Shared decision making (SDM) between physicians and patients, as opposed to HCPs making decisions on behalf of patients without proper information and consent, is supported by a growing base of evidence across a range of therapy areas from rheumatologic disease to cancer.1 So, how can SDM boost treatment adherence and persistence for biologics and/or biosimilars?
Studies show that when patients have an active involvement in treatment decisions and are more educated about their treatment they will elect for more conservative treatment options.2 Patients who adhere to their treatments are three times more likely to achieve desired outcomes, such as improved quality of life and better functional capacity, than nonadherent patients.3 When HCPs and patients engage in SDM there is a greater likelihood of adherence for patients, often with the added bonus of reduced health care costs.3 Health care costs attributable to nonadherence annually in the United States are estimated to be $100–$300 billion per year.4
How biosimilars are changing exit strategies with anti-TNF therapy
The increasing numbers of anti-TNF biosimilars available on the market represent increasing treatment options for patients and potentially improved rates of remission. HCPs are starting to re-evaluate the need of applying exit strategies for anti-TNF therapy with the reduced costs of these treatments, following the advent of biosimilars.
For each major class of treatment used alone or in combination, there is a risk of relapse following dose reduction or stopping of treatment.22 Generally, patients in clinical, biochemical and endoscopic remission have an increased chance of maintaining health when treatments are stopped.22 Whether or not to stop a treatment depends on each individual patient and SDM with the patient should take place.22
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- Elwyn G, Frosch D, Thomson R, et al. Shared decision making: A model for clinical practice. J Gen Intern Med. 2012;27(10):1361-1367. doi:10.1007/s11606-012-2077-6
- Anghel L-A, Farcaş AM, Oprean RN. Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review. 2018. doi:10.2147/PPA.S165101
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- Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr. 2015;169(11):1053-1060. doi:10.1001/jamapediatrics.2015.1982
- Chen C, Hartzema AG, Xiao H, et al. Real-world pattern of biologic use in patients with inflammatory bowel disease: Treatment persistence, switching, and importance of concurrent immunosuppressive therapy. Inflamm Bowel Dis. 2019;25(8):1417-1427. doi:10.1093/ibd/izz001
- Razanskaite V, Bettey M, Downey L, et al. Biosimilar Infliximab in Inflammatory Bowel Disease: Outcomes of a Managed Switching Programme. J Crohns Colitis. 2017;11(6):690-696. doi:10.1093/ecco-jcc/jjw216
- Ye BD, Pesegova M, Alexeeva O, Osipenko M, Lahat A, Dorofeyev A. Efficacy and safety of biosimilar CT-P13 compared with originator infliximab in patients with active Crohn's disease: an international, randomised, double-blind, phase 3 non-inferiority study. 393(10182):1699-1707, APRIL 27, 2019 DOI:https://doi.org/10.1016/S0140-6736(18)32196-2
- Gecse KB, Cumming F, D'Haens G. Biosimilars for inflammatory bowel disease: how can healthcare professionals help address patients’ concerns? Expert Review of Gastroenterology & Hepatology, 13:2, 143-155, DOI: https://doi.org/10.1080/17474124.2019.1553617
- Peyrin-Biroulet L, Danese S, Cummings F, et al. Anti-TNF biosimilars in Crohn’s Disease: a patient-centric interdisciplinary approach. Expert Rev Gastroenterol Hepatol. 2019;13(8):731-738. doi:10.1080/17474124.2019.1645595
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- Strober B, Greenberg JD, Karki C, et al. Impact of psoriasis severity on patient-reported clinical symptoms, health-related quality of life and work productivity among US patients: Real-world data from the Corrona Psoriasis Registry. BMJ Open. 2019;9(4). doi:10.1136/bmjopen-2018-027535
- Gisondi P, Del Giglio M, Girolomoni G. Treatment approaches tomoderate to severe psoriasis. Int J Mol Sci. 2017;18(11). doi:10.3390/ijms18112427
- Sbidian E, Mezzarobba M, Weill A, Coste J, Rudant J. Persistence of treatment with biologics for patients with psoriasis: a real‐world analysis of 16 545 biologic‐naïve patients from the French National Health Insurance database (SNIIRAM). Br J Dermatol. 2019;180(1):86-93. doi:10.1111/bjd.16809
- Biosimilar adalimumab is a test of shared decision-making in the NHS | Crohn’s & Colitis UK. https://www.crohnsandcolitis.org.uk/healthcare-professionals/healthcare-professionals-blog/biosimilar-adalimumab-is-a-test-of-shared-decision-making-in-the-nhs. Accessed January 17, 2020.
- Renzi C, Di Pietro C, Gisondi P, et al. Insufficient Knowledge Among Psoriasis Patients Can Represent a Barrier to Participation in Decision-making. Acta Derm Venereol. 2006;86(6):528-534. doi:10.2340/00015555-0145
- Larsen MH, Hagen KB, Krogstad AL, Wahl AK. Shared Decision Making in Psoriasis: A Systematic Review of Quantitative and Qualitative Studies. Am J Clin Dermatol. 2019 Feb;20(1):13-29. doi: 10.1007/s40257-018-0390-5.
- Doherty G, Katsanos KH, Burisch J, et al. European Crohn’s and colitis organisation topical review on treatment withdrawal [’exit strategies’] in inflammatory bowel disease. J Crohn’s Colitis. 2018;12(1):17-31. doi:10.1093/ecco-jcc/jjx101
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- Studies Investigate Drug Survival, Discontinuation of Biologics in IBD. https://www.centerforbiosimilars.com/conferences/ecco-2019/studies-investigate-drug-survival-discontinuation-of-biologics-in-ibd. Accessed January 17, 2020.
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