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Biopharmaceuticals for rheumatic diseases in Latin America, Europe, Russia, and India: Innovators, biosimilars, and intended copies

Joint Bone Spine, Volume 81, Issue 6, December 2014, Pages 471 - 477


A biosimilar is a biopharmaceutical product intended to be comparable to a previously licensed biopharmaceutical agent. The goal of such products is to increase the accessibility of biopharmaceutical therapy for rheumatoid arthritis by reducing costs. They are not like generic drugs, in that they may differ from the reference products in manufacturing, composition, and formulation. Regulatory authorities strive to ensure the absence of clinically meaningful differences between biosimilars and their reference drugs. However, small molecular differences may potentially affect pharmacodynamics (including affinity), pharmacokinetics, and immunogenicity. Intended copies are non-innovator biopharmaceutical products that, unlike biosimilars, do not have enough clinical evidence to demonstrate biosimilarity. For approval of a biosimilar, most countries require preclinical and clinical studies demonstrating comparability with the reference drug. The margin for determining equivalence or non-inferiority is determined on a case-by-case basis in each country, as there are no general criteria. The European Medicines Agency and US Food and Drug Administration have stringent regulatory processes to ensure comparability of biosimilars with their reference drugs. There are also post-marketing surveillance requirements to monitor safety. Only one biosimilar, CT-P13, has been approved for rheumatoid arthritis. However, in countries with less stringent regulation, intended copies are being commercialized and safety problems have been documented. Consequently, in such countries, there is an urgent need for appropriate regulatory processes to be established. Attempts to close the affordability gap of biopharmaceuticals should not open another gap between patients treated with an innovator drug and an intended copy.

Keywords: Rheumatic diseases, Rheumatoid arthritis, Biopharmaceuticals, Tumor necrosis factor (TNF) antagonists, Biosimilars, Innovators.


a Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico

b Department of Rheumatology, University of Debrecen Medical and Health Sciences Center, Debrecen, Hungary

c Organización Médica de Investigación, Buenos Aires, Argentina

d Department of Medicine, Universidade Federal do Paraná, Curitiba, Brazil

e Chief of ImmunoRheumatology Saludcoop Clinic and Scientific Director of IDEARG, Bogota, Colombia

f Department of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago, Chile

g Hospital Universitario de Caracas, Caracas, Venezuela

h Department of Early Arthritis, Research Institute of Rheumatology of Russian Academy of Medical Sciences, Moscow, Russia

Corresponding author. Departamento de Farmacología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Av. Instituto Politécnico Nacional 2508, 07360 México, DF, México. Tel.: +52 55 5747 3305; fax: +52 55 5747 3394.

1 All authors approved the entirety of the submitted material and contributed actively to the content of the review.