As a rheumatologist, I see daily how rheumatic diseases (RD) devastate lives. It is not just about painful and swollen joints — it is about losing independence. Rheumatic diseases, including rheumatoid arthritis, lupus, ankylosing spondylitis, and others, can slowly rob people of their ability to live normal lives. 

Simple tasks such as buttoning a shirt, turning a doorknob or holding a pen can become overwhelming challenges. Many patients describe how their world shrinks when fatigue, stiffness and pain take away the freedom to work, care for family or even move without discomfort. These are struggles that go far beyond medicine; they touch dignity, livelihood and hope.

For years, treatments could only relieve some symptoms, but real improvement in quality of life came with the arrival of biologic therapies — a true breakthrough in medicine. An important one among them is adalimumab, a monoclonal antibody that blocks tumour necrosis factor (TNF), one of the key drivers of RD's relentless inflammation. For patients worldwide, adalimumab has been life-changing — transforming lives from dependency to independence.

But for Bangladesh, the journey to accessing this revolutionary therapy was long and difficult.

When adalimumab was first launched in the global market, it quickly became one of the world's most expensive medicines. According to a 2021 congressional report, adalimumab costs approximately $77,000 (around Tk1 crore) per patient per year in the United States, and Europe was not far behind. These figures meant that for patients in low- and middle-income countries, the drug was out of reach — existing only as a distant dream.

In Bangladesh, this medicine was once beyond the reach of almost all patients. But that story has now changed. With the encouragement of local physicians, pharmaceutical companies are investing in advanced biotechnology. 

Adalimumab is being manufactured domestically at a fraction of the international cost. Today, what was once an unattainable treatment has become accessible to many patients in Bangladesh, bringing new hope to those suffering from debilitating conditions.

As a physician, I witnessed a turning point when Bangladesh's status as a Least Developed Country (LDC) under the TRIPS waiver allowed local production of advanced medicines like adalimumab. When local companies began producing adalimumab using imported bulk material, the cost fell dramatically to around Tk15,000 per dose. 

For the first time, patients who had lived with severe pain and disability finally had access to a therapy that could transform their quality of life. It was not yet affordable for everyone, but it was the first real glimmer of hope that modern rheumatology care was becoming possible in Bangladesh.

The real revolution came when a local company went beyond importing bulk drug material and established end-to-end manufacturing capacity for adalimumab from cell lines. Biosimilars — medicines that are highly similar to already approved biologic drugs — offer the same safety and effectiveness at a lower cost.

The entire biotechnology process is now mastered: upstream production through advanced cell culture and fermentation, followed by downstream purification and, finally, fill-finish manufacturing. This was no minor achievement; it placed Bangladesh among the few countries in the world with the technical ability to produce complex biosimilars independently.

The results were immediate and profound. The price of adalimumab was halved again, making treatment more accessible for a significantly larger segment of patients. And as economies of scale expand, the expectation is that costs will drop even further. What was once an imported luxury has become a homegrown product — reliable and affordable.

One remarkable aspect was not just manufacturing adalimumab but rigorously testing it in our own population through full-scale clinical trials in Bangladesh, following international protocols for data integrity, safety monitoring and compliance with regulatory frameworks.

This achievement highlighted another emerging sector in our healthcare ecosystem: the Contract Research Organisation (CRO) industry. For the first time, Bangladesh demonstrated its capacity to design, manage and execute clinical trials to international benchmarks. 

Doctors led the entire process — from designing study protocols to enrolling patients, monitoring safety, collecting data and ensuring accurate reporting — so that every step met international standards and truly reflected the needs of our patients.

A milestone achievement in this journey would not have been possible without Prof Dr Syed Atiqul Haq, Bangladesh's foremost rheumatologist, founder of the country's first rheumatology department and current president of the Bangladesh Rheumatology Society.

The story of biosimilar adalimumab in Bangladesh is not just about a drug — it is a window into the transformation of our healthcare system.

Together, these developments create a powerful ecosystem. They ensure that a patient in Bangladesh no longer has to dream of care abroad. Instead, they can receive world-class therapy in their own country — prescribed by their own doctors, manufactured by their own pharmaceutical industry and validated by their own clinical trial infrastructure.

This is just the beginning of a healthcare revolution that will touch countless lives.

Dr Minhaj Rahim Choudhury, MBBS, FCPS, MD, is a Fellow of the American College of Rheumatology. He is also the former chairman of the Department of Rheumatology, Bangladesh Medical University (BMU) and President-Elect of the Bangladesh Rheumatology Society.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.