Patients with Rheumatic, Gastroenterological Conditions Less Familiar with Biosimilars Compared with Biologics

Although patients with inflammatory conditions reported positive attitudes towards biologic treatment, they were far less familiar with biosimilars, indicating the need for clinicians to provide patient education more effectively.

Although most patients use additional information sources, results from a study published in BMC Rheumatology1 indicate a high level of trust in specialist’s recommendations regarding biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). However, many patients were unfamiliar with biosimilars and only a small percentage of patients were currently being treated with a biosimilar. Characteristics that influenced information resources included age, concerns about medications, and reading proficiency. These factors were similar among those with inflammatory arthritis (IA) and inflammatory bowel disease (IBD).

“Patient attitudes towards biosimilars significantly influence adherence and the experience of a nocebo effect after switching from biologic originator and consequently, understanding the foundations of their perceptions represents an important step towards framing messages appropriately and effectively,” investigators explained.

An online questionnaire for patients with a diagnosis of IA or IBD residing in Australia was used to determine the favorability of biologics and biosimilars, the patient’s preferred sources of information, and their familiarity with biosimilars. Patient consumer groups, such as Arthritis Australia and Crohn’s and Colitis Australia, aided in advertising the questionnaire, which integrated the Belief about Medicines Questionnaire (BMQ) and the single-item literacy screener (SILS). Results were analyzed via the chi-square and non-parametric trend test for ordered and unordered categorical variables and compared participants with IA and IBD.

In total, 838 patients responded to the study, with 144 self-reporting an IBD diagnosis, 686 with IA, and 8 with both conditions. Most (79%, n = 658) were currently treated with b/tsDMARDs. Although results indicated a high necessity belief (median 4.2), many expressed moderate concerns about biologics (median 2.8).

Most respondents used multiple sources when making their decisions (median 4) and nearly all (95%) received information about medications via specialists, with the most positive resources cited as specialists and specialist nurses. Less favorable sources were social media (median 4, IQR 1–6), chat rooms (median 4, IQR 1–6), and relatives or friends (median 2, IQR 1–5). Over half of participants (52%, n = 73/141) with IBD sought the opinions of specialist nurses, compared with only 29% (n = 202/685) of those with IA (p = 0.012).

The majority of patients (66.9%, n = 336) were uncertain of whether biosimilars were available in Australia and 35.6% had never heard of them (n = 280/787). Unsurprisingly, only 4.6% (n = 23) were currently being treated with a biosimilar. A recommendation from a specialist was the most frequently cited factor that would sway a patient to switch from a biologic to a biosimilar (71.1%, n = 352/495), followed by the proven safety and efficacy from clinical trials (57.8%, n = 286/495). It should be noted that only 60% (n = 502) of respondents answered the biosimilar section.

Younger participants and those with higher BMQ concern scores were more likely to use less reliable sources of information, such as social media. Those who scored lower on SILS, indicating limited reading ability, were more likely to obtain information from a pharmacist or clinician.

Investigators were able to determine if patients with IA and IBD had similar experiences regarding biologic medication despite having different diagnoses. Using a variety of contextual factors, such as reading ability, beliefs about medication, and demographics, strengthened the study by allowing for a more detailed approach to understanding the determinants of resource selection.

However, the inequal number of patients in the IA and IBD group limited comparisons and skewed results towards the IA group. Other limitations include selection bias and the self-reported nature of the survey, which may not be completely accurate. Further, as the data was collected in 2020, biologic and biosimilar awareness and positive attitudes towards them may have increased in the time since the survey period ended.

“Respondents with IA and IBD in this survey had generally similar positive attitudes towards biologics, but were less familiar with biosimilars,” investigators concluded. “Both groups relied heavily on specialist recommendations regarding their treatment decisions, emphasizing that as clinicians, our interactions and advice must continually strive to be of high quality, tailored to patients’ health literacy, and targeted to their healthcare beliefs.”


Khoo T, Sidhu N, Marine F, et al. Perceptions towards biologic and biosimilar therapy of patients with rheumatic and gastroenterological conditions. BMC Rheumatol. 2022;6(1):79. Published 2022 Dec 23. doi:10.1186/s41927-022-00309-4