Background Infliximab (Remicade) is a chimeric monoclonal antibody against Tumour Necrosis Factor alpha used in rheumatology, gastroenterology and dermatology. It is a costly medicine that is supplied in 100 mg vials. The dose depends on the patient’s weight.
Purpose At this time, nurses reconstitute the drug. So we wanted to know if a centralised preparation system at the pharmacy could generate savings.
Materials and methods For one year (May 2012 to April 2013) we retrospectively calculated the difference between the dispensed dose and the exact dose (adapted to weight) from individual prescriptions.
Results 25 patients were treated by infliximab, representing 133 courses over the year. Administered doses were correct (difference within ± 5%) according to patient’s weight for 49.6% of courses, were rounded down to the nearest vial for 39.1% and up for 11.3%. The majority of courses are under dosed, so a centralised system would not automatically generate additional savings. Indeed, doctors are conscious of the cost and prefer to under dose rather than waste. However publications have shown that the development of antibodies toward infliximab is inversely proportional to the dose of infliximab. There is evidence that these antibodies are associated with an increased risk of infusion reactions and a decreased response. When infliximab is rounded down to the nearest vial, is there an increased risk of lack of effect or adverse effects? So, we reconsidered the advantages of centralised preparation if the exact dose were administered. If all treatments could be prepared together on the same day of the week, at least 20 vials, i.e. 9850 € over the year, could be saved.
Conclusions Our goal to make savings thanks to centralisation met with the problem of the majority of prescriptions being for low doses, compared with the approved doses. Our study raises the issue of the clinical response to low dose infliximab. If there are real risks, wouldn’t centralised preparation improve treatment, despite costing more?
No conflict of interest.
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