By Christina Ha, MD
I know some people who are brand loyal because they are hesitant to change. I, however, am not one of them. And I take that approach in prescribing biologics and biosimilars for my patients, too.
I believe getting patients the right medication is more important than getting them the brand name product – and I didn’t come to this opinion on a whim.
I work at a high-volume medical center where we see, on average, 6,000 patients who have Crohn’s disease and ulcerative colitis each year. More than 60% have taken or are currently taking a biologic, a drug made from living cells or organisms. The revolutionary medications keep patients off steroids and many times prevent people from being hospitalized or having surgery due to poor control of their inflammatory bowel disease.
About five years ago, similar biologicals – or “biosimilars” – were first approved by the U.S. Food and Drug Administration. Despite being the same in terms of quality, safety and efficacy to their reference biologic, biosimilars got a bad rap. Regardless, I was an early advocate for their use. They are an important and necessary part of our therapeutic arsenal.
I explain this to my patients using an example about Coke and Pepsi. They have minor differences, but they are both cola. The same is true with biologics and biosimilars. Their names are different, but the active ingredients, which are the components that treat the inflammatory bowel disease, are exactly the same. The only minor differences between the products are within the inactive components that have no impact on controlling disease or causing adverse effects.
In some cases, insurers prefer the “brand name” product over biosimilars. Other times, they prefer biosimilars over the “brand name” product. For this reason, it is important that doctors are well-versed with both so they know when the health plan’s preference is right for their patient and when it’s necessary to push back because their patient would be better served using the other agent.
Biosimilars are very complex, not copies of simple chemical compounds like generic medications as we usually think of them. As a result, biosimilars undergo a thorough review process. Given the rigor, I have confidence that biosimilars are similar to and as effective as their reference product. This is why health care providers should feel confident in prescribing whichever product is best for their patient and should be comfortable changing one for the other when they believe it is the patient’s best interest. At the end of the day, it’s about how the medication works to treat the inflammation, not what it’s called.
I know there’s some trepidation because biosimilars are “still new.” To that I say, five years is an eternity in medicine. There’s a bounty of information about biosimilars now, including new randomized control trials held in the U.S. and abroad. In addition to these studies, clinical experience and years of use demonstrate that both agents work essentially the same.
Biosimilars are here to stay. Let’s embrace the data, expand our view of the medication options and get our patients the treatment they need.
Christina Ha, MD, is an assistant professor of Medicine at Cedars-Sinai Medical Center in Los Angeles, California and a member of the American Gastroenterological Association, which is a member of the Biologics Prescribers Collaborative.