Change of supplier and brand for Adalimumab.

In our clinics, many people living with moderate to severe IBD are on adalimumab. Many of you will be aware that there’s been a change in supplier and brand. Your specialists, GPs and nurses (especially the hard-working IBD nurses!) are getting lots of well-informed questions about the change from you, our awesome patients. I’ve written some of the questions we are hearing and answers we are providing for this pānui – and hope this helps in this time of change.

Ngā mihi,

Dr Zoë Raos

What is Adalimumab? What is Humira? What is Amgevita? What is with all these names?

Adalimumab is the generic (plain) name for a biological medicine that gastroenterology teams have used for a long time to treat IBD (inflammatory bowel disease). It was first made by a drug company with the brand name, Humira – the Originator (OG!) Brand. There was a patent on the medicine, which meant only one drug company could provide adalimumab.

When medicines go off-patent, there is an opportunity for other companies to make the same drug. Paracetamol is a good example of this: it can be made by many companies with different brand names, like Pamol and Pacimol. They all have to stick to strong safety protocols to be able to supply medicines in Aotearoa / New Zealand.

Biosimilar biological medicines are made to the same standard as the originator, with rigorous testing and trials. 

How does adalimumab work anyway?

Adaliumumab is a special type of medicine, called Biological Medicine in the class of anti-TNFs. Adalimumab works on white cells in the immune system to ‘turn the inflammation volume down’ at a cellular level for people living with moderate to severe IBD. For some people, adalimumab can reduce symptoms, slow down how sick people get over time and (the holy grail!) get the IBD into remission. It is such an individual thing. Sometimes other medicines work, sometimes surgery is needed. However we get there, we see how well people can be when their IBD is under control, and that makes us motivated to keep going and work hard! 

Why does Adalimumab cost so much?

Adalimimab is expensive because the drug is identical copies of special proteins called antibodies. These antibody copies are made in special factories in a very special way. Dr Richard Stein explains this super well – these biological antibody-type medicines are like jumbo jets. Big and complex in how they are made, needing special factories and people to make them and to maintain them. Other medicines (antibiotics, paracetamol and immune suppressors) have a far simpler molecular structure – more like a road bike. Still need to work and be safe, consistent and reliable, and far less complex so easier and cheaper to make (thanks Richard!). 

Why is PHARMAC changing us from Humira brand to Amgevita Brand?

In Aotearoa New Zealand, PHARMAC have negotiated that adalimumab will now be supplied as a Biosimilar medicine. The brand is Amgevita. This will save a lot of money for PHARMAC which is positive and means people who need adalimumab and meet requirements for Special Authority can still receive this important medicine. Amgevita is citrate free, which means it stings less.

Is Amgevita as good as Humira, the OG?

The Amgevita brand of Adalimumab has been in use for many years in other countries, with a long and safe track record. There are lots of trials and processes that show Amgevita works exactly the same as adalimumab. IBD specialists feel confident with this change.

When is this happening?

This brand and supply change has already started. The plan is that the majority of people in NZ will transition to the Amgevita brand of Adalimumab by October 2022. 

Is swapping from one brand to another brand of Adalimumab OK?

Prof. Richard Gearry wants to reassure you all that it is safe to swap from one to the other – this has been proven in trials, back and forth, in other countries. The dose is the same too. There are some differences, like the colour of the pen, and the way the pen works. The medicine inside the pen is still adalimumab. 

What if I change to Amgevita but me and my team think Adalimumab was better for me?

PHARMAC have allowed some wiggle room. My understanding is that, except in a few special circumstances, everyone needs to change to Amgevita first, and if there is a specific clinical indication, can go back to Humira which will be funded fortnightly. 

Who can I talk to about all this?

PHARMAC have asked that patients on Humira have a supporting discussion or appointment with an appropriate prescriber about the change to Amgevita. This can be your gastroenterologist, IBD specialist, your GP or Nurse. Your pharmacist can help too. We feel confident with the change and are here to support you through the process. Please reach out – we want to hear your questions and provide support. 

Where can I look for more info?

There is information including videos online: check out amgevita.co.nz. Crohn’s Colitis UK also has information on Biosimilars. I am sure Crohn’s Colitis NZ would be happy to talk to anyone with questions too! 

So, in summary:

• For people already on Humira brand of adalimumab, when it is time for your next prescription or special authority for adalimumab, the vast majority of people will be changed over to Amgevita brand this year
• All new patients will be started on the Amgevita brand of Adalimumab from the get-go
• Amgevita is adalimumab – effective and safe.
• Please reach out to your team or CCNZ to talk it through
• This is change and change can be hard. There will be some bumps along the way, so please bear with us! Let your team know if there is an issue with the prescription, your special authority number or supply, and your squad of hard-working docs, nurses and pharmacists will do their best to figure it out with you.

Important links:

Pharmac:  Adalimumab changes: What patients need to know

Amgevita website