Medicines

Most RA patients will accept biosimilars


Most rheumatology patients would be comfortable taking a biosimilar if it is recommended by their doctor, a Victorian survey shows.

Around 75% of 127 patients surveyed at a tertiary RA clinic said they would accept a biosimilar medication if it was recommended by a rheumatologist.

The survey, carried out by Dr Tom Kovitwanichkanont and colleagues at Department of Rheumatology, Monash Health, found that only 5.6% of patients would refuse to switch to a biosimilar, with 19% of patients stating they were unsure. The main concerns of patients refusing biosimilars related to efficacy and general concerns about change.

More than a quarter said they would be concerned about pharmacy-level switching to biosimilars, with 26% significantly worried that their physician may be unaware if they were receiving the biosimilar or reference product. The survey also revealed that only 5% of patients had an understanding of biosimilars, despite almost half (45%) already taking a biological DMARD.

Prior to answering questions, the patients surveyed were given a brief education session on biosimilars. Most patients said they would like more information about biosimilars, according to the findings, presented at EULAR 2018 in Amsterdam.

Responding to the findings, Dr Mona Marabani, Co-chair of the  ARA’s Biosimilars Working Group said the findings highlighted the high degree of trust that patients have in the rheumatologist to offer the best therapeutic options for them.

Dr Marabani said the ARA’s position – based on the latest evidence –  is that biosimilars can be expected to perform in exactly the same way as the originator for a naïve patient.

Likewise a single change – from originator to biosimilar – does not appear to compromise safety or cause toxicity, at least in the short term.

“However, there is less evidence around multiple and repeated switches, between originator and its biosimilars, and this is where we advise caution,” Dr Marabani told the limbic.

Recent PBS changes to promote uptake of biosimilars with differential authority levels for an originator and its biosimilars could misleadingly imply that the drugs have a different efficacy or safety profile, she said.

Confusion could also arise under the new system because a patient on streamlined authority could receive either of the two biosimilar versions of etanercept, she noted.

“They will have to deal with learning to use different injector devices, and as the prescriber will possibly not know what brand they are taking at any particular time, working out which drug is to blame if there is a problem will be potentially difficult.

“So our advice remains that a stable patient is best left on the medicine that is working for them – either originator or biosimilar – and avoid multiple and unregulated swaps.

Noting there is no financial advantage to the patient with respect to which brand they are prescribed, Dr Marabani said the ARA’s advice was for the doctor to consider carefully the brand they wish to use for the patient and tick the ’brand substitution not permitted’ box if they so wish.

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