Patient Awareness of Biosimilars Impacts Adherence, but Nurse-Led Education Could Help

Despite the fact that biosimilars have a longer history in the European Union than in the United States, many European patients still lack awareness of these medicines, and data suggest that a lack of awareness may be keeping patients from adhering to their therapies.

In a new paper¹ published in Joint Bone Health, French researchers reported on a nationwide cross-sectional study that assessed how informed French patients with rheumatological diseases were about biosimilars, and to assess the nature of their concerns about these drugs.

The investigators used an online assessment, made available from March 2017 to July 2017, and 629 patients responded. In total, just 43% knew what biosimilars were, and only 44% of patients who were receiving a biosimilar were told about it before starting the biosimilar.

Patients were primarily concerned about differences between the biosimilar and its reference in terms of the molecular structure of the drug (46%), and the potential for any differences in efficacy (60%) or safety (57%). More than 50% of patients said that they would be wary about accepting a switch to a biosimilar and might interrupt their treatment, while 15% said that they would refuse a switch altogether.

The investigators concluded that “Biosimilars are largely unknown to patients,” and said that information seems key to improving patients’ adherence to therapy with biosimilar.

A review article² recently published in the Journal of Crohn’s and Colitis agrees that patient awareness is a hinderance to patient adherence, and suggests that, in the context of inflammatory bowel disease (IBD), nurses could play a crucial role in providing much needed patient education.

The paper’s authors point to a 2014 survey in the European Union and United States that showed only 6% of the general population reported a general knowledge of biosimilars, and many respondents, including patients with IBD, were unclear about their access to and the efficacy of biosimilars. Educating patients about their options so that they are confident in their treatment plan and adherent to their therapy is a key feature of shared decision-making, write the authors, and nurses are ideally positioned to educate and inform patients.

However, in order to do so, nurses must know the difference between biosimilars and small-molecule generics, specific guidelines applicable to biosimilars, and potential variations in administration and handling of biosimilars versus their reference drugs. Such information can be integrated, they suggest, into training for IBD nurses.

The authors cite a recent study of a nonmandatory switch to biosimilar etanercept (the BIO-SPAN study) that used a structured communication strategy to inform patients about the switch. Of 642 patients contacted, 99% eventually agreed to the transition, and at 6 months, persistence rates of the biosimilar were 90% (comparable to the 92% rate observed in a historical cohort of patients treated with the reference). These results, they say, point to the usefulness of the structured communication strategy in building patient awareness. Furthermore, managed switching programs, which have been made possible in nations like the United Kingdom through gain-sharing agreements, have resulted in similar drug persistence among patients switched to biosimilar infliximab and patients who took only the reference.

“Through nurse-led education,” write the authors, “patients can become more confident in their treatment plan, therapy increasing drug persistence and adherence rates,” ultimately leading to improved overall quality of care.

References

1. Frantzen L, Cohen JD, Tropé S, et al. Patients’ information and perspectives on biosimilars in rheumatology: a French nation-wide study [published online January 16, 2019]. Joint Bone Spine. doi: 10.1016/j.jbspin.2019.01.001.

2. Armuzzi A, Avedano L, Greveson K, Kang T. Nurses are critical in aiding patients transitioning to biosimilars in inflammatory bowel disease: education and communication strategies [published online October 4, 2018]. J Crohns Colitis. doi: 10.1093/ecco-jcc/jjy150.