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Rieger C, Dean JA, Hall L, Vasquez P, Merlo G. Barriers and Enablers Affecting the Uptake of Biosimilar Medicines Viewed Through the Lens of Actor Network Theory: A Systematic Review. BioDrugs 2024; 38:541-555. [PMID: 38879730 PMCID: PMC11247062 DOI: 10.1007/s40259-024-00659-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND OBJECTIVE Biosimilars represent an opportunity to realise savings against the costs of innovative medicines. Despite efforts made by stakeholders, there are numerous barriers to the uptake of biosimilars. To realise the promise of biosimilars reducing costs, barriers must be identified, understood, and overcome, and enablers magnified. The aim of this systematic review is to summarise the enablers and barriers affecting uptake of biosimilars through the application of a classification system to organise them into healthcare professional (HCP), patient, or systemic categories. METHODS A systematic literature search was performed in PubMed, Scopus, CINAHL, eConlit, and Embase. Included were primary research studies published in English between Jan 2017 through June 2023 focused on enablers and barriers affecting uptake of biosimilars. Excluded studies comprised comparisons of biosimilar efficacy and safety versus the reference biologic. One reviewer extracted data that included classification of barriers or enablers, the sub-classification, and the identification of the degree of agency associated with the actor through their role and associations as a mediator within their network, through the application of Actor Network Theory. The data were validated by a second reviewer (PV). RESULTS Of the 94 studies included, 59 were cross-sectional, 20 were qualitative research, 12 were cohort studies, and three were economic evaluations. Within the review, 51 of the studies included HCP populations and 35 included patients. Policies and guidelines were the most cited group of enablers, overall. Systemic enablers were addressed in 29 studies. For patients, the most frequently cited enabler was positive framing of a biosimilar, while for HCPs, cost benefit was the most frequently noted enabler. The most frequently discussed systemic barrier to biosimilar acceptance was lack of effective policies or guidelines, followed by lack of financial incentives, while the most significant barriers for HCPs and patients, respectively, were their lack of general knowledge about biosimilars and concerns about safety and efficacy. Systemic actors and HCPs most frequently acted with broad degree of agency as mediators, while patient most frequently acted with a narrow degree of agency as mediators within their networks. CONCLUSIONS Barriers and enablers affecting uptake of biosimilars are interconnected within networks, and can be divided into systemic, HCP, and patient categories. Understanding the agency of actors within networks may allow for more comprehensive and effective approaches. Systemic enablers in the form of policies appear to be the most effective overall levers in affecting uptake of biosimilars, with policy makers advised to give careful consideration to appropriately educating HCPs and positively framing biosimilars for patients.
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Affiliation(s)
- Chad Rieger
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Judith A Dean
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | - Lisa Hall
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
| | - Paola Vasquez
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Gregory Merlo
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Australia
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Goh A, Griffin L, Sadlier M. Switching to biosimilars in dermatology: a patients' perspective. Clin Exp Dermatol 2023; 49:84-85. [PMID: 37706524 DOI: 10.1093/ced/llad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 08/13/2023] [Indexed: 09/15/2023]
Abstract
Biosimilars are legitimate copies of a biopharmaceuticals (originator biologics) that are no longer protected by patent and have undergone rigorous analytical and clinical assessment compared with their reference product, demonstrating efficacy and safety with significant cost savings when prescribed. This qualitative study was conducted to better understand the patient experience around the transition to biosimilars. Three main themes that influenced patient decisions were identified: the impact of disease, the information around biosimilars and patient autonomy. This study highlights the importance of counselling patients appropriately regarding transitioning to biosimilars and reinforces the importance of good communication to ensure patient empowerment and satisfaction.
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Affiliation(s)
- Alicia Goh
- Department of Dermatology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Laoise Griffin
- Department of Dermatology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Muriel Sadlier
- Department of Dermatology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Wirth K, Boes S, Näpflin M, Huber C, Blozik E. Initial prescriptions and medication switches of biological products: an analysis of prescription pathways and determinants in the Swiss healthcare setting. BMJ Open 2023; 13:e077454. [PMID: 37989386 PMCID: PMC10668177 DOI: 10.1136/bmjopen-2023-077454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES Biological products have contributed to extraordinary advances in disease treatments over the last decade. However, the cost-saving potential of imitator products, so-called biosimilars, is still under-researched in Switzerland. This study aims to assess biosimilars' prescriptions at treatment initiation and their determinants, as well as biological therapy switches. DESIGN The study included all patients who had at least one biosimilar available on the market at the time when they were prescribed a biological product. We analysed longitudinal data for biosimilar prescriptions in Switzerland using descriptive statistics and logistic regression to quantify the associations with individual, pharmaceutical and provider-related variables. SETTING The analysis is based on de-identified claims data of patients with mandatory health insurance at Helsana, one of the Swiss health insurance companies with a substantial enrollee base in mandatory health insurance. PARTICIPANTS Overall, 18 953 patients receiving at least one biological product between 2016 and 2021 were identified. OUTCOME MEASURES We differentiated between initial prescriptions and follow-up prescriptions. Our regression focused on initial prescriptions due to evidence indicating that patients tend to follow the medication prescribed at therapy initiation. RESULTS Although biosimilars' market share was low (28.6%), the number of prescriptions has increased (from 1016 in 2016 to 6976 in 2021). Few patients with medication switches (n=1492, 8.5%) were detected. Increased relative price difference (difference in the price of available biosimilars relative to price of corresponding reference product) was associated with decreased probability of biosimilar prescriptions, whereas male sex, an increase of available imitator drugs on the market, larger packaging sizes, and prescriptions from specialists or physicians in outpatient settings were associated with increased biosimilar use. CONCLUSION The low number of biosimilar prescriptions, despite the proliferating biosimilar market, indicates a high potential for biosimilar diffusion. The findings indicate that patients typically adhere to the therapy options initially chosen and are less inclined to make changes following the initiation of treatment. Our research highlights the need for awareness initiatives to improve understanding among patients and physicians, enabling informed, shared decision-making about biosimilar prescriptions.
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Affiliation(s)
- Kevin Wirth
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Markus Näpflin
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Carola Huber
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Eva Blozik
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Wu Q, Wang Z, Wang X, Yu H, Sun J. Patients' Perceptions of Biosimilars: A Systematic Review. BioDrugs 2023; 37:829-841. [PMID: 37676537 DOI: 10.1007/s40259-023-00620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To systematically summarize and evaluate the findings of existing studies about patients' perceptions of biosimilars by assessing their attitudes and knowledge. METHODS We conducted a systematic review of published studies concerning patients' perceptions of biosimilars, using databases of China National Knowledge Infrastructure, SinoMed, Web of Science, PubMed, Embase, and Cochrane Library. Two independent reviewers screened a total of 2197 Chinese or English papers published between 1 January 2018, and 1 October 2022. We assessed the quality of the included studies by applying the Joanna Briggs Institute appraisal tools. RESULTS Forty-three studies were included in the review, with the majority originating from Europe (n = 22) and North America (n = 10). Of these studies, 37 were cross-sectional quantitative studies, three were quasi-experimental studies, and the remaining three were qualitative studies based on semi-structured interviews. The sample sizes of the included studies ranged from 9 to 6554 patients. Twenty-two out of 31 studies investigating patients' acceptance of biosimilars found that most participants expressed satisfaction with treatment using biosimilars. However, doubts about the clinical effects and regulatory approval pathway could negatively influence patients' attitudes. The majority of patients understood the economic advantages of biosimilars; however, some incorrectly connected lower prices with lower quality. Patients generally lacked knowledge about biosimilars. There were 6-51% of participants who were familiar with biosimilars, and 25-58% thought they did not know enough about biosimilars. Physicians, pharmacists, medicines agencies, academia, and patient associations were identified as the main sources of information on biosimilars for patients. Healthcare providers not informing or advising patients about switching may hinder patients from acquiring enough knowledge. CONCLUSIONS The majority of patients expressed satisfaction with treatment using biosimilars, but limited knowledge continued to impede their perceptions. Doubts about the clinical effects and regulatory approval pathway were identified as major factors that negatively influenced patients' attitudes towards biosimilars, while the impact of a price advantage was mixed. It is essential to maintain a focus on educating healthcare professionals about biosimilars, including their clinical outcomes and the regulatory pathway, which equips them to provide comprehensive and informed guidance to patients.
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Affiliation(s)
- Qiyou Wu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhitao Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Yu
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Jing Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Gibofsky A, Jacobson G, Franklin A, O'Hara-Levi S, Peyrin-Biroulet L, McGrath M, McCabe D. An online survey among US patients with immune-mediated conditions: Attitudes about biosimilars. J Manag Care Spec Pharm 2023; 29:343-349. [PMID: 36989450 PMCID: PMC10387972 DOI: 10.18553/jmcp.2023.29.4.343] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND: Few surveys about biosimilars have been conducted among US patients. OBJECTIVE: To evaluate attitudes about biosimilars among patients with rheumatoid arthritis (RA), psoriasis and/or psoriatic arthritis (PsO/A), and/or inflammatory bowel disease (IBD). METHODS: WebMD, LLC fielded a 16-item online survey to members of the US Dynata consumer panel meeting these criteria: aged 18 years or older; self-reported specialist diagnosis of RA, PsO/A, or IBD of at least 1 year; and not currently receiving an infliximab biosimilar. A quota of 500 was set, stratified by region and condition. The survey was exempt by the institutional review board, exploratory, and not registered. RESULTS: Overall, 44% (n = 221) of patients were on a biologic; 56% (n = 279) were not on a biologic (40% [n = 199] were biologic naive and 16% [n = 80] used biologics in the past). Among all patients, 66% were unaware of biosimilars and 24% were aware (10% unsure). After being shown the US Food and Drug Administration definition of a biosimilar, main concerns were side effects (59%), long-term safety (50%), and not knowing a lot (46%). Among current users, 43% would switch to a biosimilar and 26% would not (32% unsure). Of those unwilling to switch, 51% were concerned about side effects, 42% about financial support, and 40% about efficacy. When those not on a biologic were asked if their doctor prescribed an original anti-tumor necrosis factor α but their insurance required its biosimilar, 49% would switch and 8% would not (43% unsure). 51% of patients surveyed thought pharmacist-level substitution of an interchangeable biosimilar was acceptable with notification. Survey findings were consistent among the RA, PsO/A, and IBD subgroups. CONCLUSIONS: Although two-thirds of patients surveyed were unaware of biosimilars, the majority were potentially receptive to biosimilar treatment after being provided with the definition of a biosimilar. Patients expressed a desire to know more about biosimilars in general, how they compare with original biologics, their benefits, and cost. DISCLOSURES: This study was funded by Boehringer Ingelheim Pharmaceuticals Inc. (BIPI). WebMD, LLC, fielded the survey. BIPI was given the opportunity to review the article for medical and scientific accuracy and intellectual property considerations. Dr Gibofsky is a consultant/advisor for AbbVie Inc., Biosplice Therapeutics, Lilly, Novartis Pharmaceuticals Corporation, and Pfizer Inc., and he is on the speakers' bureau for AbbVie Inc., Amgen, Lilly, and Pfizer Inc., and has stock ownership in AbbVie Inc., Amgen, Bristol-Myers Squibb Company, Horizon Pharma plc, and Pfizer Inc. Dr Peyrin-Biroulet reports that he has received personal consulting fees from Merck Sharp & Dohme, AbbVie, Janssen, Takeda, Celltrion, Pfizer, Bristol-Myers Squibb Company, Pharmacosmos, Shire, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, UCB-Pharma, Hospira, BIPI, and Lilly. Dr McCabe is an employee of BIPI. Dr McGrath was an employee of BIPI at the time the survey was conducted. Mr Jacobson, Mr Franklin, and Ms O'Hara-Levi report no disclosures.
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Affiliation(s)
- Allan Gibofsky
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | | | | | | | | | - Melissa McGrath
- Boehringer Ingelheim, Ridgefield, CT
- BeiGene USA, Inc., San Mateo, CA
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Perelman J, Duarte-Ramos F, Melo Gouveia A, Pinheiro L, Ramos F, Vogler S, Mateus C. How do hospital characteristics and ties relate to the uptake of second-generation biosimilars? A longitudinal analysis of Portuguese NHS hospitals, 2015-2021. Expert Rev Pharmacoecon Outcomes Res 2023; 23:99-109. [PMID: 36356294 DOI: 10.1080/14737167.2023.2146579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is limited evidence on within-country discrepancies in biosimilar uptake. This study analyzes differences in timing and diffusion of biosimilar uptake across Portuguese NHS hospitals and explores possible determinants. RESEARCH DESIGN AND METHODS We analyzed publicly accessible consumption data of originator biologic and biosimilar drugs for adalimumab, etanercept, infliximab, rituximab, and trastuzumab, by hospital and month for the years 2015-2021 (N = 9,467). We modeled the time to biosimilar adoption using survival regression models and the share of biosimilar consumption using generalized estimated equations with random hospital effects. RESULTS Academic hospitals were characterized by a quicker uptake of adalimumab and infliximab biosimilars but lower shares for other drugs. A higher total consumption of biologics was related to a lower share of biosimilar uptake. A stronger participation in randomized controlled trials was linked to higher biosimilar shares and quicker uptake, except for rituximab. If all NHS hospitals had biosimilar shares equal to the highest ones, potential annual savings could reach 13.9 million euros. CONCLUSION The findings suggest a need for capacity-building on biosimilar prescribing, including for doctors of academic hospitals and those working in settings where high biosimilar use would be expected.
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Affiliation(s)
- Julian Perelman
- NOVA National School of Public Health, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center, Nova University of Lisbon, Portugal
| | - Filipa Duarte-Ramos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal
| | | | - Luis Pinheiro
- Centro Hospitalar Universitário de Lisboa Norte, Portugal
| | - Francisco Ramos
- NOVA National School of Public Health, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal
| | - Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Austria
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster, UK
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Perceptions towards biologic and biosimilar therapy of patients with rheumatic and gastroenterological conditions. BMC Rheumatol 2022; 6:79. [PMID: 36550585 PMCID: PMC9783393 DOI: 10.1186/s41927-022-00309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Biologic and targeted synthetic disease modifying agents (b/tsDMARDs) have broadened the treatment landscape for autoimmune diseases particularly in patients refractory to conventional DMARDs. More recently, the introduction of biosimilars has reduced the price of bDMARDs, potentially improving accessibility. Though efficacy and safety have been described, patient attitudes to b/tsDMARDs are not well-understood. We aim to investigate patients' beliefs about biologic and biosimilar therapy, and the factors influencing their perceptions. METHODS Patient consumer groups (Arthritis Australia, Crohn's and Colitis Australia) assisted in advertising an online questionnaire for people with a self-reported diagnosis of inflammatory arthritis (IA) or inflammatory bowel disease (IBD). The questionnaire incorporated the Belief about Medicines Questionnaire (BMQ) and the single-item literacy screener (SILS). Sources and favourability of biologic/biosimilar information were analysed, using the chi-square and a non-parametric trend test for unordered and ordered categorical variables respectively, comparing respondents with IA and IBD. RESULTS Eight hundred and thirty eight people (686-IA, 144-IBD, 8 both) responded. 658 (79%) used b/tsDMARDs. The BMQ demonstrated high necessity belief (median 4.2) with moderate concerns (median 2.8) about biologics. 95% of respondents obtained medication information from specialists though most used multiple sources (median 4). The most positive resources were specialists and specialist nurses. 73/141 (52%) respondents with IBD obtained information from specialist nurses compared with 202/685 (29%) with IA (p = 0.012). Respondents with limited reading ability on SILS were more likely to discuss information with a general practitioner or pharmacist. Younger respondents and those with higher BMQ concern scores more frequently consulted less reliable sources (e.g. social media). 502 respondents (60%) answered the biosimilar questions. Only 23 (4.6%) reported currently using a biosimilar and 336 (66.9%) were unsure if biosimilars were available in Australia. Specialist recommendation was the most frequent factor that would influence a patient to change from originator to biosimilar (352/495, 71.1%). CONCLUSIONS There is a high level of trust in specialists' recommendations about b/tsDMARDs, although most people also utilise additional information sources. Contextual factors influencing resource selection include age, reading ability and degree of concern about medicines. People with IA and IBD have similar attitudes though those with IBD more frequently access specialist nurse advice.
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Friganović A, Mędrzycka-Dąbrowska W, Krupa S, Oomen B, Decock N, Stievano A. Nurses' Knowledge and Attitudes towards Biosimilar Medicines as Part of Evidence-Based Nursing Practice-International Pilot Study within the Project Biosimilars Nurses Guide Version 2.0. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10311. [PMID: 36011946 PMCID: PMC9408045 DOI: 10.3390/ijerph191610311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Introduction: The increasing availability of biosimilars can increase patient access to these drugs and reduce the economic burden. Nurses play a key role in the education, administration, pharmacovigilance and management of the side effects of biosimilars. The aim of this study was to assess the knowledge and attitudes of nurses towards biosimilar drugs in different countries. Methods: An international cross-sectional study was conducted from November 2021 to February 2022. The survey was carried out using Computer-Assisted Web Interview (CAWI), sent by the CAWI panel via the website. Results: The results showed that nurses with a greater level of education felt most knowledgeable about biosimilars (χ2 = 105.813, df = 2, p < 0.001). One-third of nurses with a doctorate and a second degree said biosimilars are used in their workplace (χ2 = 48.169, df = 4, p < 0.001); most nurses with a second degree said that they had never heard of biosimilars (41%). Doctorate-level nurses thought knowledge is the key factor to increasing biosimilar uptake (97%). Conclusions: Nurses are not knowledgeable about biosimilars. Most would like to participate in training on biosimilars. This is a very important topic, because biosimilars are constantly evolving in medicine.
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Affiliation(s)
- Adriano Friganović
- Department of Nursing, University of Applied Health Sciences, Mlinarska Cesta 38, 10000 Zagreb, Croatia
- Department of Anaesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Ber Oomen
- European Specialist Nurses Organization, 6821 HR Arnhem, The Netherlands
| | - Nico Decock
- Nurse Anaesthesia School, University Hospital of Lille, 111 Rue Charles Debierre, 59000 Lille, France
| | - Alessandro Stievano
- Centre of Excellence for Nursing Scholarship OPI, Tor Vergata University of Rome, Via Cracovia 50, 00133 Rome, Italy
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Hu Y, Song Z, Jiang D, Zhuo L, Cheng Y, Zhao R. Knowledge, Attitudes and Practice of Healthcare Providers, Healthcare Regulatory Practitioners and Patients Toward Biosimilars in China: Insights From a Nationwide Survey. Front Pharmacol 2022; 13:876503. [PMID: 35721219 PMCID: PMC9201466 DOI: 10.3389/fphar.2022.876503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: With increasing numbers of biosimilars entering the market or in the approval pipeline in China, understanding the current awareness and attitudes of biosimilars still remains the first step to promote uptake. This study aims to investigate the knowledge, attitudes and practices (KAP) of multiple stakeholders toward biosimilars, including healthcare providers (HCPs), healthcare regulatory practitioners and patients, and to provide practical information for future uptake of biosimilars in China. Methods: This nationwide cross-sectional online survey was conducted in mainland China. The questionnaire with a high level of reliability and validity was designed based on previous studies and clinical questions in the Clinical Practice Guideline for Clinical Application of Biosimilars. Logistic regression model was employed to identify possible impact factors, and Spearman’s rank correlation test was used to identify the correlation between knowledge and attitudes. Chi-squared test was used to compare the differences between different stakeholders. Results: Overall, 599 valid respondents were recruited, of whom 77.63%, 7.01% and 15.36% were HCPs, healthcare regulatory practitioners and patients, respectively. A total of 504 respondents who had heard of biosimilars were included in the KAP analysis. 76.70% of HCPs, 90.24% of healthcare regulatory practitioners and 50.98% of patients had good knowledge about the definition, while less familiarity with the development process and regulations on interchangeability and indication extrapolation was found in the former two groups. For attitudes toward biosimilars, an overall lack of positivity was shown, as only 18.20% HCPs, 14.63% healthcare regulatory practitioners and 23.53% patients were classified as having positive attitudes. More specifically, most respondents were positive about the influence of payment policy on the uptake of biosimilars, but they showed a neutral attitude toward the clinical medication and interchangeability of biosimilars. Efficacy, safety, immunogenicity, interchangeability and indication extrapolation are major concerns when utilizing biosimilars. Regarding practice, our study showed an inadequate utilization of biosimilars in China. Several further suggestions on the regulation of biosimilars were proposed by healthcare regulatory practitioners. Conclusions: There is still plenty of room for improvement of knowledge, attitudes and practice toward biosimilars among multiple stakeholders in China, which can be improved through high-quality real world evidence, educational programs and other effective measures directed towards barriers.
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Affiliation(s)
- Yang Hu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zaiwei Song
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Dan Jiang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lin Zhuo
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
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Varma M, Almarsdóttir AB, Druedahl LC. "Biosimilar, so it looks alike, but what does it mean?" A qualitative study of Danish patients' perceptions of biosimilars. Basic Clin Pharmacol Toxicol 2022; 130:581-591. [PMID: 35261174 PMCID: PMC9314148 DOI: 10.1111/bcpt.13719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
Biosimilars are highly similar follow‐on products for biologics that can foster biologics competition. Questionnaire studies have attempted to gauge the patient perspective on biosimilars, but none have delved deeper into how patients view biologics and switching of these. Considering Denmark has one of the highest biosimilar uptakes worldwide, the aim of this study was to investigate how Danish patients with psoriasis, arthritic diseases or inflammatory bowel disease perceive biosimilars. Twelve participants were semi‐structurally interviewed in either a focus group or an internet‐based, individual interview between May 2019 and July 2019. Content analysis was inductively applied. Participants on originators voiced more reluctance towards using biosimilars than those already using them. Both participants using originator and biosimilar products expressed concerns about reoccurrence of disease symptoms due to differences in effectiveness and safety. Participants generally struggled with understanding biosimilarity, and they voiced a need to be well‐informed about switching. They were all aware of and accepted how healthcare budget restrictions played a role in the push to use biosimilars. To improve biosimilar uptake and willingness to switch to a biosimilar, patient‐centred information on efficacy and safety and explanation of the societal benefits of the savings from using biosimilars must be carefully communicated.
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Affiliation(s)
- Meera Varma
- Faculty of Health and Medical Sciences, Department of Pharmacy, Social and Clinical Pharmacy Research Group, University of Copenhagen, Copenhagen, Denmark
| | - Anna Birna Almarsdóttir
- Faculty of Health and Medical Sciences, Department of Pharmacy, Social and Clinical Pharmacy Research Group, University of Copenhagen, Copenhagen, Denmark
| | - Louise C Druedahl
- Faculty of Health and Medical Sciences, Department of Pharmacy, Social and Clinical Pharmacy Research Group, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Pharmacy, Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark.,Faculty of Law, Centre for Advanced Studies in Biomedical Innovation Law (CeBIL), University of Copenhagen, Copenhagen, Denmark
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11
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Schreiber S, Puig L, Gonçalves J, Mease PJ, Panaccione R, Emery P. Critical Appraisal and Future Outlook on Anti-Inflammatory Biosimilar Use in Chronic Immune-Mediated Inflammatory Diseases. Semin Arthritis Rheum 2022; 55:152023. [DOI: 10.1016/j.semarthrit.2022.152023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/15/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
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12
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Barbier L, Mbuaki A, Simoens S, Declerck P, Vulto AG, Huys I. Regulatory Information and Guidance on Biosimilars and Their Use Across Europe: A Call for Strengthened One Voice Messaging. Front Med (Lausanne) 2022; 9:820755. [PMID: 35355594 PMCID: PMC8959407 DOI: 10.3389/fmed.2022.820755] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 12/26/2022] Open
Abstract
Background Beyond evaluation and approval, European and national regulators have a key role in providing reliable information on biosimilars and the science underpinning their development, approval, and use. Objectives This study aims to (i) review biosimilar information and guidance provided by EMA and national medicines agencies and (ii) explore stakeholder perspectives on the role of regulators in enabling acceptance and use of biosimilars. Methods This study consists of (i) a comparative review of regulatory information and position statements across medicine agencies (n = 32) and (ii) qualitative interviews with stakeholders in Europe (n = 14). Results The comparative analysis showed that regulatory information and guidance about biosimilars offered by national medicines agencies in Europe varies, and is limited or absent in multiple instances. Approximately 40% (13/31) of the national medicines agencies' websites did not offer any information regarding biosimilars, and for about half (15/31) no educational materials were provided. Only less than half of national medicines agencies provided guidance on biosimilar interchangeability and switching (8/31 and 12/31, respectively). Among the national medicines agencies that did offer guidance, the extent (e.g., elaborate position vs. brief statement) and content (e.g., full endorsement vs. more cautious) of the guidance differed substantially. Countries that have a strong involvement in EU level biosimilar regulatory activities generally had more elaborate information nationally. Interviewees underwrote the need for (national) regulators to intensify biosimilar stakeholder guidance, especially in terms of providing clear positions regarding biosimilar interchangeability and switching, which in turn can be disseminated by the relevant professional societies more locally. Conclusion This study revealed that, despite strong EU-level regulatory biosimilar guidance, guidance about biosimilars, and their use differs considerably across Member States. This heterogeneity, together with the absence of a clear EU-wide position on interchangeability, may instill uncertainty among stakeholders about the appropriate use of biosimilars in practice. Regulators should strive for a clear and common EU scientific position on biosimilar interchangeability to bridge this gap and unambiguously inform policy makers, healthcare professionals, and patients. Furthermore, there is a clear opportunity to expand information at the national level, and leverage EU-developed information materials more actively in this regard.
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Affiliation(s)
- Liese Barbier
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Allary Mbuaki
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Paul Declerck
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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13
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Vandenplas Y, Barbier L, Simoens S, Van Wilder P, Vulto AG, Huys I. Perceptions About Biosimilar Medicines Among Belgian Patients in the Ambulatory Care. Front Pharmacol 2022; 12:789640. [PMID: 35069205 PMCID: PMC8766979 DOI: 10.3389/fphar.2021.789640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background and objectives: Biosimilar medicines have been on the European market for 15 years. Despite the extensive and positive experience with biosimilars across Europe, their uptake remains limited in Belgium. One of the possible factors limiting uptake in clinical practice is the inadequate understanding and lack of trust in biosimilars among patients. This study aimed to assess the level of knowledge and perceptions about biosimilar medicines among Belgian patients in the ambulatory care. Methods: This study consisted of online questionnaires among Belgian patients in the ambulatory care (i.e., rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis, Crohn's disease, ulcerative colitis, diabetes mellitus type I and II). The results were collected between December 2020 and February 2021. The data were analyzed with descriptive and inferential statistics. Results: In total, 657 patients across all disease areas of interest participated in this study. Only 38% of patients had heard of biosimilars before. Of those patients, most (58%) were aware that biosimilars are as safe and effective as their reference product. The vast majority of respondents (68%) would agree with transitioning to a biosimilar if their physician prescribed it, only 3% would never agree with a transition to a biosimilar. If a physician would propose to change their current originator biological therapy with its biosimilar, nearly all patients (95%) want their physician to explain the decision and inform them. For additional information about biosimilars, Belgian patients prefer brochures or folders (41%), or available resources on the internet (35%). Physicians were indicated as the preferred source of information (95%), followed by pharmacists (51%), academia (39%), and patient associations (35%). Most patients require information regarding the safety and efficacy (78%), price and reimbursement (64%), and the clinical development process (56%) of the biosimilar. Conclusion: Belgian patients require information about biosimilar medicines. However, most patients are open and positive towards transitioning their current biological therapy with its biosimilar if sufficiently supported by their healthcare providers.
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Affiliation(s)
- Yannick Vandenplas
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Liese Barbier
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Philippe Van Wilder
- Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnold G. Vulto
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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14
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Levivien C, Bottois C, Lopez-Medina C, Dumas S, Hubert J, Belo S, Roux C, Conort O, Dougados M. Impact of a clinical pharmacist in a multidisciplinary consultation on the switch to a biosimilar for inflammatory rheumatic diseases. Joint Bone Spine 2021; 89:105322. [PMID: 34896303 DOI: 10.1016/j.jbspin.2021.105322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Despite several studies proving the efficacy and safety of biosimilars compared with original drugs, switching to a biosimilar remains challenging when the decision is at the discretion of physicians with mandatory consent from patients. Educating patients about biosimilars seems important to increase the prescription rate of biosimilars. This study aimed to evaluate the impact of a clinical pharmacist consultation on the switch to and retention rate of a biosimilar for patients with inflammatory rheumatic diseases. METHODS This retrospective study compared 2 groups of adult patients receiving (intervention) or not (control) a consultation with a pharmacist right before the rheumatologist consultation. The primary outcome was the frequency of patients who switched to a biosimilar at the end of the rheumatologist visit. RESULTS We analysed 141 patients (50% women, 50±15 years old, on original adalimumab (62%) or etanercept (38%)) who had never used biosimilars: 85 in the intervention group and 56 in the control group. The switch rate to a biosimilar significantly differed between the groups: 69.4% versus 41.1% in the intervention group versus the control group respectively (p<0.01). After a 1-year follow-up period, 72.5% versus 81.3% of patients who switched were still on biosimilar in the intervention versus control group respectively. CONCLUSIONS This study highlights the positive impact of a pharmacist consultation before the physician's one on switching to a biosimilar, but more studies are needed to assess the impact of this pharmacist consultation on preventing the nocebo effect and therefore on improving the retention rate of biosimilars.
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Affiliation(s)
- Clara Levivien
- Université de Paris - APHP.Centre, Département de Pharmacie clinique - Hôpital Cochin, Paris, France.
| | - Cécile Bottois
- Université de Paris - APHP.Centre, Département de Pharmacie clinique - Hôpital Cochin, Paris, France
| | - Clementina Lopez-Medina
- Université de Paris - APHP.Centre, Département de Rhumatologie - Hôpital Cochin, Paris, France; Rheumatology Department, Reina Sofia University Hospital, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Sophie Dumas
- Université de Paris - APHP.Centre, Département de Pharmacie clinique - Hôpital Cochin, Paris, France
| | - Julien Hubert
- Université de Paris - APHP.Centre, Département de Pharmacie clinique - Hôpital Cochin, Paris, France
| | - Sephora Belo
- Université de Paris - APHP.Centre, Département de Pharmacie clinique - Hôpital Cochin, Paris, France
| | - Christian Roux
- Université de Paris - APHP.Centre, Département de Rhumatologie - Hôpital Cochin, Paris, France; INSERM (U1153): Clinical epidemiology and biostatistics, PRESS Sorbonne Paris-Cité, Paris, France
| | - Ornella Conort
- Université de Paris - APHP.Centre, Département de Pharmacie clinique - Hôpital Cochin, Paris, France
| | - Maxime Dougados
- Université de Paris - APHP.Centre, Département de Rhumatologie - Hôpital Cochin, Paris, France; INSERM (U1153): Clinical epidemiology and biostatistics, PRESS Sorbonne Paris-Cité, Paris, France
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15
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Gasteiger C, Scholz U, Petrie KJ, Dalbeth N. A bio-what? Medical companions' perceptions towards biosimilars and information needs in rheumatology. Rheumatol Int 2021; 42:1993-2002. [PMID: 34705051 DOI: 10.1007/s00296-021-05037-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
Patient perceptions influence biosimilar uptake in non-mandatory transitions. Companions (support people) are often actively involved in the patient's medical journey and are likely to have unique perceptions of biosimilars, which may shape patient attitudes. This study explores the congruence between patient and companion perceptions towards biosimilars and their information needs. Patients taking bio-originators for rheumatic diseases (59% for rheumatoid arthritis) and their companions received an explanation about biosimilars. Participants (N = 78) completed questionnaires assessing their familiarity with biosimilars, perceptions, concerns, and benefits of being accompanied. Contingency tables and paired sample t-tests were used to explore differences in familiarity, confidence in knowledge, and perceptions. Intra-class correlation coefficients were calculated to assess the degree of congruence for perceptions towards biosimilars. Companions were significantly less familiar with biosimilars (p = 0.014, Cramer's V = 0.28) and reported lower confidence in their knowledge (p = 0.006, Cohen's d = 0.47) than patients. Companions and patients had moderate to good congruency for perceptions toward confidence in biosimilar use and safety, efficacy, and side-effect expectations (intra-class correlation coefficients ranging from 0.75 to 0.81). Companions and patients were most concerned about safety and effectiveness. Companions also reported concerns about cost savings driving the transition, while patients had concerns about uncertainty and testing. Patients reported the ability for discussion, improved understanding, and validation as benefits of being accompanied. Companions and patients have similar levels of perceptions and expectations towards biosimilars but report some unique information needs. Future educational interventions should involve companions and address their concerns to help improve biosimilar acceptance.
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Affiliation(s)
- Chiara Gasteiger
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Urte Scholz
- Department of Psychology-Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand.,Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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16
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Petit J, Antignac M, Poilverd RM, Baratto R, Darthout S, Desouches S, Louati K, Deparis N, Berenbaum F, Beauvais C. Multidisciplinary team intervention to reduce the nocebo effect when switching from the originator infliximab to a biosimilar. RMD Open 2021; 7:rmdopen-2020-001396. [PMID: 33495387 PMCID: PMC7839879 DOI: 10.1136/rmdopen-2020-001396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/25/2020] [Accepted: 11/04/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives To evaluate an intervention to reduce the nocebo effect (NE) when switching from the originator infliximab (OI) to the infliximab biosimilar SB2 in chronic inflammatory rheumatic disease (CIRD). Methods An intervention was built with healthcare professionals (HPs) and a patient representative, based on a systematic review of interventions reducing the NE in musculoskeletal diseases and semi-directed questioning of five patients. Our strategy consisted of training HPs, switch information given by the nurses, a consistent vocabulary. All CIRD patients switched from OI to SB2 were included for the intervention. The primary outcome was the SB2 retention rate (RR) at 34 weeks. Secondary outcomes were the SB2 RR at 12 months, discontinuation rates due to a possible NE and comparison with a historical cohort of CIRD patients receiving the OI and 6 published European cohorts. Results 45 patients were included from March 2018 (rheumatoid arthritis, n=17, spondylarthritis, n=28). After 34 weeks, the SB2 RR was 91.2%, similar to the historical cohort RR (p=0.41) but higher than the 3 European cohort RRs (p<0.05). At 12 months, the SB2 RR was 84.5% vs 88.4% for the historical cohort (p=0.52). SB2 discontinuation due to a possible NE was 6.6% after 12 months. Conclusions A tailored communication with a prominent role of nurses reduced the NE in non-medical switches from the OI to SB2 as compared to published results. The RR was similar to the historical cohort RR. The methodology used to construct this intervention may help improve the outcomes of switches with upcoming biosimilars.
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Affiliation(s)
- Juliette Petit
- Rheumatology, Hopital Saint-Antoine, Sorbonne University, Paris, France
| | | | | | - Régine Baratto
- Rheumatology, Hopital Saint-Antoine, Sorbonne University, Paris, France
| | - Sylvie Darthout
- Rheumatology, Hopital Saint-Antoine, Sorbonne University, Paris, France
| | - Sandra Desouches
- Rheumatology, Hopital Saint-Antoine, Sorbonne University, Paris, France
| | - Karine Louati
- Rheumatology, Hopital Saint-Antoine, Sorbonne University, Paris, France
| | - Nathalie Deparis
- Association ANDAR (Association Nationale de Défense Contre l'Arthrite Rhumatoïde), Paris, France
| | - Francis Berenbaum
- Rheumatology, Hopital Saint-Antoine, Sorbonne University, Paris, France
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17
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Tolonen HM, Falck J, Kurki P, Ruokoniemi P, Hämeen-Anttila K, Shermock KM, Airaksinen M. Is There Any Research Evidence Beyond Surveys and Opinion Polls on Automatic Substitution of Biological Medicines? A Systematic Review. BioDrugs 2021; 35:547-561. [PMID: 34398421 PMCID: PMC8502744 DOI: 10.1007/s40259-021-00493-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/13/2022]
Abstract
Background Biosimilars are expected to decrease growing health care expenditures. Given that uptake of biosimilars has been modest, automatic substitution has been suggested to increase their use, but the practice is not yet allowed or implemented in many jurisdictions. Methods A systematic review was performed by searching databases Scopus, Medline (Ovid), CINAHL, and Web of Science. Peer-reviewed, original studies written in English and published during the period January 1, 2006 to April 24, 2021 reporting any interventions, pilots or any other studies including experiences or perceptions of any relevant stakeholders on automatic substitution of biologics were included without limitation by setting or geography. The quality of the included studies were evaluated by pre-determined criteria. Results Altogether, 27 studies fulfilled the inclusion criteria, of which 23 were surveys, and four semi-structured interviews reporting mainly stakeholders’ perceptions on automatic substitution. Most of the studies (56%, 15/27) were from Europe. Studies were conducted among prescribers (n = 12), pharmacists (n = 5), patients (n = 4), payers (n = 1), and mixed stakeholders (n = 5). The primary objective of the majority (81%, 22/27) of the studies was to investigate some other biosimilar topic than automatic substitution. The reported perceptions of substitution were mainly negative. Studies evaluating risks, safety or effectiveness, or reporting real-life experiences of biologic substitution were lacking except one intervention and two prospective risk management studies. The overall quality of the studies was low to moderate, and the results were not generalizable due to convenience sampling not representing the populations of interest, and low response rates. Conclusions The current research evidence on the automatic substitution of biologics is scarce and of low to moderate quality, reflecting low stakeholder knowledge and their cautious attitude towards biosimilars. The safe and efficient implementation of automatic substitution requires well-designed practices, pilot studies, and evolving legislation. Supplementary Information The online version contains supplementary material available at 10.1007/s40259-021-00493-8.
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Affiliation(s)
- Hanna M Tolonen
- HUS Pharmacy, HUS Helsinki University Hospital, Stenbäckinkatu 9, 00029, Helsinki, Finland. .,Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
| | - Jenni Falck
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.,University Pharmacy, Helsinki, Finland
| | | | | | | | - Kenneth M Shermock
- Center for Medication Quality and Outcomes, The Johns Hopkins Health System, Baltimore, MD, USA.,Center for Drug Safety and Effectiveness, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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18
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Patient perspectives on the British Columbia Biosimilars Initiative: a qualitative descriptive study. Rheumatol Int 2021; 42:1831-1842. [PMID: 33961101 PMCID: PMC8102664 DOI: 10.1007/s00296-021-04874-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
In May 2019, the Government of British Columbia (BC) announced the implementation of the Biosimilars Initiative, mandating the switch of biologic (originator) drugs to biosimilars for certain patient populations in the hopes of optimizing public resources. Through this qualitative study, we aimed to identify patients’ perspectives as they undergo this change. From October 2019 to July 2020, we conducted nine pre- and six post-switch to biosimilar interviews with BC, English speaking participants, who were 18 years or older, and were currently taking a biologic medication. Participants were interviewed pre- and post-switch to a biosimilar medication and interviews were audio-recorded and transcribed verbatim for qualitative analysis. Interviews were thematically analysed and major themes and sub-categories were elucidated. The themes derived from pre and post-switch interviews captured participants’ anticipated or experienced barriers and enablers to the policy change. In general, the fears and apprehension of participants approaching the switch, including concerns surrounding the efficacy and safety of biosimilars, were addressed by their rheumatologist and social support circles. For the most part, participants were able to successfully manage their disease regardless of their baseline concerns about efficacy and safety. Experiences of changes in health delivery models were also observed secondary to the impact of the COVID-19 pandemic amongst participants. This study is the first of its kind to characterize the patient perspective regarding the BC Biosimilars Initiative. The incorporation of the patient perspective, including adequate provider-patient communication and shared decision-making can help to inform future non-medical switching policy changes.
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19
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Fenna J, McCormack D, Kitchen S, Martins D, Gomes T, Tadrous M. Effect of listing strategies on utilization of antitumor necrosis factor biologics infliximab and etanercept: a cross-sectional analysis from Ontario, Canada. J Manag Care Spec Pharm 2021. [DOI: 10.18553/jmcp.2021.27.4.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jennifer Fenna
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada, and Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Sophie Kitchen
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Diana Martins
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto; Li Ka Shing Knowledge Institute, Unity Health Toronto; and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto; ICES; and Women’s College Research Institute, Toronto, Canada
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20
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Informing Patients about Biosimilar Medicines: The Role of European Patient Associations. Pharmaceuticals (Basel) 2021; 14:ph14020117. [PMID: 33557030 PMCID: PMC7913743 DOI: 10.3390/ph14020117] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/14/2022] Open
Abstract
Biosimilar medicines support the sustainability of national healthcare systems, by reducing costs of biological therapies through increased competition. However, their adoption into clinical practice largely depends on the acceptance of healthcare providers and patients. Patients are different from health care professionals (HCPs), who are informing themselves professionally. For patients, the biosimilar debate only becomes actual when they are confronted with disease and drug choices. This paper provides a literature review on how patients are and should be informed about biosimilars, searching in scientific databases (i.e., Medline, Embase). Several large surveys have shown a lack of knowledge and trust in biosimilars among European patients in recent years. This review identified five main strategies to inform patients about biosimilars: (1) provide understandable information, (2) in a positive and transparent way, (3) tailored to the individual’s needs, (4) with one voice, and (5) supported by audiovisual material. Moreover, the importance of a multistakeholder approach was underlined by describing the role of each stakeholder. Patients are a large and diffuse target group to be reached by educational programs. Therefore, patient associations have become increasingly important in correctly informing patients about biosimilar medicines. This has led to widespread biosimilar information for patients among European patient associations. Therefore, a web-based screening of European Patients’ Forum (EPF) and International Alliance of Patients’ Organizations (IAPO) member organizations on publicly available information about biosimilars was performed. We found that the level of detail, correctness, and the tone of the provided information varied. In conclusion, it is paramount to set up a close collaboration between all stakeholders to communicate, develop, and disseminate factual information about biosimilars for patients.
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21
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Perpoil A, Grimandi G, Birklé S, Simonet JF, Chiffoleau A, Bocquet F. Public Health Impact of Using Biosimilars, Is Automated Follow up Relevant? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010186. [PMID: 33383867 PMCID: PMC7796345 DOI: 10.3390/ijerph18010186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 12/13/2022]
Abstract
Biologic reference drugs and their copies, biosimilars, have a complex structure. Biosimilars need to demonstrate their biosimilarity during development but unpredictable variations can remain, such as micro-heterogeneity. The healthcare community may raise questions regarding the clinical outcomes induced by this micro-heterogeneity. Indeed, unwanted immune reactions may be induced for numerous reasons, including product variations. However, it is challenging to assess these unwanted immune reactions because of the multiplicity of causes and potential delays before any reaction. Moreover, safety assessments as part of preclinical studies and clinical trials may be of limited value with respect to immunogenicity assessments because they are performed on a standardised population during a limited period. Real-life data could therefore supplement the assessments of clinical trials by including data on the real-life use of biosimilars, such as switches. Furthermore, real-life data also include any economic incentives to prescribe or use biosimilars. This article raises the question of relevance of automating real life data processing regarding Biosimilars. The objective is to initiate a discussion about different approaches involving Machine Learning. So, the discussion is established regarding implementation of Neural Network model to ensure safety of biosimilars subject to economic incentives. Nevertheless, the application of Machine Learning in the healthcare field raises ethical, legal and technical issues that require further discussion.
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Affiliation(s)
- Antoine Perpoil
- Compliance Department, Amgen SAS, 92100 Boulogne-Billancourt, France; (A.P.); (J.-F.S.)
| | - Gael Grimandi
- Faculty of Pharmaceutical and Biological Sciences, University of Nantes, 44035 Nantes, France; (G.G.); (S.B.)
- University of Nantes, INSERM UMR1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, 44322 Nantes, France
- Central Pharmacy, University Public Hospitals of Nantes, 44093 Nantes, France
| | - Stéphane Birklé
- Faculty of Pharmaceutical and Biological Sciences, University of Nantes, 44035 Nantes, France; (G.G.); (S.B.)
- Université de Nantes, CRCINA, F-44000 Nantes, France
| | - Jean-François Simonet
- Compliance Department, Amgen SAS, 92100 Boulogne-Billancourt, France; (A.P.); (J.-F.S.)
| | - Anne Chiffoleau
- Sponsor Department, University Public Hospitals of Nantes, 44093 Nantes, France;
| | - François Bocquet
- Law and Social Change Laboratory, Faculty of Law and Political Sciences, University of Nantes, CNRS UMR6297, 44300 Nantes, France
- Oncology Data Factory and Analytics Department, Institut de Cancérologie de l’Ouest, 44800 Nantes-Angers, France
- Correspondence:
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22
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Ismailov R, Simoens S, Khasanova Z. Greater awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado, United States: Real-world data. World J Rheumatol 2020; 10:1-10. [DOI: 10.5499/wjr.v10.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.
AIM To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others (e.g., medical professionals, family members, friends).
METHODS Our goal was to work with 80 rheumatology teams in Colorado. We developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous survey.
RESULTS There were a total of 49 (2.5%) rheumatology patients who responded to our survey. After reading our educational booklet, many survey respondents identified the correct answer in most questions focused on biosimilars or shared decision-making. Our survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or options. The improvement in scores after reading our educational materials was statistically significant for biosimilars and shared decision-making.
CONCLUSION Overall, the level of knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado was low. More educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.
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Affiliation(s)
- Rovshan Ismailov
- Complex Mechanisms of Disease, Aging and Trauma Research Foundation, Denver, CO 80246, United States
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven 3000, Belgium
| | - Zaytuna Khasanova
- Complex Mechanisms of Disease, Aging and Trauma Research Foundation, Denver, CO 80246, United States
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Chan SJ, Yeo HY, Stamp LK, Treharne GJ, Marra CA. What Are the Preferences of Patients With Rheumatoid Arthritis for Treatment Modification? A Scoping Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:505-532. [PMID: 33336324 DOI: 10.1007/s40271-020-00488-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Optimal care of rheumatoid arthritis (RA) patients entails regular assessment of disease activity and appropriate adjustment of disease-modifying antirheumatic drugs (DMARDs) until a predefined treatment goal is achieved. This raises questions about the approach to treatment decision making among RA patients and their preference for associated treatment changes. We aimed to systematically identify and synthesize the available evidence of RA patients' preferences regarding DMARD modification with an emphasis on escalating, tapering, stopping, or switching of DMARDs. METHODS A scoping review was undertaken to gauge the breadth of evidence from the range of studies relating to RA patients' preferences for DMARD modification. Pertinent databases were searched for relevant studies published between 1988 and 2019. Conventional content analysis was applied to generate themes about how patients perceive changes to their RA treatment. RESULTS Of the 1730 distinct articles identified, 32 were included for review. Eight studies investigated RA patients' perceptions of switching to other DMARDs, 18 studies reported RA patients' preferences for escalating treatment, and six studies explored the possibility of tapering or stopping of biologic DMARDs. Four overarching themes relating to RA patients' preferences for treatment modification were identified: (i) patient satisfaction, (ii) patients' beliefs, (iii) information needs, and (iv) patient-clinician relationships. CONCLUSION Uptake of treatment changes in clinical practice can be improved by understanding how RA patients approach the decision to modify their treatment and how this relates to their satisfaction, beliefs, information needs, and relationships with clinicians. Future work is needed to systematically determine the significance of these factors in RA patients' decision-making processes.
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Affiliation(s)
- Suz Jack Chan
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Hui Yee Yeo
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Cohen JD, Tropé S, Paubel P, Munos A, Bocquet F. Preconceived notions about biosimilars—a French experience. Clin Rheumatol 2020; 39:2251-2254. [DOI: 10.1007/s10067-020-05229-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/23/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
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25
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Kravvariti E, Kitas GD, Sfikakis PP. The role of the Nocebo effect in the use of biosimilars in routine rheumatology clinical practice. Mediterr J Rheumatol 2020; 30:63-68. [PMID: 32524080 PMCID: PMC7280873 DOI: 10.31138/mjr.30.1.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/05/2022] Open
Affiliation(s)
- Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - George D Kitas
- Clinical Research Unit, Dudley Group NHS Foundation Trust, Dudley, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National & Kapodistrian University of Athens Medical School, Athens, Greece
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26
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Fleischmann R, Jairath V, Mysler E, Nicholls D, Declerck P. Nonmedical Switching From Originators to Biosimilars: Does the Nocebo Effect Explain Treatment Failures and Adverse Events in Rheumatology and Gastroenterology? Rheumatol Ther 2020; 7:35-64. [PMID: 31950442 PMCID: PMC7021884 DOI: 10.1007/s40744-019-00190-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
The act of nonmedical switching, defined as switching stable patients who are generally doing well with their current therapy from an originator biologic to its biosimilar, has been endorsed as a reasonable treatment strategy. The safety and efficacy of nonmedical switching have been evaluated in randomized controlled and real-world evidence studies, which have demonstrated that although many patients maintain treatment response after the switch, some patients experience therapy failure, resulting in therapy discontinuation. It has been postulated that the vast majority, if not all, of these treatment failures result from a "nocebo effect", defined as patients' negative expectations toward the therapy change. Reports suggest that the risk of a nocebo effect is higher following a mandated nonmedical switch. Although the nocebo effect is a well-recognized phenomenon in pain studies, evidence is limited in immune-mediated diseases primarily because it is difficult to quantify, especially retrospectively. In spite of this, numerous biosimilar studies in patients with immune-mediated diseases have concluded that nonmedical switching failures are due to a nocebo effect. The objective of this narrative review was to explore the reasons for nonmedical switch failure or discontinuation and the role of the nocebo effect among patients with inflammatory rheumatic and gastrointestinal diseases who switched from an originator biologic to its biosimilar.
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Affiliation(s)
- Roy Fleischmann
- University of Texas Southwestern Medical Center, Metropleac Clinical Research Center, 8144 Walnut Hill Lane, Dallas, TX, 75231, USA.
| | - Vipul Jairath
- Division of Gastroenterology, Departments of Medicine, Epidemiology and Biostatistics, University Hospital, Western University, Room A10-228, London, ON, Canada
| | - Eduardo Mysler
- Organización Médica de Investigación, Callao 384 Piso 2 Dto 6, CABA, C1022AAQ, Buenos Aires, Argentina
| | - Dave Nicholls
- Coast Joint Care, University of the Sunshine Coast, Maroochy Waters Shopping Centre, Denna Street, Maroochydore, QLD, 4558, Australia
| | - Paul Declerck
- University of Leuven, Campus Gasthuisberg O&N 2, Herestraat 49, P.B. 820, 3000, Leuven, Belgium
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27
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Sung YK, Jung SY, Kim H, Choi S, Im SG, Lee YS, Jang EJ, Cho SK. Factors for starting biosimilar TNF inhibitors in patients with rheumatic diseases in the real world. PLoS One 2020; 15:e0227960. [PMID: 31978121 PMCID: PMC6980538 DOI: 10.1371/journal.pone.0227960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background To identify factors for starting biosimilar TNF inhibitors (TNFI) in patients with rheumatic diseases. Methods and finding Using a national claims database, we identified patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) who had used TNFIs since they were approved in Korea in 2004. We assessed changes in the proportion of each form of TNFI used between 2004 and 2017. We then selected patients starting on TNFIs between 2013 and 2017 to identify factors for starting biosimilars. In RA (n = 4,216), biosimilars were more likely to be initiated in clinics [odds ratio (OR) 2.54] and in the metropolitan area (OR, 2.02), but were less likely to be initiated in general hospitals (OR 0.40) or orthopedics (OR 0.44). In AS (n = 2,338), biosimilars were common at the hospital level (OR 2.20) and tended to increase over the years (OR 1.16), but were initiated less in orthopedics (OR 0.07). In addition, RA patients were more likely to initiate biosimilars in combination with methotrexate (OR 1.37), but biosimilars were not initiated frequently by patients with higher comorbidity scores (OR 0.97) or receiving glucocorticoids (OR 0.67). The patient factors favoring biosimilar in AS use were not clear. Conclusions In Korea, the proportion of biosimilar TNFIs has increased. Type of institution and physician specialty are more important than patient factors in affecting biosimilar use. In RA, biosimilar TNFIs tend to be initiated in combination with MTX, and are less likely to be initiated in patients taking glucocorticoids or in those with high comorbidities.
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Affiliation(s)
- Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Hyoungyoung Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Seongmi Choi
- Department of Statistics, Kyungpook National University, Buk-gu, Daegu, Republic of Korea
| | - Seul Gi Im
- Department of Statistics, Kyungpook National University, Buk-gu, Daegu, Republic of Korea
| | - Yu Sang Lee
- Department of Statistics, Kyungpook National University, Buk-gu, Daegu, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Republic of Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
- * E-mail:
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28
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Peyrin-Biroulet L, Lönnfors S, Avedano L, Danese S. Changes in inflammatory bowel disease patients' perspectives on biosimilars: A follow-up survey. United European Gastroenterol J 2019; 7:1345-1352. [PMID: 31839960 DOI: 10.1177/2050640619883704] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/22/2019] [Indexed: 01/13/2023] Open
Abstract
Background and aims The aim of this survey was to find out whether the perspectives of patients with inflammatory bowel disease concerning biosimilars have changed since the publication of our last survey carried out in 2014-2015. Methods An online survey consisting of 19 questions was made available by the European Federation of Crohn's and Ulcerative Colitis Associations between July 2018 and December 2018. Only respondents who had heard of biosimilars were asked to respond to all of the questions. Results In total, 1619 patients with inflammatory bowel disease responded the questionnaire. Most respondents were from Europe (79%), followed by Asia (8%), South America (7%) and Africa (5%). Some 44% of them had heard of biosimilars, and only these respondents continued to the biosimilar-specific questions. Respondents worried significantly more about biosimilars being less effective than the originator (50% in current and 39% in previous survey, p = 0.0004). However, respondents were more likely to believe that biosimilars will have an impact on the management of inflammatory bowel disease (75% in current and 62% in previous survey). Conclusions Many patients with inflammatory bowel disease remain unfamiliar with biosimilars. Although patients still worry about different aspects regarding biosimilars, they also tend to be more confident that biosimilars will have an impact on the management of their disease. More patient education is still needed to raise awareness about biosimilars.
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Affiliation(s)
- Laurent Peyrin-Biroulet
- Inserm 1256 Ngere and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Sanna Lönnfors
- European Federation of Crohn's and Ulcerative Colitis Associations, Brussels, Belgium
| | - Luisa Avedano
- European Federation of Crohn's and Ulcerative Colitis Associations, Brussels, Belgium
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas University, Milan, Italy
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