Lack of Biosimilar Awareness Persists in the US and Europe, Review Finds

Biosimilars have the potential to deliver substantial savings to the healthcare system, but only insofar as they are adopted and used in clinical practice. A newly published systematic review evaluated US and European healthcare provider knowledge, perceptions, and prescribing behaviors related to biosimilars, and it found that providers are still taking a cautious approach to biosimilars in part because of a lack of awareness of these medicines.

The review, conducted by researchers from the University of North Carolina at Chapel Hill and Premier, Inc, relied on data derived from 20 surveys, published between 2014 and 2017, originating from the United States, Belgium, France, Germany, Italy, Ireland, Malta, Hungary, and the United Kingdom.

In total, 16 of the studies addressed providers’ biosimilar prescribing habits. One 2014 study found that 61% of gastroenterologists had little or no confidence in biosimilars, while a 2016 study found that just 7% of rheumatologists had prescribed a biosimilar. A 2016 study found that 51% of providers limited biosimilars to biologic-naïve patients. Limited biosimilar use in small patient groups was also reported by 38% of respondents in a 2017 survey, and another 2017 study found that 95% of providers preferred to use an originator product versus a biosimilar as first-line therapy for inflammatory diseases.

Providers reported that self-study and literature available in peer-reviewed journals and/or professional guidelines were the most trusted sources of biosimilar information in the United States and Europe. However, the researchers wrote, an overall lack of awareness about biosimilars persists in both the United States and Europe, with only 22.9% of physicians and 38.8% of pharmacists reporting “complete” or “good” knowledge of biosimilars in a 2016 survey. A 2017 survey of dermatologists found that 27% of providers said they had a “complete” understanding of biosimilars, but, concerningly, 21% of that group described biosimilars incorrectly.

Clinicians also reported having concerns about biosimilars, primarily related to immunogenicity. A 2016 survey found that 23% of providers believed biosimilars to have a higher risk of immunogenicity than reference products, and more than 60% of providers in a 2017 survey reported similar concerns about immunogenicity.

Providers also took issue with biosimilars’ safety and efficacy in extrapolated indications, with over 39% of rheumatologists in a 2017 survey objecting to the extrapolation of indications for biosimilars.

Another area of concern and lack of awareness among providers is interchangeability and pharmacy-level substitution; In 2016, 89.9% of surveyed clinicians disagreed with pharmacy-level substitution of a biosimilar, and in another 2016 survey, 80% of respondents were unaware that an interchangeability designation could result in automatic substitution.

“Findings from this study indicate that clinicians in the United States and Europe are cautious about biosimilar use and do not predominantly support the use of biosimilars as safe and effective treatment options in patients already receiving bio-originator therapy,” wrote the authors, adding that “biosimilar-specific education remains a relatively neglected area of emphasis in the published literature.” The authors suggest that educational efforts focus on the major areas of immunogenicity, extrapolation, and interchangeability to build awareness and confidence among providers.

Reference

Leonard E, Wascovich M, Oskouei S, Gurz P, Carpenter D. Factors affecting health care provider knowledge and acceptance of biosimilar medicines: a systematic review. J Manag Care Spec Pharm. 2019;25(1):102-112. doi: 10.18553/jmcp.2019.25.1.102.