Impact of rituximab biosimilars on overall survival in diffuse large B-cell lymphoma: a Dutch population-based study

M. Brink, X.U. Kahle, J.S.P. Vermaat, J.M. Zijlstra, M. Chamuleau, M.J. Kersten, M. Durmaz, W.J. Plattel, P.J. Lugtenburg, W. Stevens, R. Mous, E.G.E. de Vries, M.W.M. van der Poel, P.V.N. Panday, G. Huls, T. van Meerten, M. Nijland*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


In 2017, the European Medicines Agency approved rituximab biosimilars (R-biosimilars) for treatment of diffuse large B-cell lymphoma (DLBCL). Thereafter, the Netherlands was one of the first countries to implement R-biosimilars, given lower costs compared with rituximab originator (R-originator). This study's objective was to investigate whether overall survival (OS) of patients with DLBCL receiving R-biosimilars is similar to patients treated with R-originator. DLBCL patients >18 years, diagnosed between 2014 and 2018, who received at least 1 cycle of rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) were identified in the Netherlands Cancer Registry. Patients were categorized into R-originator or R-biosimilars groups based on data from a central repository of the Dutch medicinal drug market. The primary end point was 3-year OS, defined as the time between diagnosis and all-cause death. By the end of 2018, 91% of purchased rituximab were biosimilars. In total, 4429 patients were identified with 876 in the R-biosimilars group and 3553 in the R-originator group. Patients in the R-biosimilars group less frequently received >6 cycles of R-CHOP compared with patients treated with R-originator (24% vs 30%, P = .003). The 3-year OS did not differ between patients treated with R-originator or R-biosimilars (73% vs 73%, P = .855). This was confirmed with a multivariable Cox regression analysis accounting for sex, age, International Prognostic Index score, and number of R-CHOP cycles. In conclusion, the 3-year OS is similar for patients treated with CHOP in combination with R-originator or R-biosimilars and, therefore, favors the use of R-biosimilars in DLBCL treatment management.
Original languageEnglish
Pages (from-to)2958-2964
Number of pages7
JournalBlood advances
Issue number15
Publication statusPublished - 10 Aug 2021


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