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Pharmacotherapy: Pharmacokinetics and Pharmacodynamics (including: ADE, TDM, DUE)
Analysis of the therapeutic positioning of biological drugs in the treatment algorithm for rheumatic diseases
  1. A. Barraquer-Comes,
  2. J.C. Juárez-Giménez,
  3. A. Sellas-Fernández,
  4. J.B. Montoro-Ronsano
  1. 1Hospital Universitari Vall d’Hebron, Pharmacy, Barcelona, Spain 2Hospital Universitari Vall d’Hebron, Rheumatology, Barcelona, Spain


Background The current treatment for rheumatic diseases (RD) includes biological drugs such as infliximab (IFX), etanercept (ETT), adalimumab (ADM), golimumab (GLM) rituximab (RTX), abatacept (ABT) and tocilizumab (TCZ). The treatment algorithm (clinical guidelines) includes IFX, ADM, ETT and GLM as first line, RTX as second line and ABT and TCZ as third line of choice.

Purpose The aim of this study was to describe the pattern of RD and assess current and past biological drug treatments to evaluate how they match with the expected algorithm, in a reference third level hospital.

Materials and methods Cross sectional study (June 2011), that included a sample of 166 patients (30% of the complete population), with 257 drug-patient records, treated with biological drugs and being monitored in our centre. The RDs included psoriatic arthritis (PA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic spondyloarthropathy (PS), Behçe syndrome (BS) and others.

Results The RD pattern was as follows: 52.4% of the population assessed had RA, 20.5% AS, 17.5% PA, 4.8% PS, 1.8% BS and 3% another RD. Currently, 30.1% of the population are being treated with IFX, 20.5% with ADM, 37.3% with ETT, 1.2% with GLM, 4.2% with RTX, 3% with ABT and 3.6% with TCZ. 4.3% of treatments were off-label indications. 98.2% of patients started treatment with a first-line biological drug. 99.7% of first-line biological drug treatments (IFX, ETT, ADM and GLM) complied with the treatment algorithm, 100% of treatments with RTX and 76.9% of third line treatments (ABT and TCZ) started before exhausting other therapeutic options. 9.3% of treatments did not comply with the treatment algorithm.

Conclusions The therapeutic positioning of biological drugs into the treatment algorithm is correct in 90.7% of the treatments and 95.7% of treatments were used in approved indications. 98.2% of patients started treatment with a first-line biological drug.

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