A few weeks ago, I published a Q&A with Laura Wingate, SVP of education, support, and advocacy for the Crohn’s and Colitis Foundation (Foundation). The Q&A was derived from a panel featuring Wingate and several other biosimilar stakeholders that I moderated at January’s CBI Biosimilars Summit. But I also got the chance to interact one-on-one with Wingate to discuss how to improve collaboration among manufacturers, and providers, and patients in the inflammatory bowel disease (IBD) space. Our conversation also served as a pulse-check on where the IBD patient and provider community currently stands in terms of biosimilars.
A few years ago, I heard Wingate speak on a panel of patient advocates at another conference. At the time, the IBD community was still expressing concerns over extrapolation and switching. Overall, the primary advice for manufacturers from the different patient advocates was to keep emphasizing the safety and efficacy of biosimilars.
Now that over two years have passed and clinical data about biosimilar safety and efficacy following a transition in the IBD field is more widespread, Wingate emphasized the community’s growing comfort with biosimilars and The Foundation’s acceptance of biosimilars in the biologics treatment paradigm. This not only bodes well for patients’ understanding of biosimilars, but also that of the gastroenterologist physician community. In fact, what’s important to note is that the Foundation is unique in that it works closely with and educates both patients and providers.
In this first of two articles, Wingate shared details about the Foundation’s ongoing initiatives in terms of educating physicians, as well as what can be done to better understand and improve physicians’ biologics and biosimilar prescribing practices.
Bridging The Gap Between KOLs And Community Physicians
Starting out our discussion, I wanted to learn to what extent biosimilars have gained traction within the IBD treatment paradigm. Wingate confirmed what we may have suspected outright — that the prospect of starting treatment with a biosimilar is handled differently depending on the patient. Though she acknowledged much progress has been made with new starts, there is still, naturally, hesitance with patients who are stable on their current reference products.
There are a variety of ways to educate patients about biologics and biosimilars — many of which will be touched upon in part two of this article. But at the base level, Wingate emphasized the work that needs to be done at the physician level — particularly at the community provider level. Overall, the thought-leader community and the health systems in which they work have demonstrated a willingness and ability to adapt to biosimilars entering the treatment pathway. In surveying biologics use in different regions of the country, for example, she emphasized the pockets of use that can be found near academic centers. But rural areas in which community providers reside don’t typically have access to these thought-leaders or their best biosimilar practices. As such, there is still a need to target these communities with RWE and basic biologics education. (And we cannot — I repeat, cannot — overlook nurses and physician assistants either, given their regular contact with patients during treatment.)
To best reach these community providers, Wingate pointed out how important it is for both advocacy groups and manufacturers to rely on each other’s expertise. There’s much physicians can learn from manufacturers and their educational materials. But there are also many resources from advocacy groups that manufacturers can rely on, as well, in their educational efforts.
“In addition to the Foundation’s resources, the FDA and organizations like the American Gastroenterological Association are seen as trusted sources,” said Wingate. “Where feasible, the Foundation leverages these and other partnerships to educate providers.”
Multi-Stakeholder Collaboration Critical For Improving Prescribing Practices
I also appreciated Wingate’s attention to the actual prescribing process, which arguably, leaves something to be desired. As she shared, at the physician’s practice level, there is currently a lot of pressure on the physician and patient to quickly determine the appropriate course of treatment.
“Most physicians are asked to make the treatment decision right then and there,” she said. “But if we could get to a place where patients were really given the time to do their background research and leverage the tools that exist to help in that decision making, we’d see the patient community better equipped with knowledge about biosimilars and their potential savings.”
When asked what could be done to allow for more time in that research and prescribing process, she offered some insight into the Foundation’s current efforts, including carrying out research on physicians’ decision making. At the end of this process, Wingate hopes to have a core group of best practices that the Foundation can put together into several actionable resources for physicians. Though there has been research into shared decision-making processes, she said the best practices from such research have not been implemented on a wide scale.
In a recent analysis of The Foundation’s professional members, physicians were asked about their biggest needs in biosimilar education and how they would like to receive that education. One of the most common responses was a call for live programming. As such, one of the challenges moving forward is to find a way to bring physicians more of this live programming — but perhaps in smaller chunks that bring the education straight to the physician. There is still work that needs to be done to best determine what shapes these educational programs can take.
As Wingate admitted, the Foundation’s survey didn’t drill down into the specific types of education that physicians — particularly community physicians (as opposed to KOLs) — would like to see about biologics and biosimilars (beyond expressing their preference for live programming). Generally speaking, conferences that include an FDA speaker walking physicians through the approval process and discussing safety and efficacy are well received. But next steps will be to figure out what other types of information physicians want and how they may want to receive that information outside of live programming.
One potential strategy could be facilitating greater collaboration amongst the different stakeholders. For example, one of the Foundation’s initiatives aims to bring providers and payers together at the same table. Though this effort is currently addressing step therapy, it’s a model that could be expanded to improve overall knowledge of the treatment pathway and how all biologics fit into it.
“I’d like to see us do more of this collaborative work, in which we bring the payer and providers together to talk about IBD and how best to manage it, including the treatment options, and the obstacles that providers may be experiencing in getting access to certain drugs,” added Wingate.
There are also ways this model could be used to help providers navigate challenges within their own prescribing community and highlight areas of potential future research in IBD. For example, IBD is a chronic illness often diagnosed in pediatric patients. In cases such as this, the life span of the disease can be 80-plus years. “What can we do, from a cost perspective, to learn about biosimilars and biologics?” Wingate added. “Can drug holidays — or planned treatment pauses — be integrated into the treatment pathway? There is a need for more research around that as well as how biologics and biosimilars are realized in all communities.” (This line of thinking ties nicely into the discussion from a few weeks ago at the Biosimilar Medicines Conference in Amsterdam, where a panel of physicians explored the potential impact earlier access to biosimilars could have on the overall disease state.)
Stay tuned for a forthcoming article featuring Wingate’s thoughts on how patients can be the drivers of change for biosimilars (and what this means), as well as what educational efforts resonate best with patients.