A, Onizawa H, Fujii T, Murakami K, Murata K, Tanaka M, Shimada T, Nakagawa S, Matsuda S, Morinobu A, Terada T, Yonezawa A. Comparison of safety and effectiveness between etanercept biosimilar LBEC0101 and reference in patients with rheumatoid arthritis in real-world data using the KURAMA cohort. Mod Rheumatol 2024:roae018. [PMID: 38516944 DOI: 10.1093/mr/roae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Biosimilars are anticipated to be widely used in the treatment of rheumatoid arthritis (RA), owing to their cost efficiency; LBEC0101 was the first etanercept (ETN) biosimilar approved in Japan. However, there are limited real-world data comparing its safety and effectiveness with those of a reference product. METHODS This study used data from the Kyoto University Rheumatoid Arthritis Management Alliance cohort, including patients with RA who received ETN therapy-ETN reference product (ETN-RP) or LBEC0101-between 2015 and 2021. Serum ETN levels were measured using liquid chromatography-tandem mass spectrometry. RESULTS The 1-year continuation rates of ETN-RP and LBEC0101 were 58.7% and 74.4%, respectively. Effectiveness of treatment was evaluated in 18 patients; both products significantly reduced the 28-joint RA disease activity score and erythrocyte sedimentation rate (DAS28-ESR). Moreover, to determine equivalence, we analysed 11 patients who switched from ETN-RP to LBEC0101; the DAS28-ESR and serum ETN levels before and after switching were not significantly different. CONCLUSIONS This real-world cohort study confirmed that the biosimilar of ETN, LBEC0101, was comparable to the reference product in terms of continuation rate, effectiveness at initiation of introduction, and effect persistence before and after switching in clinical practice.
Collapse
Affiliation(s)
- Tomoya Kawakami
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Sho Masui
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
- Division of Integrative Clinical Pharmacology, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Akira Onishi
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideo Onizawa
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Fujii
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosaku Murakami
- Center for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Morinobu
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Terada
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
- Division of Integrative Clinical Pharmacology, Faculty of Pharmacy, Keio University, Tokyo, Japan
| |
Collapse
|
4
|
Colina M, Khodeir M, Rimondini R, Valentini M, Campomori F, Corvaglia S, Campana G. Forty-Eight-Month Monitoring of Disease Activity in Patients with Long-Standing Rheumatoid Arthritis Treated with TNF-α Inhibitors: Time for Clinical Outcome Prediction and Biosimilar vs Biologic Originator Performance. Clin Drug Investig 2024; 44:141-148. [PMID: 38294672 PMCID: PMC10912262 DOI: 10.1007/s40261-024-01341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVES Long-term treatment of patients with rheumatoid arthritis with tumor necrosis factor-α inhibitors leads to initial changes in disease activity that can predict a late treatment response. This observational and retrospective study aimed to determine when it is possible to foresee the response to therapy in the case of long-standing rheumatoid arthritis comparing also the efficacy of the original biologics with their biosimilars. METHODS A total of 1598 patients were recruited and treated with the original biologics, adalimumab and etanercept, or with biosimilars. Patients were monitored over a period of 48 months and disease activity scores (28-Joint Disease Activity Score, Simplified Disease Activity Index, and Clinical Disease Activity Index) were measured every 6 months. RESULTS No differences in disease activity levels were observed in etanercept versus biosimilars (GP2015/SB4) and adalimumab versus biosimilar (GP2017) patient groups. All scores significantly decreased in all treatments during the first 18 months of therapy, and after 24 months reached a minimum that lasted up to 48 months. CONCLUSIONS We conclude that biosimilars of adalimumab and etanercept have equivalent effectiveness over a long period of time compared to their originator drugs, and also that the levels of disease activity after 6 months of tumor necrosis factor-α inhibitors (originator drugs and biosimilars) might predict the response to therapy at 4 years in patients with long-standing rheumatoid arthritis.
Collapse
Affiliation(s)
- Matteo Colina
- UOC (Operative Complex Unit) of Internal Medicine, Rheumatology Service, Section of Internal Medicine, Department of Medicine and Oncology, "Santa Maria della Scaletta" Hospital, via Montericco 4, 40026, Imola, Italy.
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Micheline Khodeir
- Hospital Pharmacy, Ospedale Santa Maria della Scaletta, Imola, Italy
| | - Roberto Rimondini
- Alma Mater Studiorum, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Marco Valentini
- Rheumatology Service, San Pier Damiano Hospital, Faenza, Italy
| | - Federica Campomori
- UOC (Operative Complex Unit) of Internal Medicine, Rheumatology Service, Section of Internal Medicine, Department of Medicine and Oncology, "Santa Maria della Scaletta" Hospital, via Montericco 4, 40026, Imola, Italy
| | - Stefania Corvaglia
- UOC (Operative Complex Unit) of Internal Medicine, Rheumatology Service, Section of Internal Medicine, Department of Medicine and Oncology, "Santa Maria della Scaletta" Hospital, via Montericco 4, 40026, Imola, Italy
| | - Gabriele Campana
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| |
Collapse
|
5
|
Yu Z, Gao L, Zang Y, Cheng L, Gao W, Xu Y. Adalimumab exhibits superiority over etanercept in terms of a numerically higher response rate and equivalent adverse events: A real-world finding. Immun Inflamm Dis 2024; 12:e1166. [PMID: 38415932 PMCID: PMC10832310 DOI: 10.1002/iid3.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/29/2023] [Accepted: 01/14/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Adalimumab (ADA) and etanercept (ETN) are the most commonly applied biologics for rheumatoid arthritis (RA) management in China; however, the evidence regarding their superiority is controversial. In addition, in real-world clinical settings, many factors may affect the application of these agents, such as dosage and administration period. Therefore, the present real-world study aimed to compare the efficacy and safety of ADA and ETN treatment in RA patients via the propensity score matching method. METHODS In total, 105 RA patients receiving ADA (n = 66) or ETN (n = 39) were reviewed in this retrospective study. The propensity score matching method was used to eliminate discrepancies in baseline features. Clinical response, low disease activity (LDA), and remission were evaluated based on the DAS28. RESULTS Before propensity score matching, compared with ETN, ADA yielded higher rates of clinical response at W24 (97.0% vs. 84.6%, p = .021), LDA at W12 (78.8% vs. 51.3%, p = .003), and remission at W24 (75.8% vs. 46.2%, p = .002). After propensity score matching, compared with ETN, ADA only achieved a higher rate of clinical response at W24 (96.3% vs. 77.8%, p = .043), whereas the rates of LDA and remission were not different between ADA and ETN treatments at any time point (all p > .05). In addition, the incidence of adverse events was not significantly different between the ADA and ETN treatments (all p > .05). CONCLUSION ADA shows superiority over ETN in terms of a numerically greater response rate and equivalent adverse events.
Collapse
Affiliation(s)
- Zhe Yu
- Department of Rheumatology & ImmunologyThe Affiliated Suqian First People's Hospital of Nanjing Medical UniversitySuqianChina
| | - Ling Gao
- Department of Rheumatology & ImmunologyThe Affiliated Suqian First People's Hospital of Nanjing Medical UniversitySuqianChina
| | - Yinshan Zang
- Department of Rheumatology & ImmunologyThe Affiliated Suqian First People's Hospital of Nanjing Medical UniversitySuqianChina
| | - Lu Cheng
- Department of Rheumatology & ImmunologyThe Affiliated Suqian First People's Hospital of Nanjing Medical UniversitySuqianChina
| | - Wenjia Gao
- Department of Rheumatology & ImmunologyThe Affiliated Suqian First People's Hospital of Nanjing Medical UniversitySuqianChina
| | - Yan Xu
- Department of Rheumatology & ImmunologyThe Affiliated Suqian First People's Hospital of Nanjing Medical UniversitySuqianChina
| |
Collapse
|
6
|
Kearsley-Fleet L, Rokad A, Tsoi MF, Zhao SS, Lunt M, Watson KD, Hyrich KL. Etanercept originator versus etanercept biosimilar for the treatment of rheumatoid arthritis as a first biologic: results from the BSRBR-RA. Rheumatology (Oxford) 2023; 62:3849-3857. [PMID: 36943379 PMCID: PMC10691930 DOI: 10.1093/rheumatology/kead127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES Etanercept biosimilars show comparable efficacy to their originators among biologic-naïve patients with RA in randomized controlled trials. Nationwide guidelines have obligated prescribing of etanercept biosimilars from 2016, resulting in significant cost savings. This analysis aimed to compare the effectiveness of etanercept originator vs etanercept biosimilar amongst biologic-naïve RA patients treated in routine clinical practice in the UK. METHODS Biologic-naïve RA patients starting etanercept in the British Society for Rheumatology Biologics Register in Rhematoid Arthritis (BSRBR-RA) cohort study from 2010 were included. Data collected at start of therapy includes patient demographics and disease activity. Follow-up data includes changes in disease activity and anti-rheumatic therapy. Six- and 12-month primary outcomes include DAS for 28-joints (DAS28) remission, EULAR response and minimal clinically important difference in function. Etanercept drug survival was assessed using Kaplan-Meier and Cox regression, including reasons for treatment withdrawal. Multiple imputation accounted for missing data. Propensity-decile adjustment was used to account for confounding by indication. RESULTS A total of 1806 biologic-naïve RA patients started etanercept: 1009 originator, 797 biosimilar. At 6 and 12 months, the proportion of patients achieving DAS28 remission and EULAR response were similar between treatments. During follow-up, 19% of originator patients switched onto etanercept biosimilar. Patients were censored at time of switch. Patients on originator were no more likely to stop therapy vs biosimilar; 71% of originator and 76% of biosimilar patients remained on therapy at 1 year. CONCLUSIONS In one of the largest analyses of patients with RA, biologic-naïve RA patients treated with etanercept originator showed similar outcomes vs biosimilar using real-world data. Drug survival, and disease activity after 6 and 12 months of therapy, was similar between cohorts.
Collapse
Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Aasiyah Rokad
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Man-Fung Tsoi
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kath D Watson
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - BSRBR-RA Contributors Group
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
7
|
Haugeberg G, Bakland G, Rødevand E, Hansen IJW, Diamantopoulos A, Pripp AH. Effectiveness and Persistence in SB4- and Reference Etanercept-Treated Rheumatoid Arthritis Patients in Ordinary Clinical Practice in Norway. Arthritis Care Res (Hoboken) 2023; 75:1986-1995. [PMID: 36722450 DOI: 10.1002/acr.25092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Biosimilars represent cost-effective alternatives to reference biologic disease-modifying antirheumatic drugs. Our objective was to compare drug effectiveness and drug persistence in the treatment of rheumatoid arthritis (RA), assessing the etanercept biosimilar SB4 in efficacy and safety compared with reference etanercept in a Phase III, randomized controlled trial. We applied EULAR Points to Consider for Comparative Effectiveness Research in a retrospective database study of etanercept and SB4 in patients treated in clinical practice in Norway. METHODS Patients with RA (n = 1,455) treated with etanercept or SB4 between 2010 and 2018 at 5 centers in Norway with ≥1 year of follow-up were included. Disease outcomes (Disease Activity Score in 28 joints [DAS28] at week 52) and drug persistence were compared between unmatched etanercept (n = 575) and SB4 (n = 299) cohorts and matched analyses (n = 172, both cohorts) using propensity score (PS) matching to adjust for confounders. RESULTS In unmatched analyses, the difference in change from baseline between etanercept (n = 221) and SB4 (n = 106) for DAS28 at week 52 was mean -0.02 (95% confidence interval [95% CI] -0.32, 0.27), demonstrating equivalence by the predetermined equivalence margin (±0.6). In PS-matched analyses, the difference between etanercept (n = 49) and SB4 (n = 49) was 0.03 (95% CI -0.46, 0.52), within the predefined equivalence margin. Persistence using the drug at week 52 was similar between etanercept (0.62 [95% CI 0.57, 0.65]) and SB4 (0.66 [95% CI 0.60, 0.71]) cohorts in the unmatched analysis; in PS-matched cohorts, persistence at week 52 was 0.52 (95% CI 0.44, 0.59) for etanercept and 0.68 (95% CI 0.61, 0.75) for SB4. CONCLUSION Outcomes for disease status/drug persistence at week 52 were similar between patients with RA treated with etanercept or SB4.
Collapse
Affiliation(s)
- Glenn Haugeberg
- Sørlandet Hospital, Kristiansand, and Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | | | - Are Hugo Pripp
- Oslo University Hospital and Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
8
|
Hu R, Yuan T, Wang H, Zhao J, Shi L, Li Q, Zhu C, Su N, Zhang S. Efficacy, safety and immunogenicity of etanercept biosimilars versus reference biologics in patients with rheumatoid arthritis: A meta-analysis. Front Pharmacol 2023; 14:1089272. [PMID: 36874005 PMCID: PMC9979087 DOI: 10.3389/fphar.2023.1089272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
Background: Although with the application of etanercept biosimilars in the field of rheumatoid arthritis, the evidences of their efficacy, safety, and immunogenicity are still limited. We conducted this meta-analysis to evaluate the efficacy, safety and immunogenicity of etanercept biosimilars for treating active rheumatoid arthritis compared to reference biologics (Enbrel®). Methods: PubMed, Embase, Central, and ClinicalTrials.gov were searched for randomized controlled trials of etanercept biosimilars treated in adult patients diagnosed with rheumatoid arthritis from their earliest records to 15 August 2022. The outcomes included ACR20, ACR50, and ACR70 response rate at different time points from FAS or PPS, adverse events, and proportion of patients developed anti-drug antibodies. The risk of bias of each included study was assessed using the revised Cochrane Risk of Bias in Randomised Trials tool, and the certainty of evidence was rated according to the Grading of Recommendation Assessment, Development, and Evaluation. Results: Six RCTs with 2432 patients were included in this meta-analysis. Etanercept biosimilars showed more benefits in ACR50 at 24 weeks from PPS [5 RCTs, OR = 1.22 (1.01, 1.47), p = 0.04, I 2 = 49%, high certainty], ACR50 at 1 year from PPS [3 RCTs, OR = 1.43 (1.10, 1.86), p < 0.01, I 2 = 0%, high certainty] or FAS [2 RCTs, OR = 1.36 (1.04, 1.78), p = 0.03, I 2 = 0%, high certainty], and ACR70 at 1 year from PPS [3 RCTs, OR = 1.32 (1.01, 1.71), p = 0.04, I 2 = 0%, high certainty]. In terms of other outcomes about efficacy, safety, and immunogenicity, the results showed that there was no significant difference between etanercept biosimilars and reference biologics, and the certainty of evidences ranged from low to moderate. Conclusion: Etanercept biosimilars showed more benefits in ACR50 response rate at 1 year than reference biologics (Enbrel®), other outcomes for clinical efficacy, safety, and immunogenicity of etanercept biosimilars were comparable with originator in patients with rheumatoid arthritis. Systematic Review Registration: PROSPERO, identifier CRD42022358709.
Collapse
Affiliation(s)
- Rui Hu
- Department of Pharmacy, Karamay Central Hospital, Karamay, China
| | - Tao Yuan
- Department of Pharmacy, Karamay Central Hospital, Karamay, China
| | - Hui Wang
- Department of Pharmacy, Karamay Central Hospital, Karamay, China
| | - Jianglin Zhao
- Department of Pharmacy, Karamay Central Hospital, Karamay, China
| | - Liya Shi
- Department of Pharmacy, Karamay Central Hospital, Karamay, China
| | - Quankai Li
- Department of Pharmacy, Karamay Central Hospital, Karamay, China
| | - Chunmei Zhu
- Department of Pharmacy, Karamay Central Hospital, Karamay, China.,Department of Nephropathy and Rheumatology, Karamay Central Hospital, Karamay, China
| | - Na Su
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China.,West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Shengzhao Zhang
- Department of Pharmacy, Karamay Central Hospital, Karamay, China
| |
Collapse
|
9
|
Comparison of Efficacy and Safety of Original and Biosimilar Adalimumab in Active Rheumatoid Arthritis in a Real-World National Cohort. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121851. [PMID: 36557052 PMCID: PMC9784493 DOI: 10.3390/medicina58121851] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Real-world evidence should reflect the evidence obtained from controlled trials; therefore, the study aimed to compare biosimilar adalimumab (bADA) to original adalimumab (oADA) in terms of efficacy and safety in a real-life national cohort of rheumatoid arthritis (RA) patients. Materials and Methods: The following study is a prospective observational study in which we analyzed patients treated with reimbursed biologics from the Romanian Registry of Rheumatic Diseases (RRBR). RA cases must fulfill the 2010 classification criteria, as well as specific inclusion and exclusion criteria. The RRBR database was queried for all RA patients starting oADA or bADA (FKB327, GP2017, MSB11022, SB5 available) from 2 May 2019 (the first bADA initiation) until 26 March 2022 (study search date). Results: The study included 441 patients who started oADA (48.3%) or bADA (51.7%) in the same time period. At baseline, patients starting bADA had a significantly higher mean age and lower prevalence of women. After the first six months of treatment, there were no significant differences between the oADA and bADA regarding rates of Boolean (15.0% vs. 12.3%, p = 0.401), DAS28-CRP (32.4% vs. 34.2%, p = 0.686) and SDAI (16.4% vs. 14.0%, p = 0.483) remission rates. There were 107 cases of adverse events (AE): 81.3% on oADA and 18.7% on bADA. Notably, 51.4% of AE were infections. Regarding severity, 49.5% of AEs were mild, 34.6% were moderate, and 15.9% were severe. Conclusion: Biosimilar adalimumab showed similar efficacy and safety to original adalimumab after the first six months of treatment in RA patients from a national registry.
Collapse
|
10
|
Pope J, Hall S, Bombardier C, Haraoui B, Jones G, Naik L, Etzel CJ, Ramey DR, Infante R, Miguelez M, Falcao S, Sahakian S, Wu D. Post-switch Effectiveness of Etanercept Biosimilar Versus Continued Etanercept in Rheumatoid Arthritis Patients with Stable Disease: A Prospective Multinational Observational Study. Adv Ther 2022; 39:5259-5273. [PMID: 36136243 DOI: 10.1007/s12325-022-02303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/16/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION To better inform clinicians about the use of etanercept biosimilar (SB4) in patients with rheumatoid arthritis (RA), COMPANION-B, a prospective real-world observational study, evaluated the effectiveness of the voluntary switch from originator (etanercept, ETN) to SB4 in patients with stable RA (low-disease activity/remission). METHODS The study recruited adult patients (18 years or older) with RA (2010 American College of Rheumatology criteria) prescribed ETN as their first or second biologic for at least 6 months across 14 sites in Canada and five in Australia. Patients had stable disease (Disease Activity Score-28 using erythrocyte sedimentation rate [DAS28-ESR] less than 3.2) at enrollment with no evidence of flare within the previous 3 months. Concomitant disease-modifying antirheumatic drugs (DMARDs) were permitted. Patients could elect to continue ETN or voluntarily switch to SB4 in consultation with their doctors. The primary effectiveness measure was the proportion of patients with disease worsening (defined as a DAS28-ESR increase of at least 1.2 from baseline and minimum score of at least 3.2 or a defined modification in RA treatment) during 12 months of follow-up. The secondary effectiveness measure was the proportion of patients with disease worsening at month 6. Serious adverse events (SAEs) and non-serious adverse reactions (NSARs) were recorded. RESULTS Of 163 patients enrolled, 109 elected to continue on ETN and 54 switched to SB4; 65.8% of patients received non-biologic DMARD(s), 52.6% methotrexate, and 10.5% oral corticosteroid(s). At month 12, the proportion of patients with disease worsening was comparable in the ETN group (22.8% [95% CI 15.0-32.2]) and SB4 group (17.6% [95% CI 8.4-30.9]). Similarly, the proportions of patients with disease worsening were also comparable at month 6 (ETN: 7.9% [95% CI 3.5-15.0]; SB4: 7.8% [95% CI 2.2-18.9]). SAEs were low and similar across both groups (ETN: 8.7%; SB4: 5.7%). NSARs were slightly higher in the SB4 vs. ETN group (13.2% vs. 2.9%). CONCLUSIONS SB4 demonstrated comparable effectiveness to ETN over 12 months in patients with stable RA who voluntarily switched to the biosimilar in a real-world setting.
Collapse
Affiliation(s)
- Janet Pope
- University of Western Ontario and St. Joseph's Hospital, London, ON, Canada.
| | | | | | - Boulos Haraoui
- Rheumatology Institute of Montreal, Université de Montréal, Montreal, QC, Canada
| | - Graeme Jones
- University of Tasmania-Lionheart Rheumatology, Hobart, TAS, Australia
| | - Latha Naik
- University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | | | - Maia Miguelez
- Otsuka Pharmaceutical Development & Commercialization, Inc., Montreal, QC, Canada
| | | | | | - David Wu
- Merck & Co., Kenilworth, NJ, USA
| |
Collapse
|
11
|
Larid G, Baudens G, Dandurand A, Coquerelle P, Goeb V, Guyot MH, Marguerie L, Maury F, Veillard E, Houvenagel E, Salmon JH, Flipo RM, Gervais E. Differential retention of adalimumab and etanercept biosimilars compared to originator treatments: Results of a retrospective French multicenter study. Front Med (Lausanne) 2022; 9:989514. [PMID: 36275803 PMCID: PMC9582272 DOI: 10.3389/fmed.2022.989514] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Previous studies demonstrated equivalence in terms of efficacy and safety of biosimilars (bsDMARDs) compared to original treatments (boDMARDs) and in switching situations. Less is known about what happens when initiating a bsDMARD in a molecule naïve patient. The objectives of our study were to compare the retention of treatment of subcutaneous boDMARDs and bsDMARDs globally, depending on the disease [rheumatoid arthritis (RA), spondyloarthritis (SpA), or psoriatic arthritis (PsA)], molecule [etanercept (ETN) or adalimumab (ADA)], line of treatment, or presence of citrate in the context of first use of each molecule (namely initiation) and to analyze treatment retention's predictive factors. Materials and methods This multicenter retrospective study used data from shared medical records of the RIC-FRANCE network, encompassing the prescription of hospital rheumatologists and attached practitioners, of patients with RA, SpA, or PsA, with the starting ETN between 03/10/2016 and 31/07/2020, or ADA between 23/10/2018 and 31/07/2020. Clinical data were collected from medical records. Retention analysis was performed using Kaplan-Meier curves and the log-rank test. Retention's predictive factors were analyzed using Cox proportional-hazard ratio. Results Eight hundred forty-five prescriptions were analyzed: 340 boDMARDs and 505 bsDMARDs. About 57% of prescriptions concerned women. The mean age was 51.8 years. About 38% were prescriptions for RA, 16% for PsA, and 46% for SpA. An increase in the initiation over time was observed for both ETN and ADA. The retention rate of bsDMARDs was superior to boDMARDs' one (39 vs. 23 months; p = 0.045). When molecules are compared, the difference was significant only for ETN (45 vs. 19 months for boDMARD; p = 0.0265). When comparing diseases, the difference in favor of bsDMARDs was significant in patients with RA only (p = 0.041). Citrated treatments displayed better retention compared to citrate-free treatments (p = 0.0137). Multivariable analysis of predictive factors for the cessation of treatment found shorter disease duration, boDMARD prescription, hospital practitioner prescription, late line of treatment, and female sex as significant. More side effects were observed with boDMARDs, especially more infections (17.8% vs. 7.8%). Conclusion Even if bsDMARDs' prescription increases over time, its penetration rate is still below expectations. bsDMARDs displayed better retention compared to boDMARDs, especially for ETN, and in patients with RA. Citrated treatments had better retention. Prescription by a full-time hospital-based rheumatologist is associated with poorer retention.
Collapse
Affiliation(s)
- Guillaume Larid
- Department of Rheumatology, CHU Poitiers, Poitiers, France,LITEC Laboratory, University of Poitiers, Poitiers, France,*Correspondence: Guillaume Larid, ; orcid.org/0000-0003-2317-2852
| | | | | | - Pascal Coquerelle
- Department of Rheumatology, Bethune Hospital Center, Bethune, France
| | - Vincent Goeb
- Department of Rheumatology, Hôpital Nord, University Hospital of Amiens-Picardie, Amiens, France
| | - Marie Hélène Guyot
- Department of Rheumatology, Hôpital Victor Provo, Hospital of Roubaix, Roubaix, France
| | - Laurent Marguerie
- Department of Rheumatology, Institut François Calot, Berck-Sur-Mer, France
| | | | | | - Eric Houvenagel
- Department of Rheumatology, Hôpital Saint Philibert, Hospital of Lomme, Lomme, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Hôpital Maison Blanche, Reims University Hospital, CEDEX, Reims, France
| | | | - Elisabeth Gervais
- Department of Rheumatology, CHU Poitiers, Poitiers, France,LITEC Laboratory, University of Poitiers, Poitiers, France
| |
Collapse
|
12
|
Carballo N, Pérez García C, Grau S, Monfort J, Durán-Jordà X, Echeverría-Esnal D, Ferrández O. Real-world effectiveness and persistence of reference etanercept versus biosimilar etanercept GP2015 among rheumatoid arthritis patients: A cohort study. Front Pharmacol 2022; 13:980832. [PMID: 36263118 PMCID: PMC9575986 DOI: 10.3389/fphar.2022.980832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Although several randomized clinical trials have confirmed that there is no difference in efficacy between etanercept and its biosimilar versions in the treatment of rheumatoid arthritis (RA), limited real-world evidence is available. We conducted a cohort study to compare the effectiveness and treatment persistence between the reference etanercept (ETN) and the biosimilar GP2015 in RA patients in a real-life setting. Adults with a diagnosis of RA who initiated treatment with ETN or GP2015, between January 2007 and December 2019, were included. The follow-up period was 52 weeks. The primary outcome was the mean of change in the DAS28-CRP values and the adjusted mean difference from baseline to 52 weeks between ETN and GP2015. Other effectiveness endpoints assessed were the rate of patients who achieved remission or low disease activity (LDA) at week 52, who showed a reduction of DAS28-CRP value greater than or equal to 1.2 from baseline to week 52 and rate of good responder patients (those meeting both effectiveness measures) at week 52. Treatment effectiveness over time (baseline, 26 and 52 weeks) was compared between the ETN and GP2015 groups using mixed effects models. Treatment persistence (probability of maintaining the same treatment over time) was also evaluated and shown using Kaplan–Meier survival curves. A total of 115 RA patients were included (ETN, n = 90; GP2015, n = 25). No differences were observed in the primary outcome: DAS28-CRP score decreased from baseline to week 52 [5.1 to 2.7 (mean of change -2.37) in ETN group and 5.0 to 2.2 (mean of change -2.84) in GP2015 group, p-value = 0.372] and the adjusted mean difference was −0.37 (−1.03 to 0.29). No differences were also observed in the other effectiveness endpoints assessed among patients treated with ETN or GP2015: rate of patients who achieved remission (54.1% vs. 66.7%, p-value = 0.303) and LDA (71.6% vs. 80.9%, p-value = 0.391) at week 52, reduction of DAS28-CRP value greater than or equal to 1.2 from baseline to week 52 (75.6% vs. 80.9%, p-value = 0.613) and rate of good responder patients (58.1% vs. 76.1%, p-value = 0.202). Drug survival was 82% and 80% for ETN and GP2015, respectively (log-rank p-value = 0.804). Etanercept and its biosimilar GP2015 show similar effectiveness and treatment persistence in RA patients in a real-life setting.
Collapse
Affiliation(s)
- Nuria Carballo
- Pharmacy Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Nuria Carballo, ; Santiago Grau,
| | | | - Santiago Grau
- Pharmacy Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Nuria Carballo, ; Santiago Grau,
| | - Jordi Monfort
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Rheumatology Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
| | - Xavier Durán-Jordà
- Methodology and Biostatistics Support Unit, Institute Hospital del Mar for Medical Research (IMIM), Barcelona, Spain
| | | | - Olivia Ferrández
- Pharmacy Department, Hospital del Mar—Parc de Salut Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
13
|
Cooksey R, Brophy S, Kennedy J, Seaborne M, Choy E. Real-world use of an etanercept biosimilar including selective versus automatic substitution in inflammatory arthritis patients: a UK-based electronic health records study. Rheumatol Adv Pract 2022; 6:rkac056. [PMID: 35910710 PMCID: PMC9336562 DOI: 10.1093/rap/rkac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Biosimilars are approved as an alternative treatment to their originators. We compared the clinical outcomes of etanercept (ETN) biosimilar compared with ETN originator in real-world practice, from two local health boards in Wales with different policies on switching: automatic vs selective. Methods Data from the Secure Anonymised Information Linkage (SAIL) databank in Wales were used to create a retrospective cohort study using linked primary and secondary care data. Patients aged ≥18 years with diagnosis codes for RA, PsA or AS were included. Outcomes included treatment failure and DAS-28 score (for RA). The local health board with a policy of automatic switching (i.e. clinician/nurse involvement not mandated) is labelled as automatic switch area, and the other, which required clinician/nurse supervision, as selective switch. Results Of 8925 individuals with inflammatory arthritis, 13.3% (365) received ETN biosimilar and 31.5% (863) ETN originator. The treatment discontinuation rate was similar for ETN biosimilar and originator by Kaplan-Meier analysis. More biosimilar failure patients were treated in the automatic switch area (15 vs 4.8%). In the automatic switch area, 28.8% (75 of 260) of patients switched automatically from ETN originator to biosimilar compared with 10.5% (11 of 105) in the selective switch area. ETN biosimilar reduced DAS-28 by 1.6 ± 1.8 in the selective switch area vs 0.4 ± 0.6 in the automatic switch area. Conclusion The ETN biosimilar was well tolerated. Fewer people were switched using selective policy, but this was associated with lower failure rates. Automatic switch policy led to more patients being switched and did not lead to significant worsening of disease.
Collapse
Affiliation(s)
- Roxanne Cooksey
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff
| | - Sinead Brophy
- Health Data Research UK, School of Medicine, Swansea University, Swansea, UK
| | - Jonathan Kennedy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff
| | - Michael Seaborne
- Health Data Research UK, School of Medicine, Swansea University, Swansea, UK
| | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff
| |
Collapse
|
14
|
Horta-Baas G. Patient-Reported Outcomes in Rheumatoid Arthritis: A Key Consideration for Evaluating Biosimilar Uptake? Patient Relat Outcome Meas 2022; 13:79-95. [PMID: 35388274 PMCID: PMC8977480 DOI: 10.2147/prom.s256715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This review aims to provide an overview of the impact of TNFis biosimilars, with marketing authorization, in patient-reported outcome measures (PROMs) scores and explore how PROMs endpoints might add value in biosimilars uptake in RA patients. Patients and Methods A comprehensive search of Medline, Scopus, Lilacs, and CINAHL databases was performed for papers published between January 2012 and December 2021. For inclusion, studies had to be prospective, published in a peer-reviewed journal, published in English or Spanish language; studies using PROMs as an outcome measure. After screening title and abstracts and assessing the remaining full texts fulfilling the inclusion criteria, 31 papers were used in this narrative review. Results PROMs were used as secondary outcomes in included studies. The most frequently employed domains to assess biosimilar efficacy include physical function, patient global assessment (PtGA), health-related quality of life (HRQoL), and fatigue. The results of randomized clinical trials uniformly showed that mean change in PROMs scores is comparable between biosimilar and reference biologic treatment groups. However, open-label and real-world studies revealed high rates of discontinuation of therapy, mainly for subjective worsening of disease activity or non-specific adverse events. Even without objective clinical evidence of inflammation, patients who are considered to have active disease (higher scores on PtGA) have higher discontinuation rates of biosimilars. The available information suggests that the nocebo effect is the most likely cause for the discontinuation of biosimilars. Conclusion There is scarce literature surrounding the impact of biosimilars in PROMs, especially in open-label studies. In real-life studies, biosimilars have a higher discontinuation rate than reference products. TNFis biosimilars treatment efficacy in RA depends on disease activity and other factors such as PtGA and fatigue. The nocebo effect is the best explanation for biosimilar's discontinuation.
Collapse
Affiliation(s)
- Gabriel Horta-Baas
- Rheumatology Department, Hospital General Regional # 1, Instituto Mexicano del Seguro Social, Merida, Yucatan, Mexico
| |
Collapse
|
15
|
Giordano D, Capalbo A, Gagliostro N, Fedele G, Balampanos CG, Persechino F, Bushati V, Ulisse S, Persechino S, Pellacani G. Biosimilar versus originator etanercept: a real-life clinical study. Ital J Dermatol Venerol 2022; 157:318-324. [PMID: 35274881 DOI: 10.23736/s2784-8671.22.07224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Over the last few years, novel therapeutic approaches based on the use of monoclonal antibodies against cytokines, or their cognate receptors, involved in psoriasis progression have shown remarkable results, being capable to reduce disease progression and increase patient's quality of life. Among these is etanercept (Enbrel®, Pfizer, Sandwich, UK) and its biosimilar compound SB4 (Benepali®, Samsung Bioepis, Delft, The Netherlands), both approved for the treatment of moderate to severe psoriasis. Aim of the present study was to evaluate in a less controlled environment, such as real-life, the actual bioequivalence between the etanercept (ETN) and the SB4 in term of safety, efficacy and patient's quality of life. METHODS For this purpose, we analyzed a case study consisting of 65 patients affected by plaque psoriasis, with or without psoriatic arthritis at our dermatological outpatient center of Sant'Andrea Hospital in Rome, all of them under treatment with either ETN or the biosimilar SB4 drug for at least 3 months. The indicators used to evaluate the effectiveness of the therapies were the Psoriasis Area and Severity Index, the Visual Analogue Scale (VAS) for itch, the VAS for pain, and the Dermatology Life Quality Index. RESULTS The results showed no significant differences among the two drugs in all the analyzed parameters confirming the equivalence between the ETN and its biosimilar SB4. CONCLUSIONS Overall, we can confirm the overlapping clinical efficacy between ETN and its biosimilar SB4 drug and that even in an uncontrolled environment such as real-life, the biosimilar drugs are an excellent opportunity to reduce health costs allowing to expand the audience of patients who can benefit from these innovative treatments.
Collapse
Affiliation(s)
- Domenico Giordano
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | - Alessandro Capalbo
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | - Nazareno Gagliostro
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | - Giusy Fedele
- National Institute of Oceanography and Experimental Geophysics, Sgonico, Trieste, Italy
| | | | - Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Vilma Bushati
- Nostra Signora del Buon Consiglio Catholic University, Tirana, Albania
| | - Salvatore Ulisse
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Severino Persechino
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy -
| | - Giovanni Pellacani
- Section of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy
| |
Collapse
|
16
|
Cantini F, Goletti D, Benucci M, Foti R, Damiani A, Niccoli L. Tailored first-line biologic and targeted synthetic disease modifying anti-rheumatic drugs therapy in patients with rheumatoid arthritis: 2021 updated ITABIO statements. Expert Opin Drug Saf 2021; 21:613-623. [PMID: 34937466 DOI: 10.1080/14740338.2022.2020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In 2015, the Italian board for the TAilored BIOlogic therapy (ITABIO) proposed evidence-based decisional statements for first-line tailored biologic therapy in patients with rheumatoid arthritis (RA). Taking into account the new licensed drugs, the aim of the present review was to update the previous statements. AREAS COVERED A narrative review of the most recent evidence on the efficacy and safety of old and newly licensed drugs for the treatment of articular and extra-articular RA was performed. In addition, host-related variables potentially driving the therapy choice, such as the infection risk, the cardiovascular risk, the risk of deep vein thrombosis, thromboembolism, pregnancy, and obesity were analyzed. Consequently, several statements for personalized therapy were formulated, thus providing a decisional algorithm useful for proper personalized therapy of RA patients in clinical practice. EXPERT OPINION Several clinical variables related to specific drug and host characteristics may drive the choice toward anti-TNF and non-anti-TNF biologics, or anti-JAKs, thus allowing to personalize the therapy. Consequently, the right therapy for the right patient would ensure a successful therapeutic intervention.
Collapse
Affiliation(s)
| | - Delia Goletti
- Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Via,Portuense 292, 00149 Rome, Italy
| | - Maurizio Benucci
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, Florence, Italy
| | - Rosario Foti
- Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy
| | - Arianna Damiani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Laura Niccoli
- Rheumatology Department, Hospital of Prato, Prato Italy
| |
Collapse
|
17
|
Maccora I, Lombardi N, Crescioli G, Bettiol A, Bonaiuti R, Pagnini I, Maniscalco V, Marrani E, Mastrolia MV, Ravaldi C, Consolini R, Cattalini M, Vannacci A, Simonini G. OBSIDIAn - real world evidence of Originator to BioSImilar Drug switch in juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 61:1518-1528. [PMID: 34273158 DOI: 10.1093/rheumatology/keab572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Limited data about use of biosimilars are available in children with Juvenile Idiopathic Arthritis (JIA). This study therefore aimed to evaluate long-term efficacy and safety of switching from etanercept (ETA) and adalimumab (ADA) originators to their biosimilars, in children with JIA, in a real-world setting. METHODS This is a retro-prospective non-interventional multicentre Italian comparative cohort study. Medical charts of JIA children treated with biosimilars of ETA or ADA were included. Efficacy and safety of TNF-inhibitors therapy was evaluated at last follow-up during originator and at 3, 6 and 12 months following the switch to biosimilar. RESULTS 59 children (42 female, median age at onset 88 months) were treated with biosimilar of ETA (21) and ADA (38). Forty-five switched from the originator to the BIO (17 ETA, 28 ADA). At time of switch, 12/17 patients on ETA and 18/28 on ADA were in remission. No significant difference has been found at 3, 6 and 12 months after the switch. Ten patients discontinued biosimilars due to disease remission (4 ETA, 3 ADA), family willing (1 ETA), occurrence of burning at injection site (1 ETA), and persistent activity (1 ADA). No statistically significant difference was observed between originator and BIOs, nor between originator and BIOs, and between ADA and ETA in time to disease remission achievement, time to relapse and number of patients who experienced AE. CONCLUSION Our real-life results seem to confirm the efficacy and safety profile of switching from originator of ADA and ETA to their respective BIOs also in paediatric patients with JIA.
Collapse
Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance; Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance; Florence, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence; Florence, Italy
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy
| | - Maria Vincenza Mastrolia
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| | - Claudia Ravaldi
- PeaRL - Perinatal Research Laboratory, University of Florence and CiaoLapo Foundation for Perinatal Health; Florence, Italy
| | - Rita Consolini
- Section of Clinical Immunology and Rheumatology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Cattalini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy.,Tuscan Regional Centre of Pharmacovigilance; Florence, Italy.,PeaRL - Perinatal Research Laboratory, University of Florence and CiaoLapo Foundation for Perinatal Health; Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's University Hospital; Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence; Florence, Italy
| |
Collapse
|
18
|
Rathore AS, Stevenson JG, Chhabra H, Maharana C. The global landscape on interchangeability of biosimilars. Expert Opin Biol Ther 2021; 22:133-148. [PMID: 33567923 DOI: 10.1080/14712598.2021.1889511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Biosimilars hold the potential to be an integral healthcare component that can significantly improve affordability and thereby accessibility of the otherwise expensive biotherapeutic products. Regulators, payors, and policymakers, each have a major role to play in successful adoption of biosimilars. One of the issues that has been a point of frequent discussion is that of interchangeability of biosimilars. AREAS COVERED This article aims to review the position that the major regulatory bodies have taken on interchangeability of biosimilars. Key issues that remain are also discussed. Adalimumab and etanercept have been chosen as real-world case studies to demonstrate interchangeability considerations. The need for gaining global harmonization on interchangeability is highlighted. EXPERT OPINION A global harmonization on the interchangeability can likely accelerate biosimilar adoption and result in better accessibility to biologics. Experience gained with real-world studies supports switching to biosimilars from originators however post-marketing pharmacovigilance should be in place to assess the risk-benefit profile of biosimilars in the long run.
Collapse
Affiliation(s)
- Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - James G Stevenson
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Hemlata Chhabra
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Chinmoyee Maharana
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| |
Collapse
|
19
|
Kim JW, Jung JY, Suh CH. Real-world observational study of biosimilars in inflammatory arthritis treatment: a systematic literature review. Expert Opin Biol Ther 2020; 21:57-73. [PMID: 32808557 DOI: 10.1080/14712598.2020.1812575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The use of biological agents in patients with rheumatic diseases has achieved the therapeutic target, i.e., remission or low disease activity. The share of biological agents has been growing with the approval of biosimilars, which have been recognized for their equivalent efficacy, safety, pharmacokinetics, and immunogenicity to the original as well as their reduced economic burden. AREA COVERED Biosimilars are being examined for their bioequivalence to reference products in randomized-controlled trials; however, the use of biosimilars in actual clinical practice is complicated owing to issues with switching and comorbidities. Therefore, this review describes real-world data in the rapidly evolving field of biosimilars in the treatment of rheumatoid arthritis and spondyloarthropathy, including ankylosing spondylitis and psoriatic arthritis. EXPERT OPINION According to published data, the use of biosimilars for inflammatory arthritis led to no significant inferiority in treatment outcomes and resulted in considerable cost savings in the real-world. Currently, beyond the use of biosimilars, issues with the interchangeability of biosimilars, including immunogenicity, should be addressed. Strategies to overcome these concerns will improve treatment efficacy and safety in patients with inflammatory arthritis.
Collapse
Affiliation(s)
- Ji-Won Kim
- Department of Rheumatology, Ajou University School of Medicine , Suwon, Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine , Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine , Suwon, Korea
| |
Collapse
|
20
|
Bruni C, Gentileschi S, Pacini G, Baldi C, Capassoni M, Tofani L, Bardelli M, Cometi L, Cantarini L, Nacci F, Vietri M, Bartoli F, Fiori G, Frediani B, Matucci-Cerinic M. The switch from etanercept originator to SB4: data from a real-life experience on tolerability and persistence on treatment in joint inflammatory diseases. Ther Adv Musculoskelet Dis 2020; 12:1759720X20964031. [PMID: 33133246 PMCID: PMC7576915 DOI: 10.1177/1759720x20964031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Aims: Switching from originator to biosimilar is part of current practice in inflammatory rheumatic musculoskeletal diseases (iRMDs) such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA), with evidences derived from both etanercept (ETN) to SB4-switching randomized controlled trials and real-life registries. We investigated the safety and treatment persistence of ETN/SB4 in a multi-iRMD cohort derived from two rheumatology departments in our region. Methods: Adult patients with iRMDs, treated with ETN for at least 6 months and switched to SB4 in stable clinical condition, were eligible for this retrospective evaluation. Retrospective data on adverse events, loss of efficacy and persistence on treatment were collected until latest available follow-up. Results: A total of 220 patients (85 RA, 81 PsA, 33 axSpA, 14 juvenile idiopathic arthritis and seven other conditions; 142 females, mean age 58 ± 7 years, disease duration 12 ± 4 years, ETN duration 7 ± 4 years) were enrolled, with median follow-up of 12.1 (9.7–15.8) months. A total of 50 patients (22.7%) presented with at least one adverse event, with 36 (16.4%) disease flares and 30 (13.6%: 11 for safety and 19 loss of efficacy) SB4 withdrawals. Cumulative SB4 treatment persistence was 99.1%, 88.6% and 64.6% at 6, 12 and 18 months respectively. Back-switch to ETN was performed in 17/30 cases, the remaining cases were managed with change of biologic disease modifying or conventional synthetic anti-rheumatic drug. Age was the only significant predictor of SB4 interruption at 6 months. Conclusion: Our real-life data confirm the safety profile of switching from ETN to SB4, with slightly higher treatment persistence rates compared with other real-life registries.
Collapse
Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, Via delle Oblate 4, 50141, Firenze, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Giovanni Pacini
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Caterina Baldi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Capassoni
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Lorenzo Tofani
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Marco Bardelli
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Laura Cometi
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Michele Vietri
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Ginevra Fiori
- Department Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| |
Collapse
|