BIOSIMILARS APPROVED FOR PSORIASIS TREATMENT IN EUROPE
Keywords:
Keywords: biosimilars; biologic; psoriasis; efficacy; safety; EMA.
Abstract
In recent decades, biologics have emerged as pivotal components in the therapeutic armamentarium, revolutionizing the management of various diseases, including chronic inflammatory skin disorder, the psoriasis. Biosimilars, biological formulations designed to closely mimic but not replicate existing reference biologic drugs, have heralded a seismic shift in healthcare delivery, promising equitable access to innovative therapies while fostering competition in the pharmaceutical market.
The advent of biosimilars has democratized access to effective treatments, alleviating the financial burden on healthcare systems and patients alike, particularly pertinent for conditions like psoriasis, notorious for their exorbitant treatment costs. However, despite their widespread adoption and significant promise, significant challenges remain, requiring ongoing research to comprehensively examine their clinical efficacy, safety profiles, and long-term outcomes.
This review aims to present all the biosimilars approved so far in Europe.
Biosimilars represent a transformative force in modern healthcare, but their optimal integration requires careful monitoring, robust pharmacovigilance mechanisms, and ongoing research initiatives to ensure patient safety, build trust among healthcare providers, and maximize treatment efficacy for individuals struggling with psoriasis and other chronic diseases.
References
1. Carrascosa JM, Jacobs I, Petersel D, et al. Biosimilar Drugs for Psoriasis: Principles, Present, and Near Future. Dermatol Ther (Heidelb). 2018; 8(2): 173-94.
2. Reynolds KA, Pithadia DJ, Lee EB, et al. Are biosimilars approved for use in psoriasis safe enough to replace leading biologic therapies? A review. Expert Opin Drug Saf. 2020; 19(4): 459-66.
3. Sciberras J, Zammit R, Vella Bonanno P, et al. The European framework for intellectual property rights for biological medicines. Generics and Biosimilars Initiative Journal (GaBI Journal). 2021; 10(4): 172-83.
4. European Medicines Agency. Biosimilar medicines: Overview https://www.ema.europa.eu/en/human-regulatory-overview/biosimilar-medicines-overview Accessed 28 February 2024.
5. Generics and Biosimilars Initiative (GaBI). Biosimilars approved in Europe. https://www.gabionline.net/biosimilars/general/biosimilars-approved-in-europe Accessed 1 May 2024.
6. Generics and Biosimilars Initiative (GaBI). Biosimilars approved in the US. https://www.gabionline.net/biosimilars/general/biosimilars-approved-in-the-us Accessed 1 May 2024.
7. Papp K, Bachelez H, Costanzo A, et al. Clinical similarity of biosimilar ABP 501 to adalimumab in the treatment of patients with moderate to severe plaque psoriasis: a randomized, double-blind, multicenter, phase III study. J Am Acad Dermatol. 2017; 76(6): 1093–102.
8. Giunta A, Zangrilli A, Bavetta M, et al. A single-centre, observational, retrospective, real-life study evaluating adalimumab biosimilar ABP 501 in the treatment of plaque-type psoriasis and psoriatic arthritis in originator-naïve patients and in patients undergoing non-medical switch from originator. Curr Med Res Opin. 2021;37(7): 1099-102.
9. Lee A, Shirley M. PF-06410293: An Adalimumab Biosimilar. BioDrugs. 2020; 34(5): 695-8.
10. Blauvelt A, Lacour JP, Fowler JF, et al. Phase III randomized study of the proposed adalimumab biosimilar GP2017 in psoriasis: impact of multiple switches. Br J Dermatol. 2018; 179(3): 623–31.
11. Wynne C, Schwabe C, Lemech C, et al. A randomized, adaptive design, double-blind, 3-arm, parallel study assessing the pharmacokinetics and safety of AVT02, a high-concentration (100 mg/mL) adalimumab biosimilar, in healthy adult subjects (ALVOPAD FIRST). Expert Opin Investig Drugs 2022; 31: 965–76.
12. Feldman SR, Reznichenko N, Pulka G et al. Efficacy, safety and immunogenicity of AVT02 versus originator adalimumab in subjects with moderate to severe chronic plaque psoriasis: a multicentre, double-blind, randomized, parallel group, active control, phase III study. BioDrugs. 2021;35(6): 735–48
13. Al-Salama ZT. FKB327: An Adalimumab Biosimilar. BioDrugs. 2019;33(1): 113-6.
14. Hercogova J, Papp KA, Chyrok V, et al.. AURIEL-PsO: a randomized, double-blind phase III ´ equivalence trial to demonstrate the clinical similarity of the proposed biosimilar MSB11022 to reference adalimumab in patients with moderate-to-severe chronic plaque-type psoriasis. Br. J. Dermatol. 2020;182(2): 316–26.
15. Prignano F, Choi J, Pieper B, et al. Anti-tumor necrosis factor agents in psoriasis: addressing key challenges using biosimilars. Expert Opin Biol Ther. 2021;21: 75–80.
16. Barker J, Girolomoni G, Egeberg A, et al.. Anti-TNF biosimilars in psoriasis: from scientific evidence to real-world experience. J Dermatolog Treat. 2020;31: 794–800.
17. Haranaka M, Tanaka T, Kim S, et al. Pharmacokinetics and safety of CT-P17 (40 mg/0.4 ml) versus reference adalimumab: randomized study in healthy Japanese adults. Immunotherapy. 2023; 15(3): 149-61.
18. Pan A, Gerriets V. Etanercept. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 24, 2023.
19. Gherghescu I, Delgado-Charro MB. The Biosimilar Landscape: An Overview of Regulatory Approvals by the EMA and FDA. Pharmaceutics. 2020; 13(1): 48.
20. Cho IH, Lee N, Song D, et al. Evaluation of the structural, physicochemical, and biological characteristics of SB4, a biosimilar of etanercept. MAbs. 2016; 8(6): 1136-55.
21. Burness CB, Duggan ST. Erratum to: Etanercept (SB4): A Review in Autoimmune Inflammatory Diseases. BioDrugs. 2016; 30(5): 481.
22. Glintborg B, Loft AG, Omerovic E, et al. To switch or not to switch: results of a nationwide guideline of mandatory switching from originator to biosimilar etanercept. One-year treatment outcomes in 2061 patients with inflammatory arthritis from the DANBIO registry. Ann Rheum Dis. 2019; 78(2): 192-200.
23. Deeks ED. Correction to: GP2015: An Etanercept Biosimilar. BioDrugs. 2018;32(5): 525.
24. Piaserico S, Conti A, Messina F, et al. Cross-Switch from Etanercept Originator to Biosimilar SB4 and to GP2015 in Patients with Chronic Plaque Psoriasis. BioDrugs. 2021; 35(4): 469-71.
25. Yamanaka H, Kamatani N, Tanaka Y, et al. A Comparative Study to Assess the Efficacy, Safety, and Immunogenicity of YLB113 and the Etanercept Reference Product for the Treatment of Patients with Rheumatoid Arthritis. Rheumatol Ther. 2020; 7(1):149-63.
26. Yamanaka H, Tanaka Y, Hibino T, et al. Lower injection-site reactions and long-term safety, immunogenicity, and efficacy of etanercept biosimilar YLB113: Results from a post-hoc analysis of a double-blind, randomized, phase III comparative study and its open-label extension in patients with rheumatoid arthritis. Int J Rheum Dis. 2023;26(1):108-15.
27. Agboton C, Salameh J. Biosimilars in chronic inflammatory diseases: facts and remaining questions 5 years after their introduction in Europe. Expert Opin Biol Ther. 2022; 22(2): 157-67.
28. Jung EH, Sarpatwari A, Kesselheim AS, et al.. FDA and EMA Biosimilar Approvals [published correction appears in J Gen Intern Med. 2019 Dec 5;:]. J Gen Intern Med. 2020; 35(6): 1908-10.
29. Macaluso FS, Cummings JF, Atreya R, et al.. A Systematic Review on Infliximab Biosimilar SB2: From Pre-Clinical Data to Real-World Evidence. Expert Opin Biol Ther. 2022; 22(2): 203-23.
30. Kim DW, Lee Y, Kim G, et al. Safety and Effectiveness of SB2 (Infliximab Biosimilar) in Adult Patients with Immune-Mediated Inflammatory Diseases: A Post-Marketing Surveillance in Korea. Adv Ther. 2023; 40(3): 1047-61.
31. Pagnini C, Di Paolo MC, De Angelis G, et al. Similar But Not Identical: Plaque Psoriasis Exacerbation in a Patient With Crohn's Disease After Switching From CT-P13 to SB2 Infliximab Biosimilar. Inflamm Bowel Dis. 2020; 26(8): 83-4.
32. European Medicines Agency. Remsima: European Public Assessment Report—summary for the public. 2013. https://www.ema.europa.eu/en/medicines/human/EPAR/remsima#ema-inpage-item-authorisation-details Accessed 28 February 2024.
33. Goll GL, Jørgensen KK, Sexton J, et al. Long-term efficacy and safety of biosimilar infliximab (CT-P13) after switching from originator infliximab: open-label extension of the NOR-SWITCH trial. J Intern Med. 2019; 285(6): 653-69.
34. Kurizky PS, Galvão LO, Martins GA. Efficacy and safety of biosimilar infliximab CT-P13 in the treatment of psoriasis and psoriatic arthritis: 1-year follow-up. An Bras Dermatol. 2019; 94(4): 483-4.
35. Morita A, Nishikawa K, Yamada F, et al. Safety, efficacy, and drug survival of the infliximab biosimilar CT-P13 in post-marketing surveillance of Japanese patients with psoriasis. J Dermatol. 2022;49(10):957-69.
36. McClellan JE, Conlon HD, Bolt MW, et al. The 'totality-of-the-evidence' approach in the development of PF-06438179/GP1111, an infliximab biosimilar, and in support of its use in all indications of the reference product. Therap Adv Gastroenterol. 2019; 12: 1756284819852535.
37. Blauvelt A, Chiricozzi A. The immunologic role of IL-17 in psoriasis and psoriatic arthritis pathogenesis. Clin Rev Allergy Immunol. 2018;55(3):379-90.
38. Langley RG, Lebwohl M, Krueger GG, et al. Long-term efficacy and safety of ustekinumab, with and without dosing adjustment, in patients with moderate-to-severe psoriasis: results from the PHOENIX 2 study through 5 years of follow-up. Br J Dermatol. 2015; 172(5): 1371-83.
39. Hayashi M, Umezawa Y, Fukuchi O, et al. Efficacy and safety of ustekinumab treatment in elderly patients with psoriasis. J Dermatol. 2014; 41(11): 974-80.
40. Feldman SR, Reznichenko N, Berti F, et al. Randomized, double-blind, multicenter study to evaluate efficacy, safety, tolerability, and immunogenicity between AVT04 and the reference product ustekinumab in patients with moderate-to-severe chronic plaque psoriasis. Expert Opin Biol Ther. 2023; 23(8): 759-71.
41. Derzi M, Shoieb AM, Ripp SL, et al. Comparative nonclinical assessments of the biosimilar PF-06410293 and originator adalimumab. Regul Toxicol Pharmacol. 2020; 112: 104587.
42. Genovese MC, Glover J, Greenwald M, et al. FKB327, an adalimumab biosimilar, versus the reference product: results of a randomized, Phase III, double-blind study, and its open-label extension. Arthritis Res Ther. 2019; 21(1): 281.
43. Rémuzat C, Dorey J, Cristeau O, et al. Key drivers for market penetration of biosimilars in Europe. J Mark Access Health Policy. 2017; 5(1): 1272308.
44. Generics and Biosimilars Initiative (GaBI). The sluggish US biosimilars https://www.gabionline.net/reports/The-sluggish-US-biosimilars-market Accessed 2 May 2024.
45. Aladul MI, Fitzpatrick RW, Chapman SR. Impact of infliximab and etanercept biosimilars on biological disease-modifying antirheumatic drugs utilisation and NHS budget in the UK. Biodrugs. 2017; 31: 533–44.
46. Ravasio R, Girolomoni G, Gorla R. Analisi di budget impact del biosimilare di etanercept: lo scenario italiano. Glob. Reg. Health Technol. Assess. 2018; 2018; 1–12.
47. Loft N, Egeberg A, Rasmussen MK, et al. Outcomes Following a Mandatory Nonmedical Switch From Adalimumab Originator to Adalimumab Biosimilars in Patients With Psoriasis. JAMA Dermatol. 2021; 157(6): 676-83.
48. Gisondi P, Virga C, Piaserico S, et al. Switching from one infliximab biosimilar (CT-P13) to another infliximab biosimilar (SB2) in patients with chronic plaque psoriasis. Br J Dermatol. 2020; 183(2): 397-8.
49. Ruda RC, Kelly KA, Feldman SR. Real-world outcomes following switching from anti-TNF reference products to biosimilars for the treatment of psoriasis. J Dermatolog Treat. 2023; 34(1): 2140569.
50. Panahi M, Skelly Y, Zaman R. The effect of biosimilar administration on clinical outcomes in patients with adalimumab-controlled psoriasis. Skin Health Dis. 2021; 1(4): 60.
51. Teeple A, Ginsburg S, Howard L, et al. Patient attitudes about non-medical switching to biosimilars: results from an online patient survey in the United States. Curr Med Res Opin. 2019; 35(4): 1-7.
52. Varma M, Almarsdóttir AB, Druedahl LC. “Biosimilar, so it looks alike, but what does it mean?” A qualitative study of Danish patients' perceptions of biosimilars. Basic Clin Pharmacol Toxicol. 2022; 130(5): 581-91.
2. Reynolds KA, Pithadia DJ, Lee EB, et al. Are biosimilars approved for use in psoriasis safe enough to replace leading biologic therapies? A review. Expert Opin Drug Saf. 2020; 19(4): 459-66.
3. Sciberras J, Zammit R, Vella Bonanno P, et al. The European framework for intellectual property rights for biological medicines. Generics and Biosimilars Initiative Journal (GaBI Journal). 2021; 10(4): 172-83.
4. European Medicines Agency. Biosimilar medicines: Overview https://www.ema.europa.eu/en/human-regulatory-overview/biosimilar-medicines-overview Accessed 28 February 2024.
5. Generics and Biosimilars Initiative (GaBI). Biosimilars approved in Europe. https://www.gabionline.net/biosimilars/general/biosimilars-approved-in-europe Accessed 1 May 2024.
6. Generics and Biosimilars Initiative (GaBI). Biosimilars approved in the US. https://www.gabionline.net/biosimilars/general/biosimilars-approved-in-the-us Accessed 1 May 2024.
7. Papp K, Bachelez H, Costanzo A, et al. Clinical similarity of biosimilar ABP 501 to adalimumab in the treatment of patients with moderate to severe plaque psoriasis: a randomized, double-blind, multicenter, phase III study. J Am Acad Dermatol. 2017; 76(6): 1093–102.
8. Giunta A, Zangrilli A, Bavetta M, et al. A single-centre, observational, retrospective, real-life study evaluating adalimumab biosimilar ABP 501 in the treatment of plaque-type psoriasis and psoriatic arthritis in originator-naïve patients and in patients undergoing non-medical switch from originator. Curr Med Res Opin. 2021;37(7): 1099-102.
9. Lee A, Shirley M. PF-06410293: An Adalimumab Biosimilar. BioDrugs. 2020; 34(5): 695-8.
10. Blauvelt A, Lacour JP, Fowler JF, et al. Phase III randomized study of the proposed adalimumab biosimilar GP2017 in psoriasis: impact of multiple switches. Br J Dermatol. 2018; 179(3): 623–31.
11. Wynne C, Schwabe C, Lemech C, et al. A randomized, adaptive design, double-blind, 3-arm, parallel study assessing the pharmacokinetics and safety of AVT02, a high-concentration (100 mg/mL) adalimumab biosimilar, in healthy adult subjects (ALVOPAD FIRST). Expert Opin Investig Drugs 2022; 31: 965–76.
12. Feldman SR, Reznichenko N, Pulka G et al. Efficacy, safety and immunogenicity of AVT02 versus originator adalimumab in subjects with moderate to severe chronic plaque psoriasis: a multicentre, double-blind, randomized, parallel group, active control, phase III study. BioDrugs. 2021;35(6): 735–48
13. Al-Salama ZT. FKB327: An Adalimumab Biosimilar. BioDrugs. 2019;33(1): 113-6.
14. Hercogova J, Papp KA, Chyrok V, et al.. AURIEL-PsO: a randomized, double-blind phase III ´ equivalence trial to demonstrate the clinical similarity of the proposed biosimilar MSB11022 to reference adalimumab in patients with moderate-to-severe chronic plaque-type psoriasis. Br. J. Dermatol. 2020;182(2): 316–26.
15. Prignano F, Choi J, Pieper B, et al. Anti-tumor necrosis factor agents in psoriasis: addressing key challenges using biosimilars. Expert Opin Biol Ther. 2021;21: 75–80.
16. Barker J, Girolomoni G, Egeberg A, et al.. Anti-TNF biosimilars in psoriasis: from scientific evidence to real-world experience. J Dermatolog Treat. 2020;31: 794–800.
17. Haranaka M, Tanaka T, Kim S, et al. Pharmacokinetics and safety of CT-P17 (40 mg/0.4 ml) versus reference adalimumab: randomized study in healthy Japanese adults. Immunotherapy. 2023; 15(3): 149-61.
18. Pan A, Gerriets V. Etanercept. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 24, 2023.
19. Gherghescu I, Delgado-Charro MB. The Biosimilar Landscape: An Overview of Regulatory Approvals by the EMA and FDA. Pharmaceutics. 2020; 13(1): 48.
20. Cho IH, Lee N, Song D, et al. Evaluation of the structural, physicochemical, and biological characteristics of SB4, a biosimilar of etanercept. MAbs. 2016; 8(6): 1136-55.
21. Burness CB, Duggan ST. Erratum to: Etanercept (SB4): A Review in Autoimmune Inflammatory Diseases. BioDrugs. 2016; 30(5): 481.
22. Glintborg B, Loft AG, Omerovic E, et al. To switch or not to switch: results of a nationwide guideline of mandatory switching from originator to biosimilar etanercept. One-year treatment outcomes in 2061 patients with inflammatory arthritis from the DANBIO registry. Ann Rheum Dis. 2019; 78(2): 192-200.
23. Deeks ED. Correction to: GP2015: An Etanercept Biosimilar. BioDrugs. 2018;32(5): 525.
24. Piaserico S, Conti A, Messina F, et al. Cross-Switch from Etanercept Originator to Biosimilar SB4 and to GP2015 in Patients with Chronic Plaque Psoriasis. BioDrugs. 2021; 35(4): 469-71.
25. Yamanaka H, Kamatani N, Tanaka Y, et al. A Comparative Study to Assess the Efficacy, Safety, and Immunogenicity of YLB113 and the Etanercept Reference Product for the Treatment of Patients with Rheumatoid Arthritis. Rheumatol Ther. 2020; 7(1):149-63.
26. Yamanaka H, Tanaka Y, Hibino T, et al. Lower injection-site reactions and long-term safety, immunogenicity, and efficacy of etanercept biosimilar YLB113: Results from a post-hoc analysis of a double-blind, randomized, phase III comparative study and its open-label extension in patients with rheumatoid arthritis. Int J Rheum Dis. 2023;26(1):108-15.
27. Agboton C, Salameh J. Biosimilars in chronic inflammatory diseases: facts and remaining questions 5 years after their introduction in Europe. Expert Opin Biol Ther. 2022; 22(2): 157-67.
28. Jung EH, Sarpatwari A, Kesselheim AS, et al.. FDA and EMA Biosimilar Approvals [published correction appears in J Gen Intern Med. 2019 Dec 5;:]. J Gen Intern Med. 2020; 35(6): 1908-10.
29. Macaluso FS, Cummings JF, Atreya R, et al.. A Systematic Review on Infliximab Biosimilar SB2: From Pre-Clinical Data to Real-World Evidence. Expert Opin Biol Ther. 2022; 22(2): 203-23.
30. Kim DW, Lee Y, Kim G, et al. Safety and Effectiveness of SB2 (Infliximab Biosimilar) in Adult Patients with Immune-Mediated Inflammatory Diseases: A Post-Marketing Surveillance in Korea. Adv Ther. 2023; 40(3): 1047-61.
31. Pagnini C, Di Paolo MC, De Angelis G, et al. Similar But Not Identical: Plaque Psoriasis Exacerbation in a Patient With Crohn's Disease After Switching From CT-P13 to SB2 Infliximab Biosimilar. Inflamm Bowel Dis. 2020; 26(8): 83-4.
32. European Medicines Agency. Remsima: European Public Assessment Report—summary for the public. 2013. https://www.ema.europa.eu/en/medicines/human/EPAR/remsima#ema-inpage-item-authorisation-details Accessed 28 February 2024.
33. Goll GL, Jørgensen KK, Sexton J, et al. Long-term efficacy and safety of biosimilar infliximab (CT-P13) after switching from originator infliximab: open-label extension of the NOR-SWITCH trial. J Intern Med. 2019; 285(6): 653-69.
34. Kurizky PS, Galvão LO, Martins GA. Efficacy and safety of biosimilar infliximab CT-P13 in the treatment of psoriasis and psoriatic arthritis: 1-year follow-up. An Bras Dermatol. 2019; 94(4): 483-4.
35. Morita A, Nishikawa K, Yamada F, et al. Safety, efficacy, and drug survival of the infliximab biosimilar CT-P13 in post-marketing surveillance of Japanese patients with psoriasis. J Dermatol. 2022;49(10):957-69.
36. McClellan JE, Conlon HD, Bolt MW, et al. The 'totality-of-the-evidence' approach in the development of PF-06438179/GP1111, an infliximab biosimilar, and in support of its use in all indications of the reference product. Therap Adv Gastroenterol. 2019; 12: 1756284819852535.
37. Blauvelt A, Chiricozzi A. The immunologic role of IL-17 in psoriasis and psoriatic arthritis pathogenesis. Clin Rev Allergy Immunol. 2018;55(3):379-90.
38. Langley RG, Lebwohl M, Krueger GG, et al. Long-term efficacy and safety of ustekinumab, with and without dosing adjustment, in patients with moderate-to-severe psoriasis: results from the PHOENIX 2 study through 5 years of follow-up. Br J Dermatol. 2015; 172(5): 1371-83.
39. Hayashi M, Umezawa Y, Fukuchi O, et al. Efficacy and safety of ustekinumab treatment in elderly patients with psoriasis. J Dermatol. 2014; 41(11): 974-80.
40. Feldman SR, Reznichenko N, Berti F, et al. Randomized, double-blind, multicenter study to evaluate efficacy, safety, tolerability, and immunogenicity between AVT04 and the reference product ustekinumab in patients with moderate-to-severe chronic plaque psoriasis. Expert Opin Biol Ther. 2023; 23(8): 759-71.
41. Derzi M, Shoieb AM, Ripp SL, et al. Comparative nonclinical assessments of the biosimilar PF-06410293 and originator adalimumab. Regul Toxicol Pharmacol. 2020; 112: 104587.
42. Genovese MC, Glover J, Greenwald M, et al. FKB327, an adalimumab biosimilar, versus the reference product: results of a randomized, Phase III, double-blind study, and its open-label extension. Arthritis Res Ther. 2019; 21(1): 281.
43. Rémuzat C, Dorey J, Cristeau O, et al. Key drivers for market penetration of biosimilars in Europe. J Mark Access Health Policy. 2017; 5(1): 1272308.
44. Generics and Biosimilars Initiative (GaBI). The sluggish US biosimilars https://www.gabionline.net/reports/The-sluggish-US-biosimilars-market Accessed 2 May 2024.
45. Aladul MI, Fitzpatrick RW, Chapman SR. Impact of infliximab and etanercept biosimilars on biological disease-modifying antirheumatic drugs utilisation and NHS budget in the UK. Biodrugs. 2017; 31: 533–44.
46. Ravasio R, Girolomoni G, Gorla R. Analisi di budget impact del biosimilare di etanercept: lo scenario italiano. Glob. Reg. Health Technol. Assess. 2018; 2018; 1–12.
47. Loft N, Egeberg A, Rasmussen MK, et al. Outcomes Following a Mandatory Nonmedical Switch From Adalimumab Originator to Adalimumab Biosimilars in Patients With Psoriasis. JAMA Dermatol. 2021; 157(6): 676-83.
48. Gisondi P, Virga C, Piaserico S, et al. Switching from one infliximab biosimilar (CT-P13) to another infliximab biosimilar (SB2) in patients with chronic plaque psoriasis. Br J Dermatol. 2020; 183(2): 397-8.
49. Ruda RC, Kelly KA, Feldman SR. Real-world outcomes following switching from anti-TNF reference products to biosimilars for the treatment of psoriasis. J Dermatolog Treat. 2023; 34(1): 2140569.
50. Panahi M, Skelly Y, Zaman R. The effect of biosimilar administration on clinical outcomes in patients with adalimumab-controlled psoriasis. Skin Health Dis. 2021; 1(4): 60.
51. Teeple A, Ginsburg S, Howard L, et al. Patient attitudes about non-medical switching to biosimilars: results from an online patient survey in the United States. Curr Med Res Opin. 2019; 35(4): 1-7.
52. Varma M, Almarsdóttir AB, Druedahl LC. “Biosimilar, so it looks alike, but what does it mean?” A qualitative study of Danish patients' perceptions of biosimilars. Basic Clin Pharmacol Toxicol. 2022; 130(5): 581-91.