A recent paper published in the World Journal of Gastroenterology examines the complexities posed by biologics and biosimilars in the transition care of adolescent patients who have inflammatory bowel disease (IBD).
A recent paper published in the World Journal of Gastroenterology examines the complexities posed by biologics and biosimilars in the transition care of adolescent patients who have inflammatory bowel disease (IBD). The authors, who practice gastroenterology at Southampton Children’s Hospital in the United Kingdom, define transition care as the planned movement of adolescent and young adult patients with chronic conditions from a child-centered to an adult-centered healthcare system.
Adolescents with IBD face unique age-related challenges: those taking oral medications and injections of biologics may experience delayed puberty and related issues of self-confidence. They may also have difficulty in communicating openly with new healthcare providers. Adolescent patients in the United States who attend college away from home may face additional challenges related to using their parents’ medical insurance, while patients in Canada, who must be treated as adults by age 18, must initiate transitional care at a younger age than they might in European nations. Pediatricians and adult practitioners may feel ill-equipped to effectively communicate treatment options to the adolescent patient population.
Biosimilars are of particular interest in transitioning this unique patient population to adult care; while monoclonal antibodies have revolutionized IBD treatment, biologics remain costly for health systems. Biosimilars have the potential to generate significant cost savings, and the paper’s authors cite a Royal College of Physicians audit that found that replacing infliximab with it’s biosimilar in all eligible patients with IBD in the United Kingdom’s National Health Service could realize an annual savings of £3 million (approximately $3.87 million). The authors also indicate that, in their Southampton health system alone, switching all patients with IBD from the reference to biosimilar infliximab could save the system up to £812,000 per year (approximately $1,046,586). Those savings could be directly invested into other services that would improve patient care.
However, switching from a reference treatment to a biosimilar is a particularly challenging decision in the transition care setting. While the British Society of Gastroenterology has advocated switching for patients with IBD, there are few data available on pediatric switching from reference biologics to biosimilars. Because anti-drug antibodies may develop within 2 to 3 treatments, the European Crohn’s Colitis Organisation recommends that patients with IBD not be switched for non-medical reasons, especially within the first 6 months of treatment with a biologic.
The authors of the paper suggest that switching in transition care—and potential problems arising from switching—can be avoided by initiating treatment for IBD only after a joint agreement between pediatric and adult teams. In the Southampton system, they report, joint meetings between adult practitioners and pediatric healthcare providers are used to make decisions on IBD treatment, and the practitioners send detailed treatment plans to both the hospital systems and to the affected patients for improved care coordination.
Adolescent patients should be made aware of all available options, however, and should have a proactive role in making decisions about their treatments. The authors suggest that adolescent patients with IBD should be encouraged to demonstrate responsibility in communicating with their healthcare providers concerning their therapies. “Although no data is available to prove this approach,” they say, “we feel this not only empowers patients to take active control but also helps in better compliance.”