De-Escalating Biologics for RA Safely De-Escalates Costs


(ACR2014) Analysts from the Geisinger Health System find that reducing the dose or frequency of biologics for rheumatoid arthritis patients in stable remission is a safe long-term strategy for reducing costs of care.

Sharma TS, Kirillova L, Berger A, et al., Biologic De-Escalation in Rheumatoid Arthritis: Cost Savings and Clinical Success. ACR Abstract #941, Arthritis & Rheumatism. 2014;66(1)-Supplement.

De-escalating biologic therapy in well-controlled rheumatoid arthritis (RA) is not only effective in maintaining remission or low disease activity but it also saves money, even with the lowest cost drugs, these researchers say.

In stable RA, using a lower dose or less-frequent dosing can save more than $1.2 million dollars in annualized costs if patients stay on the reduced drug regimen for a year, reports Tarun SK Sharma MD, a rheumatologist with the Geisinger Health System in Danville, PA.

The study – one of the largest to compare clinical and cost outcomes -- analyzed electronic health records for 940 RA patients treated with biologics in the Geisinger system in 2013.

Most of the Geisinger patients were on etanercept (Enbrel) or adalimumab (Humira) which, according to one managed care database analysis, were estimated to cost $17,767 and $19,272 a year per patient in 2012.1 Studies have shown etanercept to be the least expensive biologic drug.

Even so, the cost of a biologic is a concern since many patients need to be on them for prolonged periods, Sharma remarked. 

“Significant cost savings and potential reductions in clinical risks were achieved with biologic de-escalation,” he reports. The strategy was clinically effective for  85% of patients, making this “a promising strategy for improving value of care delivery and maintaining clinical disease control while reducing cost,” adds Sharma.

The study is limited by its short follow-up period of 152 days, he concedes.
A majority of patients in the study were women with an average age of 57. In half, therapy was de-escalated because of lower disease activity (CDAI <3). In over 40%, dose reductions were initiated due to patient or physician preference.

The median RA duration in the de-escalated patients was 10 years, and the median time in remission was around a year and a half (501 days).

Patients who were successfully de-escalated were more likely to have been on a biologic for two or more years at the time their dose was changed and to be rheumatoid factor (RF) positive. Other than that, there were no differences between the two groups, Sharma notes.





1.  Schabert VF, Watson C, Joseph GJ, et al., Costs of tumor necrosis factor blockers per treated patient using real-world drug data in a managed care population.J Manag Care Pharm. 2013;19:621-30.

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