Research Article

Clinical Outcomes and Patient Experience of Biosimilar to Biosimilar Infliximab Switching in Patients with Inflammatory Bowel Disease: A Prospective, Single-Centre, Phase IV Interventional Study with a Nested Qualitative Study

Table 3

Quotes to support narrative of thematic analysis.

ThemeQuote no.Group

Trust1G1“I trust you guys to do your job basically. It sounds quite blunt but I do. I do not want to go into reading everything about it and trying to learn everything about it. I see you guys know everything that is going on so, it would not bother me. I trust you. I’m pretty sure you are not going to give me something that might poison me.” (G1:051)
2G1“It comes from a history of dealing with medical professional people… which I have had a good relationship with in that way throughout my life. So, I suppose that has given me the confidence to say you know best.” (G1:015)

Clinical status at the point of switching3G1“It kind of felt like I was relatively stable and I was managing the condition quite well and then changing – it kind of went back to the old adage ‘if it ain’t broke, do not fix it’!” (G1:003)
4G2“If you have got something that works very well the question in your head is why would you change it? We’ve taken so long to get where we are you know? If it’s working why change it?” (G2:039)
5G3“I was just unsure about switching because I did not want to rock the boat if you like. I did not want it to go back to how it was…” (G3:SW)
6G3“...for once things were actually going well. After everything I’ve been through…I think I was a bit reticent to change anything, you know…kinda better the devil you know!” (G3:HW)
7G1“I was really easy going and happy about it because my Crohn’s is well controlled so I felt reassured I was still staying on a very similar drug. Umm…and so I was perfectly happy.” (G1:018)
8G1“…I found myself flaring more in the last week or two. Not sure if it was due to the change or my it was my Crohn’s. I think I was on infliximab only for about 3-4 months before the trial so I did not really find my feet properly…” (G1:003)

Past experience of switching9G2“Because of the experience I had from it, it has made me more cautious and I would worry. And the problem with that is then that you have got it in your head…you start thinking and worrying you have got symptoms and you become more aware. In your mind it all becomes more psychological and you are thinking you feel like this because you have changed drugs but maybe that’s not the case at all.” (G2:038)
10G3“I said I was not going on it because of my previous experiences.” (G3:SM)

General disposition11G1“I thought…why make it awkward. It just seemed silly to say no.” (G1:016)
12G1“I thought, ‘Well, why not?’ - as long as it did not make me any worse someone could gain from it.” (G1:16)
13G1“For the patient - benefits health wise, that nothing is going to change but that the hospital could benefit from this and save money elsewhere.” (G1:012)
14G2“I was a little bit nervous just because I always am…” (G2:026)

Information provision15G1“You can never have too much information in my opinion. It may have been a bit heavy going for some people but not for me.” (G1:057)
16G1“I do think that pack was nice because it did not hide anything. Not that you would hide anything! (laughs) I did appreciate the fact that it was all there so if I wanted to ‘Google it’ I could. I found that quite useful.” (G1:017)
17G1“It was very medically gravitated for some of the documentation you gave me especially the manufacturer’s sheet and things like that” (G1: 003)
18G1“I think when I saw the pack I was slightly overwhelmed…it seemed like a very big deal with lots of information and seemed a bit daunting…” (G1:017)
19G2“I felt reassured rather than if someone had just given me a sheet and said we are going to do this. Having someone speak to me about it was definitely better for me.” (G2:038)
20G1“As long as it’s someone who is able to answer the questions and give their confident opinion on what I’d be likely to experience and things related to it…it would not matter who did it as long as they had the information.” (G1:021)

Concerns and anxiety21G1“I do not notice any difference whatsoever. That is the nice part. I feel absolutely fine and no different.” (G1:037)
22G1“Nothing major seems to have changed. I’m just as happy on this drug as the previous” (G1:018)
23G1“If it was again considering changing just purely for the price of it I would maybe be a bit concerned about why we are getting it cheaper and cheaper and cheaper. Is it going to be cost effective or is it going to be a health effective thing? I do look at quality and finance and worry that if you are going cheaper, cheaper, cheaper - would the quality still be there?” (G1:012)
24G3“As it’s cheaper they are obviously going to use inferior medication…that’s what I think!” (G3:SW)
25G3“I did not really worry that it wasn’t safe. I did worry that it might not be as effective…” (G3:HW)