UK Health Professionals Are Well Informed About Biosimilars

A survey and drug utilization analysis conducted among 234 UK healthcare professionals (HCPs) in the specialties of dermatology, diabetology, gastroenterology, and rheumatology found that 75% of respondents were aware that biosimilars were available on their local formularies, and 77% considered biosimilars to be either extremely or very important to save costs for the National Health Service (NHS). The survey, was published online in BMJ Open on June 21, 2017.

The study is the first conducted in the United Kingdom to assess HCPs’ knowledge and understanding of biosimilars and to compare and contrast that data with the utilization of infliximab and insulin glargine in UK hospitals.

The 234 prescribing HCPs consisted of consultants (senior hospital-based physicians), registrars (physicians receiving advanced training to become consultants), pharmacists, and nurses. The HCPs—practicing in the fields of dermatology, diabetology, gastroenterology, and rheumatology—who answered the 11-question Web-based survey were members of 9 UK specialists’ societies that made the survey available to their members. The HCP’s fields were evenly distributed, and most responses came from consultants and registrars. Most participants were general, hospital-based HCPs.

Information on biosimilar infliximab and insulin glargine utilization by specialty in UK hospitals was derived from data gathered since the introduction of infliximab (biosimilar to originator Remicade) and insulin glargine (biosimilar to originator Lantus) beginning in March and September of 2015, respectively, to December of 2016. The data were provided by DEFINE software, an NHS database of medication usage that collects data from approximately 120 hospitals and covers over 90% of NHS hospitals throughout the United Kingdom. The percentage of infliximab and insulin glargine biosimilar uptake was calculated using Microsoft Excel 2013.

Gastroenterologists were the most frequent prescribers of biosimilars, prescribing biosimilars every day or week, followed by rheumatologists and diabetologists. Dermatologists prescribed biosimilars the least frequently.

Gastroenterologists had the highest utilization of infliximab by specialty in the United Kingdom (67%), followed by rheumatologists (27%) and dermatologists (6%). Further analysis of the utilization of branded and biosimilar infliximab and insulin glargine by specialty in the United Kingdom showed that, compared with other specialties, gastroenterologists had the highest utilization of infliximab biosimilars (14%) in 2015, rising to 62% by 2016. This group was followed by rheumatologists (6%, 39%). By contrast, dermatologists had the lowest utilization of infliximab biosimilars in both years (6% and 35%, respectively). Diabetologists’ utilization of insulin glargine biosimilar in 2015 (0.5%) and in 2016 (9%) represented the lowest use of biosimilars overall.

The survey also showed that HCPs had greater concerns about the safety and efficacy of biosimilars when switching patients to biosimilars rather than initiating treatment in biologic-naïve patients. The researchers believe that personal experience of biologics as well as discipline-specific guidance influenced prescribers’ responses:

• Most gastroenterology consultants had no or minor concerns about safety (95%) and efficacy (90%) of biosimilars when initiating treatment (95%) or when switching patients (93%)
• Most rheumatology consultants also had no or minor concerns about safety (92%) and efficacy (88%) when initiating treatment
• Rheumatologists had major concerns about safety (53%) and efficacy (55%) when switching patients
• Such concerns prevented only a small proportion of HCPs from switching patients (2% on safety, 9% on efficacy)

Factors increasing the use of biosimilars included guidance from the National Institute for Health and Care Excellence and robust pharmacovigilance studies on biosimilars. Only marginally less influential were potential cost savings to their organizations, local policy, and robust cost-effectiveness data for biosimilars versus branded medicines. The variation in how specialists approached switching patients to biosimilars in the different therapeutic areas reflected personal perceptions of safety and efficacy of biosimilars as well as some influence of recommendations from published guidance on biosimilars from medical societies.

The considerable increase in the use of infliximab biosimilars between 2015 and 2016 most likely reflects the views of the majority of HCPs in the study, who considered prescribing biosimilars to be “important for saving costs to the NHS.”

Cost is likely to be a potent driver of such prescribing, the researchers write. “Our survey highlighted a variance in acceptance and utilization of infliximab biosimilars between specialties, with gastroenterologists the most positive followed by rheumatologists and dermatologists the least accepting,” they concluded. More robust pharmacovigilance studies on biosimilars and guidance from trusted and reputable medical bodies will be needed to drive additional uptake for biosimilar treatments.