A pharmacist-led intervention to promote the uptake of an infliximab biosimilar by patients and physicians in a university hospital rheumatology unit

<h3>Objectives</h3> Biosimilars represent an opportunity to reduce healthcare costs. An infliximab biosimilar (b-IFX) was introduced in our hospital in 2017. Our pharmacist-led intervention aimed to improve the adoption rate of b-IFX by rheumatology physicians and outpatients. <h3>Methods</h3> In 2020, pharmacists started educating rheumatologists via medical meetings and online surveys. When the substitution rate plateaued (63%), we initiated a prospective cohort study. A senior pharmacist interviewed patients and gave them oral and written information during their infusions with the originator infliximab (o-IFX). A semi-structured questionnaire assessed patients’ beliefs, knowledge and experiences to identify barriers to switching to biosimilars. Pharmacists’ recommendations were transmitted to physicians. Patients were categorised into ‘Switch-failure’ (≥1 b-IFX infusion administered but restarted o-IFX), ‘Switch-refusal’ (refused the switch) and ‘Switch-omission’ (switch neither suggested nor made) groups. Pharmacist follow-up continued for 3 years after the interviews, with regular reminders sent to rheumatologists. <h3>Results</h3> From 1 October 2021 to 31 January 2022, 16 of 18 patients treated using o-IFX were interviewed and three, six and seven patients were categorised into the Switch-failure, Switch-refusal and Switch-omission groups, respectively. Nine patients agreed to switch during their interviews, including one patient in the Switch-failure group. Seven patients refused to switch because they were stable or had previously discontinued b-IFX due to a perceived loss of efficacy. The 3-year post-interview assessment showed that five patients had switched but one had switched back, resulting in annual savings of €44 000 and a final switch rate of 71%, a positive return on investment in pharmacist time. Four accepted switches were not performed due to coordination issues between other healthcare professionals or health-related cancellations. No o-IFX initiations occurred during the study and no rheumatologists refused substitution. <h3>Conclusions</h3> Sustained pharmacist involvement in providing targeted education to prescribers and patients was essential to identifying barriers to change and enhancing the adoption of biosimilars.