Satisfaction low with mandatory transition from Humira to biosimilar in New Zealand
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Key takeaways:
- Overall satisfaction with New Zealand’s mandatory transition to an adalimumab biosimilar was low.
- Lack of alcohol wipes and diminished patient support were key issues reported in a survey.
Patients reported low overall satisfaction with New Zealand’s mandatory nationwide transition to an adalimumab biosimilar, though most said they are still taking it and appreciated its less-painful injections, according to a study.
“While patients are frequently changed from bio-originators to biosimilars, patients’ experiences with the transitioning process are not well understood,” Chiara Gasteiger, PhD, of the University of Aukland and Stanford University, told Healio. “The adalimumab brand change was also the first large-scale mandatory community biosimilar change in Aotearoa (New Zealand), so this provided a unique opportunity to examine patients’ satisfaction with the transition.”
To analyze the experiences of patients in New Zealand with rheumatic diseases as they participated in the nationwide, mandatory transition from originator adalimumab (Humira, AbbVie) to the biosimilar adalimumab-atto (Amgevita/Amjevita, Amgen), Gasteiger and colleagues developed an online survey. The researchers used 10-point scales to collect data on specific aspects of the transition, as well as open-ended responses.
In addition, the questionnaire asked for recommendations for future transitions. A total of 117 valid responses were collected from participants with rheumatic diseases (68% women; 33% aged 51 to 60 years). More than one-third had between 2 years and 4 years of history with originator adalimumab before the transition.
Among the 112 participants who reported their current treatment, 85% (n = 95) were still taking the biosimilar at the time of the survey. On a 10-point scale, with 10 meaning high satisfaction, overall satisfaction with the transition had a mean score of 6.2 (standard deviation [SD] = 3.2), according to the researchers, who published their findings in ACR Open Rheumatology.
During the transition, patients reported the most satisfaction with the supply of the biosimilar (mean [SD] = 8.5 [2.2]), support from pharmacists (mean [SD] = 7.5 [2.9]) and how early they were notified of the transition (mean [SD] = 6.9 [2.8]). They were least satisfied with community support organizations for patients with arthritis (mean [SD] = 3.4 [3.5]) and the training for the biosimilar device (mean [SD] = 4.9 [3.8]). Satisfaction with training for the biosimilar the device predicted overall patient satisfaction (P = .004).
Compared with before the transition, patients afterward were less satisfied with the supply of sharps bins (mean 8.3 vs. 5.2, P < .001) and alcohol wipes (mean 9.3 vs. 3.2, P < .001), according to the researchers. Patients “were often not aware” alcohol wipes would not be provided with the biosimilar as they had been with the bio-originator, they wrote.
In addition, there was no patient support program comparable to the one provided with the originator drug, which had offered nurse support and sent email and text reminders to inject. This contributed to satisfaction with the patient support program falling from a mean of 8.9 to a mean of 8.1 post-transition (P < .024), according to the researchers.
“While it was great that most participants received enough notice before the transition occurred, some reported a lack of information and resources,” Gasteiger said. “Participants also reported more satisfaction with the information they received from pharmacists than patient support organizations. Patient support organizations are well-placed to provide education and resources, and address common questions. Future educational attempts should be collaborative and involve community groups, such as patient support organizations, to ensure a wider reach of information.
“I hope to see more research conducted in this area, as patients’ experiences need to be kept at the forefront when implementing brand changes,” she added. “It is also essential for health care teams to share their experiences so we can continue learning and improving brand changes for all patients and health care providers involved.”
Perspective
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Transitions to biosimilar products is an inevitable part of practicing rheumatology in the United States today. In 2023 alone, there were at least nine Humira (adalimumab, AbbVie) biosimilars that were preparing to come to market. The cost of biologic therapy and their increasing indications for many different diseases will only increase biosimilar use over time. Keeping a focus on the patient, and the patient experience, can help guide new protocols and procedures that will minimize the stress of switching medications and ensure continuity of care and good outcomes.
This New Zealand study of 117 patients that transitioned to Humira biosimilars highlights some of the issues and concerns facing patients during this process. It also identifies areas that, if addressed during the transition process, can help to ensure a high satisfaction rate on the part of the patient.
Not surprisingly, patients who were informed of the transition ahead of time and who were given counseling and information about the new biosimilar tended to have a higher satisfaction score than those who felt that communication was lacking. A similar U.K. study also found that patients who felt that communication about biosimilars was lacking experienced more side effects and difficulty using their new device. They also reported decreased symptom control on the new drug.
The study also found that satisfaction with information and support was lower when there was a mandatory transition to a new product.
As insurance companies mandate automatic biosimilar transitions and switching between biosimilar products in stable patients, it is inevitable that users will experience frustration and anxiety during these transitions. The anxiety stems from concerns about efficacy and the side effects of the new product, as well as cost and accessibility.
This study highlights how random switching to biosimilar products when a patient is stable on an existing biologic can be problematic. The burden of ensuring a smooth transition and relaying information will ultimately fall on the provider and staff, placing additional stress on a workforce that is already stretched too thin.
Addressing these concerns will be very important when developing guidelines for both practitioners and payers who are transitioning patients to biosimilars. When possible, consideration should be given to shared decision making, information transfer and patient preference. Patients should be introduced to their transition teams in advance of switching therapies. In addition, they should be provided with the practical, convenient services such as alcohol wipes and sharps disposal containers that patients have grown accustomed to expecting, and help to enhance a positive patient experience.
Further studies that illuminate the link between switching biosimilars and outcomes will help all parties involved develop concrete policies that will guide smooth transitions to new medications.
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