Background: Biologic medications have dramatically enhanced the treatment of many chronic paediatric\ninflammatory conditions. Their high cost is a factor that prohibits their broader use. Cheaper generic versions, or\nbiosimilars, are increasingly being used. Healthcare services are switching some patients over to biosimilars for\neconomic reasons, known as â??non-medical switchingâ??. Some patients unsuccessfully switch due to perceived\ndecreases in efficacy or non-specific drug effects. The implications of failed switching include exhaustion of\ntherapeutic options, unnecessary exposure to other medications, increased healthcare utilisation, worse patient\noutcomes and higher overall healthcare costs. Patient perceptions almost certainly play a role in these â??failed\nswitchesâ??.\nMethods: A thematic analysis was performed to better understand patient and parent perceptions on non-medical\nbiosimilar switching. The study was conducted in accordance with the Consolidated Criteria for Reporting\nQualitative Research recommendations. Patients with juvenile idiopathic arthritis currently taking adalimumab were\nincluded.\nResults: Nine families were interviewed just prior to a hospital trust-wide non-medical switch to an adalimumab\nbiosimilar. Several common themes were identified. The most frequent concerns were regarding practical aspects\nof the switch including the medication administration device type; the colour of the medication and administration\ndevice; and whether the injections would sting more. The relative safety and efficacy of the biosimilar was raised\nalthough most families felt that there would be no significant difference. Anxieties about the switch were largely\nplacated by reassurances from the medical team.\nConclusions: We derived recommendations based on existing adult literature and the observations from our study\nto optimise the benefits from non-medical biosimilar switching.
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