When a patient gets a biosimilar instead of the original biologic drug, they’re not getting a copy like a generic pill. Biosimilars are made from living cells-complex, delicate, and impossible to replicate exactly. That’s why adverse event monitoring for biosimilars isn’t just important-it’s essential. Unlike small-molecule generics, which are chemically identical to their brand-name counterparts, biosimilars can have subtle differences in how they behave in the body. These differences might not show up in clinical trials, but they can show up in real-world use. That’s where safety surveillance comes in.
Why Biosimilars Need Special Safety Tracking
Imagine two cars that look the same, run on the same fuel, and have the same engine size. But one was built in Germany, the other in Japan. Even if they’re nearly identical, small variations in materials or assembly could lead to different performance over time. That’s what happens with biosimilars. They’re designed to be highly similar to the original biologic-like Humira or Enbrel-but because they’re made from living organisms, tiny changes in manufacturing can affect how the immune system reacts.
The biggest concern? Immunogenicity. That’s when the body sees the drug as foreign and mounts an immune response. It might cause mild side effects like rashes or fatigue. Or worse-it could neutralize the drug, making it useless, or trigger dangerous autoimmune reactions. This isn’t theoretical. Studies have shown that even small changes in glycosylation patterns (sugar molecules attached to the protein) can increase immunogenicity risk. That’s why regulators don’t just approve biosimilars and walk away. They demand ongoing, detailed monitoring.
How Adverse Events Are Tracked Around the World
Every country has its own system for collecting reports of bad reactions. In the U.S., it’s the FDA’s FAERS database. In Europe, it’s EudraVigilance. In Canada, it’s the Canada Vigilance Program. These systems rely on doctors, pharmacists, and patients to report anything unusual after taking a drug-fever, swelling, breathing trouble, unusual fatigue.
But here’s the catch: if a patient gets a biosimilar and has a reaction, how do you know which one they got? The brand name? The manufacturer? The lot number? In many places, the answer used to be: we don’t. A 2022 survey of U.S. physicians found that 63% of them struggled to correctly document which biosimilar a patient received. That’s a huge problem. If you can’t tell which product caused the reaction, you can’t fix it.
Some countries have fixed this. Spain started requiring electronic health records to show the exact biosimilar brand in 2020. Result? Adverse event reporting accuracy jumped from 58% to 92%. In Canada, since January 2023, any report that doesn’t include the manufacturer’s name gets rejected. The FDA started requiring a unique four-letter suffix on biosimilar names-like adalimumab-atto for Amjevita-so pharmacists and doctors can tell them apart.
The Hidden Gap: Underreporting and Confusion
Even with better systems, the numbers don’t add up. In 2021, IQVIA found that biosimilars made up 8.7% of all biologic prescriptions in the U.S., but only 0.3% of adverse event reports came from them. That doesn’t mean they’re safe. It means people aren’t reporting. Why?
Patient confusion is a big reason. The Arthritis Foundation’s 2022 survey found that 41% of patients on biosimilars didn’t know whether they were getting the original drug or the copy. If you don’t know what you took, you can’t report it properly. And if your pharmacist switches your drug without telling you-something that still happens in many states-you’re left guessing.
Doctors are confused too. One rheumatologist on Medscape wrote: “I now document both the brand and the manufacturer. If I don’t, I can’t track if a reaction is from the biosimilar or the original.” That’s not how it should be. Tracking should be built into the system, not left to individual vigilance.
Active Surveillance: Going Beyond Spontaneous Reports
Waiting for people to report side effects is like waiting for smoke to appear before calling the fire department. That’s why agencies are moving to active surveillance. The FDA’s Sentinel Initiative, launched in 2008, now pulls data from over 200 million patient records-insurance claims, hospital visits, lab results. It looks for patterns: are people on a certain biosimilar having more joint pain? More infections? More hospitalizations?
Europe’s EMA took it further. In 2022, they launched VigiLyze, an AI tool that scans 1.2 million new safety reports every year. It flags unusual clusters-like a spike in lupus-like symptoms after a specific biosimilar was introduced. The system is 92.4% accurate at spotting real signals, not noise.
These tools don’t replace spontaneous reporting. They complement it. Together, they create a safety net. But they only work if the data is clean. And clean data means knowing exactly which product a patient received.
The Role of Risk Management Plans
Before a biosimilar even hits the market, the company must submit a Risk Management Plan (RMP). This isn’t a formality. It’s a detailed roadmap for safety monitoring. Health Canada requires RMPs to include specific plans for tracking immunogenicity. The FDA expects them to outline how they’ll distinguish their product’s side effects from the reference drug’s.
These plans often include:
- Post-approval studies tracking 5,000-10,000 patients for 1-3 years
- Lot-level traceability-so if a batch causes problems, you can pull it
- Training for pharmacists on how to document biosimilars correctly
- Integration with electronic prescribing systems
But implementing these plans is expensive. The Tufts Center estimates it costs $2.1 million per year just to run pharmacovigilance for one biosimilar in the U.S. That’s why smaller companies struggle. And why some rely on third-party vendors like ArisGlobal or Oracle Health Sciences to handle the heavy lifting.
What’s Next? The Future of Biosimilar Safety
The number of biosimilars is exploding. In 2022, the U.S. approved 10 new ones. By 2028, the global market is expected to hit $35 billion. More products mean more complexity. Right now, we have 35 biosimilars in the U.S. and 43 in Europe. But by 2030, experts predict over 300 biosimilars targeting just 30 reference biologics.
That’s a nightmare for safety systems. Imagine 15 different versions of a drug for rheumatoid arthritis. How do you tell which one caused a reaction? The WHO and the International Pharmaceutical Regulators Programme are pushing for a global unique identifier system-like a barcode for biologics. Think of it like a VIN number for your car. Every vial would have a unique code. If a patient has a reaction, you scan the vial and know exactly which batch, which manufacturer, which lot they got.
Pilot studies in Switzerland show this could cut attribution errors by 73.5%. The catch? It’ll cost $1.8 billion globally to roll out. But is that more than the cost of missed reactions, hospitalizations, or lost trust in biosimilars?
What Patients and Providers Can Do Today
You don’t need a global system to protect yourself. Here’s what works now:
- Ask your doctor or pharmacist: “Which biosimilar am I getting? Is it the same as last time?”
- Check your prescription label. Look for the four-letter suffix (U.S.) or full manufacturer name.
- Write down the name and manufacturer of every drug you take-especially biologics.
- If you have a reaction, report it. Even if you’re unsure which product caused it. Better to report and be wrong than to miss a pattern.
- Ask your clinic if they track biosimilars in their electronic records. If not, push for it.
Doctors, nurses, pharmacists-your documentation matters. Every time you write down the exact product name, you’re helping build the safety net for everyone else.
Bottom Line: Safety Isn’t Optional
Biosimilars save money. They make life-saving treatments accessible to more people. But their complexity demands more-not less-attention to safety. The systems we have now aren’t perfect. They’re patchwork, underfunded, and often confused. But they’re improving. With better traceability, smarter tech, and clearer communication, we can have both affordability and safety.
It’s not about choosing between biosimilars and original biologics. It’s about making sure that whichever one you get, you’re protected. Because when it comes to your health, there’s no room for guesswork.
