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ACR Open Rheumatol. 2020 Feb;2(2):79-83. doi: 10.1002/acr2.11106. Epub 2020 Jan 6.

Patterns of Tumor Necrosis Factor Inhibitor (TNFi) Biosimilar Use Across United States Rheumatology Practices.

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University of British Columbia and Arthritis Research Canada, Vancouver, British Columbia, Canada.
University of Alabama at Birmingham.
Brigham and Women's Hospital, Boston, Massachusetts.
University of California San Francisco.
Practice, Advocacy & Quality, American College of Rheumatology, Atlanta, Georgia.
University of Nebraska Medical Center, Omaha, Nebraska, and Forward, The National Databank for Rheumatic Diseases, Wichita, Kansas.
Rheumatology Division, San Francisco VA Medical Center, San Francisco, California.
Brigham and Women's Hospital, Boston, MA and Boston VA Medical Center and Harvard Medical School.



It is unclear if biosimilars of biologics for inflammatory arthritis are realizing their promise to increase competition and improve accessibility. This study evaluates biosimilar tumor necrosis factor inhibitor (TNFi) utilization across rheumatology practices in the United States and compares whether patients initiating biosimilars remain on these treatments at least as long as new initiators of bio-originators.


We identified a cohort of patients initiating a TNFi biosimilar between January 2017 and September 2018 from an electronic health record registry containing data from 218 rheumatology practices and over 1 million rheumatology patients in the United States. We also identified a cohort of patients who initiated the bio-originator TNFi during the same period. We calculated the proportion of biosimilar prescriptions compared with other TNFi's and compared persistence on these therapies, adjusting for age, sex, diagnoses codes, and insurance type.


We identified 909 patients prescribed the biosimilar infliximab-dyyb, the only biosimilar prescribed, and 4413 patients with a new prescription for the bio-originator infliximab. Biosimilar patients tended to be older, have a diagnosis code for rheumatoid arthritis, and covered by Medicare insurance. Over the study period, biosimilar prescriptions reached a maximum of 3.5% of all TNFi prescriptions. Patients persisted on the biosimilar at least as long as the bio-originator infliximab (hazard ratio [HR] 0.83, P = 0.07).


The uptake of biosimilars in the United States remains low despite persistence on infliximab-dyyb being similar to the infliximab bio-originator. These results add to clinical studies that should provide greater confidence to patients and physicians regarding biosimilar use.

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