e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Patient concerns and nocebo effect when pharmacy educated prior to switching from originator to biosimilar (#316)

Marissa Ryan 1 , Andreea Kelso 1 , Christine Carrington 1 2 , Michelle Edmonds 3
  1. Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
  2. School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
  3. Pharmacy Department, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia

Background The introduction of biosimilars of originator medicines reduces cost, increases competition, expands public access and allows re-direction of healthcare funds.1,2  A tertiary hospital in Queensland informed and educated patients planned to switch from originator to biosimilar trastuzumab or rituximab, prior to their first dose of the biosimilar; in line with the Council of Australian Therapeutic Advisory Groups guiding principle number 5.3  Informing and educating patients about biosimilars is important, since gaps in awareness, understanding, and perception of biosimilars by patients and clinicians may contribute to nocebo effects and affect clinical outcomes.4-7

Aim To identify patient questions, comments or concerns with regards to switching from an originator to a biosimilar, during a patient-pharmacist interaction; and to investigate if any nocebo effects have been reported. 4

Method Patients receiving originator trastuzumab or rituximab who were planned to switch to a biosimilar were identified using pharmacy oncology software, CHARMTM. Questions, comments and concerns at the patient-cancer pharmacist interaction were documented to elucidate themes and to facilitate an accessible record. A retrospective analysis of this data was carried out. In addition, RiskMan incident reporting system was reviewed for the 9-month period post-biosimilar introduction and any reported biosimilar nocebo effects were recorded.8

Results Of the 32 patients in this study, 15 patients (47%) had comments, questions or concerns. The main themes expressed by patients included: desire to know which country the biosimilar was manufactured in, reason for switch, and efficacy of biosimilar compared to originator medicine. Over the 9-month period post-biosimilar introduction, there were no known reports by cancer services doctors of nocebo effects due to biosimilar use.8

Conclusions Pharmacists play a central role in educating patients on biosimilar medicines.3,9 By analysing patient questions and concerns, clinicians can identify gaps in current patient education, inform future biosimilar education, and potentially assist in biosimilar uptake.

  1. Patel KB, Arantes LH Jr., Tang WY, Fung S. The role of biosimilars in value-based oncology care. Cancer Manag Res. 2018;10:4591-602.
  2. Department of Health and Ageing. National Medicines Policy 2000. Commonwealth of Australia. 1999. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/B2FFBF72029EEAC8CA257BF0001BAF3F/$File/NMP2000.pdf [cited 2020 Jul 30]
  3. Council of Australian Therapeutic Advisory Groups. Overseeing biosimilar use. Guiding principles for the governance of biological and biosimilar medicines in Australian hospitals. CATAG, 2016. Available from: http://www.catag.org.au/wp-content/uploads/2012/08/OKA10798-CATAG-Overseeing-biosimilar-use-Version-2-final.pdf [cited Jul 29, 2020]
  4. Colloca L, Panaccione R, Murphy TK. The Clinical Implications of Nocebo Effects for Biosimilar Therapy. Front Pharmacol. 2019;10:1372. doi:10.3389/fphar.2019.01372 [cited 2020 Feb 21]
  5. Peyrin-Biroulet L, Lonnfors S, Roblin X, Danese S, Avedano L. Patient Perspectives on Biosimilars: A Survey by the European Federation of Crohn's and Ulcerative Colitis Associations. J Crohns Colitis. 2017;11(1):128-33.
  6. Jacobs I, Singh E, Sewell KL, Al-Sabbagh A, Shane LG. Patient attitudes and understanding about biosimilars: an international cross-sectional survey. Patient Prefer Adherence. 2016;10:937-48.
  7. Bakalos G, Zintzaras E. Drug Discontinuation in Studies Including a Switch From an Originator to a Biosimilar Monoclonal Antibody: A Systematic Literature Review. Clin Ther. 2019;41(1):155-73.e13.
  8. RiskMan. Incident Report Division of Cancer Services. Nov 01 2019 to July 31 2020.
  9. Gregory GP, Carrington C, Cheah CY, Hawkes EA, Irving, IM, Siderov J, et al. (2020). A consensus statement on the use of biosimilar medicines in hematology in Australia. Asia-Pacific Journal of Clinical Oncology. 2020;16(4), 211-221. Available from: https://doi.org/10.1111/ajco.13337 [cited Jun 20, 2020]