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Biosimilars in IBD: hope or expectation?
  1. Krisztina B Gecse1,2,
  2. Reena Khanna3,
  3. Gijs R van den Brink1,
  4. Cyriel Y Ponsioen1,
  5. Mark Löwenberg1,
  6. Vipul Jairath4,
  7. Simon P L Travis5,
  8. William J Sandborn5,6,
  9. Brian G Feagan3,7,
  10. Geert R A M D'Haens1,2
  1. 1 Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Robarts Clinical Trials, Amsterdam, The Netherlands
  3. 3 Robarts Clinical Trials, London, Ontario, Canada
  4. 4 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
  5. 5 Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
  6. 6 Robarts Clinical Trials, San Diego, California, USA
  7. 7 Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada
  1. Correspondence to Professor Geert R A M D'Haens, Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; g.dhaens{at}

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A biosimilar is a biological medicine that enters the market subsequent to expiration of the patent of an original reference product and its similarity to the reference medicine exhibits ‘no clinically meaningful differences in terms of quality, safety and efficacy’.1 In practice, patents protect a reference product for 10 years after its approval before registration for a similar biological medicine can be applied for.1 The term ‘biosimilar’ is recognised by all regulators, but synonyms include ‘similar biotherapeutic product’ (WHO) and ‘subsequent-entry biologic’ (Canada).2 Biopharmaceutical agents are derived from living cells or organisms and are usually complex proteins. Therefore, regulators are establishing novel specific approval pathways for biosimilars that differ from those for chemical generics. Since the first approval in 2005, several biosimilars of somatropin (human growth hormone), filgrastim (granulocyte colony-stimulating factor, G-CSF) and epoetin (erythropoietin) have become available in Europe. Currently, 12 biosimilars are authorised in the European market, and numerous others, including monoclonal antibodies (mAbs), have applied for authorisation.3 ,4 This subject has received increasing attention in gastroenterology, because the patent on infliximab is due to expire and regulatory approval for two biosimilar infliximabs have already been filed for to the European Medicines Agency (EMA). One of these molecules is already available for patient care in South Korea.4 ,5

The driving force behind biosimilar development

Biological agents are currently in widespread use for the treatment of chronic inflammatory diseases. As recently as in 2000, only two of the world's top 10 grossing drugs were biological agents. In 2012, estimates are that seven are biological agents, of which adalimumab and infliximab lead the list.6 The long duration of development and high manufacturing costs are cited as the main contributors to the high cost of biological agents. For example, the average yearly cost of infliximab treatment for Crohn's disease in …

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