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New Zealand Study Reveals Importance of Patient Attitudes Toward Biosimilars


A New Zealand study of patients with rheumatic conditions suggests that providers need to be mindful of patient attitudes toward biosimilars to prevent biased therapy choices and poor outcomes.

Patients who do online searching for medical information about biosimilars are liable to have exacerbated concerns about switching to biosimilars, according to a New Zealand study that examined patient attitudes toward these agents. The study examined patients with rheumatic conditions.

The findings also indicated that women are more likely to have concerns about switching from originator drugs to biosimilars.

Among the findings:

  • There was a positive correlation between adverse events experiences from the bio-originator and adverse events anticipated from the biosimilar (P < .001).
  • There was a positive association between perceptions of bio-originator safety and the expectation that biosimilars are unsafe (P <.001).
  • There was a significant negative association between the perceived effectiveness of the current bio-originator and a preference for a biosimilar medicine (P <.001).

Recognizing that many patients have difficulty accepting biosimilars and are unwilling to switch to them, investigators set out to explore demographic and psychological characteristics associated with safety perceptions and switching concerns.

Investigators surveyed 96 patients taking originator biologics for rheumatic conditions (rheumatoid arthritis, 65%).

The survey was completed in an Auckland, New Zealand rheumatology service. Patients were predominantly female (69%) and 54 years of age on average. They were also predominantly New Zealand European (67%). The most common bio-originator therapy was rituximab (35%).

According to the findings, negative perceptions about biosimilars were associated with being female, having had only a short-term experience with a bio-originator, illness beliefs, a habit of searching for information online, high perceived sensitivity to medicines, and negative beliefs about medicines.

Online Searching Can Misinform

Patients who research medical information online are likely to be more concerned about switching from originator products to biosimilars, according to the study.

However, investigators warned that online searching for medical information by patients “can lead to Internet users accessing nonfactual information and can influence their perceptions toward unbranded medicines, particularly as information shared online often does not align with best practice guidelines.”

They said that directing patients toward reliable information after discussions about switching may help to reduce these concerns.

Further, patients who have strong emotional responses to their condition are likely to have higher concerns about switching to biosimilars. Patients with arthritis tend to have these strong emotional responses to their condition, investigators said. Another factor that influences patients’ perceptions of biosimilar safety and adverse event profiles is the experience they have with the originator products.

“This finding is consistent with recent studies that have demonstrated that [patients with] rheumatology who have effective bio-originator treatments or are satisfied with their treatment are hesitant to change, due to fearing new [adverse events],” the authors said.

Even among patients who said they expected a biosimilar to have similar safety and adverse event profiles to a bio-originator, fears and uncertainty may persist and influence treatment preferences, the authors said.

For this reason, clinicians should try to reassure patients who have had unfavorable experiences with bio-originators. “By assessing patients’ preferences for branded medicines, healthcare professionals can provide educational interventions to address misconceptions toward medicines.”

Negative perceptions of biosimilars may derive from beliefs that biosimilars are substandard in quality, safety, and efficacy to bio-originators. These can induce nocebo responses, in which the patient’s negative attitude toward the therapy worsens the outcome. Nocebo responses contribute to intentional nonadherence and wasted resources, investigators wrote.

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