Biosimilar adalimumab is a test of shared decision making in the NHS

The entry of new biosimilars and the creation of an NHS ‘local market of treatment options’ will see significant numbers of patients switched from the originator product, Humira, to one of four biosimilar alternatives in 2020.


Co-written by the National Rheumatoid Arthritis Society, National Ankylosing Spondylitis Society, RNIB, Birdshot Uveitis Society, Psoriasis Association and Crohn’s & Colitis UK.

Adalimumab is one of several biological drugs used in the treatment of autoimmune inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, non-infectious posterior uveitis, Crohn’s and colitis.

While some patients will take this in their stride, for others, the change will be met with feelings of apprehension.

Whilst the switch offers the potential for system savings within the NHS, from the patient perspective, it will also be a test of how patients are supported and whether shared decision-making is the norm in the NHS.

The NHS has set out a commitment to shared decision making. Professor Alf Collins, Clinical Director, NHS England, in his 2016 blog, summed this up as the importance of patients being able to consider their options, and the risks, benefits and consequences of pursuing those options.

NHS England’s biosimilar commissioning framework, states “shared decision making between clinical prescribers and patients will be vital if the best value, clinically effective medicines are to be used”.

On this basis, treatment decisions should always be made firstly on the basis of clinical judgement for individual patients and secondly, on the overall value proposition offered by individual medicines.

When patients are new to biologics, clinicians will want to identify which drug option is right for their disease profile and supports adherence. Discussion will allow patients to consider whether a subcutaneous injection at home or an infusion given in hospital will work best. Conversations may also involve weighing options that reduce levels of immunosuppression or that treat concurrently a patient’s other related conditions, for example, the skin and gut.

For existing users of adalimumab, understanding what these new biosimilar drugs are, how to use them, and their safety and efficacy will be crucial. Important discussions need to take place between clinicians and patients about, for example, the excipients of the different biosimilars taking into account discomfort of the injection, what type of injection or pen a patient prefers and what the homecare package may include.

We hope that ‘switching’ will also generate discussions between multidisciplinary teams and their patients, as well as the Trust, about how system savings can be invested to directly benefit patients in areas such as specialist nursing and service improvement.

Ensuring patients have clear, timely information is essential to delivering these changes successfully. Our charities have worked with NHS England to produce resources to support shared decision making , and we hope that healthcare professionals will make full use of them.

Template resources and a patient FAQ are available from the Specialist Pharmacy Service.

Patients with questions or concerns should consult the FAQ or contact their clinical team directly.

Medicines in rheumatoid arthritis

We believe it is essential that people living with RA understand why certain medicines are used, when they are used and how they work to manage the condition.