Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: One of the limiting factors for the use of biological therapies (BT) is cost. For this reason, the development of cost optimization strategies without compromising effectiveness is becoming increasingly frequent in clinical practice. Herein, we report our experience with titration of biological therapies in rheumatoid arthritis (RA) in daily clinical practice, and a comparison between two different periods of time.
Methods: An observational transversal study was performed including all patients with RA under BT (except anakinra and rituximab) in a University Hospital setting. First three months of 2011 and 2013 were included for comparison. Analyzed parameters included: dose, intervals and cost. Data were extrapolated to one year. Patients were considered as down-titrated when the quarterly dose of BT was ≤ 83% of approved dose. Effectiveness was measured by DAS28. Statistical comparison of both periods was performed by T-test and Chi-squared test.
Results: 211 and 265 patients were studied in 2011 and 2013 respectively. Percent of patients down-titrated, total mean dose and mean dose in the titrated group are shown in Table. Our data show an average decrease in total cost of 16.19% in 2013, in comparison with 9.44% in 2011. These data ranged from 0 to 34.75% with the different BT. Paired analysis of DAS28 revealed no significant differences between both time periods, 2.94 (2.05-3.84) vs 2.88 (1.80-3.96) (p=0.742).
Table. Down-titration of biologics in 2011 and 2013.
|
|
2011 |
2013 |
||||||
|
|
n |
% pdt* |
Total mean dose (%) |
Mean dose in down-titrated (%) |
n |
% pdt* |
Total mean dose (%) |
Mean dose in down-titrated (%) |
|
TOTAL |
211 |
32.54† |
88.87† |
58.82†† |
265 |
41.06 |
83.90 |
59.01 |
|
Adalimumab |
86 |
39.53 |
86.01 |
64.61 |
91 |
47.20 |
83.10 |
64.30 |
|
Etanercept |
58 |
39.66 |
80.01 |
52.85 |
80 |
53.70 |
74.20 |
52.06 |
|
Certolizumab |
14 |
0 |
100 |
– |
35 |
17.10 |
93.40 |
61.48 |
|
Infliximab |
23 |
21.73 |
115.64 |
65.07 |
18 |
5.16 |
107.39 |
82.35 |
|
Golimumab |
1 |
0 |
100 |
– |
3 |
0 |
100 |
– |
|
Tocilizumab |
19 |
31.57 |
85.74 |
54.20 |
20 |
55.00 |
77.28 |
56.70 |
|
Abatacept |
10 |
20.00 |
93.33 |
66.67 |
18 |
11.1 |
96.30 |
66.67 |
* % pdt = percentage of patients down-titrated.
† p<0.05 compared to 2013. †† p>0.05 compared to 2013.
Conclusion: Down-titration of BT in RA is feasible and occurs with increasingly frequency in daily clinical practice. This results in cost containment and contributes to rational use of these therapies.
Disclosure:
M. Arredondo,
None;
I. Cañamares,
None;
E. Ramírez-Herráiz,
None;
I. Gonzalez-Alvaro,
None;
A. Garcia-Vadillo,
None;
A. Morell,
None;
R. Garcia-Vicuña,
None;
J. M. Alvaro-Gracia,
None.
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