Development of biosimilars for rheumatology

Biosimilares/Investigación | Posted 03/05/2013 post-comment0 Post your comment

In 2012, worldwide sales for the top three selling tumour necrosis factor (TNF) inhibitors reached US$20 billion. These biological treatments for arthritis are costing patients between US$10,000–US$30,000 per year making the need for lower cost biosimilars clear [1].

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There are currently no biosimilar monoclonal antibodies (mAbs) or soluble receptor constructs (cepts—large, intricate proteins with unique tertiary and quaternary structures that are inherently difficult to replicate) approved by EMA or FDA for treatment of rheumatic diseases, although randomized controlled trials are complete or ongoing, see Table 1 [1]. EMA is, however, reviewing two applications for marketing authorization of infliximab biosimilars, one of which is thought to come from South Korean biotechnology company Celltrion, which has already received approval for its product for rheumatoid arthritis and autoimmune diseases from the regulatory authorities in Korea [2].

Table 1: Biosimilars under development for treatment of rheumatic diseases

Reference biological Manufacturer Prospective biosimilar Stage of development Indication
Trials ongoing in highly regulated markets (defined by EMA and FDA)
Adalimumab Boehringer Ingelheim (Germany) BI695501 Phase I completed
 (New Zealand)
Healthy subjects
Etanercept Hanwha Chemical (South Korea) HD203 Phase III (South Korea) RA
Etanercept LG Life Sciences (South Korea) LBEC0101 Phase I completed (South Korea) Healthy subjects
Etanercept Mycenax Biotech (Taiwan) TuNEX Phase III (Japan and South Korea) RA



 (South Korea)
CT-P13 Approved (South Korea)/ Phase 3 complete (EU) RA; AS/RA
Phase I complete (EU, South Korea)
Rituximab Boehringer Ingelheim BI 695500 Phase III (Argentina, EU, New Zealand, Norway, Peru, Ukraine, USA) RA
Rituximab Celltrion
 (South Korea)
CT-P10 Phase I (South Korea) RA
Rituximab Merck MK8808 Phase I (EU) RA
Rituximab Pfizer (USA) PF-05280586 Phase II (USA) RA
Rituximab Samsung SAIT 101 Trials halted RA
Rituximab Sandoz Pharmaceuticals (Switzerland) GP2013 Preclinical (ACR2012)
Phase II (EU, Argentina)
Rituximab Teva Pharmaceutical Industries (Israel) TL011 Phase II completed (EU) Phase III halted RA
Trials on-going in less regulated markets
Rituximab Boehringer Ingelheim BI 695500 Phase III (Brazil, Guatemala, Russian Federation) RA
Rituximab Merck MK8808 Phase I (Belarus) RA
Rituximab Sandoz Pharmaceuticals (Switzerland) GP2013 Phase II (Brazil, India) RA RA
Etanercept Avesthagen (India) Avent Preclinical  
Etanercept Protalix Biotherapeutics (Israel) PRX-106 Preclinical  
RA: rheumatoid arthritis; AS: ankylosing spondylitis.

Legislation that regulates the manufacture, registration and approval of biosimilars varies considerably between different countries, and ‘copy biologicals’ approved in less highly regulated markets may not follow the same strict requirements as is required in Europe by EMA.

Biosimilars, as with all biologicals, are complex molecules to produce, and uncertainties surrounding the exact regulatory requirements have led some companies to suspend their development. This, however, has not put off others and, with patent expiries looming, rheumatologists should expect biosimilars to be with them very soon.

Conflict of interest
Most of the authors of the research article had received study support and/or consultancy fees from both generics and originator drug manufacturers. The research article was a result of the roundtable on ‘Biosimilars for the treatment of rheumatic diseases’, Berlin, Germany, 25 April 2012, which was made possible by an unrestricted educational grant from F. Hoffmann-La Roche. The sponsor had no involvement in the roundtable agenda or development of the manuscript.

Related articles

Biosimilars in rheumatology

EU guidelines for biosimilars

Challenges in the development of biosimilars mAbs


1.  Dörner T, et al. The role of biosimilars in the treatment of rheumatic diseases. Ann Rheum Dis. 2013;72(3):322-8.

2.  GaBI Online - Generics and Biosimilars Initiative. Biosimilar monoclonal antibody approved in Korea []. Mol, Belgium: Pro Pharma Communications International; [cited 2012 May 3]. Available from:

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