Perceptions and clinical use of biosimilars among rheumatologists in ArLAR countries: a cross-sectional survey.

Background: Biosimilars are increasingly used in rheumatology practice; however, knowledge gaps and regulatory uncertainties may affect their acceptance. This study assessed the knowledge, perceptions, and clinical practices related to biosimilars among rheumatologists in the Arab League of Associations for Rheumatology (ArLAR) countries. Methods: A web-based survey of 19 questions, adapted from a European Society for Medical Oncology (ESMO) tool, was distributed among ArLAR-affiliated rheumatologists between July 2024 and January 2025. The questionnaire assessed knowledge, attitudes, clinical use, and educational preferences. A French version was developed and validated by the study steering committee. Responses were analyzed using descriptive statistics. Results: A total of 105 rheumatologists from various Arab countries participated in the survey. The mean age of participants was 43.6 ± 11.7 years, and 61.9% were females. Most participants were adult rheumatologists (94.3%), primarily from Iraq (37.1%), Morocco (19%), and Algeria (16.2%). While 85.7% reported using biosimilars in practice, only 50.5% correctly identified the formal definition. Comfort with EMA/FDA-approved biosimilars was high (mean score 4.22/5), while concerns remained about switching in stable patients and among multiple biosimilars. The majority (80%) expressed interest in additional biosimilar education, particularly on regulatory approval, extrapolation, and safety. Conclusion: ArLAR rheumatologists show high uptake of biosimilars but moderate understanding of key regulatory and clinical concepts. Regionally adapted educational programs are needed to support evidence-based biosimilar use and improve confidence in clinical decision-making.