Biosimilars in pediatric rheumatology and their introduction into routine care.

Biosimilars are biologic medications that are slightly altered versions of already approved biologic disease modifying anti-rheumatic drugs (bDMARDs). They can be manufactured after the original product's patent protection expires. The advent of biosimilar use in pediatric rheumatology started with the biosimilar to infliximab in 2013. Since then, more biosimilars have been made available including etanercept, rituximab and adalimumab. This manuscript briefly reviews the history of biosimilar introduction to treatment and suggests strategies for the adoption of biosimilar drugs in services specialized in Pediatric Rheumatology, including potential barriers and solutions to their implementation into practice. The review covers general aspects relevant to all biosimilar drugs and specific examples covering individual drugs based on the experience of a large tertiary pediatric rheumatology service in the Northwest of England.