Background/Purpose:

The introduction of biological (BG) drugs in the last 20 years has revolutionised the treatment of patients with inflammatory arthritis (IA). The development of cheaper biosimilar (BS) drugs, analogous to existing licensed BG therapies, has significant cost benefits for the treatment of IA.

In 2016, our Hospital’s Rheumatology Department switched all patients on reference etanercept (E) to an etanercept biosimilar (B). Patients were informed of their switch during a routine clinic appointment or by letter/phone.

In non privatised health settings it is inevitable that hospitals will continue switching patients from BG to their BS counterparts once efficacy, safety and licensing rights have been established. Little is known about how best to switch patients. We devised a questionnaire to investigate our patient’s experiences of switching and gain feedback on factors that could be improved.

Methods:

In May 2017, 355 anonymised questionnaires were sent to our patients with IA who had switched from E to B. We received 107 responses. Questions were semi-structured using Likert scales and focused on diagnosis, treatment history, how patients were informed of their switch and any effects they had from the switch itself.

Results:

Rheumatoid arthritis represented 68% of patients, Psoriatic Arthritis 16% and Ankylosing Spondylitis 11%. 64% were female, 36% male. 20% were 18-49 years and 80% were ≥ 50 years. 29% of patients had a disease duration of 1-10 years and 71% > 10 years. 44% were on monotherapy and 39% combined with Methotrexate.

65% of patients were informed of the switch by their rheumatology doctor, the remainder informed by their nurse/delivery company. 90% of patients were informed face to face in clinic with the remainder informed by phone/letter. 6% of patients were not given any information about B, the rest were given verbal or written information. 45% of patients found their switching experience excellent or very good, 44% was satisfactory. However 9% found their experience poor or very poor. From those patients 32% expressed that their experiences would have improved if they were given the option of switching and 21% if they were given more information about B. 39% experienced side effects (SE) whilst switching.

Factors significantly involved in patients’ having a poor experience of switching were longer disease duration (p 0.042), not feeling sufficiently supported (p 0.000000079) and experiencing SE after switching (p 0.0018). There were no significant differences when looking at age, gender, the type of clinician informing the patient of the switch, whether patients were informed in person or by phone/letter or the type of information patients were given about the switch (verbal or written).

Conclusion:

Switching onto BS is a phenomenon that is likely to continue with a need to improve patients’ experience of switching. Longer disease duration, less support from clinicians and SE from switching contribute to poor experiences. Reducing SE in patients who have switched is fundamental, including those occurring via the nocebo effect. Adequate information given in advance, having opportunities to ask questions and having a point of contact after switching are factors that patients express as important.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-factors-predict-good-patient-experiences-of-switching-from-reference-etanercept-enbreltm-to-an-etanercept-biosimilar-benepalitm-in-a-south-west-london-general-hospital/