Exploring the Reasons Behind the Substantial Discontinuation Rate Among Patients Taking CT-P13 in a Large Tertiary Hospital in Western Switzerland: A Retrospective Cohort Study Using Routinely Collected Medical Data

Abstract

Background CT-P13 is an infliximab biosimilar that was granted market authorization in Switzerland in 2016. Despite the growing literature supporting the equivalence of CT-P13 compared with originator infliximab regarding the efficacy, safety, and immunogenicity and the undeniable cost-saving opportunities, CT-P13 remains widely underused in Switzerland. Objective Leaving aside the phenomenon of a low initiation rate, this study aimed to explore the reasons behind the high discontinuation rate observed among the patients taking CT-P13 in a large tertiary hospital in Western Switzerland. Methods We performed a retrospective cohort study using routinely collected data. Patients were eligible if they received originator infliximab or CT-P13 between September 2017 and December 2020. They were included if they had received at least two CT-P13 infusions during the same period. Patients were excluded if the follow-up was incomplete prior to or 6 months after their first CT-P13 infusion and if they had an oncological main diagnosis. Primary outcomes were the reasons for treatment discontinuation. Results One hundred and fifty-six patients were included and classified into two groups: switchers who were treated with originator infliximab and were switched to CT-P13 ( n = 85, 54%) and initiators who did not receive originator infliximab prior to CT-P13 treatment ( n = 71, 46%). Included patients belonged to three different groups of diagnosis: gastroenterological (67, 43%), rheumatological (61, 39%), and immunological (28, 18%). Twenty-three (27%) switchers and 35 (49%) initiators discontinued CT-P13 after 12 months. Main reasons for CT-P13 discontinuation were lack of efficacy ( n = 21, 36%) and secondary loss of response ( n = 16, 28%); however, objective assessments were not available. Initiators’ probability to discontinue CT-P13 at 12 months was significantly higher than switchers’ ( p < 0.01). Conclusions Lack of efficacy and secondary loss of response were the main reasons for the high CT-P13 discontinuation rate observed in a large tertiary hospital in Western Switzerland. Lack of active training and coordination among healthcare professionals and little education in patients may have exacerbated patients’ subjective complaints and increased the CT-P13 discontinuation rate. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00299-2.

Current Expertise, Opinions, and Attitude toward TNF-⍺ Antagonist Biosimilars among Physicians: A Self-Administered Online Survey in Western Switzerland

“…To our knowledge, this is the first study assessing the expertise, experience, and opinion regarding TNF-⍺ antagonist biosimilars of postgraduate physicians and specialists in rheumatology, gastroenterology, and immunoallergology in Western Switzerland. This study follows previous work undertaken in Western Switzerland, which reported a substantial discontinuation rate among patients treated with an infliximab biosimilar (i.e., CT-P13) [ 34 ]. Given the economic stakes associated with biosimilars, an evaluation of potential barriers to the use of biosimilars in Western Switzerland was required.…”

“…This year’s report noted that regional disparities in Switzerland regarding the prescribing of biosimilars continued to widen and that drug costs for mandatory health insurance could have been reduced by about 100 million Swiss francs if biosimilars had been used consistently [ 61 , 63 ]. Although this amount of savings is based only on direct purchase prices and does not take into account discounts negotiated between hospitals and pharmaceutical industries or the full direct costs required to introduce a biosimilar in a hospital, it does highlight the political power of cantons to operate as they see fit and to prioritize the use of more expensive originators in their hospitals [ 34 ]. Indeed, there were no official guidelines for the implementation, management, or use of biosimilars in Switzerland at the time of this study.…”

“…To date, the exact reasons explaining the low uptake of TNF-⍺ antagonists biosimilars in Switzerland are still unclear [ 34 ]. The knowledge of Swiss prescribers regarding biosimilars has only been assessed in a 2019 survey, which reported that only 31% out of 93 Swiss specialists were very familiar with biosimilar medicines [ 27 ].…”

Factors associated with the uptake of biosimilars for breast cancer treatment from the perspectives of physicians and patients-Evidence from China

“…China approved the first biosimilar in 2019, and the number of approved biosimilars doubled during the past 3 years with a strong pipeline ( Hu et al, 2022 ). Many studies analyzed the factors associated with the uptake of biosimilars in the countries outside China ( Costa-Font and Rico, 2006 ; Berdud et al, 2016 ; Alnahar et al, 2017 ; Mouslim et al, 2020 ; Lobo and Río-Álvarez, 2021 ), including physician’s and patient’s knowledge and attitudes towards biosimilars ( Tubic et al, 2021 ), physician’s prescribing habit ( Colloca et al, 2019 ; Okoro, 2021 ; Krstic et al, 2022 ), patient’s affordability and experience of treatment with reference biologics ( Teeple et al, 2019a ). While studies about biosimilars conducted in Chinese settings are mainly limited to clinical research or market entry approval ( Diao et al, 2019 ; Xu et al, 2019 ; Rahalkar et al, 2021 ; Ren et al, 2021 ; Xu et al, 2021 ), uptake of biosimilars and studies about healthcare providers and patients are rare ( Qu et al, 2021 ; Hu et al, 2022 ).…”