Highlights

..the more we use the less effective the biologics become, therefore there is a hypothesis that if we started off by using more than one biologic, working through more and different pathways, then we would expect to get higher rates of remission… You could have various types of dual therapies, you could have two iologics as dual therapy, you could have one biologic, one small molecule as dual therapy, you could have one biologic, one small molecule with a conventional immunomodulator, which gets withdrawn at 6 weeks.

A lot of the decisions are based on patient choice, but also on the cost of therapy.

..with every subsequent biologic, the induction of remission rates drops by 10%, maintenance of remission over 52 weeks drops by 10%. So, with your first biologic, you have a probability of achieving remission in 55-60%, second biologic comes down to 40%, third biologic comes down to 25-30%. So, with every subsequent biologic, your probability of cure drops. So, those are all of the unmet needs.

I believe that biosimilars work exactly the same as originator molecules, they are cheaper, they’re no different in their administration. So, as far as my practice goes, whenever there is a biosimilar available, if it’s significantly cheaper and I can treat more patients with the biosimilar, I will certainly switch to a biosimilar.