Survey Finds Korean Oncologists Trust Biosimilars But Prescribe Originators More

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Korean oncologists found biosimilars to be as safe and effective as originators, but paradox exists: they still tend to prescribe originators over biosimilars.

From September 2022 to October 2022, researchers collected responses from Korean oncologists who completed a web-based survey surrounding their perspective of biosimilars and likelihood of prescribing them to patients.¹ The survey was self-administered, conducted over a 15-day period, and included a total of 118 participants from the Republic of Korea. Characteristics of respondents included oncologists that worked for a 10- to 19-year period as a practicing specialist (n = 57) and those in private hospital settings (n = 80).

Biosimilars are not a new concept in the Republic of Korea; the first approval was in July 2012 for Remsima, an infliximab biosimilar.² The Ministry of Food and Drug Safety (MFDS) approved the biosimilar for arthritis and it launched on the market in November 2012, 3 years before the first US approval.

Samsung Bioepis collaborated with Samil Pharmaceutical to deliver an aflibercept biosimilar to the market in the Republic of Korea.³ The company was the first to have an approval for ranibizumab and aflibercept biosimilars in the Republic of Korea.

Among the survey respondents, 75.4% (n = 89) conveyed that they'd previously prescribed biosimilars to patients, 48.3% (n = 57) said they preferred originators to biosimilars, and 16.1% (n = 19) reported favoring biosimilars over originators.¹ The main reason behind oncologists's preference for originators over biosimilars was the established trust in safety and efficacy of originators (94.7%; n = 54/57). However, 87% (n = 47/54) and 85.2% (n = 46/54) acknowledged the comparable efficacy and safety of biosimilars and their originators.

Cost influenced some oncologists (64.9%), with 16.1% preferring biosimilars to ease patient burden. Metropolitan doctors leaned towards originators (58.2% vs 7.6% for biosimilars), but most (56.8%) were hesitant to switch patients. Notably, 90.7% said they would switch their patients if they're experiencing financial hardship. Both public and private hospitals favored originators, but public hospitals were more open to biosimilars (23.7% vs 43.8%).

In considering biosimilars compared with originators, oncologists prioritized efficacy (95.8%) and safety (94.1%), but not patient preference (38.2%). Notably, only 16.1% said they wouldn't prescribe biosimilars to new patients.

A majority of respondents said they found similarities between the originators and biosimilars, but only found them to be “similar but not interchangeable.” Only 1.7% (n = 2/118) of respondents believed biosimilars were “interchangeable” with originators in terms of safety.

More than half of the survey population (75.4%; n = 89) had previously prescribed biosimilars to patients while 24.6% (29) reported having no experience of prescribing biosimilars at all. Some physicians replied that they switched patients from originators to biosimilars and prescribed biologic-naïve patients (30.5%; n = 36). Some respondents expressed their desire to prescribe accessible biosimilars but were faced with external barriers such as exclusion from formularies or patient resistance to them.

Common concerns that arose when switching prescriptions to biosimilars were mainly based on the efficacy of the drug (49.2%; n = 58). The primary concern was patients' trust in pharmaceutical treatments, which could lead to reduced use of biosimilars. More than half of participating oncologists emphasized the necessity of providing patients with detailed explanations regarding their medication choices (66.9%; n = 79).

The study focused on oncologists, excluding dermatology and rheumatology, through a closed-ended survey that limited generalizability and depth of insights. A small sample size, particularly from public hospitals, further restricted interpretation.

Based on the research results, the researchers concluded that patients and providers do not always make rational economic decisions because of biases that ultimately impact biosimilar adoption. To maintain competition in the market, biosimilars need to be priced considerably lower than originators.

References

1. Shin G, Kim BS, Kim DY, et al. Unveiling the biosimilar paradox of oncologists’ perceptions and hesitations in South Korea: A web-based survey study. BioDrugs. 2024;38:301-311. https://doi.org/10.1007/s40259-023-00640-3

2. Biosimilars approved in South Korea. Generics and biosimilars initiative. March 26, 2021. Accessed May 6, 2024. https://gabionline.net/biosimilars/general/Biosimilars-approved-in-South-Korea

3. Jeremias S. Samsung Bioepis announces new biosimilar partnership, regulatory updates. The Center for Biosimilars. February 27, 2024. Accessed May 6, 2024. https://www.centerforbiosimilars.com/view/samsung-bioepis-announces-new-biosimilar-partnership-regulatory-updates