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Consulting With Clinical Pharmacists May Help Boost Biosimilar Adoption


Having patients meet with a clinical pharmacist before a rheumatologist could help improve biosimilar adoption rates and mitigate the nocebo effect in patients with chronic diseases, according to a recent study.

Consultation visits with a clinical pharmacist prior to one with a rheumatologist was found to significantly increase the number of patients who opted for a biosimilar over a reference product, according to a retrospective analysis.

The controlled, single-center, interventional, nonrandomized, retrospective study, which was published in Joint Bone Spine, supported that idea that clinical pharmacists could aid in biosimilar adoption efforts and mitigate concerns over the nocebo effect. Additionally, education efforts that are tailored to individual patients could be beneficial in preventing and managing the nocebo effect.

“To our knowledge, this is the first study evaluating the impact of a clinical pharmacist consultation on the prescription rate of biosimilar bDMARDs,” wrote the researchers.

Over the last 10 years, the emergence of biological disease-modifying antirheumatic drugs (bDMARDs) has resulted in improvements in managing inflammatory arthritis, including rheumatoid arthritis and spondyloarthritis, and patient quality of life.

Past studies have found that the major obstacle preventing patients from switching from a reference product to a biosimilar is lack of biosimilar education offered to patients, suggesting that physicians have a key role in helping patients become more open to switching to a biosimilar.

The nocebo effect, defined by a worsening of symptoms or the onset of new clinical issues resulting from a patient’s negative attitude toward a particular regimen, is a big concern because of misinformation that has been spread regarding biosimilars and could lead to more patients switching back to a reference product after trying a biosimilar. Studies have found that the nocebo effect occurs in 15% to 30% of patients, which can result in drug nonadherence and waste, overutilization of health care resources, polypharmacy, loss of patient trust, and suboptimal outcomes.

Between April 2019 and February 2021, the researchers enrolled and followed 141 patients who were receiving therapy with originator adalimumab (Humira; 62%) or etanercept (Enbrel; 38%), The mean (SD) age of the cohort was 50 (15) years, and 50% were women. Among the patients, 85 patients were placed in the intervention group, meaning that they received a consultation with a clinical pharmacist prior to one with a rheumatologist, and 56 were placed in the control group, meaning that they only met with a rheumatologist.

Overall, 82 patients switched to a biosimilar at the end of their consultation, 59 of whom were from the intervention group (69.4%) and 23 were from the control group (41.1%; P < .01). Among those who switched to a biosimilar, 15 did not return for a visit with a rheumatologist during the year after, leaving only 67 patients left to be assessed for whether they stayed on the biosimilar or switched back to the originator. Of these 67 patients, 51 were from the intervention group and 16 were from the control group.

The researchers followed the patients for a year to see whether they switched back to the reference product. At the end of the follow-up period, 72.5% (n = 37/51) patients in the intervention group and 81.3% (n = 13/16) patients in the control group were still receiving therapy with a biosimilar.

The study has some limitations, including the lack of randomization and the retrospective nature of the analysis. Additionally, the data stemming from a single center in France and the recruitment of patients by a limited number of physicians may limit the generalizability of the results.

“A multi-centred study with other physicians could confirm the positive impact of the pharmacist consultation on the switch rate. Other studies would also be necessary to evaluate the key factors that could improve the retention rate and whether a pharmacist consultation could affect those factors,” the researchers suggested.


Levivien C, Bottois C, Medina CL, et al. Impact of a clinical pharmacist in a multidisciplinary consultation on the switch to a biosimilar for inflammatory rheumatic diseases. Joint Bone Spine. 2022;89(2022):105322. doi:10.1016/j.jbspin.2021.105322

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