Background Biologic agents have been shown to help control disease progression in rheumatoid arthritis (RA) and significant reduce joint damage. However, their considerable cost has limited their widespread use.
Objectives Biosimilars offers the opportunity for significant cost savings for national health services and the aim of this research is to better understand their use among European rheumatologists and their potential impact on patient outcomes.
Methods We used data collected as part of an online treatment survey conducted among a panel of 261 rheumatologists between January and December 2016 across 5 European markets (France, Germany, Italy, Spain and the UK). Physicians were sampled to provide a representative mix of practice types and regions. Our record form sample included 9,650 patient currently treated with a bDMARD, 297 of which received a biosimilar. We split the sample into 2 groups, biosimilar patients = those treated with Benepali (etanercept), Remsima (infliximab), Inflectra (infliximab) and Flixabi (infliximab) and originator patients = those treated with Enbrel (etanercept) or Remicade (infliximab). We analysed patient demographic data along with current DAS, joint count, HAQ score and perceived disease severity to assess response to therapy over time.
Results Biosimilars accounted for a total of 2.4% of our biologic sample with the greatest uptake of these agents reported in the UK (3.8%) and the lowest in France (1.6%). Use of biosimilars increased in patients who started their current biologic in 2016 (8.1%), with a marginally higher use seen in patients on their 2nd or higher line of bDMARD therapy vs. those on their 1st bDMARD (9.4% vs. 7.5%, respectively).
We saw no significant difference in the distribution of biosimilar and originator patients by age and gender although biosimilar patients appeared to have more severe disease. While a smaller proportion of biosimilar patients were perceived to have moderate/severe RA at diagnosis (79.1% vs. 88.4%) a greater proportion were thought to have moderate/severe disease at their latest visit (64.3% vs. 44.2%). The average DAS28 of biosimilar patients was higher at a directional level but their average HAQ score and tender/swollen joint count were non-significantly lower. Biosimilar patients were more likely to suffer from a comorbid condition (87.2% vs. 74.1%) and a autoimmune condition beyond their RA (17.2% vs. 11.6%). There were no significant differences in the proportion of patients unable to work due to their disease (4.3% on average from the total sample).
We analysed the data focusing solely on 1st line patients to reduce any bias introduced by previous lines of therapy but observed similar trends. A higher proportion of biosimilar patients were considered to have moderate to severe RA at their latest visit (67.9% vs. 43.0%) and a greater proportion of patients had a DAS28 >5.1 (23.3% vs.3.0%).
Conclusions Our research suggests that biosimilar uptake remains limited amongst European rheumatologists with a directional trend towards 2nd line use. Our data did not clearly show any significant differences in the profile of biosimilar patients or their outcomes. Increased governance from healthcare regulators and additional clinical data may be needed to further establish the efficacy and safety of these agents and drive their wider use, ensuring greater cost efficiency and the potential for wider access to biologic therapies for RA patients.
Disclosure of Interest None declared