Despite Educational Efforts, Providers Still Lack Knowledge on Biosimilars

Stakeholders hoping to see increased uptake of biosimilars in the United States are increasingly pointing to a lack of provider awareness as a key hindrance to the biosimilars marketplace. New research, to be presented at the American College of Rheumatology Annual Meeting in Chicago, Illinois, held from October 19-24, 2018, suggests that, despite efforts to educate providers, awareness of biosimilars—as well as awareness of patients’ attitudes toward them—remains low.

First, a research team from Clinical Care Options and the University of Alabama sought to measure providers’ competence with biosimilars and address educational gaps related to these products using a 2-phase online program.¹

The effort included a questionnaire that measured 1546 physicians’ knowledge of biosimilars before and after educational exercises. To address key gaps in awareness, the investigators developed their educational plan around questions that had a high frequency of incorrect responses at baseline.

At baseline, 61% of respondents—comprised of rheumatologists, gastroenterologists, dermatologists, allergists, immunologist, primary care physicians, oncologists, and other specialists—incorrectly reported that biosimilars have different efficacy from their reference products. Furthermore, 62% were not aware that biosimilars cannot be automatically substituted at the pharmacy level. Finally, 77% did not understand the concept of the extrapolation of indications for biosimilars.

After the educational program concluded, the absolute improvement in correct responses to questions from baseline was 37%, 33%, and 48% for the questions related to efficacy, substitution, and extrapolation, respectively.

The investigators concluded that these gaps in knowledge may explain why some clinicians are reluctant to consider biosimilars as treatment options for their patients.

A second research team, from Vindico Medical Education, found similar gaps in physician knowledge in their own study, based on a survey of 598 providers (rheumatologists, internists, and pharmacists) and 17 patients with rheumatoid arthritis.²

The investigators found that 49% of the providers felt their knowledge about differences between biosimilars and their reference products was “fair or poor.” Similarly, 66% lacked knowlege of the regulatory pathway for biosimilars.

Despite these gaps in understanding, 78% of rheumatologists reported that they would be comfortable prescribing a biosimilar, and 57% of pharmacists felt that biosimilars deemed interchangeable by the FDA should be substitutable at the pharmacy level (though only 16% of rheumatologists agreed with automatic substitution).

Notably, they also found that providers lacked awareness of what concerned their patients most about biosimilars. “Regarding patient concerns about biosimilars, physicians and pharmacists overestimated concerns regarding decreased efficacy and underestimated concerns regarding side effects,” wrote the authors. Patients’ greatest concern was being forced to switch products due to a payer decision, they found.

The researchers concluded that providers lack knowledge of biosimilars, and do not adequately understand patient’s concerns about these drugs. Continued educational efforts, they say, will be necessary to ensure the proper use of biosimilars.

References

1. Schwartz Z, Schulz J, Vinther A, Kuklinski A, Saag K. Uncovering clinicians’ gaps and attitudes toward biosimilars: impact of a 2-phase educational program. Presented at the American College of Rheumatology 2018 meeting, October 19-24, 2018; Chicago, Illinois. Abstract 2530. https://acrabstracts.org/abstract/uncovering-clinicians-gaps-and-attitudes-toward-biosimilars-impact-of-a-2-phase-educational-program/.

2. Robinson K, Esgro R. Revealing and addressing knowledge gaps regarding biosimilars in rheumatology practice with targeted continuing education and patient surveys. Presented at the American College of Rheumatology 2018 meeting, October 19-24, 2018; Chicago, Illinois. Abstract 2526. https://acrabstracts.org/abstract/revealing-and-addressing-knowledge-gaps-regarding-biosimilars-in-rheumatology-practice-with-targeted-continuing-education-and-patient-surveys/.