title: Bioequivalence of Biosimilar Tumor Necrosis Factor-α Inhibitors Compared With Their Reference Biologics: A Systematic Review.
abstract: BACKGROUND
  Biosimilars are of growing clinical, regulatory, and commercial importance.
  
  
  OBJECTIVE
  To summarize evidence about the bioequivalence between biosimilar and reference tumor necrosis factor-α (TNF-α) inhibitors.
  
  
  METHODS
  PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS from inception through 13 April 2016 and ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, EU Clinical Trials Register, U.S. Food and Drug Administration, and European Medicines Agency from inception through 30 April 2016.
  
  
  METHODS
  Published English-language studies of any size or design that compared the pharmacokinetics, clinical efficacy, adverse events, or immunogenicity of a biosimilar TNF-α inhibitor with a reference biologic in humans.
  
  
  METHODS
  Two reviewers independently screened titles and abstracts, extracted data from selected studies, and assessed study quality.
  
  
  RESULTS
  Of 19 eligible studies, 8 were phase 1 randomized trials, 5 were phase 3 randomized trials, and 6 were observational studies. Most phase 1 trials (n = 7) involved healthy volunteers, phase 3 trials involved patients with rheumatoid arthritis, and observational studies involved those with rheumatoid arthritis or inflammatory bowel disease. All phase 1 trials showed that pharmacokinetic parameters of the biosimilar and respective biologic were within the prespecified equivalence margin of 80% to 125%. Phase 3 trials suggested similar clinical responses and adverse events. Adverse events were usually of mild to moderate severity. Two cross-sectional observational studies showed cross-reactivity between products, whereas 4 cohort studies of patients switched from reference to biosimilar products suggested similar efficacy and safety outcomes.
  
  
  CONCLUSIONS
  Possible publication bias, small sample sizes of many studies, and lack of published studies for several biosimilars.
  
  
  CONCLUSIONS
  Preliminary evidence supports the biosimilarity and interchangeability of biosimilar and reference TNF-α inhibitors.
  
  
  BACKGROUND
  Johns Hopkins Center of Excellence in Regulatory Science and Innovation. (PROSPERO: CRD42015025262).
authors.affiliation: From Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Francine
authors.initials: F
authors.lastname: Chingcuanco
authors.affiliation: From Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
authors.affiliation: From Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Seoyoung C
authors.initials: SC
authors.lastname: Kim
authors.affiliation: From Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
mesh_terms: D000917:Antibody Formation; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D059451:Biosimilar Pharmaceuticals / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D013810:Therapeutic Equivalency; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D059451:Biosimilar Pharmaceuticals; D014409:Tumor Necrosis Factor-alpha