OC-038 Making The Change: Switching to Infliximab Biosimilars for IBD at North Bristol NHS Trust

Abstract

Introduction Infliximab biosimilars have been available since February 2015, however at the time there was limited guidance on how to introduce the products. The PLANETRA and PLANETAS studies demonstrate that biosimilars are equivalent in clinical efficacy when compared to Remicade®. From the 1st July 2015, the gastroenterology department at NBT introduced biosimilar infliximab making cost savings of £200,000. A 50:50 gain share agreement was negotiated with the local Clinical Commissioning Groups and these savings will be re-invested into Gastroenterology services. Here we describe how a multidisciplinary approach led to a safe transition to biosimilar infliximab. Methods An additional pharmacist was funded to implement the switch using projected savings from the gain share. Patients who were established on Remicade® were sent a letter with details of the proposed switch and given the opportunity to raise any concerns in a consultation with the specialist pharmacists in Gastroenterology. Verbal consent was obtained prior to switching to Inflectra®. Practical guidance for the prescribing and dispensing of biosimilar infliximab was circulated to clinicians and pharmacy staff. Educational sessions were provided to the Medical Day Case Unit nurses. Adverse events were reported via the Yellow card® Scheme and the Biologics Therapy Audit. From December 2015, patients were asked to complete a survey to explore their experiences leading up to and during the switch. We decided not to study clinical outcomes as the sample size is misrepresentative and the follow-up period too short to draw meaningful conclusions. Results In total, 64/65 patients consented to the switch. Following the switch, 7 patients discontinued treatment (2 post-surgery; 5 switched to alternative biologic). We received a 46% response rate to the survey. Patient feedback was largely positive. 83% of patients received the written correspondence; 93% reported that they understood the information leaflet in part (23%) or in full (70%). 96% had the opportunity to speak to pharmacist before their first infusion. Overall, 97% of patients were satisfied with the changeover process. Conclusion We have demonstrated how a multidisciplinary approach allowed the successful switch to a biosimilar within 3 months and the potential benefits to be had. The additional pharmacist post, funded by the projected gain share, will be made a substantive this year allowing for closer monitoring and optimisation of biologic treatment. This will lead to further cost savings through discontinuation of these drugs where appropriate. Since the completion of this project, the BSG has revised their statement to acknowledge that there is sufficient evidence to recommend use of biosimilar infliximab in IBD. Disclosure of Interest L. Chung: None Declared, B. Arnold: None Declared, R. Johnson: None Declared, M. Lockett Conflict with: sponsored by MSD to attend conference in 2016