Non-medical Switching Research Articles

Perception of Biosimilar Biologics and Non-Medical Prescription Switching among Rheumatologists: A Saudi Society for Rheumatology Initiative

BackgroundThe aim of this study was to evaluate rheumatologists’ perceptions of biosimilar biologics and Non-Medical Switching (NMS). MethodsA cross-sectional survey was conducted among registered members of the Saudi Society for Rheumatology. The questionnaire focused on biosimilars and NMS. Logistic regression was performed to ascertain the effect of demographics and practice characteristics on the use of biosimilars and NMS. ResultsOut of 249 SSR members, 143 completed the survey, generating a response rate of 57.4%. Of those (59.44%) were men with a mean (±SD) age and years of practice of 42.3 ± 9.13 and 10.3 ± 8.9, respectively. Rheumatologists managing adult patients (81.82%) and Ministry of Health practice (43.36 %) were the majority of respondents. Previous experience in prescribing a biosimilar was reported by 43 (30.07%) participants, with a higher probability among women (p = 0.015). A total of 26 (18.18%) participants had performed NMS on eligible patients. Adequate knowledge on biosimilars was reported by 69 (48.25%) participants. The adequacy of evidence to grant biosimilar approval for the studied indication and extrapolation to treat other conditions was reported by 88 (61.5%) and 69 (48.3%), respectively. The concept of totality-of-the-evidence was well understood by 37.1%. Biosimilars had been previously used by 43 (30.07) participants in their practice. NMS had been attempted by 26 (18.18), while 86 (60.1%) participants believed that NMS might harm patients. ConclusionThere is a clear knowledge gap about the biosimilar approval process among adult and pediatric rheumatologists who took part in the survey. In addition, a large number of participants reported having negative opinions about NMS. There is a need to organize SSR-led educational activities, and develop national guidelines regarding biosimilars and NMS.

Comparison of treatment retention of originator vs biosimilar products in clinical rheumatology practice in Sweden.

ObjectivesTo compare treatment retention between biosimilars and their originator products among first starters (etanercept, infliximab, adalimumab and rituximab), as well as after non-medical switch.MethodsPatients with rheumatic diseases starting, for the first time, an originator or biosimilar etanercept, infliximab, adalimumab or rituximab were identified in the national Swedish Rheumatology Quality Register. Moreover, patients switching from an originator to its biosimilar were identified and individually matched to patients continuing on the originator. One-year treatment retention was calculated and hazard ratios (HR) for discontinuation with 95% CIs were estimated, adjusting for comorbidities and socio-economic factors.ResultsIn total, 21 443 first treatment courses were identified. The proportion of patients still on the drug at 1 year and the HR for discontinuation revealed no differences across adalimumab (Humira, Imraldi, Amgevita and Hyrimoz) nor across rituximab products (Mabthera, Ritemvia/Truxima and Rixathon). The proportions on the drug at 1 year were similar for Benepali (77%) and Enbrel (75%) and the adjusted HR for Benepali compared with Enbrel was 0.91 (95% CI 0.83, 0.99). For infliximab, the proportion still on the drug at 1 year was 67% for Remicade and 66% for Remsima/Inflectra and the HR compared with Remicade was 1.16 (95% CI 1.02, 1.33). Among 2925 patients switching from an originator drug to one of its biosimilars, we noted no statistically significant or clinically relevant differences in drug survival compared with those who remained on originator therapy.ConclusionThis large observational study supports the equivalence of biologic DMARD biosimilar products and originators when used in routine rheumatology care.

Non-medical switching from originators to biosimilars in patients with rheumatic disease in routine clinical care: what is the best strategy?

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The Economic Impact of Originator-to-Biosimilar Non-medical Switching in the Real-World Setting: A Systematic Literature Review.

IntroductionTo save costs to the healthcare system, forced non-medical switch (NMS) policies that cut drug coverage for originator biologics and fund only less expensive biosimilars are being implemented. However, costs related to the impact of NMS on healthcare resource utilization (HCRU) must also be considered. This study aims to summarize the evidence on the economic impact of an originator-to-biosimilar NMS.MethodsA systematic literature review (SLR) was conducted. Publications reporting on HCRU or costs associated with originator-to-biosimilar NMS in the real-world setting were searched in MEDLINE and EMBASE from January 2008 to February 2020. In addition to hand searching the reference lists of relevant publications and SLRs, key conference websites, PubMed, and various government sites were also searched for the 2 years preceding the search (2018–2020).ResultsA total of 1845 citations were identified, of which 49 were retained for data extraction. Most studies reporting on the HCRU associated with NMS reported on post-NMS HCRU alone without a comparison pre-NMS. However, four studies described a difference in HCRU (i.e., investigations pre- vs post-switch or between non-switchers vs switchers), all of which reported a relative increase in HCRU, including laboratory testing, imaging, medical visits, and hospitalizations, amongst patients who underwent an originator-to-biosimilar NMS. Most studies reporting on the costs associated with NMS reported significant savings following NMS on the basis of drug costs alone. However, four studies specifically reporting on the difference of costs following originator-to-biosimilar NMS all demonstrated an increase in HCRU-related costs associated with NMS (increase in HCRU-related costs of 4–37% or 148–2234 2020 Canadian dollars).ConclusionAmongst the studies that reported on the difference in HCRU pre- vs post-switch or between non-switchers and switchers, all showed an increase in HCRU and related costs associated with NMS, suggesting that the expected overall savings due to less costly drug prices may be reduced as a result of an increase in HCRU and its associated costs post-switch. Nevertheless, more real-world studies that include NMS-related healthcare costs in addition to drug costs are needed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01951-z.

Originator-to-biosimilar non-medical switch may not yield such great cost savings

Originator-to-biosimilar non-medical switch may not yield such great cost savings

Non-medical switching of prescription medications, brand-name drugs and out-of-pocket spending on medicines among Peruvian adults

Abstract Objectives This study evaluated the association between non-medical switching of prescription medications (NMSPM) with brand-name drugs and out-of-pocket spending (OPS) on drugs among Peruvian adults. Methods We conducted a secondary analysis of the National Survey of User Satisfaction Health using an analytical cross-sectional design. We included 3155 adults who went to drugstores and pharmacies with prescriptions. The independent variable was the self-reported NMSPM. The outcomes were brand-name drug purchase and OPS on drugs. We calculated crude and adjusted prevalence ratios (PR) with their respective 95% confidence intervals (CIs), and the OPS on drugs was analysed using linear regression with crude and adjusted β and their 95% CIs. Key findings The rate of NMSPM was 6.7%, the proportion of brand-name drug purchases was 55.7% and the average spending on drugs was US$1.73. In the adjusted analysis, the proportion of brand-name drug purchases with NMSPM was higher than without (73.3% versus 54.5%; P < 0.001), with a statistically significant association (adjusted PR = 1.38; 95% CI = 1.29 to 1.47; P < 0.001), and the association between NMSPM and OPS on drugs was statistically significant (adjusted β = 0.23; 95% CI = 0.16 to 0.30; P < 0.001). Conclusions There is a greater probability of brand-name drug purchases and OPS on drugs when NMSPM exists among adults who go to drugstores and pharmacies in Peru.

Infliximab use in the Netherlands: Uptake and characteristics of originator and biosimilars over time.

The objective of this retrospective cohort study was to provide an overview of the utilization of originator and biosimilar infliximab in the Netherlands. All infliximab dispensings were selected from the PHARMO In-patient Pharmacy Database from 2002-2018. Descriptive analyses were performed in order to characterise initiators and to describe switching patterns over time. Overall, 3840 patients with 61 274 infliximab dispensings were identified. 2496 patients initiated an originator infliximab and 777 patients initiated a biosimilar infliximab. Overall, 57% of the patients was female and mean age was 43.2 years. Both originators and biosimilars were mostly prescribed by gastroenterologists, followed by internists and rheumatologists. After market authorisation of the first biosimilar, the proportion of new patients initiating the biosimilar increased from 39% in 2015 to 91% in 2018. Out of 704 patients eligible for switching 34% switched. Among switchers, the proportion of females was 60% and mean age at index was 45.1 years. Among nonswitchers, 55% were female and mean age was 39.8 years. The median time to switch was 1.7 years and switchers were most frequently initiated on infliximab by a rheumatologist (42%), while nonswitchers were most frequently initiated by a gastroenterologist (42%). The results of this large population-based cohort show an increase in biosimilar initiation in daily clinical practice. The number of switchers remains relatively low as nonmedical switch is not encouraged in the Netherlands.

S837 Payor-Mandated Non-Medical Switching From Infliximab to Biosimilar Creates Dosing Delays

S837 Payor-Mandated Non-Medical Switching From Infliximab to Biosimilar Creates Dosing Delays

A critical review of substitution policy for biosimilars in Canada

Abstract: Canada has approved a total of 36 biosimilars. While the approval of biosimilars is regulated at the national level, decisions about biosimilar substitution are made at the provincial level. Four Canadian provinces, representing around 50% of the population in Canada, have now implemented policies requiring non-medical switching of biosimilars – switching from a patient from an originator biological to a biosimilar primarily for economic reasons. In this article, we compare biosimilar substitution policies in Canada to policies in Europe and the US, finding an enhanced focus on clinical and marketplace factors in these regions. We also find evidence that in some cases non-medical switching may pose a risk to patients and suggest that Canada could learn from more mature markets, such as those in Europe, where switching policies better consider patient needs, preserve physician choice and promote market competition.

Role of Adalimumab Biosimilar in the Treatment of Non-Anterior Uveitis Associated with Behçet's Syndrome.

IntroductionTo evaluate the efficacy of SB5, an adalimumab biosimilar, in the management of Behçet’s syndrome (BS)-related uveitis.MethodsData from eight BS patients (16 eyes) with active non-anterior uveitis and/or systemic uncontrolled disease or performing non-medical switch to SB5 were retrospectively collected and analyzed.ResultsComplete control of uveitis was observed in all 16 eyes without relapses during follow-up. The number of relapses 12 months prior to SB5 initiation and at last follow-up was 100 and 0 per 100 patients/year, respectively (p = 0.010). At baseline, four eyes had active retinal vasculitis, whereas at 3 months and at last follow-up, retinal vasculitis had resolved in all of them (p = 0.018). Median visual acuity did not vary significantly between baseline and last follow-up visit (p = 0.109). No ocular complications emerged during treatment.ConclusionsSB5 is effective in the treatment of BS-related non-anterior uveitis. It reduces uveitis relapses and controls retinal vasculitis while allowing preservation of visual acuity.

Comparison of Renal Responses Between Continuous Mycophenolate Mofetil and Conversion from Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium in Lupus Nephritis.

BackgroundMycophenolate mofetil (MMF) is extensively used for induction and maintenance therapy in patients with lupus nephritis (LN). Enteric-coated mycophenolate sodium (EC-MPS) was developed to reduce the adverse gastrointestinal effects of MMF. However, the therapeutic efficacy of MMF and EC-MPS in LN remains unclear. This study aimed to examine the treatment effects of EC-MPS in LN patients with prior MMF exposure.MethodsIn this medical records review study, we included 54 LN patients, of whom 34 converted from MMF to EC-MPS at equimolar doses in 2016–2018 (nonmedical switching group) and 20 received continuous MMF treatment. Patients achieving complete remission or partial remission before the conversion were categorized as responders, whereas those who had never achieved complete remission or partial remission were categorized as nonresponders.ResultsBaseline proteinuria was higher in the nonmedical switching group. Although elevation in proteinuria was observed after nonmedical switching, the serum creatinine concentration and estimated glomerular filtration rate both improved. Responders in the nonmedical switching group had lower proteinuria and higher complement 3 levels. In the subgroup analysis, albeit the modest increase in daily urine protein, anti–double-stranded DNA antibody levels, estimated glomerular filtration rate, and complements 3 and 4 seemed comparable after conversion.ConclusionSwitching to EC-MPS demonstrated a similar short-term renal response to continuous MMF treatment in LN patients. Prospective randomized trials are required to verify our findings.

Cost and clinical impact of a nonmedical DPP-4 inhibitor switch in patients with diabetes.

BACKGROUND: Nonmedical formulary switches (NMFS) routinely occur in managed health care plans and involve changing preferred medications for reasons outside of clinical considerations. The cost implications of NMFS are infrequently published and the clinical outcomes rarely assessed. OBJECTIVE: To assess the real-world clinical and cost implications of an NMFS involving sitagliptin and linagliptin. METHODS: An NMFS was made to the Geisinger Health Plan (GHP) commercial, health care reform, and Medicaid formularies on February 1, 2018, involving a change in preferred medication from sitagliptin to linagliptin. Claims data from GHP and clinical information from electronic health records of the Geisinger Health System were used to evaluate the cost and clinical impact of this change. Patients aged 18 years or older who were continuously enrolled in a GHP commercial, health care reform, or Medicaid plan throughout the entire study period and had at least 1 fill for sitagliptin during the preswitch phase were included in the study. We investigated the differences in various clinical and economic outcomes from pre- to postswitch among those who switched and remained adherent to the new preferred therapy throughout the 12-month postperiod ("linagliptin switch" group) and patients who did not ("other switch" group). Clinical outcomes included all-cause hospitalization, diabetes-related hospitalization, and glycosylated hemoglobin (HbA1c), while economic measures included changes in per member per month (PMPM) spending. The negative binomial regression model was used to estimate utilization counts. A generalized linear model with a log link and gamma distribution was used to analyze cost data. RESULTS: 1,203 patients met the inclusion criteria. Of these, 501 (41.6%) individuals switched to and remained at least 80% adherent to linagliptin in the postperiod, while 702 (58.4%) did not. No difference between groups was found when comparing the pre- to postswitch change in all-cause hospitalization (incidence rate ratio (IRR) = 1.46, 95% CI = 0.66-3.23, P = 0.3436) or diabetes-related hospitalization (IRR = 1.39, 95% CI = 0.62-3.10, P = 0.4203). Additionally, no difference was found between groups regarding the change in HbA1c 12-month postswitch compared with baseline (difference between groups = -0.10%, 95% CI = -0.39%-0.19%, P = 0.4962). Total PMPM spending was 43% higher in the other switch group compared with the linagliptin switch group (IRR = 1.43, 95% CI = 1.25-1.63, P < 0.0001). This trend was driven by 92% higher medical PMPM spending in the other switch group compared with the linagliptin switch group (IRR = 1.92, 95% CI = 1.58-2.33, P < 0.0001) but was offset by 12% lower pharmacy PMPM spending in the other switch group (IRR = 0.88, 95% CI = 0.82-0.95, P = 0.0009). CONCLUSIONS: An NMFS from sitagliptin to linagliptin resulted in overall health plan savings with no significant changes in health outcomes. DISCLOSURES: Funding for this study was provided by Geisinger Health System, which had no role in the study outside of a final review of the submitted manuscript. Johns and Gionfriddo are Geisinger employees. The authors report no financial conflicts of interest.

Switch z originálního na bio­similární adalimumab SB-5 u nemocných s Crohnovou chorobou – dlouhodobé výsledky

Background and aims: Originator-adalimumab, an established treatment for patients with Crohn‘s disease (CD) showed no difference in efficacy or adverse events vs the adalimumab biosimilar SB5 (SB5-adalimumab) over 10 weeks of treatment. To understand the long-term efficacy of SB5-adalimumab in CD, patients who switched from originator-adalimumab to SB5-adalimumab were compared to a cohort who remained on originator-adalimumab over a follow up of 104 weeks. Methods: In this analysis, data on patients ≥18 years and diagnosed with CD treated at the IBD ISCARE centre were collected prospectively between July 2018 and January 2021. Clinical disease activity as measured by Harvey-Bradshaw index (HBI) at Week 52 was the primary outcome, while C-reactive protein (CRP), faecal calprotectin (FC), adalimumab trough levels in Weeks 10, 26, 52, 78, and 104, adverse events leading to therapy withdrawal, and persistence on treatment were secondary outcomes. To ensure comparable treatment cohorts, patients were propensity score matched (PSM) for age, gender, diagnosis, and disease activity. Results: A total of 54 patients were matched according to the given criteria in each group. At Week 52, the mean [SD] HBI score was 3.2 (2.5) in the originator-adalimumab group and 4.0 (3.6) in SB5-adalimumab patients (difference [95% CI] –0.78 [–2.8, 1.3]). Similarly, no clinically significant differences in CRP, FC, or trough levels were noted between originator-adalimumab and SB5-adalimumab cohorts through Week 52. The Kaplan-Meier estimates (95% CI) of patients remaining on treatment for the originator-adalimumab vs SB5-adalimumab cohorts were 0.870 (0.785–0.965) vs 0.648 (0.533–0.789) at Week 52. Conclusions: These long-term study results in CD patients after a non-medical switch from originator-adalimumab to SB5-adalimumab showed that the biosimilar SB5 had similar therapeutic effects as originator-adalimumab in terms of clinical disease activity, biological parameters, and pharmacokinetics profile at the primary endpoint of 52 weeks, as well as 104 weeks. Differences in persistence were not clinically driven. Persistence on treatment was lower in patients treated with biosimilar adalimumab SB-5.

The Great Debate With IBD Biosimilars: Con: Biosimilars Should Not Be Routinely Used as a First Line Biologic and Not Switched From Reference Biologics.

The costs associated with biologic therapy in immune-mediated diseases, including inflammatory bowel disease has steadily increased since their introduction over 2 decades ago. The introduction of biosimilars has the promise of cost savings and putting reimbursement pressure on future market entries. However, the interpretation of evidence to support the use of biosimilars either as first line or as part of a nonmedical switch strategy is not straight forward due to low to very low-quality evidence. In particular, switching to a biosimilar is associated with both clinical, ethical, and possibly medicolegal issues. Due to these factors, solutions to address cost efficiency should involve an open, transparent, and collaborative dialogue among the various stakeholders and if at all possible involve strategies that allow patients to remain on originator biologics.

Non-Medical Switching Impact on Patients and Providers – Psoriatic Disease Community Taking a Stand

Non-Medical Switching Impact on Patients and Providers – Psoriatic Disease Community Taking a Stand

PBI8 Economic Impact of an Originator-to-Biosimilar Non-Medical Switch in the Real-World Setting: A Systematic Literature Review

To save costs to the health care system, forced non-medical switch (NMS) policies that cut drug coverage for originator biologics and fund only less expensive biosimilars are being implemented. However, costs related to the impact of NMS on health care resource utilization (HCRU) must also be considered. This study aims to summarize the evidence on the true economic impact of an originator-to-biosimilar NMS. A systematic literature review (SLR) was conducted. Publications reporting on HCRU or costs associated with originator-to-biosimilar NMS in the real-world setting were searched in MEDLINE and EMBASE from January 2008 to February 2020. In addition to hand searching the reference lists of relevant publications and SLRs, key conference websites, PubMed and various government sites were also searched for the two years preceding the search (2018-2020). A total of 1,845 citations were identified, of which 49 were retained for data extraction. Most studies reporting on the HCRU associated with NMS reported on post-NMS HCRU alone without a comparison pre-NMS. However, all 4 studies that described a difference in HCRU reported an increase in resources, including laboratory testing, imaging, medical visits, and hospitalizations, amongst patients who underwent an originator-to-biosimilar NMS. Most studies reporting on the costs associated with NMS reported a significant savings following NMS based on drug costs alone. However, all 4 studies specifically reporting on the difference of costs found that, when both HCRU-related costs and drug costs are considered, the overall savings associated with originator-to-biosimilar NMS were greatly reduced and, at times, resulted in an increase, rather than decrease, in annual costs per patient. Amongst the studies that reported on the difference in HCRU, all showed an increase in HCRU and related costs associated with NMS. Nevertheless, more real-world studies that include NMS-related healthcare costs in addition to drug costs are needed.

PBI10 Economic Impact of Originator-to-Biosimilar Non-Medical Switching on Health Care Resource Utilization in Rheumatic Patients in Quebec, Canada

A number of Canadian jurisdictions have or are planning to implement mandatory originator-to-biosimilar non-medical switching (NMS) by funding only less expensive biosimilars; however, other costs unrelated to drug acquisition may need to be also considered, including those pertaining to health care resource utilization (HCRU). The objective of this study was to estimate the economic impact of NMS on HCRU in Quebec, Canada.

Multiple Switches From the Originator Infliximab to Biosimilars Is Effective and Safe in Inflammatory Bowel Disease: A Prospective Multicenter Cohort Study.

BackgroundThough a single nonmedical switch from the originator infliximab (IFX) to a biosimilar is considered effective and safe for most patients with inflammatory bowel disease (IBD), very limited data are available on multiple successive switches.MethodsWe performed a prospective multicenter cohort study of adult IBD patients who underwent 2 switches from the originator IFX to CT-P13 to SB2 (group 1), 1 switch from CT-P13 to SB2 (group 2), and 1 switch from the originator IFX to CT-P13 (group 3). Patients were assessed at 4 and 12 months since the most recent switch for remission using clinical (physician’s assessment) and biochemical (C-reactive protein [CRP], and fecal calprotectin [FC]) measures. Patients discontinuing treatment for ineffectiveness or adverse events before month 12 were imputed as nonremitters.ResultsOne hundred seventy-six patients (Crohn’s disease 71%, ulcerative colitis 27.8%, IBD unclassified 1.2%; group 1, 69; group 2, 80; group 3, 27) were included. At 12 months after the most recent switch 76.9% (40 of 52, group 1), 65.7% (46 of 70, group 2) and 76.9% (20 of 26, group 3) of patients were in clinical remission. Treatment persistence at 12 months was 85.0%, 87.0%, and 70.1%, respectively. There were no significant differences in the rate of clinical, CRP, FC remission, or treatment persistence at 12 months between the 3 groups. Infusion reactions occurred in 1.7% of patients (3/176), all in patients with antidrug antibodies from group 2.ConclusionsMultiple successive switching and switching between biosimilars of IFX seemed to be effective and safe.

AB0217 NON MEDICAL SWITCH FROM ETANERCEPT ORIGINATOR TO BIOSIMILAR GP2015 IN PATIENTS WITH CHRONIC INFLAMMATORY ARTHROPATHIES

Background:In the last decades, new biologic drugs were introduced for the treatment of chronic inflammatory arthropathies, progressively leading to a relevant increase of medical costs. However, the introduction of biosimilars (biologic molecules similar to branded drugs with expired patent) permitted to optimize the financial resources. The non-medical switch (NMS) is the switch from a biologic originator to a biosimilar agent for economic reasons only, on the basis of the substantial equivalence as regards efficacy and safety between originator and biosimilar drugs.In literature, several evidences from clinical trials and registry studies showed that the switch from etanercept originator to biosimilar SB4 was safe [1]. Instead no sufficient data may be found regarding the biosimilar GP2015.Objectives:We aimed to evaluate efficacy, safety, and retention rate in a series of patients with chronic arthritis treated with etanercept originator who underwent to NMS towards the ETN biosimilar GP2015.Methods:From March to June 2020, all patient referred in our Centre affected by rheumatoid arthritis (RA), psoriatic arthritis (PA) and axial spondyloarthritis (axSpA) treated with etanercept originator and in remission/low disease activity for at least 6 months underwent to NMS. Data on disease activity (DAS28-PCR/CDAI/SDAI; DAPSA; BASDAI), eventual adverse events and causes of withdrawal of therapy were collected at 2, 4 and 6 months after the switch.Results:We recruited 71 consecutive patients (M/F: 24/47; mean age 55,8± 11,1 years; 39 RA; 15 PA; 17 axSpA; mean duration therapy 7.3±3.8 years). Disease activity was unchanged for almost all patients after 6 months from the switch (median ΔDAS28-PCR/CDAI/SDAI: 0,1/0/0,5; median ΔDAPSA: 0; median ΔBASDAI: 0) Moreover, the 6-month retention rate was 97.2%. Only 2 patients (2.8%) switched back to the originator due to loss of efficacy in one case and adverse events in the second case (paraesthesia, headache, dizziness and worsening of arthralgia).Conclusion:Our study confirmed that the NMS from ETN originator to GP2015 represents a safe practice that maintains the efficacy of the current treatment.

POS0301 NO MAJOR DIFFERENCES BETWEEN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE WHO UNDERWENT MONO- OR MULTISWITCHING OF BIOSIMILARS IN ROUTINE CARE (PERCEPTION STUDY)

Background:The increasing availability of biosimilars (bsDMARDs) has created a financial incentive to encourage switching to cheaper products (“non-medical switch”) leading to different switching scenarios. While the clinical efficacy and safety of multiswitching seems to be established (1), limited data on patients’ knowledge about bsDMARDs and satisfaction with care are available.Objectives:The aim of our study was to learn more about the outcome of mono- and multiswitching scenarios in routine care with respect to patients’ attitudes towards bsDMARDs in chronic inflammatory rheumatic diseases (CIRD) such as rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA).Methods:Consecutive patients with CIRD who were planned to switch treatment of one adalimumab biosimilar (ADA-bsDMARD) to another ADA-bsDMARD were recruited. The number of previous ADA-bsDMARD categorized the patients into: monoswitch = 1 and multiswitch = &gt;1. Demographics and standard assessments using validated outcome parameters for disease activity, physical function, and patient satisfaction with care (Leeds Satisfaction Questionnaire (LSQ) were documented. LSQ contains items on five subscales (provision of information; empathy with the patient; attitude to the patient; access to and continuity with the care giver; and technical competence) and a general satisfaction scale. Knowledge about bsDMARDs was recorded using a structured questionnaire.Results:Out of 90 patients in total, there were 42 with a monoswitch and 48 with a multiswitch scenario (Table 1). Patients were satisfied with care irrespective of the switching scenario. However, the knowledge about bsDMARDs was generally rather low (Figure 1). Less than one third of patients was able to identify correct answers about manufacturing, efficacy/safety issues, approval status and costs of bsDMARDs. However, when comparing the two switch scenarios, no differences in disease characteristics nor in satisfaction with care were found. Also the number of switches had not increased the knowledge about bsDMARDs.Table 1.Patients and disease characteristics stratified by switch scenarioVariables*Monoswitch (n=42)Multiswitch (n=48)P-WertSex, male, n (%)23 (54.7)26 (54.2)Age, years44 (14)51 (11)Rheumatoid Arthritis, n (%)14 (33.3)7 (14.6)Axial Spondyloarthritis, n (%)23 (54.8)31 (64.6)Psoriatic arthritis, n (%)5 (11.9)10 (20.8)Disease duration, years9.2 (2.5)10.6 (6.7)0.48DAS282.2 (1.2)2.9 (0.7)0.13HAQ1.2 (0.6)1.2 (0.5)0.91ASDAS2.1 (1.2)1.6 (1)0.70BASFI4.6 (2.9)3.7 (2.9)0.87Patient satisfactionLSQ-General (1-5) #3.7 (0.7)3.9 (0.6)0.58LSQ-Information (1-5)3.7 (0.6)3.6 (0.4)0.20LSQ-Empathy (1-5)3.6 (0.6)3.5 (0.5)0.57LSQ-Technical (1-5)4.1 (0.5)4.1 (0.5)0.51LSQ-Attitude (1-5)3.8 (0.7)3.9 (0.5)0.62LSQ-Access (1-5)3.7 (0.6)3.8 (0.6)0.70*values in mean (SD)# values of 1 indicate dissatisfactionConclusion:This study shows that multiswitching did not lead to reduced satisfaction with care in patients on treatment with bsDMARDs. Especially, the number of switches did have no negative impact on patients satisfaction. The observation that patients who underwent multiple switches had no more knowledge about bsDMARDs than patients who just had one switch may just be explained by the positive experience most patients had with switching.