Researchers Report a Successful Switch and Suggest That Patient Education Played a Role

The switch included patients with rheumatoid arthritis and psoriatic arthritis who were treated at a single center in Amsterdam, the Netherlands.
Kelly Davio
May 16, 2019
The body of literature on switching form reference infliximab to biosimilar CT-P13 continues to grow, and this month, a new paper, appearing in the International Journal of Rheumatic Diseases, added new findings from a real-world switch conducted in the Netherlands.

The switch included patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) who were treated at a single center in Amsterdam, the Netherlands. In total, 47 patients were approached about switching via a letter and follow-up contact from a nurse or pharmacist. Communication about the switch followed the standards of the Dutch Association of Hospital Pharmacists.

Eventually, 45 patients—41 of whom had RA and 4 of whom had PsA—agreed to the switch and received CT-P13 at their next infusion. Concomitant methotrexate was taken by 69% of the patients.

The primary outcome of the study was the percentage of patients continuing treatment with the biosimilar at 2 years. Disease Activity Score in a count of 28 joints with erythrocyte sedimentation rate (DAS28-ESR) at 1 year was a secondary outcome. Each patient who switched was also asked to complete a qualitative questionnaire about the quality of information they received.

The last available mean (SD) DAS28‐ESR score prior to the transition was 2.34 (1.02). At 1 year after the switch, the mean (SD) DAS28‐ESR score was 2.31 (1.1).

At the end of 2 years, a total of 39 patients (87%) were still using CT-P13. Two patients switched to different anti–tumor necrosis factor therapies (1 to etanercept and 1 to adalimumab) because of inefficacy. Both of these patients had high DAS28-ESR scores at the time of the switch. One patient discontinued infliximab due to a malignancy. A total of 3 patients switched back to the reference infliximab. Among these 3 patients, at 2 years, 1 patient had discontinued the reference due to a malignancy, and 1 had switched to abatacept due to increased disease activity.

All 45 patients completed the questionnaire, and 15 (33%) said that the information they received about the switch was excellent, 24 (54%) said that it was good, 4 (9%) said that it was reasonable, and 2 (4%) said that it was sufficient. No patients said that the information provided was insufficient.

According to the study’s authors, the quality of the information provided—and the satisfaction of the patients with that information—may have contributed to the success of the switch and to the low discontinuation rates that were observed at 2 years.

Layegh Z, Ruwaard J, Hebing RCF, et al. Efficacious transition from reference infliximab to biosimilar infliximab in clinical practice. Int J Rheum Dis. 2019;22(5):969-873. doi: 10.1111/1756-185X.13512.


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