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How to assess the satisfaction of patients with chronic inflammatory diseases after switching [...]

Bouguen G, Peyrin-Biroulet L, Buisson A, Lafarge D, Tropé S, Montagu G, et al., Congrès EULAR 2023, AB1826-HPR (Mai 2023)


Background : Patients experience may be negatively impacted when starting biosimilar due to a poorly executed switch which could result in poor adherence and nocebo effect.


Objectives : This study aims to identify suitable patient satisfaction dimensions to design an observational study on real-life switches.


Methods : A qualitative exploratory study was performed. In-depth, semi-structured interviews were conducted by a sociologist with patients with inflammatory diseases treated by anti-TNF biosimilar to determine patient switching experiences and expectations, identify dimensions for the observational study’s questionnaire (ePRO). Patients were recruited with the help of patients’ associations.


Results : Four patients (3 females) were included: 2 with rheumatoid arthritis and 2 with Crohn’s disease. Two patients had adalimumab biosimilar, 1 etanercept biosimilar and 1 adalimumab originator (switch-back). The following dimensions were identified:


  • Information transparency: patients were unfamiliar with biosimilars and some did not know they were using them. Some reported distrusting biosimilars but accepted them because they trust their physician.

  • Patient Involvement: physicians decide whether to offer a biosimilar, but patient acceptance is determined by their interpretation of the situation. Patients found it difficult to express their treatment preferences and reported that physicians didn’t always prompt these discussions.

  • The time of injection: patients had to learn the injection procedures but received relatively little support during the switch in handling the new device. Some experienced greater pain, differences in comfort or reported errors in use.

  • Transition: the sustainability of the switch may have been constrained by delays in supply in the city. In some cases, the pharmacy dispensed the originator drug as a replacement.


These led to the following ePRO composition: BMQ, HLSEU-Q16 (health literacy), ad hoc items on shared decision making, expectations, patient training, satisfaction with provided information and injection. All 4 patients understood the final questionnaire.


The study design is an open label multicentric study of 300 patients in 30 sites (rheumatology and gastroenterology, hospital, and private practice) when offered a switch. The primary objective is to assess patients’ overall satisfaction with injections 3 months post-initiation compared to the previous adalimumab. The first patient was included in June 2022.


Conclusion : This work proposes an original methodology for the selection and design of criteria for an observational study. An exploratory qualitative study highlighted different factors of patient satisfaction during the switch to adalimumab biosimilar. It guided the choice of e-PROs and the construction of specific items.


(Poster) Bouguen G, Peyrin-Biroulet L, Buisson A, Lafarge D, Tropé S, Montagu G, et al. How to Assess the Satisfaction of Patients with Chronic Inflammatory Diseases After Switching to a Biosimilar? Insights from an Exploratory Qualitative Study Preliminary to an Observational Study. Annals of the Rheumatic Diseases 2023;82:2145–2145. https://doi.org/10.1136/annrheumdis-2023-eular.1293

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