AB0403 Dose Optimization of Biological Therapies in Rheumatoid Arthritis in Clinical Practice

Background Biological therapies (BT) have resulted in a remarkable improvement in the treatment of rheumatoid arthritis (RA). One of the limiting factors for its use is cost. For this reason, the development of optimization strategies is becoming increasingly frequent. Objectives To analyze the optimization of BT in RA in daily clinical practice. Methods We conducted an observational cross-sectional study including all patients with RA under BT (except anakinra and rituximab) in a tertiary referral hospital. Data from the first three months of 2013 were analyzed and extrapolated to one year. The analyzed parameters included: dose, administration intervals and cost. In addition, in order to have an estimate of the tendency of this practice, data from the first three months of 2011 were taken for comparison. Patients were considered as down-titrated/optimized when the quarterly dose of BT was ≤83% of the approved dose. Effectiveness was measured by DAS28. Statistical comparison of both periods was performed by T-test. Results 265 patients were studied in 2013. Percentage of down-titrated patients, total mean dose and mean dose in the titrated group are displayed in Table. Our data showed an average decrease of 16.10% in total mean dose of BT. This represented an additional 5% reduction in total mean dose compared to 2011. Data ranged from 0 to 25.80% with the different BT. This reduction in quarterly dose was not associated to loss of efficacy as measured by average DAS 28 between 2011 and 2013 [DAS 28 =2.94 (2.05-3.84) vs 2.88 (1.80-3.96) (p=0.742)]. Table 1. Down-titration of biologics in 2013 n % pdt* Total mean dose (%) Mean dose in down-titrated (%) TOTAL 265 41.06 83.90 59.01 Adalimumab 91 47.20 83.10 64.30 Etanercept 80 53.70 74.20 52.06 Certolizumab 35 17.10 93.40 61.48 Infliximab 18 5.16 107.39 82.35 Golimumab 3 0 100 – Tocilizumab 20 55.00 77.28 56.70 Abatacept 18 11.10 96.30 66.67 *% pdt = percentage of patients down-titrated. Conclusions Optimization of BT in RA is increasingly frequent in clinical practice. This strategy contributes to cost containment in this and other conditions. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4952