Switching From Originator to Biosimilar Infliximab Increases Rate of Flares Among Patients With Recurrent Noninfectious Uveitis

Physicians should monitor for flares after switching, especially within the first 90 days.

Patients with noninfectious uveitis had more ocular flares after switching from originator infliximab to biosimilar infliximab-abda, according to a retrospective case series published in the American Journal of Ophthalmology.

Medical records were reviewed from patients (N=17) who received infliximab treatment for noninfectious uveitis at the Cleveland Clinic since 2017. Clinical outcomes and details about flares after switching to biosimilar infliximab-abda were assessed.

Patients had a mean age of 43.6±17.8 years, 76.5% were women, and 82.4% were using additional immunotherapies. The subtypes of uveitis included idiopathic panuveitis (n=6), human leukocyte antigen B27-associated iritis (n=2), idiopathic iritis (n=2), sarcoidosis-associated posterior uveitis (n=2), idiopathic scleritis (n=2), idiopathic retinal vasculitis (n=2), and Behçet retinal vasculitis (n=1).

Originator infliximab had been used for an average of 49.2±49.9 months at a dose of 1.286±0.704 mg/kg/week prior to switching to the bioequivalent. While using the originator infliximab, 2 patients (11.8%) had a documented flare which were occurring during the visit prior to switching medications.

After switching, the average initial infliximab-abda dose was 1.294±0.707 mg/kg/week which was not significantly different from the originator dose (P =.791).

After the switch, 6 patients (35.3%) were documented to have a uveitis flare at an average time-to-flare of 141.3±129.8 days. Among those with a flare, 4 of the 6 had their flare within 90 days. All but 1 of the flares within 90 days were controlled by a dose increase.

The average number of flares per person-year was significantly greater on the bioequivalent (0.916±1.54) compared with the originator (0.192±0.612; P =.039).

Patients who had a flare prior to switching medications were not at increased risk for a flare after changing medications (odds ratio [OR], 0.67; 95% CI, 0.14-3.17; P =1.00).

This study was limited by its small sample size and heterogeneous sample of noninfectious uveitis subtypes.

These findings suggested that switching from originator infliximab to biosimilar infliximab-abda increased risk for uveitis flares, especially within the first 90 days. Clinicians should be aware of this trend and monitor for flares. Additional studies are needed to assess whether increasing the dose of infliximab-abda may lead to clinical quiescence.

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Deaner JD, Srivastava SK, Hajj-Ali RA, et al. Recurrence rates of inflammation after switching from the originator infliximab to biosimilar infliximab-abda for noninfectious uveitis. Am J Ophthalmol. 2021;225:172-177. doi:10.1016/j.ajo.2020.08.005