¹Martin Lee

¹Mediclinic Parkview

Background(s): Tumour Necrosis Factor Inhibitors (TNFis) have shown to be very effective in the treatment of a number of inflammatory diseases but carry a significant financial cost. The first adalimumab biosimilar was introduced to the United Arab Emirates (UAE) in 2019. This descriptive analysis aims to document the effect of the introduction of an adalimumab on the prescribing habits of a single practitioner in the UAE over a 4-year period between 2020 and 2024.

Method(s): Electronic Health Record (EHR) data was reviewed from a consultant rheumatologist working in an insurance-based healthcare system over a 4-year period between January 2020 and December 2023. Anonymised data was collected from patients who were prescribed adalimumab for the first time in this period. In January 2020 bio-originator adalimumab (Humira) and biosimilar adalimumab (Amgevita) were available. A second biosimilar adalimumab (Hyrimoz) was introduced in April 2021.

Result(s): Over the study period 7,965 patient consultations were recorded (3,590 new patient and 4,375 follow-up). 92 of these patients were started on adalimumab in this period. Of these 92 patients, 52 were female (56.5%) and 40 were male (43.4%). Of these 92 patients, the most common diagnosis was axial spondyloarthritis (AxSpA) (38, 41.3%) followed by psoriatic arthritis (PsA) (23, 25.0%), juvenile idiopathic arthritis (JIA) (9, 9.8%) enteropathic arthritis (8, 8.7%), rheumatoid arthritis (RA) (7, 7.6%), sarcoidosis (4, 4.3%), Behcet’s disease (1, 1.1%), reactive arthritis (1, 1.1%) and uveitis (1, 1.1%).

Conclusion(s): Biosimilars have the potential to have a huge positive impact on the care of our patients in rheumatology and multiple other specialties. The use of biosimilars improves the access to advanced therapies for patients who need them and can drive down costs to the healthcare system as illustrated by National Institute of Health and Care Excellence (NICE) recommendations published in 2021 and sales data from Denmark published in 2022. The adalimumab bio-originator, Humira, was approved by the US Food and Drug Administration (FDA) in 2002 and by 2018 had became the highest selling biologic in the global pharmaceutical market.

This descriptive analysis from one practitioner in the UAE demonstrates how the introduction of a more cost-effective biosimilar medications has the potential to alter the prescribing habits of a clinician. The first adalimumab biosimilar, Amgevita, became available in the UAE in 2019 and was initially marketed at around 70% of the cost of Humira. In 2021 a second adalimumab biosimilar, Hyrimoz, was introduced to the market at around 50% of the cost of Humira.

The main limitation of this retrospective data review is the fact that is collected from a single clinician in a single hospital practice. The clinic is based in a hospital catering for patients with higher-end insurance coverage and therefore may not reflect prescribing habits of clinicians working in other healthcare systems within the UAE or clinicians with different clinical experiences of bio-originator and biosimilar medications.