Same but different? A thematic analysis on adalimumab biosimilar switching among patients with juvenile idiopathic arthritis

Abstract

Background Biologic medications have dramatically enhanced the treatment of many chronic paediatric inflammatory conditions. Their high cost is a factor that prohibits their broader use. Cheaper generic versions, or biosimilars, are increasingly being used. Healthcare services are switching some patients over to biosimilars for economic reasons, known as ‘non-medical switching’. Some patients unsuccessfully switch due to perceived decreases in efficacy or non-specific drug effects. The implications of failed switching include exhaustion of therapeutic options, unnecessary exposure to other medications, increased healthcare utilisation, worse patient outcomes and higher overall healthcare costs. Patient perceptions almost certainly play a role in these ‘failed switches’. Methods A thematic analysis was performed to better understand patient and parent perceptions on non-medical biosimilar switching. The study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research recommendations. Patients with juvenile idiopathic arthritis currently taking adalimumab were included. Results Nine families were interviewed just prior to a hospital trust-wide non-medical switch to an adalimumab biosimilar. Several common themes were identified. The most frequent concerns were regarding practical aspects of the switch including the medication administration device type; the colour of the medication and administration device; and whether the injections would sting more. The relative safety and efficacy of the biosimilar was raised although most families felt that there would be no significant difference. Anxieties about the switch were largely placated by reassurances from the medical team. Conclusions We derived recommendations based on existing adult literature and the observations from our study to optimise the benefits from non-medical biosimilar switching.

Practical Strategies for Advanced Practitioners Streamlining the Integration of Oncology Biosimilar Therapies Into Practice

“…In contrast, although biosimilars typically offer a more affordable version of the same reference product, patient skepticism can be triggered by the lower cost of biosimilars compared with reference products that are typically more expensive ( Renton et al, 2019 ). Irrational thoughts about potentially receiving an inferior product, and the negative expectations stemming from a patient's misconceptions that their medication will harm rather than improve their health (nocebo effects), can pose clinical challenges ( Janjigian et al, 2018 ; Spanou et al, 2019 ).…”

“…By virtue of the patient-centered and holistic approach to health care adopted by APs, they possess the relevant competencies to play an important role in the education of physician colleagues, oncology professionals, patients, and their caregivers about biosimilars ( Mayden et al, 2015 ; Walsh et al, 2014 ). Extending general education about biosimilars to practice support staff and administrative staff can also help to promote one voice among all patient-facing personnel ( Manolis et al, 2016 ; Rathore et al, 2019 ; Renton et al, 2019 ). Healthcare-system pharmacists are ideally situated to take the lead in multidisciplinary efforts to evaluate biosimilars for institutional use via Pharmacy and Therapeutics (P&T) committee reviews and formulary management, and, when necessary, on a case-by-case basis ( American Society of Health-System Pharmacists, 2013 ; Cuellar et al, 2019 ; Dolan, 2018 ; Hobbs & Crawford, 2019 ; Ventola, 2015 ; Zlatkus et al, 2020 ).…”

Enhancing treatment success in inflammatory bowel disease: Optimising the use of anti-TNF agents and utilising their biosimilars in clinical practice

“…The key challenge with adalimumab biosimilars is likely to be around practical issues. As a subcutaneous drug, transitioning onto a biosimilar may also mean changing the delivery device and home care process, which may lead to patient anxiety [54] . Patient reassurance and education are essential to manage these concerns to ensure that individuals do not feel pressured into switching and are comfortable with how to use any new devices [52] .…”

Intermediäre Uveitis bei Erwachsenen und Kindern – Update

“…etwas unterschiedlich sein. Insbesondere bei Kindern kann das in der Injektionslösung der meisten Biosimilars enthaltene Citrat bei der Injektion als unangenehm auffallen, zudem darf im Falle eines Medikationswechsels vom Originalpräparat hin zu einem Biosimilar ein u. U. auftretender Nocebo-Effekt nicht außer Acht gelassen werden [35].…”