Monday, June 26, 2017

Patients’ Perspectives Concerning a Shift to Biosimilars at the 2017 EULAR Annual Meeting in Madrid

I have already looked at biosimilars at the 2017 EULAR Annual Meeting in Madrid [1]. But we have less data on the patients’ perspectives. Luckily the Danish Rheumatism Association shared experiences at the meeting.

L.M. Thomsen presented [2]: “PATIENT SAFETY IN RELATION TO BIOSIMILARS – HOW CAN WE ACT AS A PATIENT ORGANIZATION?” Changing from originator drug to biosimilars “caused considerable insecurity among the patients, who were afraid of biosimilars and their effectiveness and safety profile.” The Danish Rheumatism Association participated in a national plan for better monitoring and information about biologics and biosimilars: “1) Monitoring biological drugs and biosimilars on batch level, 2) Information campaign to health professionals and patients, 3) Digital solutions and easy reporting of side effects from health professionals and patients, 4) Focus on monitoring patient safety by the authorities.”

I had already referred to B. Glintborg and colleagues, who presented the following study [3]: “PRESCRIPTION PATTERNS OF BIOLOGICAL DISEASE MODIFYING DRUGS AND BIOSIMILARS IN ANKYLOSING SPONDYLITIS – A COLLABORATION BETWEEN BIOLOGICAL REGISTERS IN THE FIVE NORDIC COUNTRIES”. Conclusions: “The use of bsDMARDs in AS is rapidly increasing. …”. The interesting part is the picture. If an infliximab biosimilar is introduced, one would assume that originator infliximab is prescribed less frequently. That happened, but at a slower rate than expected. Also the etanercept biosimilar soared up after introduction. Interestingly this has led to a reduction in prescribing not only of etanercept originator but also of the infliximab biosimilar. But a strange thing happened – the rate of prescriptions for adalimumab, golimumab, and certolizumab decreased rapidly in the wake of the introduction of biosimilars; the drop even accelerated after the launch of the etanercept biosimilar.
In 2014 a total of 1164 patients had been treated with either originator biologics or biosimilars, in 2015 the number reached 1338 patients, and in 2016 the total number dropped to 1165 patients.

When changing to biologics, we like to save money and treat more patients. But the opposite happened. It might be the reflection of anxiety and insecurity about effectiveness and safety of biosimilars on the side of the patients, but on the side of prescribing rheumatologists it might reflect uncertainties in the vicissitudes of reimbursements and information policies. Is a shared decision between patient and rheumatologist still possible or have other forces already driven wedge in between the two?

Links and References:
[2] DOI: 10.1136/annrheumdis-2017-eular.3716
[3] DOI: 10.1136/annrheumdis-2017-eular.1891


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