Analysis Finds Misinformation About Interchangeable Biosimilars Undermining US Health Policy, Physician Confidence, and Patient Health

WASHINGTON, July 16, 2024 (Newswire.com) - The Alliance for Safe Biologic Medicines (ASBM) announces the publication of a paper underscoring the critical role of the FDA’s interchangeable biosimilar data requirements in maintaining the safety and efficacy of biosimilar substitutions. Titled “Misinformation about interchangeable biosimilars undermines US health policy, physician confidence, and patient health," the paper discusses the successes of the FDA’s data-driven approach in building physician and patient confidence in biosimilars and provides an analysis of the potential risks associated with weakening these proven standards.

In the U.S., as in most advanced nations, a prescribing physician may substitute any biosimilar for its reference product. However, substitution of biosimilars at the pharmacy level is controversial, opposed by majorities of physicians worldwide, and banned in many countries including most of Western Europe. In the U.S., only biosimilars deemed “interchangeable” by the FDA may be substituted by a pharmacist. Thirteen of the 53 approved biosimilars have earned that designation by providing additional data to the FDA demonstrating no loss of safety or efficacy even following multiple switches between a reference biologic and the biosimilar. This data may or may not include a switching study; several interchangeables have been approved without them.

ASBM Chairman and paper co-author Ralph McKibbin, MD: “All FDA-approved biosimilars are safe and effective, but treatment plans are not one-size-fits-all. Each is uniquely tailored, and patients frequently try several products before finding one that best stabilizes their condition. Physicians need to be confident that a substitution by a pharmacy or insurance company won’t disrupt the patient’s treatment stability. The interchangeable standard’s data requirements provide that assurance.”

ASBM Executive Director and paper co-author Michael S. Reilly: “While 89% of U.S. physicians are confident in the safety and efficacy of biosimilars, 69% believe only the physician and patient should determine which biologic to use, not a third-party such as a pharmacy or insurance company. These views are shared by physicians worldwide. But when a biosimilar carries an interchangeable designation, the majority (58%) of U.S. physicians are more comfortable with a pharmacy-level substitution because of the additional safety and efficacy data. The FDA’s standards are working, and any effort to lower them could compromise the progress we’ve made in building physician and patient confidence in biosimilars.”

The publication of this paper comes at a critical time as the FDA seeks public comment on recent draft guidance that proposes to lower the data requirements for demonstrating interchangeability, and the U.S. Senate is considering a bill that would deem all biosimilars interchangeable and severely restrict the FDA’s ability to ask for additional data. The paper critically examines the recent meta-analysis often cited by proponents of lowering these standards. Focusing on safety but neglecting efficacy impacts and extrapolating multi-switch safety from mostly single-switch studies, McKibbin and Reilly argue the data do not support the proposed policy change.

Reilly attributes the push to weaken the current standard to widespread misconceptions and misinformation about interchangeability: “Some incorrectly believe switching studies are mandated by the FDA for a biosimilar to be deemed interchangeable, when in fact the FDA has flexibility and approved several without switching studies. Others confuse European Medicines Agency’s definition of “interchangeable” (meaning physician-substitutable) with the U.S. definition (meaning pharmacist-substitutable) and incorrectly believe the proposed policy change would bring the U.S. in line with Europe. In reality, pharmacy substitution of biosimilars is rare in Europe and frequently banned by EU member states. Accurate information and education are critical to avoid policy missteps that will undermine the FDA’s success in building physician confidence in biosimilars and protecting patients’ health.”  

The full paper can be accessed in the latest issue of the Journal of the Generics and Biosimilars Initiative (GaBI Journal) here.

Source: Alliance for Safe Biologic Medicines