Gastroenterologist Recounts Clinical Experience With Switching Patients to Biosimilars

In an interview with The Center for Biosimilars^®, Jason Schairer, MD, a gastroenterologist practicing in the Henry Ford Health System in Michigan who specializes in treating patients with inflammatory bowel disease, said that he has seen biosimilars begin to make inroads into clinical practice.

“In our practice,” he said, biosimilars “have slowly been increasing uptake based on provider preference, based on insurance company preference, and based on pharmacy preference to the point where many of our patients are currently receiving biosimilar [anti—tumor necrosis factor] therapy.”

Patients who are naïve to a given agent have had no qualms about starting treatment with a biosimilar rather than a reference product, he reports, although patients who are well maintained on a reference product are sometimes apprehensive, and that requires educating the patient about the data on switching.

Patients in Schairer’s practice who have switched to a biosimilar have not experienced any clinical differences in their treatment thus far, and Schairer points out that some of his patients have had to switch their therapy back and forth multiple times.

“A couple different things are coming together,” he said. “The first is that the individual insurance may mandate medication or the other. In addition, the insurer may now currently recommend that we don’t do our infusions in our office but rather in a third-party infusion center, and that infusion center may have their own pharmacy that has their own preference,” so patients may have switched from a first medication to a second in the practice’s own setting, then back to the first medication in the infusion center setting.

Despite the fact that no biosimilars are yet designated interchangeable by the FDA, says Schairer, “I think the data from Europe support that it should be safe and reasonable, and clinically I’ve seen no problems” in undertaking multiple switches. The primary problem with multiple switches is that it can be frustrating for patients and require additional paperwork for providers.

“I see no reason as a healthcare provider to intentionally go back and forth needlessly, but I see no concerns that, if I do that, bad things would happen.”

Schairer explained that he has spoken with many fellow providers from around the country who have reached out about insurers’ mandates that patients switch treatments. “They have their own anxieties and worries about that process. Now, I don’t share most of their anxieties, but I appreciate that it’s very concerning when you’re used to something that’s been working.”

In counseling his peers on the process of switching patients, he said, “We reference the NOR-SWITCH trial, we reference the Italian data, the Korean data. In general, people have not lost response and, for the most part, have not had increased side effects. I just tell them that, if it’s going to save our patients money, I’m okay with it, but I do hope that insurers are passing savings on to the patients.”

Whether those savings are indeed passed along is an open question; Schairer says that, so far, patients have not yet told him about saving money by switching to a biosimilar. Instead, they have told him that their costs will rise if they fail to make the switch. While biosimilars may be providing savings for the healthcare system as a whole, “I can’t really say [patients] are being factored into the decision.”

Schairer discloses speaking on biosimilars at events sponsored by Pfizer.