Informing and involving patients in their biosimilar treatment journey: Practical support for starting patients on, or switching them to, biosimilars
The type of practical support that a patient receives when they start taking a biosimilar therapy can have a big impact on how they feel about their treatment.1,2 So how can we provide the best possible support to these patients, to help instill confidence in their medication, and ensure that they adhere to it, so that they get the maximum benefit? Here we look at an example of best practice for facilitating a smooth start to patients’ biosimilar treatment journeys.
A survey conducted by the European Federation of Crohn’s and Ulcerative Colitis Associations found that patients want to be involved in decision-making when starting on a biosimilar and also in the development of a treatment management plan.3 Indeed, an article by Coulter reported that actively engaged patients are more likely to adhere to treatment recommendations.1 So what are the best ways of informing and educating patients to help them feel comfortable with their biosimilar medication? A look at two successful case studies, the first reported by the European Specialist Nurses Organisations (ESNO)2 and the second from a clinical commissioning group in the UK,4 can help to inform best practice and provide some useful recommendations.
Case study 1: Switching inflammatory bowel disease (IBD) patients from a reference medicinal product to a biosimilar2
A hospital in Belgium switched all IBD patients on a reference medicinal product to a biosimilar. To inform and educate patients about the decision, the following steps were taken:
- Patients received a personal letter explaining what was happening and why, focusing on the advantages for them
- They also received a face-to-face explanation
- Patients’ GPs also received a personal letter, so that they could be ready to answer patients’ questions and address any concerns
- All healthcare professionals involved in the switch process – the IBD team, pharmacists, day clinic nurses, physicians and inpatient nurses – took part in the communication process, with the consultant IBD nurse playing a central role
- All stakeholders were invited to an interdisciplinary lecture, to prepare them for questions that patients were likely to as
- Nurses received a ‘pocket dictionary’ which included frequently asked questions
- The cost-savings that were made meant that the hospital could now provide a full-time IBD nurse, whereas previously there had only been one part-time IBD nurse, to support patients during their clinic visits
- The team now had the capacity to provide support for patients at home
- The care pathway was improved
Nurses (and patients)
- The process led to a review of the administration procedure, which led to it being made simpler and more streamlined, resulting in shorter waiting times and improved pre-delivery protocols
Hospital and healthcare system
- Because the biosimilar was less expensive than the reference biological medicine, the medicines were made available to more patients
- The financial viability of the healthcare system was extended
Case study 2: Switching patients with rheumatoid arthritis (RA) from a reference medicinal product to a biosimilar4
A working group of clinicians and stakeholders in West Berkshire in the UK was formed to support the switch of rheumatic patients (including those with RA) from a reference biological medicine to a biosimilar. Patients were supported as follows:
- Letters and information sheets were sent out to patients informing them of the plan to switch
- Discussions were held with patients about the reason for the switch programme and in order to gain their consent
- Educational events were organised to provide further information to patients
- Patients had a follow-up visit in clinic 12 weeks after the switch to monitor their response/any effects of the switch
- A patient survey was conducted to see how patients got on with the switch
- Survey responses showed that there was high recall among the patients of the written information they had received about the switch, and the discussions they had had in clinic
- Nearly two thirds of those who responded to a follow-up survey had no concerns about safety, with a similar amount of patients reporting no problems with the switch
- The median visual analogue score for confidence in the biosimilar was 8 out of 10
Local healthcare providers
- A 25% cost saving was achieved across the year by the clinical commissioning group
- A long-term biosimilar switch pharmacist was appointed to horizon-scan, plan and implement switch programmes for every biosimilar that came to market, thanks to the savings made by reducing drug acquisition costs
So what can we learn from the above case studies about successfully starting patients on a biosimilar, so that they can benefit from the outcomes? It’s primarily about communication: before, during and after initiating treatment with a biosimilar. Patients need to feel informed and involved, and, ideally, professional stakeholders need to be included, prepared, and trained to respond to patients’ questions in order to reassure them. A specialist nurse, or nurses, at the centre of the operation can be instrumental in helping to facilitate the whole process.
1. Coulter, A. When should you involve patients in treatment decisions? British Journal of General Practice 2007; 57 (543): 771-772.
2. European Specialist Nurses Organisations (ESNO). Switch Management between Similar Biological Medicines – A Communication and Information Guide for Nurses. Available at: https://www.medicinesforeurope.com/wp-content/uploads/2018/06/biosimilar-nurses-guideline-final.pdf Accessed February 2021.
3. Peyrin-Biroulet, L et al. Patient Perspectives on Biosimilars: A Survey by the European Federation of Crohn’s and Ulcerative Colitis Associations, Journal of Crohn's and Colitis, Volume 11, Issue 1, January 2017, Pages 128-133, https://doi.org/10.1093/ecco-jcc/jjw138
4. Chan A, et al. Implementing and delivering a successful biosimilar switch programme – the Berkshire West experience. Futur Healthcare Journal 2019; 6 (2):143-145.