Background Perceptions on bio-originator (bo) and bio-similar (bs) biologics among HCPs and pts, as well administrative regulations or economic incentives may influence their utilisation in clinical practice. The ATTRA registry captures more than 95% of pts with RA and AS treated with biologics in the Czech Republic (CZ). Access to biological therapy in CZ is limited to about 30 authorised centres. Bs infliximab (INF) has been prescribed in CZ since 11/2013, and bs etanercept (ETA) since 1/2016 concurrently with bo INF and ETA. There has been no administrative regulation concerning the use of bs or bo in CZ.
Objectives To explore whether age, gender, employment status, or level of education influence the choice of bs vs. bo variant of the same bDMARD in pts with RA or AS starting bDMARD in CZ.
Methods Data from the ATTRA registry on pts with RA or AS starting their first bDMARD between 11/2013 and 10/2017 were used. The start of bo vs. bs ETA, or bo vs. bs INF as the first bDMARD was the main outcome of interest. Multivariate logistic regression analysis was used to explore the impact of education, employment status, age and gender on the start of a first bDMARD after adjustment for disease characteristics, and the bDMARD molecule.
Results 560 pts started ETA (22.6% bo, 14.2% bs) or INF (9.7% bo, 53.5% bs) in the study time frame. In the multivariate model (table 1) pts starting ETA (ref. INF) had lower odds to receive a bs (OR 0.11, CI95% 0.07–0.17), and pts with primary education (vs. secondary or tertiary) had higher odds to receive any bs (OR 1.84, CI95% 1.08–3.13). When we performed separate analyses for pts treated in academic/public hospitals (n=314), the adjusted OR for pts with primary education was 0.78 (CI95% 0.37–1.64), while in private centres (n=246) the OR was 5.32 (CI 95% 2.32–12.16). When we introduced an interaction term for type of practice x level of education, the adjusted OR for pts with primary education in private centres was 2.26 (CI95%, 1.14–4.46, p=0.019).
Conclusions We found that in private centres providing biological therapy in CZ, pts with primary education had higher adjusted odds to obtain bs as the first bDMARD. We cannot exclude that different pt characteristics and residual confounding may have been involved. The interpretation is complex and related not only to perception of bs by HCPs and pts, but also to unmeasured economic incentives and other factors.
Acknowledgements This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organisation 0 23 728
Disclosure of Interest None declared
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