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New Survey Looks at Physician Attitudes Toward Biosimilars


A retrospective study of physician surveys on biosimilars demonstrated that understanding physician attitudes toward biosimilars is crucial to improving uptake of these agents.

Even in a place like Europe, which is considered well ahead of the United States in terms of adoption of biosimilars and represents 80% of the global biosimilar market, biosimilars constitute only 1% of the total sales of biologic medicines.

It turns out that not all European physicians are familiar with biosimilars, and those who do know something about biosimilars tend to overestimate their knowledge of these agents, according to a new study, which encompassed information mostly on physicians in Europe but also from the United States.

These are issues that should be addressed, because physicians’ reluctance to prescribe biosimilars may restrict potential savings that would allow treatment of larger patient populations and improve efficiencies in medical treatment, the authors noted. “It is vital to study physicians’ attitudes towards and perceptions of the uptake of biosimilars,” they said.

The investigators drew their conclusions from a study of already published material from multiple sources. They evaluated physicians based on the following

  • Self-rated knowledge of biosimilars
  • Measured knowledge of biosimilars
  • Information sources about biologic medicines
  • Attitudes toward and experience with biosimilars
  • Use of biosimilars for biologic-naïve patients
  • Switching between originators and biosimilars for patients already treated with biologic medicines
  • Thoughts on pharmacist-led substitution of biologic medicines

The studies evaluated in the investigation (N = 23) were mainly from Europe (n = 16) and North America (n = 4). The studies were published between 2014 and 2019, although most (n = 20) were published in 2017 or earlier.

Most of the physicians included in the studies, which included surveys, reported that they had at least a basic understanding of biosimilars: 5% to 44% reported high familiarity; 49% to 76%, familiarity; 2% to 25%, no familiarity.

Measured Knowledge Falls Short

Although many indicated they had general familiarity with biosimilars, their actual measured knowledge indicated lower levels of understanding: 18% to 66% of physicians incorrectly described biosimilars as generic medicines, and 31% to 72% incorrectly thought they were structurally identical to originator medicines. Because they are biologics and differ slightly from batch to batch, biosimilars are not structurally identical to originator medicines.

When looking for information about biologic medicines, 25% to 84% of physicians said they turned to scientific publications; 32% to 76%, pharmaceutical companies; 26% to 75%, professional society guidelines; 17% to 71%, conferences and educational events.

The authors said physicians’ attitudes toward biosimilars appear contradictory: 6% to 38% consider biosimilars and originator products to be interchangeable, and 28% “never think so.” Some studies indicated that 65% to 67% of physicians have concerns about biosimilar use, but other studies reported that 54% to 94% of physicians feel somewhat or very confident prescribing biosimilars.

“Regardless, a positive attitude towards biosimilars does not automatically translate into prescribing, as physicians seem to prefer originator products to biosimilars,” the authors wrote.

There are also differences between specialties. “Gastroenterologists seem to be frequent prescribers of biosimilars, while dermatologists and rheumatologists seem less enthusiastic,” the authors wrote.

Solid Evidence Helps

Physicians tended to be more enthusiastic about biosimilars if there are robust pharmacovigilance studies to support their use, easier access to treatment for patients, or regulatory approvals in place. Disadvantages that discourage use include distrust in safety, efficacy, immunogenicity, and uncertainty about using biosimilars outside their approved indications. Quality, traceability, and tolerability of biosimilars were also concerns, along with how patients feel about biosimilars.

The physicians used multiple sources of information about biologic medicines, such as scientific publications (25%—84%), self-study (35%–84%), pharmaceutical companies (32%–76%), guidelines from professional societies (26%–75%), educational events and conferences (17%–71%), other published literature (46%–68%), physician colleagues (28%–54%), safety registries (52%) and pharmacist colleagues (19%).

Physicians (39%—89%) were more willing to prescribe biosimilars for biological drug-naïve patients rather than for those already being treated with biologic medicines. “The proportion of physicians willing to switch from an originator to a biosimilar was 51% or less, except in a single study in which the percentage was 91%,” investigators said.

“Most physicians (64%—95%) were concerned about or disagreed with pharmacist-led substitution of biologic medicines,” the authors added.

They concluded that “physicians’ knowledge of biosimilars in many cases was inadequate, and this may contribute to the low prescribing and uptake of biosimilars…. It is vital that in the near future physicians and other healthcare professionals are provided targeted, evidence-based information on biosimilars to support their uptake and to gain the full cost-saving potential of these medicines.”

A 2019 study indicated that physicians ranked savings for patients as their top concern when considering whether to use biosimilars.


Sarnola K, Merikoski M, Jyrkkä J, Hämeen-Anttila K. Physicians’ perceptions of the uptake of biosimilars: a systematic review [published online May 5, 2020. doi: 10.1136/bmjopen-2019-034183.

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