℞ Strategy: Switching

Biologic or tofacitinib monotherapy for rheumatoid arthritis in people with traditional disease‐modifying anti‐rheumatic drug (DMARD) failure: a Cochrane Systematic Review and network meta‐analysis (NMA)

We performed a systematic review, a standard meta‐analysis and network meta‐analysis (NMA), which updates the 2009 Cochrane Overview, ‘Biologics for rheumatoid arthritis (RA)’. This review is focused on…enhrruBiologics or tofacitinib alone for people with rheumatoid arthritis who had not improved…
onlinelibrary.wiley.com

Biologics or tofacitinib for people with rheumatoid arthritis unsuccessfully treated with biologics: a systematic review and network meta‐analysis

Biologic disease‐modifying anti‐rheumatic drugs (DMARDs: referred to as biologics) are effective in treating rheumatoid arthritis (RA), however there are few head‐to‐head comparison studies. Our systematic…enruBiologics or tofacitinib for rheumatoid arthritis Review questionWe studied the effects…
onlinelibrary.wiley.com

Introducing New Biosimilars Into Current Treatment Algorithms

Three biosimilar products are now licensed for the treatment of rheumatic diseases in Europe. The European Medicines Agency (EMA) requires that similarity…
Targeted biologics have revolutionised the treatment and outlook of patients with inflammatory joint diseases. The combination of high-cost long-term therapy straining healthcare systems with impending expiry of key biologics patents has led to heightened interest in the development of biosimilars.
emjreviews.com

NOR-SWITCH Study Validates Biosimilar Use in Multiple Indications

reports the results of the NOR-SWITCH study – a trial performed in Norway as biosimilars were being introduced. This study was designed to assess the efficacy and safety of transitioning from the originator (Remicade) to the less expensive biosimilar CT-P13 (Remsima/Inflectra) in the treatment of Cr…
rheumnow.com

What can we do when an RA patient fails to respond adequately to a conventional synthetic DMARD (csDMARD) like Methotrexate, or to even a first-line biologic DMARD (bDMARD), typically an anti-TNF?
1) Do we switch to another anti-TNF, or to a different targeted therapy like Tocilizumab, Abatacept or a targeted synthetic DMARD (tsDMARD) like Tofacitinib?
2) Do we combine with other csDMARDs, or switch to another bDMARD/tsDMARD as monotherapy, or should we add on the bDMARD/tsDMARD to the existing csDMARD?

In these days of escalating health costs, especially the stratospheric pricing of bDMARDs/tsDMARDs, and with the emerging biosimilars coming onto the market priced competitively a third cheaper, should we not switch to such if bioequivalence in clinically efficacy and safety have been demonstrated? I think so.

Decisions, decisions.