Pharmacist-Led Drug Monitoring Reduced Remicade Costs, Improved Utility

A pharmacist-led proactive therapeutic drug-monitoring program for patients taking Remicade (infliximab; Janssen) reduced costs and improved dose utility, according to research presented at Digestive Disease Week 2018.

“Optimized infliximab dosing in patients with IBD is required to achieve therapeutic drug levels,” Clarissa Rentsch, B.Pharm, senior clinical pharmacist of gastroenterology at Alfred Health, and colleagues wrote. “Rapid assays enable same-day dose adjustment with the potential benefits of faster dose-optimization, improved clinical outcomes, and reduced risks associated with high levels.”

The researchers sought to determine how drug monitoring with rapid assay compared to standard ELISA assay. They conducted a 1-year, prospective, single-center study to determine how use rapid assay impacted proactive dose-adjustment and cost-effectiveness among adult patients with IBD. Study participants were administered 8 weekly doses of 5 mg/kg maintenance Remicade therapy, with trough infliximab concentrations assessed by rapid testing in order to determine immediate does adjustment targeting. Further, they measured cost impacts using retail prices for Remicade and rapid assay testing.

According to the study findings, rapid assaying resulted in dose reductions for 51% of patients and dose-escalations for 26% of patients. Further, at 6 months 49% of patients achieved therapeutic levels of Remicade and at 1 year 58% achieved therapeutic levels. The researchers added that during the study period more than half of patients received less than 5 mg/kg of Remicade during therapy optimization. 

Additionally, the researchers found that rapid assay testing reduced per-patient per-year spending by $214 AUD compared to the standard of care. 

“The rapid test is accurate and its application in the setting of maintenance therapy led to dose adjustment in 3 of 4 patients and higher rates of therapeutic levels, implying standard weight-based dosing is inadequate,” the researchers concluded. “Dose-reduction did not carry risk of relapse. This rapid-test strategy has the potential to reduce patient risks and improve outcomes without negative cost implications.”

—David Costill