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Biosimilar Switching Safety — SCE Rheumatology MCQ

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HardRheumatology PharmacologyBiosimilar Switching SafetySCE Rheumatology

A clinically stable patient receiving originator adalimumab is asked to switch to an NHS-approved biosimilar for procurement reasons. She worries that the community pharmacy may later alternate brands without telling anyone. What is the best response?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Discuss the switch, prescribe by brand and do not allow automatic pharmacy substitution

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · B = shown as D · C = shown as E

C is correct. An authorised biosimilar has demonstrated comparability and can be switched under clinical oversight, but NHS advice makes the decision one shared by prescriber and patient. Biological medicines should be identified and prescribed by brand for traceability, and pharmacy-level substitution should not occur without prescriber involvement. A mistakes biosimilarity for superiority. B removes consent, traceability and brand-specific pharmacovigilance. D does the opposite of safe traceability. E creates avoidable undertreatment and a potential flare; a washout is not routinely needed for a direct switch. Apparent nocebo symptoms should be assessed respectfully rather than used to deny either the patient’s experience or the medicine’s evidence base.

Reference: NHS England: what is a biosimilar medicine?: https://www.england.nhs.uk/long-read/what-is-a-biosimilar-medicine/