Rheumatologists Grow More Comfortable With Biosimilars, but Concerns Remain

Confidence in biosimilars is growing among rheumatologists, but concerns about efficacy and the lack of economic benefit remain the top barriers to adoption, according to a new report from Cardinal Health.

Rheumatology Insights includes the responses of more than 100 rheumatologists nationwide and focuses on key trends, such as health equity, industry trends, and biosimilars.

The first biosimilar in the rheumatology space became available in the United States in 2016 with the launch of Inflectra, an infliximab biosimilar (referencing Remicade). There are currently 4 infliximab biosimilars approved, only 3 of which have come to market; 2 etanercept (Enbrel) biosimilars are approved, although legal challenges have delayed the launch of these products until 2029; and 7 adalimumab (Humira) biosimilars approved and just on the verge of launching.

With only 3 rheumatology biosimilars on the market in the United States, adoption has been slow within the specialty, the report notes. However, there seems to be some momentum: Adoption of infliximab biosimilars increased from approximately 15% in 2020 to more than 40% in 2022.

In the latest report, 76% of rheumatologists said they were very familiar with biosimilars, up from 53% in 2020. Compared with the last report in 2020, rheumatologists are also more comfortable prescribing biosimilars to their patients, with 62% saying they are very comfortable in 2022 compared with 41% in 2020. There was a smaller change among rheumatologists who say they are not very comfortable (6% in 2022 vs 10% in 2020).

The respondents continue to feel like the patients they are more likely to prescribe a biosimilar to are new patients (40% in 2022 vs 42% in 2020) and existing patients for whom payers have mandated a biosimilar (41% in 2022 vs 35% in 2020). A small proportion remain likely to prescribe biosimilars to patients having success on a reference product (9% in 2022 vs 11% in 2020) and patients having limited success on a reference product (4% in 2022 vs 5% in 2020).

“After seven years, biosimilars continue to be an important topic in the rheumatology space,” Sonia Oskouei, PharmD, BCMAS, DPLA, vice president of biosimilars at Cardinal Health, wrote in the report. “However, rheumatologists remain fairly divided on their excitement regarding the growing number of rheumatology biosimilars anticipated to come to market. Excitement aside, the majority of survey participants ultimately agree that biosimilars will positively impact rheumatology care.”

A majority (64%) did say that they expect biosimilars will have a positive impact on rheumatology care. Only 15% disagreed with the idea. However, 54% of rheumatologists in 2022 (vs 65% in 2020) said the economics of biosimilars are not favorable enough to motivate them to switch from the reference products. Concerns about the lack of economic benefit was one of the top concerns about prescribing biosimilars (24% in 2022 vs 21% in 2020).

The top concern about biosimilars that rheumatologists cited as a barrier to adoption was about efficacy of biosimilars (36% in 2022 vs 38% in 2020). A large majority (85%) of rheumatologists said they believe educating patients that biosimilars are safe and effective is important, and 96% said they are comfortable discussion these options with patients.

Next year, rheumatologists will face a wave of new biosimilars as all of the approved adalimumab biosimilars start coming to market in the United States. The first adalimumab biosimilar that will launch is Amjevita from Amgen, which is anticipated to launch in January 2023. Cyltezo will be the first interchangeable biosimilar when it launches in July 2023, and Hadlima has an approved high-concentration, citrate-free formulation.

More than 80% of rheumatologists said they were comfortable prescribing an adalimumab biosimilar once they become available. The key decision criteria for rheumatologists to utilize an adalimumab biosimilar would be patient out-of-pocket costs (64%), clinical and/or real-world evidence studies (62%), and coverage by pharmacy benefit managers/payers (54%).

"The promise of biosimilars rests on the twin pillars of affordability and accessibility. Through increased competition for some of the costliest and critical treatment options, biosimilars are positioned to deliver meaningful savings across multiple stakeholders—healthcare institutions, the overall healthcare delivery system and most importantly, patients," Oskouei said in a statement. "With so many biosimilars for Humira (adalimumab) expected to launch beginning in 2023, our research suggests that these therapies will make quite an impact on the overall treatment paradigm for patients with rheumatic conditions."