Marín-Jiménez I et al. published in April 2021 a report based on a survey that was launched in Spain between June and November 2020 among hospital pharmacists and specialty physicians (dermatology, rheumatology, gastroenterology) to analyse knowledge, perceptions, attitude, barriers and facilitators of biosimilars uptake. Response rate was close to 100%.
The survey showed that there were certain knowledge gaps about different aspects of biosimilars including biosimilar development (physicochemical issues, pharmacokinetics and pharmacodynamics), but also about switching, extrapolation, interchangeability or substitution. However, the reported level of importance of these aspects was in general high.
It was found that there was a great variability in the types and brands of biosimilars depending on the hospital, and identified several organization preferences, policies, and practices regarding biosimilars access and use in clinical practice. Many of the participants agree on economic/efficiency reasons as the main drivers for incorporating biosimilars to the organization, but one/third of specialist physicians were unaware of procedures and criteria behind it. Generally, perception and attitude to biosimilars were positive. If used, biosimilars were predominantly prescribed in biological treatment-naïve patients (this indication was considered adequate, and participants felt comfortable with it). Reluctance to switch in clinical practice was common as well as to switch between biosimilars (from similar or different reference biologicals) or to multiple switching. On the other hand, although around half of the participants have experience with indication extrapolation, hospital pharmacists were significantly and clearly more comfortable than specialist physicians with extrapolation.
Switching did not modify patients clinical monitoring for most of participants. When explaining and proposing a biosimilar to patients, specialist physicians indicated that some patients are quite reluctant, though they accept it in the end. Similarly, hospital pharmacists stated that some specialist physicians in case a switch was proposed, almost a half raise some objections.
A large percentage of respondents believe that adherence to biosimilars is similar to that of reference biological medicines.
The main barriers to biosimilars uptake were the lack of confidence and knowledge. Concerns about biosimilar long-term efficacy and safety were found, especially from real-word evidence, but also about the lack of biosimilars traceability or the risk of biological reference medicines stock shortages. The main facilitators were the development of recommendations from professional associations and societies and the demonstration of interchangeability efficacy.
The report concluded that biosimilar educational activities are necessary to improve the current situation. More supportive evidence on biosimilars will contribute to it. In addition, organizations might also benefit from engaging health professionals into the design of policies, practices and protocols to help promote biosimilar uptake properly.
Conflict of interest
This project  was funded by an unrestricted grant from Fresenius Kabi
España. For full details of the authors’ conflict of interest, see the research paper .
Abstracted by Emilio Monte Boquet, Jefe de Sección. Servicio de Farmacia Hospitalaria, Unidad de Atención Farmacéutica a Pacientes Externos (UFPE), Hospital Universitari i Politècnic La Fe, Departament de Salut València La Fe, Spain.
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1. Marín-Jiménez I, Carrascosa JM, Guigini MA, et al. Knowledge, perceptions, attitude, barriers and facilitators of the use of biosimilars among hospital physicians and pharmacists: a Spanish survey. Farm Hosp. 2021;45(5):240-46.
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