Background Biologic molecules for rheumatological, gastroenterological and dermatological diseases are expensive treatments. Marche Region Resolution 974/2014 aims to estimate healthcare use of these drugs by introducing (since August 2014) a treatment plan for molecules not enlisted in the national (ie, AIFA-Italian Drug Agency) monitoring registry.
Purpose To optimise biologic drug use through adherence evaluation of patients who visited the Pharmacy of Macerata General Hospital (136 750 inhabitants/catchment area).
Material and methods We drafted a review of certolizumab, etanercept, adalimumab, abatacept, infliximab, tocilizumab, golimumab and ustekinumab prescriptions received by the hospital pharmacy from September 2014 to August 2015. Diseases treated were: rheumatoid arthritis, ankylosing spondylitis, spondyloarthritis, psoriasis, psoriatic arthritis, juvenile idiopathic arthritis, ulcerative colitis and Crohn’s disease. Data collection produced a database with patient information, prescriber, diagnosis, doses provided by the pharmacy and therapy adherence. Dosage, dosing schedule and administrations frequency (first or second year of treatment) were compared with data in the Summary of Product Characteristics (SPC). Body weight and year of treatment (first or following) were unknown.
Results During 1 year of treatment, 2 207 239.03€ was spent on treating 229 patients (0.17% of inhabitants). Adalimumab, infliximab and etanercept had the highest costs (27.7%, 24% and 21.4%, respectively). The database displayed that: rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis were the main diseases 53 (23.1%), 25 (10.9%) and 24 (10.5%) cases, respectively; 4354 doses had been provided (2625 packages). Leaving out treatment failures (interruptions and switches), the number of administrations was consistent with SPC data. A total of 28.8% patients (66/229) were non-adherent: 45 interruptions (68.2%) with 33.3% due to rheumatoid arthritis; and 21 switches (31.8%) with 33.3% for rheumatoid arthritis and 23.8% for psoriatic arthritis. Adalimumab had the most number of switches (9 vs 21) in the treatment of psoriatic arthritis (33.3%) and ankylosing spondylitis (22.2%).
Conclusion Treatment plans allowed monitoring biologic prescriptions over a 1 year period and promoted clinician-pharmacist collaboration. Monitoring leads to a multidisciplinary approach and analysis of switching reasons (ie, inefficacy or adverse drug reactions) will be the next step to enhance the quality of care in rheumatological, gastroenterological and dermatological patients.
References and/or Acknowledgements Marche Region Resolution 974/2014
No conflict of interest.