Ophthalmologists, Patients Hesitate to Switch to Anti-VEGF Biosimilars

A survey investigating physician and patient perspectives on anti-vascular endothelial growth factor (VEGF) biosimilars in neovascular age-related macular degeneration (nAMD) revealed hesitancy regarding their use across both cohorts.

These survey data, presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting, suggested most physicians and patients believed switching to biosimilar anti-VEGF agents should not be mandatory for treating retinal diseases, including nAMD, in Canada.

Investigators, led by Anna Tran, Queen's University, then completed follow-up interviews to supplement survey responses, with many physicians noting their fear of adverse reactions to anti-VEGF biosimilars, the need for more education, and discomfort with being an early adopter of biosimilars.

“I think it shouldn’t be black and white,” a surveyed physician said. “In general, I think if there’s no specific reason why I feel strongly against having that medication for a patient, I don’t mind using it. But, basically, the bottom line is, I think there should definitely be some physician input as to what we’re using.”

As patents for anti-VEGF agents expire, biosimilars are entering the market, but there are concerns about their safety and efficacy to the originator drug. There are questions on how the transition from originators to biosimilars could impact patient outcomes and provider practices.

In the current analysis, Tran and colleagues evaluated the perspectives of Canadian ophthalmologists and patients with nAMD on anti-VEGF biosimilar efficacy and safety, including current knowledge of rollout policy in the country.

The analysis invited ophthalmologists who performed anti-VEGF injections from August to October 2023 to participate in a physician survey through the Canadian Ophthalmological Society and Canadian Retina Society. Patients with nAMD were invited in person in August 2023 to participate in a patient survey.

These surveys included ranking questions and visual analysis scales (VAS) to assess agreement with the given statements – agreement with the statements was defined as a VAS response between 7 and 10. All participants were invited to a semi-structured interview to supplement these responses.

In the physician survey, 37 ophthalmologists across 9 provinces participated, with 3 completing a follow-up interview. Most (84%) were women and more than half (58%) practiced in an urban setting and were considered retina specialists (55%).

Upon analysis, half (50%) of ophthalmologists were unaware of their province’s biosimilar rollout policy, with 75% indicating discomfort with incorporating biosimilars into their practice.

Approximately 78% of ophthalmologists felt the switch to biosimilars should not be mandatory. The safety and efficacy of biosimilars were commonly ranked as the top two reasons for the choice of anti-VEGF treatment.

For the patient survey, 50 patients with nAMD participated, with 11 completing a subsequent interview. Most (70%) participants were female and experienced either 6 months to 3 years (46%) or 3 to 10 years (42%) of anti-VEGF treatment.

Of the patient population, 88% indicated discomfort with switching to a biosimilar, but 94% admitted they believed their doctor should decide the best drug for their treatment. Financial coverage of anti-VEGF injections was often ranked as the least important factor for treatment.

Patients also indicated a desire for more testing of anti-VEGF biosimilars and hesitancy with switching from a currently working treatment. However, patients indicated they fully trusted in their ophthalmologist’s treatment decision.

“So, if the physician prescribes [a biosimilar] and says to me that ‘no, this will be exactly the same thing,’ then I’m fine,” a patient said. “I don’t have any issues, I want that coming from my physician. Not because they’ve been mandated by the government or by insurance companies on cost savings.”

Reference

_{Tran A. Physician and Patient Perspectives on Efficacy and Safety of Anti-VEGF Biosimilars in the Treatment of Neovascular Age-related Macular Degeneration. Poster presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting. Stockholm, Sweden. July 17-20, 2024.}