Planning the transition
A thoughtful communication plan is essential when it comes to successfully transitioning patients to biosimilars. Even small details can make a big difference.

Planning the transition

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Lars-Erik (The Parker Institute):  If you are considering adopting biosimilars – there are several things you should keep in mind. For patients that you may want to transition from an originator product to its biosimilar, the most important thing to consider is the patient’s disease activity. Any patient being transitioned should be stable. In other words, the patient should be in remission or experiencing low disease activity.

In addition to ensuring that a patient is stable, any comorbidities should also be considered, assessed and, if unstable, treated before considering a transition to a biosimilar. In addition to the medical concerns, there are patient-driven factors that need to be considered. 

Tanja (The Parker Institute):  Before prescribing a biosimilar it is important to consider several psycho-social factors, such as anxiety, obsessive personality, pain and fatigue. These are factors that are of importance to patients as they relate directly to quality of life.

Lars-Erik:  And in your opinion, will these flavour the entire experience, and should they be stabilised or at least assessed and monitored carefully? 

Tanja:  Yes, it’s important to acknowledge that not managing these factors may mean that patients will ultimately feel as if they are not being treated correctly. A medication that only treats their disease may not necessarily equate to their 'having a good life' or 'feeling well-treated'. How the patient feels in totality can have an impact on how they do on any medication we prescribe – even a biosimilar    

BIO-BBU-0026b - Date of preparation: April 2018

When transitioning to biosimilars, what should we consider?


Patient Related Factors for Transitioning

* The diagram shows an example from Rheumatology

When transitioning to a biosimilar, there are several questions that you need to consider

  • Is the patient medically Treated to Target (T2T)?
    Any patient being switched should be stable, in remission or experiencing low disease activity1,2
  • Is the patient psychosocially sound?
    The patient should have no significant Psycho-Social factors that are indicative of a predisposition to nocebo3,4,5,6,7,8

References

  1. Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force Ann Rheum Dis 2016;75:3–15.  
  2. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update Ann Rheum Dis 2017;76:960–977. 
  3. Corsi, N. et al. Changes in perception of treatment efficacy are associated to the magnitude of the nocebo effect and to personality traits. Sci. Rep. 6, 30671; doi: 10.1038/srep30671 (2016).  
  4. Geers, A. L., Helfer, S. G., Kosbab, K., Weiland, P. E. & Landry, S. J. Reconsidering the role of personality in placebo effects: dispositional optimism, situational expectations, and the placebo response. J Psychosom Res 58, 121–127, doi: 10.1016/j.jpsychores.2004.08.011 (2005).  
  5. Darragh, M., Booth, R. J. & Consedine, N. S. Who responds to placebos? Considering the “placebo personality” via a transactional model. Psychol Health Med 20, 287–295, doi: 10.1080/13548506.2014.936885 (2015)  
  6. Nestoriuc, Y. et al.  Beliefs about medicines predict non-specific side effects in rheumatoid arthritis patients Arthritis Care Res (Hoboken). 2010 June ; 62(6): 791–799. doi:10.1002/acr.20160.  
  7. Enck, P. et al. New Insights into the Placebo and Nocebo Responses. Neuron 59, July 31, 2008; 195-206
  8. Kumar, k. et al. Determinants of adherence to disease modifying anti-rheumatic drugs in White British and South Asian patients with rheumatoid arthritis: a cross sectional study BMC Musculoskeletal Disorders (2015) 16:396


Patient Archetypes

When transitioning a patient to a biosimilar you must also take into account the diversity of patients.  You may want to consider situational language based on that patient’s personality.

How you engage with each segment will differ, and perhaps not all communication strategies discussed here are appropriate for each archetype.  These archetypes are discussed further in the section >> archetype communication


The Transition Path

Transitioning: from a patient's perspective

From a patients' perspective there are typically several touchpoints during the transition phase

  1. Information letter before visit  
    This can be a very powerful method to provide detail and context to the transition leaving more time for an open Q&A during the consultation. The letter can be provided, for example, together with the last batch of former medication. See example 'Patient Letter' below
  2. Consultation with doctor   
    This can be 1-2 consultations highlighting the information letter discussing any questions that arise.  Positive language can vary by patient archetype
  3. Receiving the medication 
    Speaking with "One Voice" and getting to know the medication under professional guidance.  For example, change of device can be discussed
  4. Patient monitoring 
    Ongoing consultation is discussed in the Post Transition Monitoring section


Patient Letters

Your Letterhead

Address

 

Dear [Patient]

 

Message: Why are you switching?

You’re currently treated with a biologic drug [reference drug]. In the meantime, the patent period of this drug runs out and due to scientific progress in manufacturing other companies are allowed to manufacture and sell this drug, too. These drugs called biosimilars. The main reasons why we are using biosimilars are the following ones: A biosimilar is available for a more economical affordable price and offers us the opportunity to provide sustained treatment for you and other patients. And finally it allows us to treat more patients with these innovative and life changing drugs in the future.

Message: Scientific Background

Many clinical trials demonstrated that biosimilars have demonstrated equivalent efficacy, and comparable safety to the reference product. These results were confirmed in our daily clinical practice.

Message: Local Relevance

All new patients [with the same indication] start with this drug at our hospital. Based on our positive experience we would like to transition all our patients [with the same indication] to this drug.

Message: Open Door & Follow up

If you have any questions please feel free to contact [practice phone number] between [practice opening hours] or we can discuss them in our next appointment on the [date] at [time].

Please read the letter carefully and write down your questions. All of them will be answered during our next appointment.

Yours sincerely

[doctor name]