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Switching and Discontinuation Patterns Among Patients Stable on Originator Infliximab Who Switched to an Infliximab Biosimilar or Remained on Originator Infliximab

Authors Fitzgerald T, Melsheimer R, Lafeuille MH, Lefebvre P, Morrison L, Woodruff K, Lin I, Emond B

Received 10 October 2020

Accepted for publication 16 December 2020

Published 6 January 2021 Volume 2021:15 Pages 1—15


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Doris Benbrook

Timothy Fitzgerald,1 Richard Melsheimer,2 Marie-Hélène Lafeuille,3 Patrick Lefebvre,3 Laura Morrison,3 Kimberly Woodruff,1 Iris Lin,1 Bruno Emond3

1Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA; 2Medical Affairs, Janssen Biologics BV, Leiden, the Netherlands; 3Analysis Group, Inc., Montréal, Québec, Canada

Correspondence: Bruno Emond
Analysis Group, Inc., 1190 Avenue des Canadiens-de-Montreal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7, Canada
Tel +1 514-394-4455
Fax +1 514-394-4461

Objective: To compare switching and discontinuation patterns of patients stable on originator infliximab (IFX) who switched to an IFX biosimilar (switchers) or remained on originator IFX (continuers) in the United States.
Methods: Symphony Health Solutions’ Patient Transactional Datasets (10/2012– 03/2019) were used to identify adults with ≥ 2 claims for either rheumatoid arthritis (RA), psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, or inflammatory bowel disease (IBD); and ≥ 1 claim for originator or biosimilar IFX. The index date was the first IFX biosimilar claim for switchers or a random originator IFX claim for continuers. All patients were required to have ≥ 5 originator IFX claims during the 12 months pre-index (prevalent population). The subset of patients with ≥ 12 months of observation prior to the first originator IFX claim was also analyzed (incident population). Switchers were matched 1:3 to continuers. Discontinuation was defined as having ≥ 120 days between 2 consecutive index treatment claims.
Results: Prevalent switchers (N=1109) were 3.57-times more likely than continuers (N=3327) to switch to another originator biologic (hazard ratio [HR]=3.57, p< 0.001). Of 249 prevalent switchers who switched to another originator biologic, 200 (80.3%) switched back to originator IFX. Incident switchers (N=571) were 2.55-times more likely than continuers (N=1713) to switch to another originator biologic (HR=2.55, p< 0.001). Of 118 incident switchers who switched to another originator biologic, 90 (76.3%) switched back to originator IFX. Prevalent switchers were 1.25-times more likely than continuers to discontinue index therapy (HR=1.25, p< 0.001). Similar results were observed in RA (prevalent population; switching: HR=3.49, p< 0.001; discontinuation: HR=1.23, p=0.009) and IBD (prevalent population; switching: HR=3.82, p< 0.001; discontinuation: HR=1.29, p=0.003) subgroups.
Conclusion: Patients switching from originator to biosimilar IFX were more likely to switch to another originator biologic (notably back to originator IFX) and discontinue index treatment than those remaining on originator IFX; however, reasons for switching are unknown.

Keywords: biosimilars, chronic inflammatory disease, treatment discontinuation, infliximab, treatment switching

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