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. 2018 Jun;38(6):481-490.
doi: 10.1007/s40261-018-0637-1.

Epoetin Biosimilars in the Treatment of Renal Anemia: What Have We Learned From a Decade of European Experience?

Free PMC article

Epoetin Biosimilars in the Treatment of Renal Anemia: What Have We Learned From a Decade of European Experience?

David Goldsmith et al. Clin Drug Investig. .
Free PMC article


Biosimilars are biological medicines that are approved via stringently defined regulatory pathways on the basis that comparable safety, efficacy, and quality have been demonstrated to their reference medicine. The advantage of biosimilar drugs is that they may be less expensive than the reference medicine, allowing for greater patient access and cost savings in already stretched healthcare budgets. Biosimilar epoetins have been available in Europe for a decade. Complementing in vitro and preclinical characterization, and pharmacokinetic/pharmacodynamic studies, clinical trials provided the additional data needed to reassure European authorities that biosimilar epoetins were sufficiently similar to the reference epoetin to warrant approval. Post-approval, real-world studies have provided further evidence that biosimilar epoetins are an effective and well-tolerated option for the treatment of renal anemia, with ongoing pharmacovigilance and observational studies monitoring for any unexpected long-term signals that have not been identified in clinical development studies. As the evidence and experience with these products increase, many of the initial concerns are being alleviated. Nephrologists can be increasingly confident that European Medicines Agency-approved biosimilars offer high-quality, affordable, effective alternatives to existing reference medicines used to treat renal anemia, and may help yield cost savings and improve patient access.

Conflict of interest statement


Editorial support was provided by Tony Reardon of Spirit Medical Communications Ltd., supported by Hexal AG/Sandoz International GmbH.

Conflict of Interest

DG, FD, and CC have served as advisors to Sandoz (study Steering Committee members). MS and AK are employees of Sandoz International GmbH/Hexal AG.

Ethics approval

This article does not contain any studies with human participants or animals performed by any of the authors.


Fig. 1
Fig. 1
Key clinical studies of biosimilar epoetins in Europe [, , , –50]. PK pharmacokinetic, PD pharmacodynamic, IV intravenous, SC subcutaneous, CKD chronic kidney disease, HD hemodialysis

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    1. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014;9:e84943. doi: 10.1371/journal.pone.0084943. - DOI - PMC - PubMed
    1. Li S, Foley RN, Collins AJ. Anemia and cardiovascular disease, hospitalization, end stage renal disease, and death in older patients with chronic kidney disease. Int Urol Nephrol. 2005;37:395–402. doi: 10.1007/s11255-004-3068-2. - DOI - PubMed
    1. Eriksson D, Goldsmith D, Teitsson S, Jackson J, van Nooten F. Cross-sectional survey in CKD patients across Europe describing the association between quality of life and anaemia. BMC Nephrol. 2016;17:97. doi: 10.1186/s12882-016-0312-9. - DOI - PMC - PubMed
    1. van Nooten FE, Green J, Brown R, Finkelstein FO, Wish J. Burden of illness for patients with non-dialysis chronic kidney disease and anemia in the United States: review of the literature. J Med Econ. 2010;13:241–256. doi: 10.3111/13696998.2010.484307. - DOI - PubMed
    1. KDIGO Chapter 3: Use of ESAs and other agents to treat anemia in CKD. Kidney Int Suppl. 2012;2:299–310. doi: 10.1038/kisup.2012.35. - DOI - PMC - PubMed