Background and importance Dosing optimisation means therapeutic benefit with the lowest possible dose for each patient, improving patient adherence and reducing adverse effects.
Aim and objectives To determine the impact of an implantation tool in the electronic medical history (ECHR) for rheumatology patients being treated with biologic drugs with or without optimisation.
Material and methods The multidisciplinary team defined optimisation strategies based on dose reduction or dosing interval. The tool was designed to be incorporated as an alert in the ECHR (Selene): ‘B’ for patients with biologic drugs (etanercept, infliximab, adalimumab, certolizumab, golimumab, tocilizumab, abatacept, secukinumab, baricitinib, tofacitinib, ustekinumab) and ‘BO’ for patients with optimised biological drugs. Eight months post-implementation, the impact of these tools on optimisation of treatments was assessed.
Results At the beginning of the study, the ‘B’ alert was included in the ECHR of 236 patients and 8 months later the ‘B’ alert was visible in 279 patients, an increase of 18%. The distribution of the drugs at the beginning and post-intervention were: etanercept (23% vs 22%), adalimumab (19% vs 21%), golimumab (14% vs 14%), certolizumab (13% vs 13%), secukinumab (9% vs 12%), infliximab (8% vs 6%), abatacept (6% vs 6%), tocilizumab (4% vs 4%), baricitinib (3% vs 2%) and tofacitinib (2% vs 3%).
For the ‘BO’ alert, at the beginning of the study it was included in 63 patients and in 91 patients at the end of the study, an increase of 44%. A total of 44% of patients were diagnosed with ankylosing spondylitis, 42% with rheumatoid arthritis and 14% with psoriatic arthritis. Drugs that were optimised were: adalimumab (54% vs 45%), infliximab (22% vs 14%), etanercept (21% vs 21%), certolizumab (2% vs 7%) and golimumab (3% vs 4%). This time, also optimised were: tocilizumab (3%), abatacept (1%), secukinumab (1%), tofacitinib (2%) and ustekinumab (1%). In 88% optimisation was performed by spacing of the dosing interval and in 12% by dose reduction.
Conclusion and relevance This tool has been shown to be effective in monitoring patients receiving treatment with biologic drugs and it has had a high impact on optimising these treatments.
References and/or acknowledgements No conflict of interest.
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