, Volume 31, Issue 5, pp 439–446 | Cite as

Patients’ Understanding and Attitudes Towards Infliximab and Etanercept Biosimilars: Result of a UK Web-Based Survey

  • Mohammed I. Aladul
  • Raymond W. Fitzpatrick
  • Stephen R. ChapmanEmail author
Original Research Article



Infliximab and etanercept biosimilars present significant potential cost savings to the NHS. Patients need to be involved in the decision to use these medicines but there is limited published literature on their knowledge and attitudes about these biosimilars.


The aim of this study was to investigate ankylosing spondylitis and rheumatoid arthritis patients’ knowledge and attitudes towards infliximab and etanercept biosimilars in the UK.


A self-administered web survey was conducted among the members of the National Rheumatoid Arthritis Society and the National Ankylosing Spondylitis Society in the UK between 2 March 2017 and 2 June 2017.


A total of 182 patients participated in this survey. The majority of participants (73%) were on etanercept, and 66 and 80% of patients on originator biologic and biosimilars, respectively, understood what biosimilars were. Patients who were currently on biosimilars had greater confidence in their effectiveness and the doctor’s decision to initiate than those who were originally on originator biologics that doctors proposed to switch to biosimilars. The majority (82%) of participants on biosimilars thought that biosimilars help to save money for the NHS, while just over half (54%) of participants on the originator biologics thought the cost of treatment should not be considered when prescribing biosimilars.


Survey participants had a good knowledge and understanding of biosimilars. Participants on biosimilars were confident and positive about biosimilars’ safety, efficacy and switching, whereas participants on the originator biologics were more reluctant to switch to biosimilars. Those patients who expressed concerns felt that more clinical trials on switching biosimilars, better communication and reassurance by healthcare professional teams and further involvement in decision making would increase their acceptance of biosimilars.



The authors would like to acknowledge the National Rheumatoid Arthritis Society and the National Ankylosing Spondylitis Society, everyone who provided assistance in the dissemination of the survey, and all participants who completed the questionnaire. Mohammed Aladul was sponsored by the Higher Committee for Education Development in Iraq.

Compliance with Ethical Standards


This study was not funded by any organisation and the researchers are independent of any funding bodies.

Conflict of interest

Mohammed I. Aladul, Raymond W. Fitzpatrick and Stephen R. Chapman declare that they have no conflict of interest.

Informed consent

Electronic informed consent was obtained from all individual participants included in the study.

Ethical approval

This study approved by the Ethics Review Panel at Keele University (Ref. ERP393).


All authors have contributed to this study and all authors reviewed and approved the final version of the manuscript. MIA participated in the study design, data collection, and interpretation of results, prepared the manuscript draft, and performed all analytical testing and manuscript review. RWF participated in the study design, interpreted the results and reviewed the manuscript and corrected the final version of the manuscript. SRC designed the study, interpreted the results and reviewed the manuscript and corrected the final version of the manuscript.

Supplementary material

40259_2017_238_MOESM1_ESM.pdf (1 mb)
Supplementary material 1 (PDF 1068 kb)


  1. 1.
    Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W. The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes. 2009;7(1):25.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Smolen JS, Aletaha D, Koeller M, Weisman MH, Emery P. New therapies for treatment of rheumatoid arthritis. Lancet. 2007;370(9602):1861–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Van der Kooij SM, de Vries-Bouwstra JK, Goekoop-Ruiterman YP, Ewals JA, Han KH, Hazes JM, Kerstens PJ, Peeters AJ, van Zeben D, Breedveld FC, Huizinga TW, Dijkmans BA, Allaart CF. Patient-reported outcomes in a randomized trial comparing four different treatment strategies in recent-onset rheumatoid arthritis. Arthritis Care Res. 2009;61(1):4–12. doi: 10.1002/art.24367.CrossRefGoogle Scholar
  4. 4.
    Health and Social Care Information Centre. Prescribing Costs in Hospitals and the Community England 2014–15. 2015. Accessed 30 May 2017.
  5. 5.
    Azevedo VF, Galli N, Kleinfelder A, D’Ippolito J, Urbano PC. Etanercept biosimilars. Rheumatol Int. 2015;35(2):197–209.CrossRefPubMedGoogle Scholar
  6. 6.
  7. 7.
    Aladul M, Fitzpatrick R, Chapman S. CP-024 factors affecting uptake of biosimilars. Eur J Hosp Pharm. 2017;24:A10–1. doi: 10.1136/ejhpharm-2017-000640.23.CrossRefGoogle Scholar
  8. 8.
    IMS Institute. Delivering on the potential of biosimilar medicines: the role of functioning competitive markets. 2016. Accessed 11 July 2017.
  9. 9.
    Chapman SR, Fitzpatrick RW, Aladul MI. Knowledge, attitude and practice of healthcare professionals towards infliximab and insulin glargine biosimilars: result of a UK web-based survey. BMJ Open. 2017;7:e016730. doi: 10.1136/bmjopen-2017-016730.CrossRefPubMedGoogle Scholar
  10. 10.
    Nota I, Drossaert CH, Taal E, Vonkeman HE, van de Laar MA. Patient participation in decisions about disease modifying anti-rheumatic drugs: a cross-sectional survey. BMC Musculoskelet Disord. 2014;15(1):333.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    NHS England. What is a biosimilar medicine? 2015. Accessed 30 May 2017.
  12. 12.
    Jacobs I, Singh E, Sewell KL, AL-Sabbagh A, Shane LG. Patient attitudes and understanding about biosimilars: an international cross-sectional survey. Patient Prefer Adherence. 2016;10:937.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sullivan E, Piercy J, Waller J, Black CM, Kachroo S. Assessing gastroenterologist and patient acceptance of biosimilars in ulcerative colitis and Crohn’s disease across Germany. PloS One. 2017;12(4):e0175826.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Waller J, Sullivan E, Piercy J, Black CM, Kachroo S. Assessing physician and patient acceptance of infliximab biosimilars in rheumatoid arthritis, ankylosing spondyloarthritis and psoriatic arthritis across Germany. Patient Prefer Adherence. 2017;11:519.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
  16. 16.
    Lyons BA. Selecting and evaluating sources of patient education materials. In: Muma RD, Lyons BA, editors. Patient education: a practical approach. Massachusetts, Burlington: Jones & Bartlett Publishers; 2011. p. 10–4.Google Scholar
  17. 17.
    Peyrin-Biroulet L, Lönnfors S, Roblin X, Danese S, Avedano L. Patient perspectives on biosimilars: a survey by the European Federation of Crohn’s and Ulcerative Colitis Associations. J Crohn’s Colitis. 2017;11(1):128–33.CrossRefGoogle Scholar
  18. 18.
    Dunne SS, Dunne CP. What do people really think of generic medicines? A systematic review and critical appraisal of literature on stakeholder perceptions of generic drugs. BMC Med. 2015;13(1):173.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    The British Society of Rheumatology. British Society for Rheumatology Position statement on biosimilar medicines (Revised January 2017). 2017. Accessed 1 June 2017.

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.School of PharmacyKeele UniversityNewcastle-under-LymeUK
  2. 2.School of PharmacyUniversity of MosulMosul, NinevehIraq

Personalised recommendations