Switching between reference adalimumab and biosimilars in chronic immune-mediated inflammatory diseases: A systematic literature review

Br J Clin Pharmacol. 2022 Feb;88(4):1529-1550. doi: 10.1111/bcp.15101. Epub 2021 Nov 2.


Aims: Adalimumab is a biological therapy used to treat different chronic inflammatory diseases. At present, there is an increasing number of adalimumab biosimilars. To assume the acceptability of interchangeability between reference adalimumab and biosimilars, there should be evidence about efficacy and safety of this switching. Regulation of this practice falls under the authority of individual European Union Member States. The aim of this study is to systematically review the evidence on the efficacy, safety and immunogenicity of switching between reference adalimumab and biosimilars in different chronic immune-mediated inflammatory diseases.

Methods: Studies presenting data about switching between reference adalimumab and biosimilars were identified by sensitive search strategies in Medline and EMBASE from 1 January 2004 to 30 June 2021.

Results: A total of 471 references were obtained and 21 finally included in the analysis (total number of patients switching: 2802). Eight different adalimumab biosimilars were tested after receiving reference adalimumab. Eight articles included rheumatoid arthritis (RA), one miscellaneous rheumatic disease, six psoriasis (PSO) and six inflammatory bowel disease (IBD) patients. Overall, the efficacy results in the switching groups were comparable to those obtained in the arms of continuous biosimilar and continuous reference adalimumab. There were no significant differences in treatment emergent adverse events, anti-drug or neutralising antibodies among the three groups.

Conclusions: Switching between reference adalimumab and biosimilars has no impact on efficacy, safety and immunogenicity in patients with RA, PSO and IBD. This finding was consistent for the different adalimumab biosimilars analysed. These conclusions could probably be extended to other rheumatic diseases such as psoriatic arthritis and ankylosing spondylitis.

Keywords: adalimumab; autoimmune diseases; biologics; biosimilar pharmaceuticals; switch.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adalimumab / adverse effects
  • Arthritis, Rheumatoid* / drug therapy
  • Biosimilar Pharmaceuticals* / adverse effects
  • Chronic Disease
  • Humans
  • Inflammatory Bowel Diseases* / drug therapy
  • Psoriasis* / drug therapy
  • Rheumatic Diseases* / drug therapy


  • Biosimilar Pharmaceuticals
  • Adalimumab