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What oncologists do not understand about biosimilars Posted 18/09/2020

The availability of biosimilars may improve access to health care by increasing the number of therapeutic options available at potentially lower costs. However, based on the results of multiple surveys of many healthcare providers (HCPs) conducted in recent years, clinicians appear wary of prescribing biosimilars.

There is a growing consensus that educating HCPs about biosimilars can improve understanding of these products and instill confidence in their use. The American Society of Clinical Oncology (ASCO) concurred in a 2018 statement that continuous HCP education on biosimilars is ‘critical to inform, promote, and use biosimilar products in a medically appropriate and cost-effective way to treat cancer’ [1].

To assess and address knowledge and practice gaps as well as barriers to the use of biosimilars in oncology management, a live and online continuing medical education (CME) programme for oncology HCPs was developed and launched in September 2017 and concluded in December 2018.[2] The programme was developed by Gary H Lyman, MD, MPH, of the Fred Hutchinson Cancer Research Center, Seattle, Washington, and Jeffrey Crawford, MD, of Duke Cancer Institute, Durham, North Carolina. Three live presentations of the programme were conducted at ASCO regional chapters in Delaware, Maryland and Pennsylvania. To assess gains in knowledge and potential practice change after participation, multiple-choice questions based on the programme content were posed to participants prior to programme and after completion.

A total of 9,599 individuals participated in the activities (114 in the live meetings and 9,485 in the web course). Attendees at the live meetings were predominantly physicians (MD/DO, 66%; 14%, NP/PA; 14%, RN/BSN; 12%, pharmacist 9%)) and predominantly oncologists (76%). The web course participants were predominantly nurses (RN/BSN, 58%; MD/DO, 17%; pharmacist, 17%; NP/PA, 6%).

Responses to the pre-activity questions indicated significant gaps in knowledge of the approval process for biosimilars: only 10% of participants knew that approval was based on ‘no clinically meaningful differences with the reference biological in terms of safety, purity and potency’. This finding was also supported by oncology HCP’s self-reported lack of familiarity with the approval process: only 6% considered themselves ‘very familiar’ or ‘expert’ with the process prior to the programme. Only 6% were ‘very confident’ or ‘expert’ in utilizing biosimilars in practice prior to the programme, which was reflected in the level of knowledge among participants of the evidence supporting the use of a trastuzumab biosimilar (36% and 17% of live and online participants, respectively).

Interestingly, none of the six barriers to the use of biosimilars that were queried (institutional or formulary restrictions, patient reluctance to use biosimilars, lack of familiarity with the biosimilar approval process, lack of efficacy data, lack of safety data, or other, including lack of time, cost of therapies, and insurance) were rated as major barriers by more than 15% of participants.

Responses to the multiple-choice questions following completion of the programme indicated statistically significant (p < 0.05) knowledge gains among oncology HCPs regarding the biosimilar approval process and evidence supporting biosimilar use in cancer treatment. However, it was noted that perceptions of biosimilars remained a question as those were ‘very confident’ or ‘expert’ in utilizing biosimilars were almost constant (6% prior to the programme, 7% following programme completion).

These results indicate the ability of educational programmes to improve knowledge and familiarity of the use of biosimilars. However, the post-activity level of confidence in using biosimilars suggests further education is needed in this rapidly moving field to ensure that clinicians have the knowledge and competence they need to use these new treatment options in an evidence-based manner as the number of available biosimilars continues to expand.

Conflict of interest
The authors of the research paper [2] declared that there was no conflict of interest. 

Abstracted by Chad Williamson, MS, MBA, CMPP, Rockpointe, Columbia, MD, USA.

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References
1. GaBI Online - Generics and Biosimilars Initiative. ASCO issues position statement on biosimilars in oncology [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Sep 18]. Available from: www.gabionline.net/Biosimilars/General/ASCO-issues-position-statement-on-biosimilars-in-oncology 
2. Williamson C, Berger L, Sullivan TP, et al. Addressing oncologists’ gaps in the use of biosimilar products. Am J Manag Care 2019;25(6 Spec No.):SP188-SP191. 

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