Biologics can be scary for patients: Addressing your patient’s fears

By Jules Murtha | Medically reviewed by David Ozeri, MD, FACP, FACR
Published February 24, 2023

Key Takeaways

  • Patients may be fearful of using biologics due to how they’re portrayed in the media. Anxiety over possible side effects and the injection of biologics may also influence patients’ willingness to try them.

  • Biologics fall under a class of medications known as disease-modifying antirheumatic drugs. They are large molecules produced in living cells that have been found to effectively treat inflammation.

  • To help address patients’ fears about biologics, physicians can cater their approach in shared decision-making to each patient’s personality.

Physicians may wonder why patients are resistant to biologic treatments. Many biologic drugs are FDA-approved,[] after all, and their efficacy is supported by clinical trial evidence.[]

Despite what the science says, patients who’d likely benefit from taking biologics are frequently fearful of doing so—largely because of how they’re portrayed outside of the exam room.

Physicians can address fears surrounding biologics by tailoring their approach to the unique personality traits of each patient.

Why patients fear biologics

When it comes to patient hesitancy toward biologic drugs, several factors (and misconceptions) related to the clinically tested treatments tend to fuel the fear.

A study published by Cutis in 2021 stated that some patients with psoriasis may have seen biologic drugs portrayed poorly in the media, or heard stories from friends and family who’ve had negative experiences with them.[] These experiences may influence their willingness to try them.

Additionally, some patients may be anxious about using biologics due to their potential negative side effects.

Although this anxiety isn’t entirely unfounded—biologics may increase the risk of cancer, as well as serious infections—studies show that biologics tend to have an “overall more favorable side effect profile when compared with corticosteroids,” according to an article published by Inflammatory Bowel Diseases.[] Yet, some patients still perceive biologics to be less beneficial and more “dreadful” than corticosteroids.

Still for other patients, it's a fear of needles that turns them off. Biologic drugs do not come in pill form; instead they're administered via injection or IV—a process that may contribute to patients’ hesitancy to embrace biologic treatment, according to a 2022 article published by the Arthritis Foundation.[]

Rheumatologist David Ozeri, MD, an MDLinx medical advisor, offered his perspective on patient concerns about biologics.

"As for biologics, they are relatively new. We are amid a pandemic and one of the main side effects are weak immune systems," he said. "Before starting, blood tests are needed to rule out other latent infections, a careful cancer history is taken, and the fact that there is no end date once medication is started and the need for constant blood tests makes patients uncomfortable."

"However, a selling point for biologics is that studies show that people live longer and better when their autoimmune disease is inactive. They can stop whenever they decide, so they possess the power to discontinue therapy."

David Ozeri, MD, FACP, FACR  

Address fears with the right language

Fortunately, researchers have uncovered several strategies that clinicians can employ to get patients on the same page about these reportedly underutilized treatments.

Let’s say a patient has a condition like inflammatory bowel disease (IBD) or psoriasis. While biologics may be an effective route to treat their condition, the patient is reluctant due to the controversies surrounding them. How should a physician approach this conversation?

The answer may require a close look at the patient’s personality. According to the aforementioned article published by Inflammatory Bowel Disease, patients with different personality traits tend to respond differently to the idea of biologics.

Patients who believe that their health is influenced by chance are more likely to perceive biologics as a scary form of treatment. Patients who believe it is influenced by their own choices or behaviors, however, prove to be less scared of biologics.

Clinicians can use this information to take cues from their patients and tailor an approach to their personality traits and risk perception.

Additionally, the authors of the Cutis article stated that having a good story in your back pocket may play a key role in getting your patients on board with biologics.

"The use of an anecdote—alone or in combination with clinical trial evidence—to help patients overcome fears of starting a biologic medication for their psoriasis may be an effective way to improve patients’ willingness to take treatment. "

Johnson MC, et al., Cutis

Overall, the research indicates that combining a personalized approach with anecdotal evidence may help patients to shift their perception of biologics from a scary treatment to one that offers significant benefits.

What this means for you

Despite their efficacy and overall favorable side-effect profile, biologics remain underutilized treatments for inflammation-related conditions such as IBD. Patients may be fearful of injecting biologics, and may have concerns about potential negative side effects. You can address their anxiety surrounding biologics more effectively by tailoring your approach to their personality traits. You can also use anecdotes—possibly along with clinical trial evidence—to assuage patients’ fears, thus improving their willingness to try biologics.

This article is part of Room for Better Rheum Care, where physicians and patients share the latest research, tips, and strategies for raising treatment expectations and delivering improved care in RA, PsA, and nr-AxSpA.

Related: Many RA patients are resistant to DMARD therapy. Here's how to address this obstacle head-on

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