Biosimilars for the Management of Inflammatory Bowel Diseases: Economic Considerations

Biological drugs revolutionized the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. However, not all clinically eligible patients have access to biologicals due to significant costs and budget impact. Biosimilars are highly comparable to their originator product in terms of clinical efficacy and safety. Biosimilars are priced 15-75% lower than their reference product, which makes them a less costly alternative and is expected to offer better patients access to biologicals. The total projected cost savings are significant. If the achieved budget savings were used to cover more biological therapy, several additional IBD patients could be treated. Currently, the main barriers to the increasing uptake of biosimilars are the few incentives of the key stakeholders, while physicians' and patients' skepticism towards biosimilars seems to be changing. Over the coming years, biosimilars are expected to gain a growing importance in the treatment of IBD, contributing to a better access to treatment, improving population-level health gain and sustainability of health systems. This review summarizes the results of the literature on the economic considerations of biosimilars in IBD and the role of biosimilar infliximab in the treatment of IBD.

Adherence to biologic DMARD therapies in rheumatoid arthritis

IMPORTANCE OF THE FIELD

The efficacy of the biologic disease-modifying antirheumatic drugs (DMARDs) shown in clinical trials may be jeopardized due to prevalent poor patient adherence.

AREAS COVERED IN THIS REVIEW

Patient adherence including compliance and persistence with biologic DMARDs in rheumatoid arthritis.

WHAT THE READER WILL GAIN

This is a comprehensive review of the literature. The various definitions and methodologies of measurement used in adherence research are reviewed and data are presented by separating compliance and persistence. Differences in compliance rates were mainly based on numerical trends. There was evidence for and against greater persistence with infliximab versus adalimumab and etanercept. There was a trend in favour of greater compliance and lower persistence with TNF-alpha inhibitor monotherapy versus in combination therapy with methotrexate.

TAKE HOME MESSAGE

The evidence suggests that adherence to biologic DMARDs is suboptimal. When further research is applied in the field, agreed definitions and methodology need to be used to allow for cross-study comparisons. In addition, adherence should be assessed in conjunction with clinical outcomes and not on its own so that it can be better understood what levels of adherence provide the required clinical outcomes.

Fibrinolytic response to venous occlusion in healthy subjects: relationship to age, gender, body weight, blood lipids and insulin

The physiological variability of fibrinolytic response to 20 min upper arm venous occlusion was studied in 191 healthy women and men, 19-80 years old. It was observed that fibrinolytic response measured by the absolute amount of t-PA antigen after venous occlusion increased with increasing age (from 10.7 at 19-30 years to 25.0 ng/ml at 71-80 years), was higher in men than in women (20.9 vs 15.6 ng/ml), higher in obese than in slim subjects (29.5 vs 12.3 ng/ml) and higher in subjects with moderately elevated blood cholesterol (33.3 vs 18.2 ng/ml) and triglycerides (30.0 vs 24.4 ng/ml, all p < 0.05 or less) than in subjects with normal levels of these variables. Due to simultaneous increase in basal levels of t-PA antigen in all these cases, relative increases in t-PA antigen after venous occlusion were not altered. Fibrinolytic response measured by t-PA activity, but not with euglobulin clot lysis time, increased with age. PAI-1 antigen was not affected by venous occlusion, while PAI activity decreased to zero in most subjects (in 61-80%) regardless of age, gender or blood lipids. However, in obese subjects and especially in subjects with elevated insulin, fibrinolytic response was reduced as determined by residual PAI activity after venous occlusion (1.3 and 10.6 IU/ml, respectively) due to the increased basal level of PAI-1. It was concluded that age, gender, body weight, blood lipids and insulin significantly modulate fibrinolytic response to venous occlusion.