Simon Rule, MD: Subcutaneous Rituximab Versus an Intravenous Biosimilar

Simon Rule, MD, Plymouth University Medical School, discusses the role of biosimilar rituximab in the era of subcutaneous reference rituximab in oncology.


I don’t know if you know that in the [United Kingdom, UK], biosimilar rituximab has taken the entire market. There’s no biosimilar subcutaneous, but the biosimilar intravenous basically has had a massive impact with respect to cost. The biosimilar that’s used in the UK was over 40% cheaper than the MabThera. From a healthcare system that buys a lot of drug, that’s a big, big impact. So from an intravenous point of view, we’re using the biosimilar. I don’t have a choice; that’s what we’re doing. But of course there's only 1 subcutaneous.

Certainly in the maintenance setting, the hidden costs of somebody being in a chair all afternoon versus the subcutaneous are massive. Even within the [National Health Service, NHS], that’s recognized. So subcutaneous within a maintenance setting is allowed. I think in maintenance, you need to give the subcutaneous. You could argue whether intravenous when you’re giving somebody intravenous chemotherapy is cost effective or not, and maybe it is because the patient is in the chair anyway. So that’s perhaps where you could argue for a biosimilar intravenous, but certainly maintenance, I don’t think there’s any role for an intravenous formulation over a subcutaneous one.

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