Biosimilar Initiatives: Discounting Cost, Not Education

Biologic medicines (biologics) are made using living cells and are the most advanced therapy available for numerous conditions. As patents expire on branded biologics, biosimilar medicines (biosimilars) made to be like their biologic reference product enter the market driven by their cost-saving potential. 

Biosimilars are used in the field of rheumatology, oncology, gastroenterology, dermatology and endocrinology, with ophthalmology on the horizon. Increasingly studies emphasize that appropriate implementation of biosimilar policies is contingent upon comprehensive patient education, as their beliefs and behaviours can have considerable effects on treatment adherence.[1] In fact, negative perceptions of biosimilars may produce a nocebo effect, which contributes to the intentional non-adherence to treatments and can result in poor patient outcomes.

A recent article by The Centre for Biosimilars expands on the importance of providing reliable patient education about biosimilars to rheumatology patients undergoing biologic therapies in New Zealand:

Patients with reported negative perceptions about biosimilars are concerned with safety and ultimately fear adverse effects of switching treatments. Fears and uncertainties about biosimilars often lead patients to seek information online. However, according to the Centre for Biosimilars, on-line information is not always consistent with professional evidence-based guidelines. “By assessing patients’ preferences […] healthcare professionals can provide educational interventions to address misconceptions toward medicines”[2] reported Tony Hagen, Senior Editor at the Centre. 

As exclusivity periods for biologics expire, biosimilars may be considered in the treatment of retinal diseases such as diabetic retinopathy (DR), diabetic macular edema (DME) and age-related macular degeneration (AMD).[3] According to the DR Barometer Study undertaken by the International Federation on Ageing (IFA), the International Diabetes Federation (IDF), and the International Agency for the Prevention of Blindness (IAPB), some 93 million adults suffer from DR worldwide. With the increasing prevalence of diabetes alongside the growing global ageing population, there is a real and urgent need for patients and their families to have access to education, screening and safe and effective treatment. Given the functional changes that accompany vision loss, a patient-centered approach to education about biosimilars must be a priority to overcome negative perspectives, facilitate the clinical consultation and inform decision-making.

The World Health Organization’s (WHO) World Report On Ageing and Health further emphasizes the prerequisite of the patient-centered lens in crafting effective policies and plans to support the global ageing population:

“This will require focusing on their unique needs and preferences and including them as active participants in care planning and in managing their health states.”

For ophthalmology patients, reliable information and educational resources about biosimilars are severely lacking unlike the rheumatology field. While biosimilars may offer a decrease in public expenditure compared with biologics, the importance of investing in patient and health care professional education cannot be discounted.

While biosimilar policies in ophthalmology remain in development now is the time for concerted efforts to raise awareness of this new trend in order to effectively respond to patient fears and concerns about treatment options. The IFA Expert Centre provides a point of contact to international specialists in retinal diseases and patient advocacy including Prof. Hans-Peter Hammes, Head of Endocrinology at the University Medical Center Mannheim of University of Heidelberg, Germany; or Dr. Jane Barratt, Secretary General of IFA.

[1] Kristensen L. E., et al. (2018). Non-pharmacological Effects in Switching Medication: The Nocebo Effect in Switching from Originator to Biosimilar Agent. BioDrugs, 32, 5, 397‐404. doi:10.1007/s40259-018-0306-1

[2] Gasteiger, C., et al. (2020). Patients’ beliefs and behaviours are associated with perceptions of safety and concerns in a hypothetical biosimilar switch. Rheumatology International, 10.1007/s00296-020-04576-7. doi:10.1007/s00296-020-04576-7

[3] Sharma, A., et al. (2018). Biosimilars in ophthalmology: "Is there a big change on the horizon?" Clinical ophthalmology, 12, 2137-2143, doi:10.2147/OPTH.S180393