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Cost-effectiveness Analysis of Reference Infliximab (Remicade) Compared to its Biosimilar (Remsima) in Iraqi Patients with Rheumatoid Arthritis (Conference Paper )#

The study objective was to conduct Pharmacoeconomics study (cost-effective analysis) between infliximab reference (Remicade) and its biosimilar (Remsima) in patients with rheumatoid arthritis (RA) in Iraqi hospitals.

This is a retrospective multicenter pharmacoeconomic analysis conducted at two large teaching governmental hospitals in Baghdad, Iraq which provided infliximab to patients with RA. Data were collected from patient’s medical records and face-to-face interviews with the patients from December 2021 to April 2022.

The study included 57 patients with rheumatoid arthritis (RA).  The patients were categorized into two groups according to the type of infliximab they received over 30 weeks: 27 patients received reference infliximab (Remicade) and 30 patients received biosimilar infliximab (Remsima). The two groups had comparable demographic and baseline disease parameters, with a mean age of 49.6 years and a BMI of 30.0. The vast majority of participants were women (82.5%) with low level of formal education (65%). Overall, both infliximab biopharmaceuticals had good effectiveness to reduce the RA disease activity (CDAI) and improve patient quality of life. They both had comparable adverse reactions including UTI, fatigue, and headache. There was no significant difference (P-value >0.05) in disease activity between the two groups according to RA clinical disease activity index (CDAI) score across all three-time measures: before biological therapy, 14 weeks post-therapy and 30 weeks post-therapy.

In 2019, Remicade was slightly more effective and provide better quality of life, but costlier ($41,896 per QALY) compared to Remsima. It was not clear whether the reference biologic (Remicade) or its biosimilar (Remsima) was more cost effective. In 2021, Remicade was more cost effective compared to Remsima because Remicade was less expensive and relatively more effective according to CDAI and EQ-5D-5L scores. Registering and purchasing both reference infliximab and its biosimilar was good idea to keep the competition in the price and maintain infliximab for RA patients. 

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Publication Date
Sun Apr 30 2023
Journal Name
Al-kindy College Medical Journal
Comparison between Reference Infliximab (Remicade) and its Biosimilar (Remsima) in Patients with Ankylosing Spondylitis: A Field-based Pharmacoeconomic Study

Background: Ankylosing spondylitis is a chronic inflammatory disease that mostly involves the spine and sacroiliac joints. It is associated with a decreased quality of life. Biological medicines such as infliximab and its biosimilar are the mainstay treatments for active ankylosing spondylitis.

Objective: The study objective was to conduct a pharmacoeconomic study comparing the cost-effectiveness of the reference infliximab with its biosimilar in ankylosing spondylitis patients visiting public hospitals.

Subjects and Method: This is a two-center pharmacoeconomic study performed at two large teaching governmental hospitals in Baghdad, Iraq, which s

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Publication Date
Thu Oct 01 2015
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Development of Anti-bodies against Infliximab in Iraqi Patients with Rheumatoid Arthritis.

Background: Rheumatoid arthritis is a common chronic and destructive autoimmune arthropathy .Treatment with infliximab gives great improvement to a large numbers of patients with RA ,however, in some patients after prolonged treatment infliximab can induce anti-infliximab antibodies formation and result to loss of infliximab efficacy and active persistent disease.
Objective: to investigate the frequency of anti-infliximab antibodies in Iraqi patients with rheumatoid arthritis.
Patients and methods: fifty Iraqi RA patients(36 females and 14 males) compared with 50 control( 25 healthy control and 25 case control (patients with RA on other treatment) ) were included in this study from begging of March 201

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Publication Date
Fri Jan 13 2023
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Immunogenicity of the biosimilar CT-P13 infliximab or the original infliximab in Iraqi patients with Ankylosing spondylitis does not correlate with their demographic characteristics

Background: Ankylosing spondylitis is a rare disease affecting people with hereditary factors. Its treatment includes life style modification and use of drugs such as the biologic agent infliximab or its biosimilar, CT-P13 infliximab. Despite their therapeutic usefulness, these agents are associated with a number of serious adverse effects such as immunogenicity.

Objectives: The aim of current study was to investigate if immunogenicity of the biosimilar CT-P13 infliximab or the original infliximab, in Iraqi patients with Ankylosing spondylitis, is affected by any of the patients’ demographic characteristics.

Methods: A retrospective open-label study was conducted from Dec

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Publication Date
Sun Apr 05 2015
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Predictors of Response to (Etanercept) in the Treatment of Iraqi Patients with Active Rheumatoid Arthritis

Background: Since the introduction of tumour necrosis factor-alpha (TNF-α) inhibitors including etanercept, their efficacy and safety in treatment of rheumatoid arthritis (RA) have been studied in many randomized controlled clinical trials. However, data regarding predictors of clinical response to anti-TNF therapy are still sparse.
Objective: To assess the predictors of response to etanercept in treatment of Iraqi patients with active RA.
Methods: An open label single group prospective study was conducted over 15 months on 190 Iraqi patients with RA. All the included patients were given etanercept at a dose of 50 mg by subcutaneous injection on
a weeklybases. Each patient was followed at regular intervals of bas

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Publication Date
Tue Jan 01 2019
Journal Name
Annals Of Tropical Medicine And Public Health
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Publication Date
Mon Oct 01 2012
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Validity and reliability of CDAI in comparison to DAS28 in Iraqi patients with active rheumatoid arthritis

Background: Rheumatoid arthritis (RA) disease activity plays a central role in causing disability both directly and via indirect effects mediated through joint damage. Evaluation of RA disease activity is therefore important to predict the outcome and effectiveness of therapeutic interventions during follow-up. Clinical disease activity index (CDAI) is new simple tool for measurement of disease activity.
Objectives: To assess validity and reliability of CDAI in comparison to disease activity score-28 joints (DAS28) in Iraqi patients with active RA.
Patients and Methods: Sixty nine Iraqi RA patients were included in this study. All patients were fulfilling the ACR classification criteria and active. Full history was taken and comple

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Publication Date
Tue Jun 20 2023
Journal Name
Baghdad Science Journal
Estimation levels of CTHRC1and some cytokines in Iraqi patients with Rheumatoid Arthritis

Collagen triple helix repeat containing-1 (CTHRC1) is an essential marker for Rheumatoid Arthritis (RA), but its relationship with pro-inflammatory, anti-inflammatory, and inflammatory markers has been scantily covered in extant literature. To evaluate the level of CTHRC1 protein in the sera of 100 RA patients and 25 control and compare levels of tumour necrosis factor alpha (TNF-α), interleukin 10 (IL-10), RA disease activity (DAS28), and inflammatory factors. Higher significant serum levels of CTHRC1 (29.367 ng/ml), TNF-α (63.488 pg/ml), and IL-10 (67.1 pg/ml) were found in patient sera as compared to that in control sera (CTHRC1 = 15.732 ng/ml, TNF-α = 33.788 pg/ml, and IL-10 = 25.122 pg/ml). There was no significant correlation be

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Publication Date
Sun Jan 03 2010
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Cytokine Profile in Patients with Rheumatoid Arthritis

Background: Cytokines produced by inflammatory cells play a pivotal role in synovial inflammation and joint destruction in rheumatoid arthritis.
Patients and Methods: The cytokine serum levels were measured by EASIA (Enzyme amplified sensitivity immunoassay) in sera from 50 RA patients, and 40 healthy donors. Cytokine levels were compared in different RA subpopulations (positive or negative rheumatoid factor (RF), long term or recent onset disease, high or low disease activity). In addition, the possible association with other demographic and clinical parameters (gender, age, etc) was also analyzed.
Results: It was demonstrated that IL-2, IL-6 and IFN-δ levels were elevated in serum samples of RA pati

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Publication Date
Thu Oct 01 2015
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Expression of CD69 molecule in Rheumatoid Arthritis Iraqi patients

Background: Rheumatoid arthritis (RA) is an autoimmune disease, where the normal joint tissues attacked by body’s immune system, causing their inflammation. Cluster of Differentiation 69 (CD69) is a human transmembrane C-Type lectin protein encoded by the CD69 gene. It’s expression was induced by activation (in vivo and in vitro) of T lymphocytes and Natural Killer (NK) Cells. As CD69 early activation has been implicated in the pathogenesis of some inflammatory diseases, its expression on peripheral blood T-lymphocytes must be evaluated.
Objective: To evaluate the expression of CD69 on peripheral blood T-lymphocytes in RA Iraqi patients. 
Patients and methods: This study carried out between March 2

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Publication Date
Thu Nov 16 2023
Journal Name
Al-rafidain Journal Of Medical Sciences ( Issn 2789-3219 )
Evaluating TLR4 Gene Expression to Monitor Disease Progression in Iraqi Patients with Rheumatoid Arthritis

Background: Toll-like receptors (TLRs) play a significant role in the activation of adaptive immunity and may have an essential role in the development of rheumatoid arthritis (RA). Objectives: To assess the gene expression of TLR4 in individuals with RA compared to healthy individuals. Methods: From July to December 2022. A total of 100 individuals were encompassed in the study, consisting of 50 individuals diagnosed with RA, of whom 42 were females and 8 were males, with an average age of 45.22 years. Additionally, there were 50 healthy control participants, 40 of whom were females and 10 were males, with an average age of 45.64 years. To assess the TLR4 transcript levels, blood samples were collected from each participant, and RN

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