Abstract
BackgroundTo identify factors for starting biosimilar TNF inhibitors (TNFI) in patients with rheumatic diseases.Methods and findingUsing a national claims database, we identified patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) who had used TNFIs since they were approved in Korea in 2004. We assessed changes in the proportion of each form of TNFI used between 2004 and 2017. We then selected patients starting on TNFIs between 2013 and 2017 to identify factors for starting biosimilars. In RA (n = 4,216), biosimilars were more likely to be initiated in clinics [odds ratio (OR) 2.54] and in the metropolitan area (OR, 2.02), but were less likely to be initiated in general hospitals (OR 0.40) or orthopedics (OR 0.44). In AS (n = 2,338), biosimilars were common at the hospital level (OR 2.20) and tended to increase over the years (OR 1.16), but were initiated less in orthopedics (OR 0.07). In addition, RA patients were more likely to initiate biosimilars in combination with methotrexate (OR 1.37), but biosimilars were not initiated frequently by patients with higher comorbidity scores (OR 0.97) or receiving glucocorticoids (OR 0.67). The patient factors favoring biosimilar in AS use were not clear.ConclusionsIn Korea, the proportion of biosimilar TNFIs has increased. Type of institution and physician specialty are more important than patient factors in affecting biosimilar use. In RA, biosimilar TNFIs tend to be initiated in combination with MTX, and are less likely to be initiated in patients taking glucocorticoids or in those with high comorbidities.
Highlights
The introduction of biosimilars is likely to widen access and reduce treatment inequalities in inflammatory arthritis due to their lower cost compared to the originator biologics [1, 2]
Using a national claims database, we identified patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) who had used TNF inhibitors (TNFI) since they were approved in Korea in 2004
Type of institution and physician specialty are more important than patient factors in affecting biosimilar use
Summary
The introduction of biosimilars is likely to widen access and reduce treatment inequalities in inflammatory arthritis due to their lower cost compared to the originator biologics [1, 2]. Observational studies have been performed to evaluate the effectiveness and safety of biosimilars in clinical practice, and these have shown similar effectiveness and safety [8,9,10,11,12]. In spite of these encouraging results, several concerns with biosimilars still exist from the patients’ perspective in the real world [13, 14]. To identify factors for starting biosimilar TNF inhibitors (TNFI) in patients with rheumatic diseases
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