A decision to promote the infliximab biosimilar for patients with inflammatory bowel disease (IBD) in Canada has paid off with a decrease in emergency admissions and an increase in dose escalation.¹

A team, led by Anat Fisher, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, monitored the impacts of a policy decision to promote the use of infliximab biosimilars on the use of medications and health services during the first year of the policy.

The Policy

The British Columbia government announced a new policy to switch from originator to biosimilar infliximab for patients with IBD in 2019, known as the Biosimilars Initiative.

In the population-based cohort, the investigators identified administrative health data and developed 3 historical cohorts and 1 policy cohorts of patients with IBD who were treated with infliximab. The team then monitored the cumulative incidence of medications and health services. The data was based on allinfliximab pharmacy records for patients with IBD who were enrolled in the provincial health plan between August 1, 2018 and August 31, 2020.

The final analysis included 1839-2368 participants who were treated with the originator aged 4-90 years with a mean age of 43 years.

The investigators described longitudinal trends in the use of the infliximab biosimilar among patients with IBD using an anonymized, linkable administrative data collected by the BC Ministry of Health and the Canadian Institute of Health.

Results

The team sought medical endpoints of the dispensation of infliximab, including initial and subsequent dispensations, infliximab dose escalation, defined as a 25% or greater increase in daily dose for current prescription compared with the average of earlier dispensations, the dispensation of a different biologic medication, the dispensation of antibiotic medication used for IBD-related conditions, and the new use of prednisone, defined as the absence of days’ supply of any systemic corticosteroid in the 6 months prior to the dispensing of prednisone.

The results show a 0.9% increase in the first dispensation of infliximab, either the biosimilar or originator during the first year of follow-up. There was also a 16.2% increase in infliximab dose escalation, a 2.4% decrease in the dispensation of antibiotics, and a 2.6% decrease in the new use of prednisone.

Finally, there was an anticipated increase in visits to physicians and gastroenterologists to manage switching to biosimilars of 24% and a 5% decrease in discharges from the hospital and a 2.9% decrease in emergency admissions to the hospital.

“British Columbia’s Biosimilars Initiative for nonmedical switching from originator to biosimilar infliximab for inflammatory bowel diseases was not associated with harmful impacts on medications and health services use,” the authors wrote. “An increase in dose escalation was accompanied by an improvement in health status proxies.”

References:

Anat Fisher, Jason D. Kim, Colin R. Dormuth, "Monitoring a Mandatory Nonmedical Switching Policy from Originator to Biosimilar Infliximab in Patients with Inflammatory Bowel Diseases: A Population-Based Cohort Study", Gastroenterology Research and Practice, vol. 2023, Article ID 2794220, 13 pages, 2023. https://doi.org/10.1155/2023/2794220