232 Clinical outcomes of a multi-disciplinary switching programme to biosimilar etanercept for patients with rheumatoid arthritis

Abstract

Background: Biosimilar etanercept, benepali offers the potential for large drug acquisition cost savings and is licenced in the UK for rheumatoid arthritis (RA). There is limited published data on switching (Table Presented) patients with rheumatoid arthritis from originator product to biosimilar etanercept with regards to clinical efficacy, tolerability and safety. This study aimed to compare these above parameters as well as report patient perspectives of switching to the biosimilar. Methods: This was a prospective study of a managed programme where patients were offered an education session, and attended a dedicated biosimilar switching clinic staffed by a rheumatology consultant, registrar and specialist pharmacist pre-switch and four months post-switching. In both the pre- and post-switch assessments a disease activity score in 28 joints (DAS-28) was calculated and each patient completed a health assessment questionnaire (HAQ), European Quality of Life-5 Dimensions (EQ-5D) and an 11-part biosimilars questionnaire which asked about tolerability and adverse effects of the biosimilar. Results: 151 patients with RA switched from enbrel to benepali between January 2017 and June 2017. This has resulted in a cost saving of approximately £500,000 per annum at current prices. Six of these patients were unable to attend the biosimilars switching clinic. Table 1 compares the clinical as well as patient reported outcomes both pre- and post- switching benepali. For the majority of outcomes, benepali favoured enbrel. Conclusion: This study demonstrates that in a relatively short period of time, a large number of patients with RA were switched to etanercept biosimilar in a safe and controlled manner. The most significant finding is the improvement in DAS28, with many patients achieving clinical remission. This could be explained by lower levels of immunogenicity with benepali, or may be an artefact introduced by lower rates of anxiety at follow up. The benepali pen was preferred to enbrel and patients commented on the easier technique and less manual dexterity required. Mild improvement in the patient reported quality of life outcomes was evident following the switch, (p>0.05). Reassuring results of this switching programme should positively encourage clinicians and patients to switch to biosimilar in order to optimise the cost saving to the NHS.