Exploring the Reasons Behind the Substantial Discontinuation Rate Among Patients Taking CT-P13 in a Large Tertiary Hospital in Western Switzerland: A Retrospective Cohort Study Using Routinely Collected Medical Data

Marko Krstic; Jean-Christophe Devaud; Joachim Marti; Farshid Sadeghipour

doi:10.1007/s40801-022-00299-2

Exploring the Reasons Behind the Substantial Discontinuation Rate Among Patients Taking CT-P13 in a Large Tertiary Hospital in Western Switzerland: A Retrospective Cohort Study Using Routinely Collected Medical Data

Drugs Real World Outcomes. 2022 Sep;9(3):425-436. doi: 10.1007/s40801-022-00299-2. Epub 2022 May 19.

Authors

Marko Krstic^{1

2

3

4}, Jean-Christophe Devaud^{2

3}, Joachim Marti^{5

6}, Farshid Sadeghipour^{7

8

9

10

11}

Affiliations

¹ Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
² Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
⁵ Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
⁶ Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.
⁷ Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland. [email protected].
⁸ Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. [email protected].
⁹ Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. [email protected].
¹⁰ School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. [email protected].
¹¹ Section de Pharmacie, UNIL-Sorge, Bâtiment Génopode, CH-1015, Lausanne, Quartier, Switzerland. [email protected].

Abstract

Background: CT-P13 is an infliximab biosimilar that was granted market authorization in Switzerland in 2016. Despite the growing literature supporting the equivalence of CT-P13 compared with originator infliximab regarding the efficacy, safety, and immunogenicity and the undeniable cost-saving opportunities, CT-P13 remains widely underused in Switzerland.

Objective: Leaving aside the phenomenon of a low initiation rate, this study aimed to explore the reasons behind the high discontinuation rate observed among the patients taking CT-P13 in a large tertiary hospital in Western Switzerland.

Methods: We performed a retrospective cohort study using routinely collected data. Patients were eligible if they received originator infliximab or CT-P13 between September 2017 and December 2020. They were included if they had received at least two CT-P13 infusions during the same period. Patients were excluded if the follow-up was incomplete prior to or 6 months after their first CT-P13 infusion and if they had an oncological main diagnosis. Primary outcomes were the reasons for treatment discontinuation.

Results: One hundred and fifty-six patients were included and classified into two groups: switchers who were treated with originator infliximab and were switched to CT-P13 (n = 85, 54%) and initiators who did not receive originator infliximab prior to CT-P13 treatment (n = 71, 46%). Included patients belonged to three different groups of diagnosis: gastroenterological (67, 43%), rheumatological (61, 39%), and immunological (28, 18%). Twenty-three (27%) switchers and 35 (49%) initiators discontinued CT-P13 after 12 months. Main reasons for CT-P13 discontinuation were lack of efficacy (n = 21, 36%) and secondary loss of response (n = 16, 28%); however, objective assessments were not available. Initiators' probability to discontinue CT-P13 at 12 months was significantly higher than switchers' (p < 0.01).

Conclusions: Lack of efficacy and secondary loss of response were the main reasons for the high CT-P13 discontinuation rate observed in a large tertiary hospital in Western Switzerland. Lack of active training and coordination among healthcare professionals and little education in patients may have exacerbated patients' subjective complaints and increased the CT-P13 discontinuation rate.