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PurposeTo evaluate the efficacy and safety of the biosimilar infliximab in adult patients with inflammatory arthritis switched from reference product in our center.Patients and methodsIn April 2014, patients attending our rheumatology service for infliximab infusions were switched from reference product to the biosimilar infliximab following consent and hospital approval.ResultsAround 34 patients with inflammatory arthritis were switched from reference product to biosimilar infliximab in 2014: 50% female, mean age 55 years (standard deviation=12.9), mean disease duration 14.79 years (9.7), median duration on infliximab 57 months, and two-thirds on oral disease-modifying antirheumatic drugs. There was no difference in efficacy or safety in the first 6 months of therapy. By the end of 2015, the mean follow-up on biosimilar infliximab was 15.8 (standard deviation=6.3) months. Our results showed no significant difference in Health Assessment Questionnaire score, patient global assessment of disease activity, number of disease flares, or the medication dose between the originator and the biosimilar infliximab. However, reported pain and C-reactive protein values were significantly higher during the longer follow-up period (p=0.043, 0.001 respectively). There was no significant difference in the number of adverse events or infusion reactions during follow-up periods. Only five (14.7%) patients discontinued the biosimilar infliximab.ConclusionOur patients experienced similar efficacy and safety for managing their arthritis with the biosimilar infliximab as the reference product infliximab, but at a much lower cost.

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at a maintenance dosage of 30 mg to 50 mg daily, it is a highly effective treatment. Adverse reactions are dose-related and generally typical of hypervitaminosis A. As acitretin has no immunomodulatory effects in comparison to conventional treatments, it is thus a superior option in conjunction with ongoing treatment with immune checkpoint inhibitors.To date there are no treatment guidelines for this unique patient cohort and often immunotherapy is ceased in the setting of an acute symptomatic cutaneous adverse event. However, in cases of anti-PD-1 induced or exacerbated psoriasis, we recommend a timely dermatological consult with consideration of acitretin alongside ongoing immunotherapy.

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