Real-World Evidence Shows Adalimumab Biosimilars Maintain Efficacy Despite Injection Site Tolerability Concerns
Key Insights
A Dutch retrospective study of 185 patients found no significant difference in disease flares between adalimumab originator Humira and biosimilar Hyrimoz across multiple immune-mediated inflammatory diseases.
One-quarter of patients experienced adverse events after switching to Hyrimoz, with injection site pain being the most common complaint affecting 13.5% of patients.
A separate meta-analysis of 10,812 IBD patients confirmed comparable clinical remission rates and safety profiles between adalimumab and infliximab biosimilars versus their reference products.
Real-world evidence from the Netherlands demonstrates that adalimumab biosimilars maintain therapeutic efficacy comparable to the reference product Humira, though tolerability concerns related to injection site reactions present clinical challenges for some patients. A retrospective cohort study evaluating 185 patients who switched from Humira to the biosimilar Hyrimoz (GP2017) found no significant difference in disease flare rates over one year of treatment.
Clinical Efficacy Remains Consistent After Biosimilar Switch
The Dutch study, conducted at a specialized center treating immune-mediated inflammatory diseases, tracked patients for one year before and after switching from adalimumab originator to Hyrimoz in 2022. During treatment with the reference product, 29 flares occurred in 28 patients, compared to 24 flares in 23 patients during biosimilar treatment, showing no statistically significant difference in the primary endpoint.
Patient populations included those with systemic disease with uveitis (search) (32%), isolated uveitis (22%), Behçet disease (search) without active uveitis (20%), and neurosarcoidosis (12%). The investigators found no significant differences in sex, age, or indication for adalimumab treatment between patients who experienced flares during biosimilar treatment and those who did not.
Injection Site Tolerability Emerges as Primary Concern
Despite comparable efficacy, 46 patients (25%) experienced adverse effects after switching to Hyrimoz, with injection site pain being the most frequently reported issue affecting 25 patients (13.5%). The authors attributed these reactions to the biosimilar's larger injection volume and presence of citrate in the formulation, which differs from the citrate-free reference product used at their center.
Of the 60 patients (32%) who discontinued Hyrimoz treatment, 27 (15%) cited adverse effects as the primary reason, with injection site pain being the most common cause for discontinuation. The study authors characterized pain with Hyrimoz injection as "a major concern" when switching from the reference product to this particular biosimilar.
Broader Meta-Analysis Confirms Biosimilar Effectiveness
Supporting these findings, a comprehensive meta-analysis published in Revista Española De Enfermedades Digestivas analyzed 37 studies encompassing 10,812 patients with inflammatory bowel disease (search) (IBD). The analysis confirmed comparable clinical remission rates between biosimilars and originators for both adalimumab and infliximab across Crohn's disease (search) (OR = 0.87; 95% CI: 0.74-0.96) and ulcerative colitis (search) (OR = 1.25; 95% CI: 0.83-1.90).
Biomarkers including C-reactive protein and fecal calprotectin remained stable after transitioning to biosimilars, with pooled discontinuation rates of 13% (range: 2%-36%). Safety profiles showed no significant differences between biosimilars and reference products, and antidrug antibody incidence demonstrated comparable rates (OR = 0.96; 95% CI: 0.46-2.02).
Clinical Implications for Treatment Decisions
The Dutch study revealed that among 23 patients who experienced flares during biosimilar treatment, 17 (74%) switched back to the reference product, with most achieving inactive disease status afterward. However, the authors noted that drug and antibody levels were measured in only a minority of patients, preventing definitive conclusions about the underlying mechanisms.
Both studies utilized various biosimilar formulations, including infliximab-dyyb (CT-P13, Remsima, Inflectra), SB2 (Renflexis), and adalimumab-bwwd (Hadlima, SB5), demonstrating the broad applicability of findings across different biosimilar products. The meta-analysis authors emphasized the need for standardized reporting of mucosal healing, drug monitoring, and economic metrics to optimize biosimilar adoption in clinical practice.
These real-world data provide healthcare providers with evidence-based guidance for biosimilar switching decisions, highlighting the importance of patient counseling regarding potential injection site reactions while confirming maintained therapeutic efficacy across diverse patient populations.