Abstract
Purpose :
To compare outcomes and costs of TNF-alpha inhibitor biosimilars to the reference medication in the treatment of pediatric non-infectious uveitis (NIU).
Methods :
A retrospective study was conducted at a single pediatric tertiary care center between November 2003 and November 2023. Inclusion criteria were patients aged ≤ 18 years treated with a biosimilar tumor necrosis factor alpha inhibitor for NIU and had a history of active uveitis with at least 1 month ophthalmology follow-up. Patient demographics, disease classification, disease activity and medication information were collected. Means and frequencies were evaluated. Statistical analysis was performed using R (v 4.3.2).
Results :
10 patients met the inclusion criteria. Mean age at initiation of biosimilar or reference infliximab was 10.2 ± 2.6 years (range 6– 15). 50% (5/10) were female. 80% (8/10) had anterior uveitis and 60% (6/10) had juvenile idiopathic arthritis. Five patients were started on reference infliximab, and all were switched to biosimilar infliximab. Five were started directly on biosimilar infliximab and none were switched back to reference infliximab.
Mean flares/year was 0.13 ± 0.21 for patients on reference infliximab and 0.20 ± 0.54 after switching to biosimilar (n=5). Mean duration was 3.9 ± 0.65 years on infliximab and 0.99 ± 0.82 years on biosimilar. For those initially started on biosimilar infliximab (n=5), mean flares/year were 0.04 ± 0.08 and mean duration was 1.9 ± 2.1 years.
For those that switched from reference to biosimilar infliximab, the average annual cost was $32,084.27 ± 20,552.31 for infliximab and $16,123.02 ± 9678.26 for biosimilar infliximab (n=5). For patients who started on biosimilar infliximab, average annual cost was $20,153.77 ± $17,274.66 (n=5). All cases of biosimilar initiation and switches were due to insurance mandates.
Conclusions :
The exclusive factor driving initiation or switch to biosimilar infliximab was an insurance mandate. Pediatric patients experienced more flares per year after switching to biosimilar infliximab than when they were on reference infliximab. No patients were switched back to reference infliximab from biosimilar infliximab. The cost profile of reference infliximab was two times the cost for biosimilar infliximab. Limitations of the study include short duration of follow up and small sample size of patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.