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Approximately Half of Patients Demonstrated Poor Health Literacy Prior to Biosimilar Switch

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Health literacy was categorized as problematic in 36.2% of patients and insufficient in 15.1%.

The article was originally published on HCP Live®. This version has been lightly edited.

A real-world study showed patients with inflammatory bowel disease (IBD) or chronic inflammatory rheumatic disease treated with reference adalimumab who were switched to the biosimilar CT-P17 generally believed the switch was a treatment necessity. Higher satisfaction rates were observed among those who were convinced of the necessity compared with those with greater concerns about treatment.1

However, health literacy levels were categorized as either problematic or insufficient in 51.3% of patients with longer disease duration and long-standing biologic use, according to data presented at the 2024 European Congress of Rheumatology (EULAR).1

“Switches to biosimilars are not always well-accepted by patients,” wrote a team of investigators led by Laure Gossec, MD, PhD, professor of rheumatology in Sorbonne Université and Pitié-Salpêtrière Hospital, France.1 “Patients’ beliefs, concerns, and knowledge about health could impact their satisfaction towards switching.”

To assess the beliefs about medicine and health knowledge that may influence a patient’s satisfaction post-switch to a biosimilar, investigators conducted the prospective, multicenter, observational YU-MATTER study. The French study enrolled patients with IBD or chronic inflammatory rheumatic disease who were treated with the reference drug or a biosimilar with low concentration (50 mg/mL). These patients were then switched to CT-P17, a high concentration and citrate-free formulation, for 3 months.1

The primary outcome was patient satisfaction after the 3-month trial period, which was evaluated through a 7-point Likert scale. The Beliefs About Medicines Questionnaire (BMQ) was used to assess patient beliefs prior to the switch, including any concerns and perceived necessity.1

The BMW is a validated tool that has been shown to predict treatment adherence. The assessment consists of 2 5-item scales, in which a score of 1 represents “strongly disagree” and 5 represents “strongly agree,” that evaluate the necessity of a prescribed medication for managing their disease as well as worries about adverse effects.2

Patients’ knowledge was determined using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Any association between beliefs and/or knowledge and satisfaction with the switch was assessed using the Wilcoxon test.1

A total of 232 patients were included in the study, of which most (82%; n = 167) had either Crohn disease or ulcerative colitis, and 28% (n = 65) were diagnosed with a rheumatic condition, including rheumatoid arthritis (n = 17), non-radiographic axial spondyloarthritis/psoriatic arthritis (n = 13), or radiographic axial spondyloarthritis (n = 35). Among the cohort, the median disease duration was 9 years, the median age was 43 years, and approximately half of patients (49.6%) were women. The median total adalimumab duration prior to the switch was 47 months.1

The scores of both the BMQ and HLS-EU-Q16 were comparable across patient characteristics, including the type of disease, disease duration, duration of adalimumab treatment, age, and sex. The link between the HLS-EU-Q16 score and the BMQ necessity/concerns differential was moderate (Spearman coefficient, 0.37; 95% CI, 0.26-0.48).1

Before the switch to the biosimilar, patients reported an overall positive view of the drug, as determined by the BMQ-necessity score being higher than the BMQ-concerns score. Health literacy was deemed adequate in 48.7% of patients; however, it was categorized as problematic in 36.2% and insufficient in 15.1%.1

At the end of the trial, most (76.2%; n = 144/189) were satisfied with the switch to CT-P17. Unsurprisingly, the median necessity/concerns differential was higher among those who were satisfied with the switch compared with unsatisfied patients (+6 vs +3, respectively; P = .001). However, the HLS-EU-Q16 score was not linked to patient satisfaction (P = .12).1

“These results suggest that although satisfaction with switching was generally high, beliefs and concerns remain important and could lead to non-adherence,” investigators concluded.1 “Patient information and education should be reinforced before a switch to a biosimilar.”

References

  1. Gossec L, Bouguen G, Marotte H, Foulley, et al. Perceived Need for Treatment is Associated with Patient Satisfaction After a Switch to a Biosimilar; Health Literacy is Often Limited: A Prospective Multicentre Observational Study of 232 Patients. Presented at: EULAR. Vienna, Austria. June 12 – 15, 2024.
  2. R. Neame, A. Hammond, Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis, Rheumatology, Volume 44, Issue 6, June 2005, Pages 762–767, https://doi.org/10.1093/rheumatology/keh587

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