Real-World Dose Tapering of Biologics Reduces RA Costs

A study presented at the 2018 Annual European Congress of Rheumatology (EULAR 2018) found that dose tapering of biologics was cost saving for the treatment of rheumatic diseases in a real-world setting.

“The treatment of rheumatic diseases has been revolutionized in the biologic era,” Shabnam Batool, FCPS, a rheumatologist, and colleagues wrote in their presentation. “Remission and low disease activity are realistic targets. Several trials have suggested that dose reduction is achievable without loss of clinical effect. However, ‘real life’ response data is still lacking.”

In order to determine how dose tapering impacts clinical response and costs among patients with rheumatic diseases, the researchers contacted 97 patients with low disease activity currently taking biologics to enroll in the dose-tapering program. They enrolled a total of 40 patients in the dose-tapering program, including 24 rheumatoid arthritis patients, 9 psoriatic arthritis patients, and 7 ankylosing spondylitis patients. The biologic drugs tapered during the study included Humira (adalimumab; Abbvie), Enbrel (etanercept; Amgen), Simponi (golimumab; Janssen) and Xeljanz (tocilizumab; Pfizer).

The researchers found that 32 patients were successfully maintained on lower doses of their biologic without any need of increasing their doses to date. They found that 8 patients experienced flare ups during dose-tapering, and 2 of these patients were able to recapture disease maintenance after their doses were increased. 

Dr Batool and colleagues found that the estimated cost savings associated with dose tapering in this cohort were between €170,000 and €340,000 over 2 years.

“Successful tapering of biologic drugs can be achieved and sustained in non-trial settings for patients with low disease activity,” they concluded. “Significant cost savings have been confirmed with likelihood of recurrent savings over future years.”