Wu Qiyou, Lian Zhiwei, Wang Xin, Cheng Hanchao, Sun Jing, Yu Hui, Zhang Gong, Wu Fan, Liu Jian, Chen Chuanben
School of Health Policy and Management, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
Front Pharmacol. 2023 Jan 12;13:1044798. doi: 10.3389/fphar.2022.1044798. eCollection 2022.
To investigate the factors associated with the treatment of breast cancer with biosimilars from the perspectives of physicians and patients, and to generate evidence for promoting the uptake of biosimilars. This study targeted trastuzumab and its indicated human epidermal growth factor receptor 2 (HER2) positive breast cancer and included female HER2 positive breast cancer patients under treatment of trastuzumab at a provincial oncology medical center in southern China from 1 January 2021, to 31 December 2021. The study extracted patients' demographic, socioeconomic and clinical information and the basic information of their attending physicians from the hospital information system. We performed a bivariate multiple logistic regression analysis of predictive factors of the use of trastuzumab biosimilar. A total of 446 patients (aged ranging between 26 and 74, 51.4 ± 9.06) were included in the analysis, and 19.1% chose biosimilar trastuzumab. Older patients, patients enrolled in the urban and rural resident health insurance program compared with those enrolled in the urban employee health insurance program, patients who initiated treatment after January 2021 when biosimilar entered clinical use compared with those who initiated treatment before, patients with female attending physicians, younger attending physicians and with chief attending physicians compared with deputy chief attending physicians were more likely to adopt biosimilar trastuzumab for treatment ( < 05). Controlling the other factors unchanged, when the patient's attending physician was deputy chief physician, increasing 1 year age of the patient was associated with an increased probability of adopting biosimilar by .8% ( = .008, 95%: .002-.01, = .01). When the patient was aged between 26 and 60, the probability of adopting biosimilar for the patient whose attending physician was a chief physician was higher than for those whose attending physician was a deputy chief physician, and the gap was the largest when the patient was at the age of 45 ( = .20, 95%CI: .13-.27, < .01). The uptake rate of biosimilars is still low at its initial development stage in China. Educational policies and physicians making recommendations to the indicated patients at the initiation stage of treatment are helpful to avoid reduced willingness to switch to biosimilars due to non-clinical reasons. Patients with lower ability-to-pay will have better accessibility to biologic regimens through the uptake of biosimilars. Official guidelines and professional training are critical to enhancing physicians' willingness and confidence in adopting biosimilars.
从医生和患者的角度调查与生物类似药治疗乳腺癌相关的因素，并为促进生物类似药的使用提供证据。本研究以曲妥珠单抗及其适应证人表皮生长因子受体2（HER2）阳性乳腺癌为研究对象，纳入了2021年1月1日至2021年12月31日在中国南方某省级肿瘤医疗中心接受曲妥珠单抗治疗的女性HER2阳性乳腺癌患者。该研究从医院信息系统中提取了患者的人口统计学、社会经济和临床信息以及其主治医生的基本信息。我们对使用曲妥珠单抗生物类似药的预测因素进行了双变量多元逻辑回归分析。共有446例患者（年龄在26至74岁之间，51.4±9.06）纳入分析，19.1%的患者选择了曲妥珠单抗生物类似药。年龄较大的患者、参加城乡居民医疗保险的患者与参加城镇职工医疗保险的患者相比、2021年1月生物类似药进入临床使用后开始治疗的患者与之前开始治疗的患者相比、女性主治医生治疗的患者、年轻主治医生治疗的患者以及主任医师治疗的患者与副主任医师治疗的患者相比，更有可能采用曲妥珠单抗生物类似药进行治疗（P<0.05）。在其他因素不变的情况下，当患者的主治医生为副主任医师时，患者年龄每增加1岁，采用生物类似药的概率增加0.8%（P = 0.008，95%CI：0.002 - 0.01，P = 0.01）。当患者年龄在26至60岁之间时，主治医生为主任医师的患者采用生物类似药的概率高于主治医生为副主任医师的患者，且在患者45岁时差距最大（P = 0.20，95%CI：0.13 - 0.27，P<0.01）。在中国，生物类似药在其初始发展阶段的使用率仍然较低。教育政策以及医生在治疗初始阶段向适应证患者推荐有助于避免因非临床原因导致改用生物类似药的意愿降低。支付能力较低的患者通过采用生物类似药将能更好地获得生物制剂治疗方案。官方指南和专业培训对于提高医生采用生物类似药的意愿和信心至关重要。
