Background and importance Biologic treatment optimisation (BTO) consists of reducing the dose and/or increasing the interval between doses in patients who have maintained their therapeutic goal for at least 6 months. In 2013, our hospital created a BTO protocol for chronic inflammatory arthropathies, based on the consensus established between the Spanish Rheumatology Society and the Hospital Pharmacy Society.
Aim and objectives To analyse the percentage development of BTO for subcutaneous biologic therapy (SBT) in patients with chronic inflammatory arthropathies, and to determine the drugs involved after implementation of the protocol.
Material and methods This was an observational retrospective study comparing patients with chronic inflammatory arthropathies being treated with SBT and BTO in 2016 and 2019. Optimisation was defined as any prescription with a lower dose or a longer administration interval than usual. Variables measured were number of patients being treated with SBT, optimisation percentage (patients with optimised prescriptions/patients treated) and optimisation percentage for each drug (optimised prescriptions of a drug/prescriptions of that drug). Data were collected from the electronic prescription software.
Results In September 2016, 246 patients were treated with SBT: 22% patients had their prescription optimised. Higher percentages for optimisation were observed for tocilizumab, adalimumab and etanercept (44%, 34% and 22%, respectively). Golimumab, certolizumab and abatacept had lower percentages for optimisation (15%, 11% and 8%, respectively).
In September 2019, 337 patients were treated with SBT: 32% patients had their prescription optimised, 10% more than in 2016. A higher percentage of optimisation was observed for tocilizumab, etanercept and adalimumab (55%, 45% and 44%, respectively). Golimumab, certolizumab and abatacept had a lower percentage of optimisation (32%, 27% and 27%, respectively). Optimisation of secukinumab was very limited (2016, 0%; 2019, 3%). No prescriptions for ustekinumab or sarilumab were optimised.
Conclusion and relevance The rise in patients treated with SBT for chronic inflammatory arthropathies has been accompanied by a rise in the optimisation percentage over time, showing how rheumatologists consider BTO effective and safe. This strategy pursues the minimal effective dose with a consequent reduction in adverse events and economic savings. Optimisation was performed mainly for drugs that have been commercialised longer (adalimumab and etanercept) and drugs with a frequent dosing interval (etanercept and tocilizumab). Future comparisons will show if drugs with longer dosing intervals could also be optimised.
References and/or acknowledgements No conflict of interest.
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