Pediatric Inflammatory Bowel Disease, Second Edition provides an essential reference with an emphasis on the unique pediatric issues of IBD. Chapters focus on complications of IBD specific to children and adolescents. The new "2010 Red Book" contains extensive updates and additions and provides the latest pricing and product information on more than 100,000 prescription and OTC items. Questioning Protocol is a healthcare solutions book from a mom's perspective. of their respective owners and rights holders and are used solely to represent the The previous 3 medications approved are Inflectra, Renflexis, and Ixifi. Found insideThis practical manual provides a real-world educationally focused resource. It enables the reader to gain a good understanding of a range of skin diseases, their differential diagnosis and various medical and/or surgical treatment options. The patient does not have any FDA labeled contraindications to therapy with the requested agent AND 2. Until now. Now there is hope, with The Autoimmune Connection. In this invaluable text, Jill M. Buyon, M.D., and Rita Baron-Faust explain the nature of the various autoimmune disorders. Remicade was J&J's top selling drug, representing 20% of its total global drug sales. These may be biosimilar but they are NOT the same. Hey, thanks for that info, Scipio! I have no idea what the -dyyb means, but I sure hope it is just as effective. The previous 3 medications approved are Inflectra, Renflexis, and Ixifi. They were made by Lisa Bell of Coherus Biosciences. Remicade® (infliximab) Inflectra (infliximab-dyyb) Initial Evaluation Remicade® (infliximab) and Inflectra (infliximab-dyyb) will be approved when following are met: 1. Remicade® remains cost-effective, and even discounted biosimilars are insufficient to move physicians and patients off the originator drug. Medicare benefits that help cover the cost of […] A patient may or may not see any savings, given the convoluted system of insurance and medical reimbursement in this country. Cookie Preferences The Food and Drug Administration considers them essentially the same as the original drug, as long as their variations fall into the same range as the brand-name biologics. Biosimilar Drug Profile: Inflectra was the first FDA-approved biosimilar version of infliximab (reference product, Remicade ®) manufactured by Janssen Pharmaceuticals. Found inside – Page 178... law in 2010 as a component of the Affordable Care Act and aimed at reducing costs and increasing patient access. ... were granted in 2013 by the EMA for Remsima®/Inflectra®, which are biosimilar versions of Remicade® (infliximab), ... a potentially lower cost option. Per some Cigna plans, infusion of medication MUST occur in the lowest cost, medically appropriate setting . Ah, that makes sense! Privacy Policy This affects members 18 years and older with existing prescriptions, and applies to prescriptions covered under the medical and pharmacy benefit. its price comparisons.All trademarks, brands, logos and copyright images are property Remicade/Inflectra issue. This book provides a comprehensive and complete overview of biomarkers in clinical practice for inflammatory bowel disease (IBD) bringing together the literature in a clear and concise manner. Found insideIn Europe, where biosimilars have been around since 2006, the average discount compared to the price of the brand ... the size of discounts will likely increase, and the potential cost savings from the introduction of biosimilars in the ... INFLECTRA Tier 4 . I was initially put on Remicade and within a few weeks I . Inflectra itself is a biosimilar infliximab. When Inflectra launched, it had a wholesale acquisition cost that was 15% less than Remicade's WAC — or $946.28 per 100 mg vial vs. $1,113. Notably, Merck priced Renflexis at a deeper discount to Remicade than Pfizer's starting price for its own biosimilar of Remicade, Inflectra (infliximab-dyyb). Remicade currently costs £419 for a 100ml vial while both versions of the biosimilar infliximab will cost around 10% less at £377, according to NICE. So has anyone tried Inflectra yet? Inflectra Kevzara Kineret Olumiant Orencia Otezla Remicade Renflexis Rinvoq Rituxan Siliq Simponi (Aria) Skyrizi Stelara Taltz Tremfya Xeljanz (XR) Other: _____ . The Inflectra launch was considered "at-risk" at the time and Pfizer priced the drug at only a 15% discount to Remicade's wholesale acquisition cost (WAC). Early indications are that the prices for these substitute medications will only lop 15 or 20 percent off the price, said Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy, at a Tuesday meeting in Washington, D.C. That discount is a far cry from the one for standard generic drugs, McClellan said at a forum hosted by Duke and Friends of Cancer Research. But, as these competing drugs start to appear on the market, consumers aren't reaping a windfall. Found inside – Page 751The time and costs associated with mammalian biopharmaceutical development and manufacturing of biosimilars will be ... to Johnson & Johnson's Remicade® (infliximab) under the trade names Remsima® and Inflectra® respectively (see Table ... But they cost 25 to 50 per cent less than the original. Coverage for Renflexis (infliximab-abda), Remicade (infliximab), or other non-preferred infliximab product will be . Although biosimilars can offer significant cost savings, there is a paucity of real-world data and guidelines about . Retacrit now has a 25% share of the market for epoetin alpha vs 18% for Procrit and 57% for Epogen. Every year, thousands of Americans are prescribed Inflectra by their doctors to treat Crohn's disease and ulcerative colitis. " U. S. President John F. Kennedy, speech, Rice University, September 12, 1962 My primary purpose for writing this book was much more than to provide another information source on Chemistry, Manufacturing & Controls (CMC) that would rapidly ... References. Remicade (infliximab) was the first biologic therapy approved for use in people with IBD, approved back in 1998. › Will need aprroval from Cigna before it can be covered ("prior authorization").3 › This medication will move, or recently moved, to preferred brand. REMICADE® is administered by IV infusion for at least 2 hours. Biologics and biosimilars frequently require special handling (such as refrigeration) and processing to avoid contamination by microbes or other unwanted substances. With Remicade, it is also important to factor in the hospital infusion costs. But when Renflexis came onto the market, it did so with a WAC 35% less than that of Remicade, or $753.39. Inflectra costs about $997 per 100 mg vial while Remicade costs about $1,229 for the same amount. According to the B.C. In Europe, governments have a big hand in deciding which drugs are made available to patients in government-sponsored health systems. More than one vial may be needed for a full dose. Pfizer launched Inflectra last fall at a 15% discount, which disappointed some who were expecting greater savings from biosimilars. As a result, even the brand-name drugs vary a bit from batch to batch. This book covers the pathophysiology and treatment of anemia in inflammatory bowel diseases and discusses controversial aspects specifically when it comes to iron therapy. It was only when I logged onto my GP site to look at my records did I find out I had Inflectra instead of Remicade. In these conditions, the body's . (The WAC price doesn't reflect rebates drugmakers typically offer.). It is the 4th biosimilar approved for Remicade. This translates to a yearly list price of $6,149 for the biosimilar versus $7,235 for Remicade. Infliximab injection is used to reduce the symptoms of moderate-to-severely active Crohn's disease and ulcerative colitis in adults and children who have been previously treated with other medicines but did not work well. And the doctor may have a financial incentive to opt for the more expensive drug, including some cancer drugs. When it becomes available, Avsola will be sold at a lower cost than Remicade. The patient is not currently being treated with another biologic . For example, doctors routinely prescribe Herceptin to treat certain forms of breast cancer. In clinical trials with infliximab products, the most common adverse reactions occurring in >10% of patients included infections (eg, upper respiratory, sinusitis, and pharyngitis), infusion-related reactions, headache, and abdominal pain. Remicade (Infliximab, Inflectra, Renflexis, Ixifi, Avsola) Remicade is used to treat certain types of arthritis (rheumatoid arthritis, arthritis of the spine, psoriatic arthritis), certain bowel diseases (Crohn's disease, ulcerative colitis), and a certain severe skin disease (chronic plaque psoriasis). Remicade and Inflectra are both brand-name drugs. Currently, Medicare bases some payments to doctors on the price of chemotherapy drugs, so doctors make more when they prescribe more expensive drugs, Schilsky noted. The FDA approved RENFLEXIS as biosimilar to Remicade (infliximab). As of Q3 2020, the wholesale acquisition cost of autoimmune disease drug Remicade was around 1,168 U.S. dollars, compared to 946 U.S. dollars for the biosimilar Inflectra. hide caption, The wholesale acquisition cost (a benchmark price in the drug industry) for Inflectra is $946 a vial, only 15 percent off $1,113 for a comparable vial of Johnson & Johnson's Remicade, according to data from Truven Health Analytics. But Inflectra, the second so-called biosimilar set to hit the market, isn't exactly a steal. Dr. Pasadhika is a retinal surgeon and chief of the Uveitis Service at Chulalongkorn University in Bangkok, Thailand. A biologic is a medication made from a living organism. • An infusion nurse will give you RENFLEXIS over a period of about 2 hours. It is the 4th biosimilar approved for Remicade. You must log in or register to reply here. Found insideTo be able to make a biosimilar drug requires $75–$250 million, which includes the cost of legal requirements, ... 2015 filgrastim-sndz/Zarxio filgrastim/Neupogen April 5, 2016 infliximab-dyyb/Inflectra infliximab/Remicade August 30, ... After a year of follow-up, there was no meaningful differences between the two groups (though there were nonsignificant findings that provided potential fodder for skeptics). The normal regimen for both drugs consists is an IV infusion every 8 weeks or 6.5 times a year. They look, act, and behave similar to each other. 1 The randomized 54 week clinical trial (RCT . Found inside – Page 47Sagonowsky E. J&J fires off legal salvo to block Remicade biosim launch. ... Herrmann R, Lazzarino M, Thomas X, Noga J, Baker N, Dansey R, Bosi A. A single dose of pegfilgrastim compared with daily filgrastim for supporting neutrophil ... Remicade® remains cost-effective, and even discounted biosimilars are insufficient to move physicians and patients off the originator drug. In 2017, Merck & Co., Inc. ("Merck") received approval to launch and launched another competing biosimilar, Renflexis. So far, scientists have found no meaningful differences between these drugs and their mimics. Coverage will be provided for Inflectra or Avsola contingent on the coverage criteria in the . You can read more about biosimilars here. This means it may cost you less to fill. Pfizer launched Inflectra last fall at a 15% discount, which disappointed some who were expecting greater savings from biosimilars. At the time of its launch, Pfizer list priced Inflectra at $946 a vial, only 15% below $1,113 for a comparable vial of Remicade. For a better experience, please enable JavaScript in your browser before proceeding. The NICE spokesman says that this also means the draft guidance states: "That treatment should be started with the least expensive drug," - ie, that biosimilar versions should be used ahead . This series is aimed at health economists in academia, the pharmaceutical industry and the health sector, those on advanced health economics courses, and health researchers in associated fields. Found inside – Page 119Most of these products were approved in the 1990s, with the exception of Erbitux, which was approved in 2004, and Inflectra, a biosimilar for Remicade, that was approved by the EMA in 2013. The NS0 cell line was originally used as a ... Avsola is approved to treat all 8 conditions that Remicade treats. JavaScript is disabled. Is it just a special name because the drug (in this case, Inflectra) is a generic for a biologic (Remicade)? But Herceptin has a 25-year-history that looks not only at relapse rates, but at long-term survival and other significant endpoints. I suppose by the time I go for the 5th infusion, they will have approved it. Biosmilars of Remicade . Notably, Merck priced Renflexis at a deeper discount to Remicade than Pfizer's starting price for its own biosimilar of Remicade, Inflectra (infliximab-dyyb). Found insideTABLE 12.20 Reported Observational Studies Experience Currently Limited to Celltrion's CT-P13 (Inflectra/Remsima) Compare vs. Continued Ref. Product Switch x1 or Alternating Sample Size of Switched Cohort (n) Duration after Switch Buer ... And I have no idea why, since it supposedly is cheaper. A biosimilar is technically the “generic” version of a biologic medication. This information is for informational purposes only Dr P. Marazzi/Science Source Effective October 1, 2020, the immune-modulating medication Inflectra is now the preferred brand-name medication over Remicade. Inflectra (infliximab-dyyb), a biosimilar to Remicade (infliximab), is now covered by Medicare and Medicaid. Found inside... to a biopharmaceutical manufacturing process during development and commercial manufacturing: The REMICADE® Story. ... Aapro M, Cornes P, Sun D, Abraham I. Comparative cost efficiency across the European G5 countries of originators ... Found inside – Page 261Subsequently, the biosimilars Inflectra® (infliximab-dyyb) and RenflexisTM (infliximab-abda) for Remicade® ... Biosimilars have the potential to reduce overall health care costs spent on biological products compared to their original ... The reason is it's much cheaper. Patients taking Remicade (infliximab) can safely switch to its biosimilar drug Inflectra (CT-P13), according to results from the NOR-SWITCH study, presented at UEG (United European Gastroenterology) Week 2016, in Vienna, Austria.   It could be used to treat Crohn's disease or ulcerative colitis, and it is also approved for kids as young as 6, in certain circumstances. If the use of the biosimilar for Remicade in Canada had mirrored the median OECD use in 2015 (10.1%), it would have translated into $41.7 million reduction in drug expenditures. Note: Chart shows the highest annual price, according to wholesale acquisition cost, for a vial containing 100 milligrams of powder for preparing an intravenous solution. Inflectra (Infliximab-Dyyb) Posted by Mitch Fraker - See Editorial Guidelines Obtain your Inflectra prescription for the set monthly price of $50.00 per month. Inflectra (infliximab-dyyb) Renflexis (infliximab-adba) . Since biologics are made out of living cells, it is impossible to make an exact replicate. This makes Inflectra the first US biosimilar monoclonal antibody treatment to be approved in . It is approved for use for rheumatoid arthritis, plaque psoriasis, Crohn's disease and ulcerative colitis. Found insideBy bridging medical and surgical treatment modalities for IBD, this is the perfect reference for GI researchers, medical students, therapeutic GI endoscopists, IBD specialists, surgeons and advanced health care providers. This new edition includes 700 full-color illustrations and a new, more accessible format to make finding information a snap for the busy practitioner. Includes a glossary of allergy and immunology for quick and easy reference. Enbrel averages more than $4,000 per month. The most common adverse effects of Avsola include the following: A launch date for Avsola is not available yet. Why Does Medicare Have So Many Parts, and What Does Each Cover. Inflectra (Pain relief and inflammatory disease) › Will move to a lower tier (preferred brand) on the Cigna Standard Prescription Drug List. Remicade is an infusion used to treat chronic autoimmune disorders. Pfizer said in its Wednesday statement that Inflectra is now available at a 19% discount to the Remicade WAC and has an average selling price (ASP) that is more than 10% lower, "with . Learn about side effects, uses, and more of Remicade (infliximab), a prescription infusion that treats inflammatory diseases in adults and some children. Backed by numerous scientific studies, Food Over Medicine details how dietary choices either build health or destroy it. Food Over Medicine reveals the power and practice of optimal nutrition in an accessible way. Data announced jointly today by Pfizer Inc. (NYSE:PFE) and Celltrion Healthcare, at the 12th Congress of the European Crohn's and Colitis Organisation (ECCO), showed that for patients with moderate-to-severe Crohn's disease (CD), treatment with INFLECTRA (infliximab CT-P13) has similar efficacy and safety to treatment with REMICADE (infliximab). The drug is created by pharmaceutical company Celltrion. Because INFLECTRA is a biosimilar to Remicade, you can expect the same treatment experience that you had with Remicade. If the use of the biosimilar for Remicade in Canada had mirrored the median OECD use in 2015 (10.1%), it would have translated into $41.7 million reduction in drug expenditures. Found insideFocusing on the key essentials you need to know, Axial Spondyloarthritis provides a quick, expert overview of axSpA from a clinical perspective. Infliximab injection is used alone or together with other medicines (eg, methotrexate) to reduce the symptoms . The FDA has recently approved Avsola, a biosimilar that treats several conditions including Crohn's disease and ulcerative colitis. Indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in patients with moderately-to-severely active rheumatoid arthritis in combination with methotrexate. Remicade . A previous version of this post incorrectly attributed comments about drug-development data to Emily Alexander of drugmaker Abbvie. This is despite further discounting of Inflectra from 15% to 35% vs. Remicade and the launch of a second Remicade biosimilar (Renflexis; Merck; launched July 2017 at 35% discount vs. Remicade). REMICADE Tier 4 . Ankylosing spondylitis information, ankylosing spondylitis treatment, ankylosing spondylitis forums, ankylosing spondylitis diagnosis, articles on ankylosing . Found insideSeveral products of this type are currently available: infliximab ('Remicade'), etanercept ('Enbrel'), adalimumab ('Humira') and golimumab ('Simponi'). ... The major drugs listed here cost $20–25,000 per patient per annum in the USA. The ACR has issued an official statement regarding the FDA's approval of Inflectra (infliximab-dyyb), a biosimilar to Remicade. Inflectra will be the second. products of these rights holders. Leah Christl, at the FDA's Center for Drug Evaluation and Research, says that as of Oct. 5, the agency is processing 66 projects involving biosimilar drugs, which are potentially substitutes for 20 existing medications. Europe, which is a decade ahead of the United States in developing these drugs, has gathered 400 million patient life-years of data (which, for example, would be studies of 40 million people for 10 years), and hasn't identified any safety issues, said Lisa Bell, senior vice president of regulatory affairs for Coherus Biosciences. section. Biologics vs . On Monday, Pfizer said it would start selling Inflectra, its version of the blockbuster rheumatoid arthritis drug Remicade, in late November. These drugs are produced in living cells. "At what point does the doctor and the patient have the confidence to make that switch" to the substitute brand, Schilsky asked at the meeting in Washington. Biosimilars are less expensive versions of their reference biologic drugs. Background: Inflectra, a biosimilar infliximab has been approved by the European Medicine Agency since September 2013 for all licensed indications of Remicade (innovator infliximab) claiming its pharmacokinetics, safety, and efficacy was comparable to those of innovator INX. The estimated total cost recorded according to public plans for Remicade in Canada (exclusive of Quebec) in 2016 was $361,502,867 Canadian, representing an average cost per claim of Remicade of $4,471 (versus Inflectra, $1,934). Pfizer argues in the lawsuit that J&J's insurer . The REMICADE® Pediatric Ulcerative Colitis (UC) trial was a multicenter, phase 3, randomized, open-label, parallel-group trial to evaluate the safety and efficacy of REMICADE® in pediatric patients aged 6 to 17 years with moderately to severely active UC (N=60; Mayo score of 6 to 12; endoscopic subscore ≥ 2) and an inadequate response to . The ASP for reference Remicade has dropped to 33% below its pre-biosimilar cost, and the ASPs for Renflexis and Inflectra currently stand at 40% and 43% . Truven Health Analytics Remicade's owner asserts that Inflectra infringes on a patent that doesn't expire until September 2018 and vows to "defend our intellectual property rights." And a number of stakeholders -- not . Descriptions. The already-approved biologic medicine is known as the reference product, originator, or originator biologic product. Because these biotech drugs are similar but not identical to the brand-name medicines they mimic, pharmacists generally are restricted from substituting one for the other automatically, unlike most traditional generics. Aug 21, 2018 #1 I was officially diagnosed with Crohn's in September 2017 though I had been having issues long before that. Paying for REMICADE® Janssen CarePath can explain your potential out-of-pocket costs and identify cost-support options that may help with managing your out-of-pocket costs—whether you have commercial or private health insurance, government-funded healthcare coverage such as Medicare or Medicaid, or have no insurance coverage: The wholesale acquisition cost (a benchmark price in the drug industry) for Inflectra is $946 a vial, only 15 percent off $1,113 for a comparable vial of Johnson & Johnson's Remicade, according to. The case for biosimilars as these new medicines are sometimes called isn't quite as straightforward as it is for standard generics. Humira cost between $1,800 and $2,400 per month. Found inside – Page 118For payers, trade-offs include cost savings versus low total budget impact and safety and efficacy concerns in ... system extracted a 45 percent discount on Celltrion's Inflectra, a biosimilar of Janssen's Remicade (infliximab), ... Dr. Richard Schilsky, senior vice president and chief medical officer of the American Society of Clinical Oncology, said a competitive product was shown to be at least as good as the original drug in a study that measured the likelihood that a woman taking the drug would suffer a relapse. Originally designated CT-P13, Celltrion submitted a biologic license application for approval via the 351(k) biosimilar pathway in August 2014. Remember that INFLECTRA: Is approved for all eligible indications of Remicade Has a similar efficacy and safety profile to Remicade Is dosed the same way as Remicade Is delivered the same way . "On the other hand, 15 to 20 percent of a very big price – a very large number — is still a big number.". If your patient has already begun treatment with drug samples of Avsola, Inflectra, or Renflexis, please choose "new start of . Costs. It is given by slow injection into a vein, typically at six- to eight-week intervals. The NICE spokesman says that this also means the draft guidance states: "That treatment should be started with the least expensive drug," - ie, that biosimilar versions should be used ahead . Finally, Inflectra® does not just compete against Remicade®, but against lots of other FDA-approved drugs for chronic inflammatory conditions. Found inside – Page 260Prior to FDA approval, the European Commission had already approved Inflectra® and allowed extrapolation for all ... Furthermore, patients were able to maintain responses initially attained by Remicade® and then switched over to CT-P13. Focused resource to batch real-world data and guidelines about emphasis on the criteria! Less than the original for Avsola is approved for use in people with,... University in Bangkok, Thailand psoriasis, Crohn & # x27 ; s disease and ulcerative ``. Antibody treatment to be approved in biologics are made out of living,! New, more accessible format to make finding information a snap for 5th... Appropriate setting is administered by IV infusion every 8 weeks or 6.5 a! Remicade® Story drug Profile: Inflectra was the first biologic therapy approved for use in with..., Noga J, Baker N, Dansey R, Bosi a effective!, pfizer said it would start selling Inflectra, the body & # x27 ; s disease and ulcerative ``... Is it & # x27 ; s insurer infliximab ( reference product, Remicade ® ) manufactured by Janssen.! Specifically when it becomes available, Avsola will be sold at a lower cost than Remicade of allergy immunology... Over a period of about 2 hours full-color illustrations and a new, accessible! Bit from batch to batch covered by Medicare and Medicaid originator biologic.... A big hand in deciding which drugs are made out of living cells, it impossible. Pfizer said it would start selling Inflectra, Renflexis, and even discounted biosimilars are insufficient to physicians! Full-Color illustrations and a new, more accessible format to make an exact replicate inflammatory... 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So far, scientists have found no meaningful differences between these drugs and their inflectra cost vs remicade what. 18 years and older inflectra cost vs remicade existing prescriptions, and Ixifi application for via... Post incorrectly attributed comments about drug-development data to Emily Alexander of drugmaker Abbvie previous 3 medications approved are,! Dansey R, Lazzarino M, Cornes P, Sun D, Abraham I you less to.! Were made by Lisa Bell of Coherus Biosciences & amp ; J & amp ; &... Case for biosimilars as these competing drugs start to appear on the market, is n't a... 20–25,000 per patient per annum in the hospital infusion costs has a 25-year-history that looks not only relapse. Patient does not have any FDA labeled contraindications to therapy with the autoimmune Connection means, I. First FDA-approved biosimilar version of this post incorrectly attributed comments about drug-development data to Emily Alexander of drugmaker Abbvie comes. European Commission had already approved Inflectra® and allowed extrapolation for all relapse rates, against! Bowel disease, Second Edition provides an essential reference with an emphasis on the coverage criteria the. Same amount ankylosing spondylitis information, ankylosing spondylitis treatment, ankylosing spondylitis,. The market, is now covered by Medicare and Medicaid trial ( RCT off the originator drug available... Janssen Pharmaceuticals data to Emily Alexander of drugmaker Abbvie biologic Medicine is as. Practical manual provides a real-world educationally focused resource initially attained by remicade® and then over... Were expecting greater savings from biosimilars does not just compete against remicade®, but at long-term survival other. Aapro M, Thomas X, Noga J, Baker N, Dansey R, Bosi a inflectra cost vs remicade! To CT-P13 a retinal surgeon and chief of the blockbuster rheumatoid arthritis Remicade. Per cent less than the original psoriasis, Crohn & # x27 s! Reveals the power and practice of optimal nutrition in an accessible way Renflexis over a period of about 2.. Must occur in the so-called biosimilar set to hit the market for epoetin alpha 18. 997 per 100 mg vial while Remicade costs about $ 997 per 100 mg vial while Remicade costs $. To prescriptions inflectra cost vs remicade under the medical and pharmacy benefit register to reply here to patients in government-sponsored health.! Medical and pharmacy benefit unwanted substances ) to reduce the symptoms conditions including Crohn & # x27 ; s.. Behave similar to each other versus $ 7,235 for Remicade Remicade is an IV infusion at... Articles on ankylosing opt for the more expensive drug, including some drugs... For chronic inflammatory conditions an IV infusion every 8 weeks or 6.5 times year! Then switched over to CT-P13 reference product, Remicade ® ) manufactured by Pharmaceuticals. Every 8 weeks or 6.5 times a year to Celltrion 's CT-P13 ( Inflectra/Remsima ) Compare.!
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