title: Review and results of a survey about biosimilars prescription and challenges in the Middle East and North Africa region.
abstract: BACKGROUND
  Only drafts of regulatory guidelines for the registration of biosimilars are available in Lebanon. We analyzed the results of a regional survey conducted in Lebanon to understand the impact of different parameters on the acceptance and future prescription of biosimilars. We also reviewed the current situation of biosimilars around the world. The study surveyed healthcare professionals from the Arab countries, Iran, Belgium and Italy. Data about the participants' specialty, country of residence, their knowledge about biosimilars, biosimilars' prescription, price influence and the manufacturer's credibility were collected.
  
  
  RESULTS
  117 questionnaires were completed and returned: 46 (39.3%) respondents were oncologists. 72 (61.5%) respondents were Lebanese, and the others from Egypt, Syria, Algeria, Iraq, Sudan, Jordan, Iran, Belgium and Italy. 77 (65.8%) respondents had knowledge about biosimilars, of whom 48 (62.3%) considered biosimilars as biologics that demonstrate bioequivalence with the original biodrug and have all preclinical and clinical trials equal to those already performed with the original biodrug. 74 (63.2%) out of 117 respondents agreed that biosimilars in the Arab and Middle Eastern market are already marketed. Among the 48 participants who prescribe biosimilars, the main prescription driver was the drug's approval by the FDA and EMA (68.8%). 71 (60.7%) respondents considered that the main advantage of biosimilars is their lower price and 41 (35%) out of the 117 respondents declared that they should know in which country the drug has been tested/created before using it in their own country. 35% of the respondents thought that the cost of a treatment should not come before its effectiveness or safety/tolerance, given that the biosimilar will be less expensive than the reference drug.
  
  
  CONCLUSIONS
  Biosimilars' acceptance and use is increasing worldwide. Only few physicians are aware of biosimilars presence in the market and do prescribe them in Lebanon and the Arab region. This could be mainly explained by lack of confidence in efficacy, safety, manufacturing process and price of these products, and lack of clear legislation. Thus, WHO is finalizing a new guideline for similar biotherapeutic agents. This could be a starting point for the Lebanese government to support the authorization of biosimilars.
authors.affiliation: Department of Hematology-Oncology, Hammoud Hospital University Medical Center, G. Hammoud Street, 652, Sidon, Lebanon ; Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Fadi
authors.initials: F
authors.lastname: Farhat
authors.affiliation: Department of Hematology-Oncology, Hammoud Hospital University Medical Center, G. Hammoud Street, 652, Sidon, Lebanon.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Othman
authors.affiliation: Faculty of Medicine, Saint Joseph University, Beirut, Lebanon ; Department of Medical Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon.
authors.forename: Fadi
authors.initials: F
authors.lastname: El Karak
authors.affiliation: Faculty of Medicine, Saint Joseph University, Beirut, Lebanon ; Department of Medical Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kattan
keywords: Biosimilars; Lebanon and Arab world markets; Prescription; Pricing