Patients in an Australian clinic were generally open to using biosimilars but knew little about them, according to a recent study.
When it comes to product launches and approvals, Australia and the United States are roughly equal in terms of the maturity of their biosimilars markets. A recent study revealed another similarity: Despite a national initiative to make the Australian public more aware of biosimilars, Australian patients may have very low familiarity with biosimilar therapy.
Investigators did a single-clinic study (N = 132) of patients with rheumatoid arthritis (RA) during the 2017 period when the etanercept biosimilar (SB4, Brenzys) became the first biosimilar medicine for RA in Australia.
“The proportion of our cohort who were familiar with biosimilar therapy was very low (6%); this result matched the 9% to 11% biosimilar awareness levels among patients with inflammatory conditions in the United States and Europe,” the investigators wrote.
However, the same study revealed that more than three-quarters of patients with RA were open to using biosimilars if recommended by their rheumatologist.
Huge Potential to Cut Costs
The authors noted that Australia’s national, single payer system spends approximately US $1.4 billion yearly on biologics and it has been estimated that widespread use of biosimilars could potentially reduce that by up to 24%. The Australian Department of Health launched a Biosimilar Awareness Initiative in 2015 to educate prescribers, pharmacists, and patients on the benefits of biosimilars. Australia is encouraging the use of biosimilars, aiming to expand patient access to biologics.
In May 2019, Australia's Generic Biosimilar Medicines Association furthered this effort by launching an educational site on biosimilars for prescribers, pharmacists, and patients.
The etanercept biosimilar became available for dispensing through community pharmacies in April of 2017. The investigators conducted the study “prior to any significant prescribing of biosimilars” with the goal of understanding the perception of biosimilars by patients not yet familiar with these drugs. Patients with RA who visited a clinic in an Australian tertiary hospital between August 2017 and February 2018 were invited to participate.
Although there has been much investigation into physician awareness, knowledge, and attitudes regarding biosimilars, the authors say the patient perspective has been less studied, particularly in Australia. They noted patient acceptance is important for widespread adoption of biosimilars, citing inadequate patient acceptance as a leading factor inhibiting switching from originator to biosimilar in European rheumatology studies.
Each patient in the Australian study was asked about their awareness and potential acceptance of biosimilars before being shown a visual aid explaining the concept of biosimilars, after which biosimilar acceptance was assessed again.
Although just 6% of patients surveyed were familiar with biosimilars, prior to education, 77% reported they would accept a biosimilar if it were recommended by their rheumatologist.
Other international studies have shown high acceptance rates (Germany, 70%; France, 89%) when biosimilars were first introduced in those countries. Just 5% of patients in the Australian study said they would refuse a biosimilar. Another 18% were unsure, but 50% said they wanted to know more about biosimilars after seeing the visual aid.
The investigators also found that patients who routinely refuse generics were significantly more likely to refuse biosimilars.
Patient Concerns About Biosimilars
Among those who said they would refuse a biosimilar, 57% were concerned about efficacy, and 14% were concerned about safety. Among those who would accept biosimilars, approximately 12% to 15% reported concerns about efficacy, safety, operating a new injection device or changing medicines.
Overall, only 25% of patients were concerned about pharmacy-level substitution without consulting the prescriber. In Australia, pharmacists are allowed to substitute a biosimilar for the reference biologic unless the prescriber explicitly prohibits it. Some Canadian provinces have implemented automatic substitution of biosimilars for reference biologics. In the United States, many states have considered or implemented policies allowing pharmacists to switch to biosimilars unless the physician has indicated otherwise.
The investigators said the low awareness in Australia “identifies a need to improve Australian patient awareness of biosimilars.”
However, “this study demonstrates a high baseline patient acceptance of biosimilar concept despite being initially unfamiliar and highlights the impact of patients’ trust in their rheumatologist,” they concluded.
The investigators cautioned the study was conducted with the patients of a single clinic where the majority of patients were satisfied with their treatment. They concede the same level of patient trust might not be found in other settings.
Kovitwanichkanont T, Raghunath S, Wang D, et al. Who is afraid of biosimilars? Openness to biosimilars in an Australian cohort of patients with rheumatoid arthritis. Intern Med J. 2020;50(3):374—377. doi:10.1111/imj.14753.