Background and Importance Pharmaceutical proposals (PPs) in a multidisciplinary programme (MP) for immune-mediated inflammatory diseases could improve drug effectiveness and efficiency of clinical decision-making.
Aim and Objectives To evaluate the impact of PPs in a MP for the management of immune-mediated inflammatory dermatological and rheumatological diseases.
Material and Methods Patients with rheumatoid arthritis (RA), spondyloarthritis, psoriasis and psoriatic arthritis (PA) receiving etanercept or adalimumab for at least 6 months continuously were screened in MP during May 2021 to September 2022. Internists, dermatologists, pharmacologists and pharmacists composed the MP. Bibliographic search on optimal therapeutic ranges (OTRs) of drugs was developed and PP protocol based on biochemical and clinical criteria was designed. Biochemical tests on serum drug levels and anti-drug antibodies were provided by pharmacists. Pharmaceutical interviews (PIs) about disease evolution were conducted before PPs. PPs were treatment optimisation (TO) based on extended dosing regimens or treatment discontinuations, drug switching (DS) due to loss of effectiveness, or unchanged therapy (UT). Patients with accepted TO had telematic PIs after 1 and 3 months (answers: ‘good course’/’mild disease’/’poor course’). Recorded data: drugs, multidisciplinary meetings, biochemical test and PIs, drugs levels and anti-drug antibodies, type of accepted PPs and telematic PI answers.
Results MP included 645 patients. Drugs distribution: 51.8% etanercept and 48.2% adalimumab. There were 25 multidisciplinary meetings. Up to study cut-off time, 408 biochemical tests and PIs were performed. Results of bibliographic search presented adalimumab OTRs of 5-8 μg/mL for RA and PA, 3.2-7 μg/mL for psoriasis and 4.6-12 μg/mL for spondyloarthritis. Etanercept OTRs: 2-3 μg/mL for RA and spondyloarthritis, and 2-7 μg/mL for PA and psoriasis. Serum drug levels were outside the OTR in 72.9% of patients. Anti-drug antibodies were found in 18 patients. PPs accepted were 305: 183 (60%) TO, 52 (17%) DS and 70 (23%) UT. Telematic PIs answers 1 month after TO were: 81.8% ‘good course’, 3.6% ‘mild disease’ and 14.6% ‘poor course’. At 3 months were: 69.8% ‘good course’, 5.7% ‘mild disease’ and 24.5% ‘poor course’.
Conclusion and Relevance Most of accepted PPs in our MP (DS and TO) can improve effectiveness and efficiency of treatments for immune-mediated inflammatory diseases in clinical decision-making. Almost three quarters of patients with TO presented good disease evolution.
References and/or Acknowledgements None
Conflict of Interest No conflict of interest
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