More Data Underscore the Importance of Educating Patients as Part of a Biosimilar Switch in IBD

Much concern has recently been raised about the nocebo effect and its potential role in discontinuation after a switch to a biosimilar. Data that support education as a potential way to prevent the nocebo effect are increasing, however, and a recently presented study added to that growing body of evidence.

In a study conducted from 2017 to 2018 among all of the infliximab-treated patients with inflammatory bowel disease (IBD) in a single center, patients who were in clinical remission were invited to complete a questionnaire to assess their biosimilar knowledge and acceptance of a switch.

All patients had the opportunity to accept or reject the switch to biosimilar CT-P13 (Inflectra, Remsima) from the reference (Remicade), either with or without patient education. The study’s primary end point was the percentage of patients who accepted the switch after receiving an educational session after an initial refusal to switch.

A total of 86 patients, 36% of whom had ulcerative colitis and 64% of whom had Crohn disease, were included. Initially, 47% of patients refused the switch. Among this subgroup, 78% agreed to an educational session. Ultimately, 68% of the subgroup accepted the switch.

At week 16, persistence with the biosimilar was 91%. There were no patients who developed antidrug antibodies after the switch. At weeks 0, 8, and 16, respectively, the mean (SD) Mayo scores were 0.68 (0.69), 0.81 (0.95), and 0.57 (0.76) (P = .733), and the mean (SD) Harvey-Bradshaw scores were 0.88 (1.70), 1.95 (2.27), and 2.14 (2.36) (P = .134).

Analysis of the survey found that, before being presented with the option to switch, 77% of patients had never heard of biosimilars, although 85% were in favor of switching. A total of 61% expressed fears about using biosimilars, however.

After the survey, at week 16, 84% of patients said they had knowledge of biosimilars, 93% were in favor of switching, and only 39% had concerns about using biosimilars.

According to the authors, these data highlight not only the safety of a switch from the reference to the biosimilar infliximab in patients with IBD, but also the fact that education can play a crucial role in acceptance of switching.

Reference

Hastier-De Chelle A, Cluzeau V, Condat J, Arab N, Hebuterne X, Filippi J. Impact of patient education on switch acceptance in IBD patients in remission, with infliximab originator switched for an infliximab biosimilar: a prospective study. Presented at: Digestive Disease Week 2019; San Diego, CA; May 18-21, 2019. Abstract Tu1035.