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Pharmacists’ Perspectives of Biosimilars: A Systematic Review

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Abstract

Background and Objective

While biosimilars are less expensive than their originator biologics, various factors are known to impede their uptake in clinical practice including concerns regarding their interchangeability, efficacy, and safety. Pharmacists are well positioned to promote the adoption of biosimilars, thus, the aim of the review was to assess pharmacists’ knowledge and perceptions of biosimilars to identify the need for pharmacist-directed biosimilar education.

Methods

We conducted a systematic literature search for published articles indexed in MEDLINE via EBSCOHOST, Web of Science, Scopus, Cochrane Library, Dimensions, and Google Scholar databases. We included studies written in English from their earliest publication dates until December 2021. Only studies concerning pharmacists’ perspectives on biosimilars were included. Two reviewers extracted data from the studies that included pharmacists’ knowledge, perceptions, and opinions about interchangeability and automatic substitution of biosimilars. We also assessed the methodological quality of the included studies using the Joanna Briggs Institute Analytical Cross-Sectional Studies Assessment (JBI-ACSSA) for quantitative studies and the Critical Appraisal Skills Programme (CASP) for qualitative studies.

Results

Out of the 22 studies included in the review, 19 were cross-sectional quantitative studies, and the other three were qualitative studies. The sample size of the included studies ranged from 19 to 1500 participants. The level of knowledge of biosimilars graded as good, considerable, above average, or excellent among pharmacists varied from study to study, with a range of 47–86%. Only 22–51% of pharmacists were comfortable if biosimilars were prescribed for all of the indications previously used for the originator products. Pharmacists’ acceptability of switching from the originator to a biosimilar also varied, with a range of 26–84%. However, most pharmacists viewed the substitution of the originator with a biosimilar without physicians’ permission as unacceptable. Data from three studies reported that 22–74% of pharmacists had attended biosimilar training. They obtained information about biosimilars from scientific publications, pharmaceutical companies, and continuing education. Based on the criteria of JBI-ACSSA and CASP, the overall methodological quality of the studies ranged from moderate to high. The majority of the studies did not describe the sampling methods used and the strategies to deal with confounding factors.

Conclusions

Pharmacists’ knowledge and perception about biosimilars varied and were limited, especially about interchangeability and substitution, efficacy, safety, and indication extrapolation. A better understanding of biosimilars amongst pharmacists could help them to encourage prescribers’ acceptance of biosimilars.

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Acknowledgments

The authors thank the Director-General of Health Malaysia for his permission to publish this article.

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Authors and Affiliations

  1. Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia

    Noraisyah Mohd Sani, Zoriah Aziz, Rema Panickar & Adeeba Kamarulzaman

  2. Pharmacy Services Programme, Ministry of Health Malaysia, Petaling Jaya, Malaysia

    Noraisyah Mohd Sani & Rema Panickar

  3. Faculty of Pharmacy, MAHSA University, Jenjarom, Malaysia

    Zoriah Aziz

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Correspondence to Zoriah Aziz.

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The authors received no financial support for the research, authorship, or publication of this systematic review.

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Noraisyah Mohd Sani, Zoriah Aziz, Rema Panickar, and Adeeba Kamarulzaman have no conflicts of interest that are directly relevant to the content of this article.

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This study was conceptualized and designed by NMS and ZA. NMS carried out the search. NMS and RP independently performed the screening of studies for inclusion and quality evaluation. NMS extracted the data, which RP validated, and all authors thoroughly reviewed them. NMS prepared the manuscript’s first draft. ZA and AK conducted a critical assessment of the manuscript for significant intellectual content. ZA made critical revisions to the draft manuscript. All authors read and approved the final manuscript for publication.

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Mohd Sani, N., Aziz, Z., Panickar, R. et al. Pharmacists’ Perspectives of Biosimilars: A Systematic Review. BioDrugs 36, 489–508 (2022). https://doi.org/10.1007/s40259-022-00541-x

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