BIRMINGHAM, ENGLAND — One promising strategy for holding down the cost of biologic therapy for patients with rheumatic diseases is to prescribe low doses when possible, results from two new studies have suggested.
With infliximab, for example, the typical dosage regimen in ankylosing spondylitis (AS) is 5 mg/kg given by infusion at weeks 1, 2, and 6 and then every 8 weeks. This is higher than the usual regimen for rheumatoid arthritis (RA).
“Because of cost pressures, we tried using conventional RA doses of 3 mg/kg in 13 AS patients,” Ramesh N. Jois, M.D., said at the joint meeting of the British Society for Rheumatology and the German Society for Rheumatology.
All patients had Bath AS Disease Activity Index (BASDAI) scores greater than 4 at baseline. Mean disease duration of these patients, 12 of whom were male, was 16.9 years.
Clinical response was judged to be a 50% or greater reduction in the BASDAI score at 3 months.
One patient did not respond to the low-dose regimen and required an increase to the higher dose. All other patients showed statistically significant improvements across multiple measures of efficacy, said Dr. Jois of the department of rheumatology, Norfolk and Norwich (England) University Hospital.
Some patients now have been on the regimen for 12 months, with persisting benefits. (See chart.)
Five patients have been able to reduce their methotrexate dose (mean reduction 14 mg/wk). One stopped cyclosporine, another stopped sulfasalazine, and five discontinued nonsteroidal anti-inflammatory drugs altogether, he said.
No side effects were seen with the low-dose infliximab therapy.
Use of this regimen has led to a significant cost savings of approximately $29,000 per patient per year, for a total cost savings of $315,000 to the unit in the past year, Dr. Jois said in a poster session. “We advise starting all AS patients on low-dose infliximab. Consider increasing to the higher dose only if they fail to respond,” he said.
Dr. Jois disclosed that his department has received research grant support from Wyeth, Schering-Plough, and Abbott Pharmaceuticals.
In a second study, 36 patients with RA and 3 patients with AS were treated with the standard etanercept regimen of 25 mg twice weekly for at least 3 months. Those with RA who achieved a Disease Activity Score (DAS)-28 below 3.2 and those with AS who achieved a very good response then were asked to gradually increase the interval between their etanercept injections from twice weekly to once weekly, said Veronica E. Abernethy, M.D., of the rheumatology practice development unit, St. Helens and Knowsley NHS Hospitals, Merseyside, England.
Currently, 7 of the 39 have successfully reduced their etanercept to once weekly without any deterioration in disease activity, which has resulted in a cost savings of $67,675 per year. This figure represents 9% of the total etanercept cost for the 39 patients, Dr. Abernethy said in a poster session.