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Response to ‘‘To switch or not to switch’: the missing piece in the puzzle of biosimilar literature?’ by Scherlinger et al
  1. Bente Glintborg1,2,
  2. Anne Gitte Loft3,4,
  3. Emina Omerovic5,
  4. Oliver Hendricks6,
  5. Asta Linauskas7,
  6. Jakob Espesen8,
  7. Kamilla Danebod2,
  8. Dorte Vendelbo Jensen2,
  9. Henrik Nordin9,
  10. Emil Barner Dalgaard10,
  11. Stavros Chrysidis11,
  12. Salome Kristensen12,
  13. Johnny Lillelund Raun13,
  14. Hanne Lindegaard14,
  15. Natalia Manilo15,
  16. Susanne Højmark Jakobsen16,
  17. Inger Marie Jensen Hansen16,
  18. Dorte Dalsgaard Pedersen17,
  19. Inge Juul Sørensen1,18,
  20. Lis Smedegaard Andersen19,
  21. Jolanta Grydehøj20,
  22. Frank Mehnert21,
  23. Niels Steen Krogh22,
  24. Merete Lund Hetland18
  1. 1 The DANBIO Registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Glostrup, Denmark
  2. 2 Department of Rheumatology, Gentofte and Herlev Hospital, Copenhagen University Hospital, Gentofte, Denmark
  3. 3 Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  4. 4 Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  5. 5 Department of Rheumatology, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark
  6. 6 Kong Christian X’s Gigthospital, Gråsten, Denmark
  7. 7 Department of Rheumatology, North Denmark Regional Hospital, Hjørring, Denmark
  8. 8 Department of Rheumatology, Vejle Hospital, Vejle, Denmark
  9. 9 Department of Rheumatology, Zealand University Hospital, Køge, Denmark
  10. 10 Department of Rheumatology, Silkeborg Hospital, Silkeborg, Denmark
  11. 11 Department of Rheumatology, Esbjerg Hospital, Esbjerg, Denmark
  12. 12 Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
  13. 13 Department of Rheumatology, Sygehus Lillebælt, Kolding, Denmark
  14. 14 Department of Rheumatology, Odense University Hospital, Odense, Denmark
  15. 15 Department of Rheumatology, Frederiksberg Hospital, Copenhagen, Denmark
  16. 16 Department of Rheumatology, OUH, Svendborg Hospital, Svendborg, Denmark
  17. 17 Department of Rheumatology, Viborg Hospital, Viborg, Denmark
  18. 18 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  19. 19 Department of Internal Medicine, Rønne Hospital, Rønne, Denmark
  20. 20 Department of Rheumatology, Holstebro Hospital, Holstebro, Denmark
  21. 21 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  22. 22 ZiteLab, Copenhagen, Denmark
  1. Correspondence to Dr Bente Glintborg, The DANBIO Registry, Rigshospitalet, and Department of Rheumatology, Gentofte and Herlev University Hospital, Glostrup 2600, Denmark; glintborg{at}

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Thank you for the interest1 in our recent publication, in which we explored treatment outcomes following a Danish mandatory switch from originator to biosimilar etanercept (SB4, 50 mg) in routine care.2 We showed that of the 2061 patients who were receiving originator etanercept and thus were eligible for the switch, as many as four of five (79%) switched to the biosimilar, despite the continued availability of the originator drug (as 25 mg pen or 50 mg powder solution). Among the patients who switched, we observed high retention rates of the biosimilar. The 6-month retention rate after switch (88%) was very similar to results of a recent Dutch study (90%), which reported outcomes of a non-mandatory switch following a specifically designed communication strategy.3 Furthermore, we found that the disease activity and flare rates 3 months prior to versus 3 months after the switch were similar at the level of the individual patients. Thus, we agree with Scherlinger and Schaeverbeke that biosimilars hold the potential to provide sustainable healthcare in inflammatory rheumatic diseases at reduced costs.1

The question raised by Scherlinger et al is whether the outcome of a shared patient-physician decision (=non-mandatory) is more favourable than a mandatory switch. In previous studies that explored non-mandatory switching, the shared patient-physician decision-making included training of personnel and use of specific questionnaires or communication techniques.3 4 For the Danish mandatory switch, no extra resources were allocated to conduct the switch procedure and no specific education of the healthcare personnel was provided. Furthermore, it was beyond the scope of our study to explore the practical aspects of the switch procedure including communication strategy with the patients. However, we have previously demonstrated that a mandatory switch from originator to biosimilar infliximab did not lead to a detectable increase in the use of healthcare resources.5

To determine whether shared patient-physician decision is superior to a mandatory switch in terms of lower nocebo effect, increased treatment efficacy and reduced healthcare costs, large-scale studies which are designed to explore these specific aspects are necessary—and highly needed. Such studies must also include evaluation of the extra healthcare resources allocated to and arising from the strategies investigated.

In conclusion, our paper adds important evidence to the use of biosimilars in routine care—however, some pieces are still missing in the puzzle.



  • Handling editor Josef S Smolen

  • Contributors All authors contributed to and approved this letter to the editor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BG: AbbVie, Biogen, Pfizer, MSD. MLH: Orion, BMS, AbbVie, Biogen, Pfizer, MSD, Celltrion. IMJH: Roche. AGL: AbbVie, MSD, Novartis, Pfizer, Roche, UCB. OH: AbbVie, Roche, Novartis. HN: AbbVie, Novartis, Medac. LSA: Pfizer.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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