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Biologic biosimilar switching — SCE Rheumatology MCQ

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EasyRheumatological PharmacologyBiologic biosimilar switchingSCE Rheumatology

A 46-year-old man with stable axial spondyloarthritis on adalimumab originator is asked to switch to an adalimumab biosimilar through an NHS medicines optimisation programme. He is anxious that the drug is experimental. Disease is well controlled. What is the most appropriate management?

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Correct answer: E — Discuss biosimilar equivalence and monitor after shared decision-making

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

Discuss biosimilar equivalence and monitor after shared decision-making is best because biosimilar switching can be appropriate with patient information, shared decision-making and disease monitoring. A is less suitable because rituximab is not an axial SpA treatment; B is less suitable because prednisolone is not needed for a biosimilar switch; C is less suitable because documented disease activity helps detect true loss of response; E is less suitable because abrupt cessation risks flare. Clinical pearl: communication reduces nocebo effects during biosimilar transitions.

Reference: NICE medicines optimisation guidance; BSR bDMARD safety guideline 2019