Background Rheumatology department at a South West England District General Hospital.
Objectives To audit our use of biologic therapies in patients with inflammatory arthritis. To establish how many patients we are increasing the dosage interval, which patients we are choosing to do this for and what are the success rates from this. Evaluate what the financial implications are in doing this.
Methods Using the “Homecare Patient List” patients with any inflammatory arthritis who were on a biologic medication were identified. Patients with a firm diagnosis of Rheumatoid Arthritis (RA) or Psoriatic Arthritis (PsA) were identified from this. Patients on one of 6 biologic medications (abatercept, adalimumab, certolizumab, etanercept, golimumab, and tocilizumab) were then included. Further inclusion criteria for the audit included being on a biologic medication for over 6 months (ie. Started before April 2015) and having regular follow up with our service (at least every 6 months).
148 patients were identified as suitable (108 Rheumatoid arthritis, 40 Psoriatic arthritis). Demographics were collected from hospital electronic records and then information regarding biologic medications and clinical status was taken from clinic letters using Epro records. Clinic letters prior to 2013 were not viewed. Results were collected in MS Excel template.
Results Of the 108 RA patients; 76 female and 36 male, mean age was 61 years with a range of 32 years to 78 years. In 40 of these patients we attempted to taper the interval of their biologic medication. 87% of these patients were on methotrexate as an anchor medication. Biologic medications that were tapered included adalimumab, etanercept and certolizumab. In the 40 patients tapered this change has been maintained or increased in 28 patients, giving a success rate of 70%. 12 patients have returned to the original dosing regimen due to increased disease activity.
In the Psoriatic Arthritis patient group, there were 21 females, 19 males, with a mean age of 52 years (age range 31 years to 73 years). In 5 of these patients we have attempted to taper the interval of their medication. The majority of those tapered were on monotherapy adalimumab. The changes were maintained in 80% of patients.
Conclusions In total we have attempted to taper 30% of RA and PsA patients on biologic therapies, 71% of these attempts have been maintained or increased. We are increasing the dosage intervals successfully by varying amounts, with a range from 16% to 55%, and by a mean of 30.58% over all medications included. Etanercept has successfully had the largest increase in interval with dosing intervals increasing by a mean of 55% compared to once every 7 day dosing. This has significant financial implications with an annual savings of £72,108.60 based on the data in this audit.
Disclosure of Interest None declared