Patients are willing to switch to a biosimilar – if the message is right

A patient’s willingness to switch from an originator to biosimilar molecule is influenced by how the physician frames the discussion, specialists in New Zealand have shown.

Patients with RA were twice as willing to switch when given a positively framed brief explanation about biosimilars that emphasised the similarities with originator drug, compared to when their physician focused on the differences and uncertainties, a study found.

‘Positive framing’ of discussions also led to patients having a perception of greater biosimilar efficacy, according to the study involving 96 biologic-using patients recruited in an Auckland  rheumatology outpatients clinic.

Clinicians at the University of Auckland tested the impact of how messages on biosimilars are framed by exposing patients to one of two different video explanations by a physician – with either positive or negative framing.

When similarities between biologic and biosimilar were emphasised in the explanation and the physician used positive body language such as smiles and nods, 67% (32/48) of patients reported they were willing to switch to a biosimilar.

However when the explanation focused on differences between biologics and biosimilars, and the physician used negative body language and less confident vocal tone to imply uncertainty regarding efficacy and safety, only 47% of patients expressed a willingness to switch to a biosimilar.

Overall, patients in the positive framing group were 2.36 times more likely to be willing to switch to the biosimilar than those in the negative group. Patients in the positive group also thought the biosimilar would be significantly more effective than those who in the negative group. There were no differences in perceptions of  safety, expected side effects, concerns or anxiety about switching.

The overwhelming concerns about biosimilars expressed by patients related to possible loss of efficacy compared to their current biologic, rather than safety, side effects or manufacturing quality.

“It has taken almost 20 years to find a medication combo that works reasonably well – I worry that a biosimilar would be going backwards,” said one patient.

Others believed there hadn’t been enough research into biosimilars and that they would be “guinea pigs.”

The researchers said the findings showed that a brief positively-framed explanation could help overcome the negative perceptions of biosimilar efficacy held by many patients that act as a barrier to switching.

Notably, patients believed they would need at least a 30 minute consultation with the rheumatologist to discuss biosimilars, whereas physicians believed 10 minutes would be sufficient.

“The results suggest that a similar video explanation could be developed into an intervention to improve perceptions and willingness to switch to biosimilars. Patients could view such an intervention video prior to their consultation, to receive initial information about biosimilars.

“This could help to prevent lengthened consultation times, while still ensuring that patients have sufficient information to make informed treatment decisions.”

The findings are published in Arthritis Care and Research.

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