Patients With RA, IBD Trust Specialists’ Biologic and Biosimilar Recommendations

Patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) have comparable positive attitudes towards biologics, and both felt that their specialists’ recommendations about biologic and targeted synthetic disease modifying agents (b/tsDMARDs) were trustworthy, even though most people also used other information sources, found an Australian study published in BMC Rheumatology.

The researchers sought to analyze patient beliefs about biologic and biosimilar therapy and what factors affect those beliefs. This is important because attitudes towards biosimilars can affect treatment adherence as well as impact a nocebo effect following a switch from a biologic originator.

In addition, while perceptions of patient and provider beliefs towards biosimilars has been explored, research contrasting populations with RA, or inflammatory arthritis (IA), as it is known in Australia and other parts of the world, and IBD, who see different specialists but use comparable biologics, has not yet been done.

“The introduction of biosimilars to the Australian pharmaceutical market has reduced the cost of biologics which may lead to easier access to these medicines with fewer restrictions in future. However, uncertainty regarding the concept of biosimilars and their regulatory process has created controversy around the prospect of switching from originators to biosimilars,” said the researchers.

Despite this, biosimilar use in rheumatology practice is increasing in Australia, although patient attitudes towards b/tsDMARD are not well understood. Australia currently has 3 etanercept biosimilars, 2 infliximab biosimilars, 8 adalimumab biosimilars, and 3 rituximab biosimilars.

An online questionnaire was advertised for people with a self-reported diagnosis of IA or IBD and combined the Belief about Medicines Questionnaire (BMQ) and the single-item literacy screener (SILS).

After exclusions, answers from 838 individuals were included in the final analysis (686 with IA, 144 with IBD, and 8 with both). Of those, 658 (79%) used b/tsDMARDs. The BMQ showed high necessity belief (median 4.2) with moderate concerns (median 2.8) about biologics.

The survey asked respondents not only where they got their medical information but also to note how favorable, or positive, they rated different information sources.

Most respondents (95%) got medication information from specialists, yet most used more than 1 source (median 4).

Specialists and specialist nurses were seen as the most positive source or information. A little over half (52%; 73/141) of respondents with IBD received information from specialist nurses compared with 202/685 (29%) with IA (P = .012).

Those who responded with limited reading ability on SILS were more likely to discuss information with a general practitioner or pharmacist. Respondents who had higher BMQ scores and were younger were more likely to consult less reliable sources, such as social media.

More than half of respondents (60%) answered the biosimilar questions and just 23 (4.6%) said they were currently using a biosimilar and 336 (66.9%) weren’t sure if biosimilars were available in Australia.

Recommendation by a specialist was the most frequent factor that would prompt a patient to change from an originator to a biosimilar (71/1%; 352/495).

Respondents with IBD reported that specialist nurse information is valuable, but said specialist nurses for IA are not nearly as accessible or available, showing the need for more training and implementation of rheumatology specialist nurses.

Of note, the researchers said, “The very low proportion of respondents in this survey who were currently using biosimilars is surprising and calls into question whether patients are aware of being on biosimilars or bio-originators and if they are being appropriately informed about switching, as we were not able to confirm the actual medication the patients were using.”

Previously, patients taking originator products thought that treatment cost shouldn’t influence prescribing, which might explain why this study’s respondents, almost all of whom said they were on originator products, were unsure about and put low importance on biosimilar financial benefits.

Those who were more concerned about biologics were more likely to seek information on social media, but the directionality of that relationship has not been determined, the authors said.

Some key limitations in the study included that the results were skewed towards the IA group because sample sizes between groups were inequal, and there was an inherent selection bias in the English survey circulated by consumer groups that might not show real-life clinic patient populations. Also, the survey relied on self-reported diagnoses and data was collected in 2020, and biosimilar and biologic awareness might have grown since then, with more positive attitudes and physician and patient acceptance.

Reference

Khoo T, Sidhu N, Marine F, et al. Perceptions towards biologic and biosimilar therapy of patients with rheumatic and gastroenterological conditions. BMC Rheumatol. Published online December 23, 2022. doi:10.1186/s41927-022-00309-4