Switching patients to biosimilars is sometimes a contentious issue and many patients have concerns about switching. Patients characteristics have been shown to influence negative perceptions about switching in generics [2, 3], but little research into biosimilar switching has been carried out. Therefore, a New Zealand study examined which demographic and psychological characteristics are associated with patients’ safety perceptions and concerns about switching to biosimilars [1].

Negative perceptions can include beliefs that biosimilars are substandard in quality, safety and efficacy to originator biologicals. While some patients also report concerns about being switched to a biosimilar without discussion with their treating physician. It is thought that negative perceptions can lead to a nocebo effect and increase non-adherence to treatment.

Ninety-six patients taking originator biologicals for rheumatic conditions (65% for rheumatoid arthritis) completed the Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire and Perceived Sensitivity to Medicines Scale. Demographic factors, information seeking, concerns about switching and safety perceptions were also assessed. Pearson’s correlations and hierarchical linear regressions were conducted to explore whether patient characteristics are associated with perceptions of biosimilars. At the time of the study, biosimilars were not publicly funded for patients with rheumatic diseases in New Zealand.

Negative safety perceptions were associated with being female, short-term originator biological use, illness beliefs, seeking health information online, high perceived sensitivity to medicines and negative beliefs about medicines. Only being female (β = 0.24, p = 0.02) was independently associated. More concerns about switching were associated with being female, illness beliefs, high perceived sensitivity to medicines, information-seeking behaviours and preferring originator drugs. Seeking health information online (β = 0.20, p = 0.04), preferring originator drugs (β = 0.29, p = 0.004) and stronger emotional responses (β = 0.26, p = 0.01) were independently associated. Perceived originator biological effectiveness was inversely associated with preferring biosimilars (rs = –0.33, p < 0.001).

Patients who have stronger emotional responses to their condition, are females, seek health information online and prefer originator drugs that have more negative perceptions about biosimilars. Experiences with originator biologicals influence attitudes towards switching.

The authors therefore recommended that ‘healthcare professionals should refer patients to credible information to reduce the risk of patients seeking incorrect information about biosimilars’. They added that ‘providers should also assess and reassure patients who have had unfavourable experiences with originator biologicals, in terms of safety and side effects, as these influence perceptions towards biosimilars’. They conclude that ‘by assessing patients’ preferences for brand-name medicines, healthcare professionals can provide educational interventions to address misconceptions towards medicines.

Conflict of interest
Several of the authors of the research paper [1] reported conflict of interest, including having received speaker fees, consulting fees, or grants from Janssen and AbbVie, AstraZeneca and Amgen. For full details of the authors’ conflict of interest, see the research paper [1].

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Switching approaches to biosimilars in Nordic countries

References
1. Gasteiger C, Lobo M, Dalbeth N, et al. Patients' beliefs and behaviours are associated with perceptions of safety and concerns in a hypothetical biosimilar switch. Rheumatol Int. 2020;10. doi:10.1007/s00296-020-04576-7. [Epub ahead of print]
2. GaBI Online - Generics and Biosimilars Initiative. Factors associated with increased side effects and lower perceived efficacy when switching to a generic [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Jun 5]. Available from: www.gabionline.net/Generics/Research/Factors-associated-with-increased-side-effects-and-lower-perceived-efficacy-when-switching-to-a-generic
3. GaBI Online - Generics and Biosimilars Initiative. Patient perceptions of generics in Ireland [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Jun 5]. Available from: www.gabionline.net/Generics/Research/Patient-perceptions-of-generics-in-Ireland

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