Originator Users in Finland Hesitant on Using Biosimilars

Mari Pölkki, PhD

Credit: LinkedIn

A recent survey in Finland found originator users are against switching to biosimilars—primarily due to their lack of biosimilar knowledge—but biosimilar users are not opposed to the interchange between biosimilar and originators.¹

“Our findings indicate that patients’ knowledge regarding biosimilars and biological medicines in general could be notably improved,” wrote investigators, led by Mari Pölkki, PhD, from Oriola Corporation, Expert Services, in Espoo, Finland. “Patients’ own awareness of their currently used biosimilar or originator was surprisingly weak.”

More and more biosimilars have been entering the market, opening the room for a less expensive treatment option for treating cancer, and rheumatic diseases, among other conditions. In Europe, the European Medicines Agency (EMA) approved 86 biosimilars, according to an EMA statement back on September 29, 2022.²

As of 2015, biosimilars were allowed to be interchanged in Finland under the supervision of a healthcare professional.¹ This remained in effect until an amendment passed in Finland’s Medicine Act, allowing pharmacies to bypass health care professionals and interchange biological medicines, starting January 1, 2024.

With this law, pharmacies could interchange a biosimilar approved in the EU with its reference product or with another biosimilar of the same reference product. However, patients accustomed to originators have hesitations surrounding biosimilars. They worry biosimilars will provoke or worsen immune responses, but experts at medicines agencies concluded switching between originator drugs and biosimilars is not expected to trigger immunogenicity.

Before Finland began interchanging biological medicines in pharmacies, a patient survey study gathered people’s opinions on biosimilar substitution in the pharmacies and their knowledge about biological medicines. Patients were eligible to complete the survey if they were using continuous, self-injectable, biological medicines with biosimilars on the market. They were either on adalimumab, etanercept, pegfilgrastim, or filgrastim.

Investigators collected anonymous data from 88 community pharmacies around Finland between May – October 2022. The survey took the form of an electronic semi-structured questionnaire with 25 questions.

Most participants (n = 199) were female (69%) with a median age of 50 years. Participants were more likely to use biosimilars vs originators if they were female (70% vs. 58) or if they were slightly younger (48 years vs. 53 years). Nearly half of the sample (45%) had secondary education as their highest level of education.

Females were more likely to use biosimilars, as 58% of females were originator users and 70% of females were biosimilar users.

Since drugs were interchanged in pharmacies, respondents did not know if they were taking an originator or biosimilar—and many couldn’t tell the difference after taking the medication, either. Patients were most likely to use a biosimilar if the biological medicine was more recent.

“The first results of this large patient survey study show that the longer the biologic medicine had been in use, the more likely it was about an originator and not switched to a biosimilar,” investigators wrote.

Most of the originator users (72%) used their current biological medicine for > 3 years. However, 89% of biosimilar users had been using their current biological medicine for < 3 years.

“The findings indicate that in recent years, biological therapy has more likely than earlier been initiated with a biosimilar, but there is still demand towards this trend in order to restrain health care costs,” the team added.

Nearly half (47%) of biosimilar users could name the brand of the medicine and were aware the product was a biosimilar. However, 31% believed the medicine was an originator.

Likewise, 80% of originator users knew they used an originator but none of them thought they were using a biosimilar. Moreover, 20 – 23% of originator and biosimilar users did not know which product they were using.

In the survey, 41% of patients reported being hesitant to try a biosimilar, and only 40% of the respondents allowed their pharmacies to switch their biological medicine to the lower-cost product. Many people (76%) wanted to keep the drug their clinician had prescribed to them.

Overall, more biosimilar users (45%) than originator users (31%) were comfortable with the idea of interchanging originators with biosimilars. In contrast, originator users were more against the interchange than biosimilar users (30% vs. 15%), although 79% of patients did not have an opinion.

“Use of biosimilars instead of originators saves costs…but according to our knowledge there is only very little published information about effects and importance of interchange in pharmacies,” investigators concluded. “Pharmacies will have an important role in guiding patients, especially among those who currently use originators, towards more affordable alternatives…The patients must feel comfortable with the substitution when offered to them, and they need to understand the similarity of efficacy and safety of different products to guarantee good compliance.”

^References

1. ^{Pölkki M, Prami T. Biosimilars Would Reduce Health Care Costs But Are Yet Poorly Known - Patient Survey Study Among Biological Medicine Users. Integr Pharm Res Pract. 2024;13:9-16. Published 2024 Feb 3. doi:10.2147/IPRP.S440888}
2. ^{Biosimilar Medicines Can be Interchanged. European Medicines Agency. September 19, 2022. https://www.ema.europa.eu/en/news/biosimilar-medicines-can-be-interchanged. Accessed February 15, 2024.}