Malaysian hospital pharmacists’ perspective on and role in promoting biosimilars use

This survey study carried out by Mohd Sani N et al. aimed to evaluate Malaysian pharmacists’ perspectives of biosimilars and to determine factors associated with pharmacists successfully promoting their use.

While biologicals enhance strategies for treating diseases such as cancer and autoimmune disorders, patients’ accessibility remains a problem because of their high prices. The emergence of biosimilars may offer a solution, as they are highly similar to their originator biologicals but at a lower cost. Thus, cost savings from biosimilar use are contingent, in part, on their uptake. In countries where national policies or measures to improve uptake are lacking, prescriber acceptability of biosimilars is key. However, concerns about biosimilar efficacy, safety, immunogenicity, interchangeability and extrapolation of indications may become barriers to biosimilar acceptance. Given the expanding availability of biosimilars, including in Malaysia, pharmacists’ role in promoting biosimilar acceptance among prescribers is imperative.

The survey study was a nationwide, web-based survey involving hospital pharmacists throughout Malaysia. Multivariate logistic regression analysis was used to identify factors associated with ‘successful biosimilar promotion’, which was defined as prescribers accepting pharmacists’ recommendation to switch patients from the originator to a biosimilar.

The survey response rate was 55% (913/1660). Nearly 66% of the total respondents had previous work experience handling biosimilars in hospitals. Malaysian pharmacists would want to play a major role in promoting biosimilar prescribing, but they indicated they were currently undertrained and lacked knowledge, particularly regarding the characteristics and regulatory requirements of biosimilars. Respondents also lacked confidence on biosimilar use for indications approved based on extrapolation. Concern regarding the efficacy of biosimilars was found as the greatest barrier to promoting their use. Over 60% of respondents perceived patients may safely be switched to biosimilars with the same clinical outcome, while around half of them were against automatic substitution by pharmacists without the prescriber's consent. These results suggested that respondents’ perspectives were likely impacted by their present scientific understanding of biosimilars.

Age, training, experience, awareness of the availability of biosimilars, knowledge, and confidence were identified as factors associated with the successful promotion of biosimilars to prescribers. Among the statistically significant factors, the strongest variable associated with the successful promotion of biosimilars was ‘confident to promote the use of biosimilars’. The odds were three times greater than for those who were not confident (odds ratio [OR], 3.33; 95% confidence interval [CI], 2.10‒5.26; p < 0.001). Meanwhile, the odds of pharmacists successfully promoting the use of biosimilars to prescribers decreased with a 1-year increase in age [OR = 0.95; 95% CI, 0.91‒1.00; p = 0.031]. Those who had attended biosimilar training had higher odds than those who had not (OR = 1.59; 95% CI, 1.14‒2.20; p = 0.006). Additionally, pharmacists who were aware of the availability of biosimilars in their hospital had higher odds than those who were unaware (OR = 1.66; 95% CI, 1.01‒2.72; p = 0.046). Respondents who had prior experience handling biosimilars in the workplace also had higher odds of successfully promoting biosimilars than those who had no prior experience (OR = 1.76; 95% CI, 1.16‒2.66; p = 0.007).

The study concluded that lack of biosimilar training, knowledge and confidence among Malaysian pharmacists may undermine their efforts to promote prescribers’ acceptance of biosimilars. Hence, improving knowledge and confidence through adequate training and providing prescribing information on the website of the national regulatory authority are critical to strengthening pharmacists’ role in successfully promoting biosimilar use.

Conflict of interest
The authors of the research paper [1] declared that there was no conflict of interest.

Abstracted by Noraisyah Mohd Sani, Faculty of Medicine, University of Malaya and Professor Dr Zoriah Aziz, Faculty of Pharmacy, MAHSA University, Malaysia.

Editor’s comment
Readers interested to learn more about US pharmacists’ perspective on biologicals are invited to visit www.gabi-journal.net to view the following manuscript published in GaBI Journal:

Naming and labelling of biologicals – the perspective of hospital and retail pharmacists

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Reference
1. Mohd Sani N, Aziz Z, Kamarulzaman A. Malaysian hospital pharmacists ’ perspectives and their role in promoting biosimilar prescribing: a nationwide survey. BioDrugs. 2022;37(1):109–20.

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