Patients with Rheumatic Diseases Report Low Satisfaction After Mandatory Biosimilar Switch

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Patient satisfaction rates with a mandatory nationwide transition in New Zealand from reference adalimumab (Humira) to a biosimilar were low, according to a study in ACR Open Rheumatology. The study found satisfaction was impacted by provision of care supplies, quality of patient support programs, training on the biosimilar device, and support and information from patient support organizations.

From March to September 2022, an estimated 3000 rheumatology patients receiving reference adalimumab initiated a mandatory transition to a biosimilar. The goal of the mandatory switch was to save money and improve access for additional patients.

Patient speaking with doctor. Image credit: Dragana Gordic -

“Understanding patients’ experiences of the adalimumab transition is particularly important as the biologic is self-administered at home,” the authors noted.

They utilized a survey to understand satisfaction of patients with rheumatic diseases. A total of 137 participants responded to the survey, with 20 being excluded due to completing less than half of the survey. Ultimately, responses from 117 participants with rheumatic diseases were included.

The respondents were mostly women (68%) between the ages of 51 and 60 years (33%). Nearly half (48%) had a diagnosis of rheumatoid arthritis. Thirty-five percent had 2 to 4 years of experience with the reference product before the change.

Following the transition period, 85% were still taking the biosimilar. Of those no longer taking the biosimilar, 88% had changed back to the originator and 12% were taking an entirely new treatment. Reasons for discontinuing use of the biosimilar included loss of disease control/efficacy (75%) and safety concerns, such as possible drug reactions and new side effects (25%).

Satisfaction response options ranged from 0 (not at all satisfied) to 10 (extremely satisfied). The overall mean (SD) satisfaction with the transition was 6.2 (3.2).

Areas that received the lowest mean satisfaction scores were:

  • Support from patient support organizations: 3.4 (3.5)
  • Information from patient support organizations: 3.5 (3.2)
  • Training for biosimilar device: 4.9 (3.8)

Areas that received the highest mean satisfaction scores were:

  • Supply of the biosimilar: 8.5 (2.2)
  • Support from pharmacists: 7.5 (2.9)
  • Information before the change occurred: 6.9 (2.8)

The authors noted the high satisfaction with communication from pharmacists, highlighting that pharmacists seemed to take on additional educational responsibilities and “were a major source of information for patients during the brand change.”

After the transition, respondents said they were less satisfied with the provision of supplies such as sharps bins and alcohol wipes, as well as the patient support program provided by the manufacturer. There was no significant difference in satisfaction with obtaining prescriptions and authorization before and after the transition.

More than half of participants said there was less injection pain with the biosimilar and that the device was easy to use. In addition, they said the biosimilar controlled their disease as well as the originator. However, some participants did perceive the biosimilar was less effective at controlling their arthritis flares and joint pain.

While some patients said they were very well informed about the change, others said they only found out about the change when they picked up their prescription.

Key recommendations from the participants for future changes included:

  1. Improve communication before the change
  2. Provide more information, such as reason for the change, cost, and supplies provided
  3. Provide a comparable patient support program
  4. Allow for patients to stay on the originator if their disease is well controlled
  5. Ensure options to change back

One of the main limitations of the study was possible selection bias and the fact that less than 5% of patients with rheumatic diseases impacted by the change were included. The nature of the study also relied on individuals recalling past experiences. Finally, as the adalimumab biosimilar is administered at home, the results of the survey may not be generalizable to medications that are administered at other sites of care.

“Ultimately, patient experiences should be kept at the forefront when implementing biosimilar transitions in the future,” the authors concluded.


Gasteiger C, Lobo M, Stanley R, Wong LS, Murdoch R, Dalbeth N. Rheumatology patients' experiences of a mandatory nationwide transition to an adalimumab biosimilar. ACR Open Rheumatol. Published online November 23, 2023. doi:10.1002/acr2.11634

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