heard about biosimilars , their knowledge and understanding of these agents is low . In a survey of 1201 US physicians across different specialties including dermatology , oncology and rheumatology , significant knowledge gaps were identified in their understanding of biosimilars . 11 Although Cohen et al 11 conducted their survey around the time that biosimilars were first approved by the FDA , a later study in 2018 among US oncology clinicians including doctors , pharmacists and advanced practice providers , found that 74 % ( n = 77 ) of respondents were unable to provide a satisfactory definition of a biosimilar . 12
In 2018 , a continuing medical education program for oncologists , pharmacists and nurses in the US , using a pre- and post-test format and involving 9599 individuals , further identified an initial lack of knowledge , competence and confidence among oncologists and other health providers regarding biosimilars . 13 In contrast , in a survey by the European Society for Medical Oncology among 393 prescribers from mainly Europe , 49 % reported using biosimilars in clinical practice , with 57.4 % stating that they felt comfortable using an EMA-approved biosimilar . 14 The American Society of Clinical Oncology has produced a statement on biosimilars that is hoped will help provide the necessary education and support to drive uptake and acceptance of biosimilars . 15
Oncology pharmacists can potentially play an important role in ensuring increased biosimilar uptake within their institutions . In a survey of pharmacists ’ knowledge , areas of learning identified included evaluation of comparative efficacy between the biosimilar and originator , managing a switchover to a biosimilar and understanding medication safety issues in relation to biosimilar use . 16 With a greater understanding of the clinical use of biosimilars , pharmacists are ideally placed to reassure clinicians who might still have doubts over the efficacy and safety of biosimilars compared with the reference products . Pharmacists can also lead in discussions over formulary inclusion of biosimilars .
Patient perspectives Although it is necessary to obtain buy-in from the prescribing physicians , gaining the support of patients using biosimilars is equally important . The available data from surveys with patients suggests that there is a need for greater education around biosimilars . In a survey of 75 oncology patients , 66 % believed that more expensive drugs were no more effective than cheaper ones for the same disease and 44 % were happy for their physician to prescribe them a less expensive anti-cancer drug . 17 Nevertheless , a small number of patients expressed a concern that drug price might be a proxy for quality . Other work among 1696 patients with autoimmune diseases found that 85 % were concerned that biosimilars would not treat their condition as effectively as the reference product . 18 The survey also revealed that 83 % of patients were concerned that non-medical switching , in which a stable patient is changed to a biosimilar for no medical reasons , may cause side-effects . 18 Interestingly , the study identified that some of the most influential factors affecting patients ’ decision-making over whether to switch included a physician ’ s recommendation , how well the biosimilar is expected to work , its safety and their out-of-pocket cost . Patient – doctor communication is therefore imperative , particularly in light of the evidence for the ‘ nocebo effect ’; that is , where there is a reduction in the treatment benefit that is largely due to patient ’ s negative expectations of a biosimilar rather than any systemic effect from treatment . 19
Strategies to improve access to equitable oncology care The first oncology biosimilar to be approved and introduced to the US market was Zarxio ( Filgrastimsndz ) in 2015 and several oncology biosimilars for Avastin , Herceptin and Rituxan have also been approved , some of which have already entered the US market . Nevertheless , as discussed above , there are considerable barriers to overcome to enhance biosimilar uptake . Physician reassurance through education remains an important consideration , especially as many will be cautious of using biosimilars in the curative cancer setting due to greater familiarity and confidence in the efficacy of
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