Pharmacy Can Help Drive Adoption of Rheumatoid Arthritis Biosimilars

This article was originally published on Pharmacy Times^®. This version has been edited. To read the full article, click here.

Rheumatoid arthritis (RA), an autoimmune inflammatory disease that attacks the synovial tissues in the joints, is the most common form of autoimmune arthritis, affecting 1.3 million people in the United States.¹ Rheumatologists often employ disease-modifying anti-rheumatic drugs (DMARDs) to slow disease progression, but many patients have an incomplete response. For those people, biologic DMARDs are usually prescribed, but these drugs are too costly for many, putting optimal disease management out of reach for this population.²

To meet the need for more affordable biologIcs, biosimilar DMARDs were developed, reducing costs to allow more patients to access these critical therapies. So far, 4 biosimilars for the RA reference product Remicade have received FDA approval, but only 3 are currently available on the US market: Inflectra, Renflexis, and Avolsa.⁴

Although these medications have no clinically meaningful differences with their reference biologics and offer significant cost advantages, adoption of these products by rheumatologists has been slow.⁵ Educating providers and patients about the biosimilar approval process could decrease patient resistance and increase the likelihood of rheumatologists embracing biosimilars.

Several more RA biosimilars will be released soon, and stakeholders remain cautiously optimistic. The impact of these biosimilars could be massive, both in terms of cost savings and health outcomes, so it is worthwhile to examine how pharmacists can help overcome obstacles blocking the uptake of these life-changing therapies.

Education is key to acceptance

Both rheumatologists and patients have been slow to accept biosimilars due to the lack of awareness around the biosimilar streamlined approval process. Providers may not know that biosimilars have no clinically meaningful differences from the original product, which may lead to concerns that biosimilars might not be as effective or safe as brand products.

Patients also have concerns, especially if they switch to a biosimilar from a drug they have taken for a long time. Often when this happens, the nocebo effect comes into play. This is when adverse effects (AEs) or symptoms are experienced with a drug just because the patient believes they may occur.9

These symptoms may not actually materialize because the treatment is not working, but the patient believes that is what is happening. In other specialties like oncology, this situation is not as big an issue because the provider can use scans and lab tests to verify what is actually happening, but rheumatologists usually rely on qualitative factors, such as asking the patient about pain level or range of motion.

This is discouraging to rheumatologists, as these patients strongly believe they have experienced treatment failure with the biosimilar. Some patients may also refuse to even try a biosimilar because they do not understand the drug is highly similar to the more expensive brand product with no clinically meaningful differences in the safety and efficacy.

Pharmacists can lead the way

The public has a high level of trust in pharmacists, as demonstrated by more than 30 years of polling from Gallup, which for decades has placed pharmacists among the most trusted professions.10 Consequently, pharmacists can play a key role with helping rheumatologists and patients understand and accept the new RA biosimilars entering the market.

Pharmacists will have the opportunity to use their knowledge of biosimilars to reinforce their benefits, safety, and efficacy. Rather than just telling patients they will be getting a product similar to what they had in the past, the pharmacist can explain in detail they will be receiving a product just as clinically safe and effective as the one they have been taking, and it will actually cost less than the brand product. Additionally, they will be able to answer any questions that may arise.

The pharmacist’s skill set is tailor-made for the roll out of products such as biosimilars, and there is little doubt they can do a fantastic job of getting providers and patients on board with these complex products. Pharmacists have been tackling problems like this for years and have a proven track record of affecting change.

For example, when generics were launched in the late 1990s, there was a high level of patient distrust around their use. Pharmacists were able to educate patients to the point where today when patients fill a prescription, many request a generic. If history is any indication, pharmacists will be able to achieve comparable results with biosimilars.

Read the full article on Pharmacy Times.

References

1. Editorial Staff. How common is rheumatoid arthritis? MedicalNews Today. Accessed online April 4, 2023. https://www.medicalnewstoday.com/articles/rheumatoid-arthritis-prevalence
2. Conran C, Moreland L. A review of biosimilars for rheumatoid arthritis. Current Opinion in Pharmacology. Volume 64, June 2022, 102234. Accessed online April 4, 2023. https://www.sciencedirect.com/science/article/abs/pii/S1471489222000613
3. White E, Billingsley A. Is there a biosimilar for remicade? GoodRXHealth. February 22, 2023. Accessed online July 1,2023. https://www.goodrx.com/remicade/biosimilar-list.
4. U.S. Food & Drug Administration. Biosimilars: Overview for health care professionals. December 13, 2022. Accessed online July 1, 2023. https://www.fda.gov/drugs/biosimilars/overview-health-care-professionals#What%20is%20a%20biosimilar%20product
5. National Cancer Institute. NCI Dictionary of Cancer Terms: nocebo effect. Accessed online April 5, 2023. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/nocebo-effect
6. Editorial Staff. Why trust in pharmacists remains high. CVS Health. June 03, 2022. Accessed online April 10, 2023. https://www.cvshealth.com/news/pharmacy/why-trust-in-pharmacists-remains-high.html#:~:text=Americans%20have%20a%20special%20confidence,health%20care%20needs%20monthly2.