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Patients Who Receive Positively Framed Biosimilar Information More Than Twice as Likely to Accept a Switch


Among the patients who viewed positively framed video explanations of biosimilars, 67% were willing to switch.

In recent months, the role of the nocebo effect—a phenomenon in which a patient experiences a worsening of symptoms or poor outcomes because of negative beliefs about a given therapy—in the biosimilars context has been increasingly discussed, and some evidence has pointed to provider communication as playing a role in the nocebo effect, as the framing of biosimilars can be a driver of either patient acceptance or a lack of confidence. Now, a study from New Zealand underscores the key role of the provider in framing information about biosimilars.

The study was based on prior research on the perceptions of generic medications, and it included 96 patients with rheumatic diseases, all of whom were taking a reference biologic. The patients were randomized to 4 study arms (n = 24 in each arm), each of which received 1 of 4 video explanations about switching to a biosimilar. Each video featured a clinician explaining basic information related to biosimilars, then giving 1 of 4 different explanations.

Patients viewed the videos to which they had been randomized, then completed a postpresentation questionnaire. The first video included positive framing that emphasized similarities of reference drugs and biosimilars, the second included negative framing and emphasized differences between the products, the third included positive framing plus an analogy that compared a biosimilar to bread baked with a different brand of yeast, and the fourth included negative framing plus the same analogy. The positively framed explanations also included cues like nodding and smiling, while the negative explanations included a less confident-sounding vocal tone.

Among the patients who viewed the positively framed videos, 67% were willing to switch to a biosimilar. Only 46% of those who viewed negatively framed videos were willing to make a switch, however; those who saw the positively framed messaging were 2.36 times more likely to be willing to switch (95% CI, 1.04-5.40). The presence of an analogy in the framing did not predict a willingness to switch.

Those who received positive messaging had a greater expectation than those who received negative messaging that a biosimilar would be effective, but there were no significant differences between groups with respect to beliefs about safety or side effects or with respect to anxiety about switching.

When patients provided free responses to open-ended questions related to concerns about biosimilars, many said that they were concerned about biosimilars’ efficacy (50%) and safety (46%). They reported that information that would be important for them to know would relate to safety and efficacy, information from clinical trials, manufacturing information, and information on whether they could switch back to a reference if needed.

“In terms of clinical implications,” write the authors, “the results suggest that a similar video explanation could be developed into an intervention to improve perceptions and willingness to switch to biosimilars. Patients could view such an intervention video prior to their consultation, to receive initial information about biosimilars.” They also add that further research could investigate how positive framing could impact nocebo responses and nonadherence after switching.


Gasteiger C, Jones ASK, Kleinstäuber M, et al. The effects of message framing on patients’ perceptions and willingness to change to a biosimilar in a hypothetical drug switch [published online June 24, 2019]. Arthritis Care Res. doi: 10.1002/acr.24012.

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