Abstract Vascular ulcers (VU) constitute a major cause of pain and disability, and significantly compromise quality of life. VU have a natural tendency to become chronic and in many cases exhibit anunsatisfactoryresponse to many of the standard therapeutic options.The case of a 73 year-old Caucasian female with severe pain and poorly-controlled pain (Visual Analogic Scale-VAS- of 8-9) due to three lower leg long-standing VUs is reported and discussed herein. The patient was treated with topical instillations of undiluted sevoflurane as per institutional off-label protocol (starting doses of 1mL/cm2 twice a day, and up-titrated according to response to a maximum of 7 mL twice daily). The VAS score dropped to 0-1 shortly after initiation of therapy and remained stable throughout treatment up until the closure of the observations. Subsequently, opioid therapy was gradually tapered down and ultimately abandoned.Sevoflurane application resulted on adequate and sustained pain management of refractory VU, with no significant side effects. On account of its beneficial effectivity and safety profiles, topical sevoflurane emerges as an add-on alternative for the long-term management of VU, and potentially other painful conditions.

According to the European Medicine Agency, a "biosimilar" is a biological medicinal product that contains a version of the active substance of an original biological medicinal product (reference or innovative medicinal product) that has been authorized in the European Economic Area. The similarity to the reference medicinal product in terms of quality, biological activity, safety and efficacy needs to be set on a comprehensive comparability basis. The generic standard approach (demonstration of bioequivalence with a reference medicinal product by appropriate bioavailability studies), which is applicable to a wide range of chemically derived medicinal products, is not sufficient to prove the similarity of biotechnology derived products due to their structural complexity. Furthermore, these biopharmaceuticals products, in comparison with the conventional ones, show a greater ability to activate the immune response. The evaluation of biosimilar medicines for authorisation purposes by the European Medicine Agency does not include recommendations on whether a biosimilar should be used interchangeably with its reference medicine. Substitution policies are, therefore, within the remit of the EU member states. In order to support pharmacovigilance monitoring, all appropriate measures should be taken to clearly identify any biological medicinal product with due regard to its brand name and batch number. The situation of the European Community and the regulatory framework have been developed since the first applications (growth hormone), almost a decade ago, until the recent advent (monoclonal antibodies). The introduction to the market of biosimilars have positive effects on competition by improving access to biological therapies.

Según la Agencia Europea del Medicamento, un medicamento biosimilar es aquel obtenido por biotecnología que contiene una versión de la sustancia activa del medicamento biológico original (de referencia o innovador), previamente autorizado en el Espacio Económico Europeo. La similitud entre medicamento de referencia y biosimilar en términos de calidad, actividad biológica, seguridad y eficacia debe ser establecida según criterios de comparabilidad integral. El enfoque estándar para un medicamento genérico (demostración de bioequivalencia por estudios de biodisponibilidad) es aplicable a medicamentos derivados de síntesis química y no es suficiente para productos obtenidos por biotecnología, debido a su mayor complejidad estructural. Además estos productos biofarmacéuticos, en contraste con los convencionales, demuestran una mayor capacidad para activar la respuesta inmunitaria. La intercambiabilidad y sustitución en el acto de la prescripción y dispensación, respectivamente, es un aspecto que se plantea de forma continuada y deberá ser tratado por cada Estado Miembro de la Unión Europea, según comunica la Agencia Europea del Medicamento. Con el fin de apoyar la farmacovigilancia y trazabilidad se deberán tomar medidas oportunas para la identificación, atendiendo al nombre del producto, número de lote y fecha de caducidad. La situación en el entorno de la Comunidad Europea así como el marco regulatorio en términos de autorización y comercialización han evolucionado desde las primeras solicitudes (hormona del crecimiento), hace casi una década, hasta la reciente aparición de medicamentos biosimilares molecularmente complejos (anticuerpos monoclonales). Actualmente, la introducción en el mercado de estos medicamentos favorece la competencia mejorando el acceso a nuevas terapias biológicas.