• S C Kowalski, J A Benavides, P A B Roa, C Galarza-Maldonado, C V Caballero-Uribe, E R Soriano, C Pineda, V F Azevedo, G Avila-Pedretti, A M Babini, A Cachafeiro-Vilar, M Cifuentes-Alvarado, S B Cohen, P E Díaz, L Diaz Soto, C Encalada, B Garro, I A G Sariego, M Guibert-Toledano, V J K Rodriguez, M E L Lopez, A P Ortega, A S Russell, P Santos-Moreno, I S Terán, A Vargas, G Vásquez, R M Xavier, D X Xibillé Firedman, E Mysler, and J Kay.
• Universidade Federal do Paraná, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil. sckowalskii@gmail.com.
• Clin. Rheumatol. 2019 May 1; 38 (5): 1485-1496.

IntroductionBiologics have improved the treatment of rheumatic diseases, resulting in better outcomes. However, their high cost limits access for many patients in both North America and Latin America. Following patent expiration for biologicals, the availability of biosimilars, which typically are less expensive due to lower development costs, provides additional treatment options for patients with rheumatic diseases. The availability of biosimilars in North American and Latin American countries is evolving, with differing regulations and clinical indications.ObjectiveThe objective of the study was to present the consensus statement on biosimilars in rheumatology developed by Pan American League of Associations for Rheumatology (PANLAR).MethodsUsing a modified Delphi process approach, the following topics were addressed: regulation, efficacy and safety, extrapolation of indications, interchangeability, automatic substitution, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. Consensus was achieved when there was agreement among 80% or more of the panel members. Three Delphi rounds were conducted to reach consensus. Questionnaires were sent electronically to panel members and comments about each question were solicited.ResultsEight recommendations were formulated regarding regulation, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics.ConclusionThe recommendations highlighted that, after receiving regulatory approval, pharmacovigilance is a fundamental strategy to ensure safety of all medications. Registries should be employed to monitor use of biosimilars and to identify potential adverse effects. The price of biosimilars should be significantly lower than that of reference products to enhance patient access. Biomimics are not biosimilars and, if they are to be marketed, they must first be evaluated and approved according to established regulatory pathways for novel biopharmaceuticals.Key Points• Biologics have improved the treatment of rheumatic diseases. • Their high cost limits access for many patients in both North America and Latin America. • Biosimilars typically are less expensive, providing additional treatment options for patients with rheumatic diseases. • PANLAR presents its consensus on biosimilars in rheumatology.

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