Personalized rheumatic medicine through dose reduction reduces the cost of biological treatment – a retrospective intervention analysis

Autor:	Lars Holger Ehlers, Marlene Andersen, Troels Ring, Michael Kruse Meyer, Claus Rasmussen, Allan Stensballe, Grethe Neumann Andersen
Rok vydání:	2019
Předmět:	Male Drug medicine.medical_specialty media_common.quotation_subject Immunology MEDLINE Drug Costs Arthritis Rheumatoid Biological Factors 03 medical and health sciences 0302 clinical medicine Rheumatology Intervention analysis Intervention (counseling) Epidemiology medicine Humans Immunology and Allergy 030212 general & internal medicine Precision Medicine Intensive care medicine Retrospective Studies media_common 030203 arthritis & rheumatology Health economics Dose-Response Relationship Drug business.industry Retrospective cohort study Health Care Costs General Medicine Middle Aged Antirheumatic Agents Disease Progression Female Observational study business Follow-Up Studies Forecasting
Zdroj:	Meyer, M K, Andersen, M, Ring, T, Andersen, G N, Ehlers, L H, Rasmussen, C & Stensballe, A 2019, ' Personalized Rheumatic Medicine through Dose Reduction Reduces the Cost of Biological Treatment – a retrospective intervention analysis ', Scandinavian Journal of Rheumatology, vol. 48, no. 5, pp. 398-407 . https://doi.org/10.1080/03009742.2019.1585940
ISSN:	1502-7732 0300-9742
DOI:	10.1080/03009742.2019.1585940
Popis:	Objective: The effects of a dose-reduction intervention of biological disease-modifying anti-rheumatic drugs (bDMARDs) in patients in remission were analysed with epidemiology and health economics strategies. The aims were to analyse changes in bDMARD dosage, evaluate potential disease worsening, and estimate cost reduction. Method: This uncontrolled single-centre observational study analysed bDMARD-treated patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA). bDMARD expenditure constituted a proxy for bDMARD doses, which enabled group-level analysis. Interrupted time-series regression was used to analyse changes in treatment cost due to the dose reduction. Disease activity and treatment durations were monitored to investigate disease worsening. Results: In total, 997 biological treatment cases were analysed. This involved 527 bDMARD patients, where an unknown fraction of patients was given reduced doses. Disease activity of RA and PsA patients decreased from 2001 to 2009 and remained stable after that, while disease activity for SpA patients was unchanged, indicating no disease worsening from the intervention. The dose tapering resulted in decreased bDMARD expenditure, indicating a decrease in bDMARD consumption, which led to an accumulated cost reduction of 4 178 000 EUR. Conclusions: The results suggest that dose reduction can be safely performed in patients in treatment remission on a group level without compromising treatment efficacy. Subcutaneous bDMARDs, including abatacept, adalimumab, and etanercept, were observed to be well suited to customizing dosage. This study highlights the potential for individualized and personalized rheumatic medicine by providing dose reduction to individual patients, while monitoring disease activity.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ee76bb98263333ea1bce5ff83561410e https://doi.org/10.1080/03009742.2019.1585940 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.