In AS, Tailored Tapering Not Only Works, It's Less Costly


Allowing physicians to use their own judgment in gradually reducing TNF-blocker doses for their patients with ankylosing spondylitis proved both safe and cost-effective in a Czech study.

Závada J, Uher M, Sisol K, et al., A tailored approach to reduce dose of anti-TNF drugs may be equally effective, but substantially less costly than standard dosing in patients with ankylosing spondylitis over 1 year: a propensity score-matched cohort study. Ann Rheum Dis. (2014) Aug 27. doi: 10.1136/annrheumdis-2014-205202. [Epub ahead of print]

After they achieve low-disease activity, using a tailored method to taper doses of tumour necrosis factor (TNF) blockers can save your ankylosing spondylitis (AS) patients money without sacrificing effectiveness, according to a new study from the Czech Republic.

The prospective study of 186 AS patients in a biologics registry, who reached low disease activity with either standard or individually tapered doses of anti-TNF drugs, finds that lower doses produce similar clinical outcomes after one year, while saving around $5,444 (€4214) annually.

The observational study of active AS patients treated with standard doses of TNF-blockers (n=83) or reduced doses (n=53), sometimes given at longer intervals, finds no differences in mean changes in Bath Ankylosing Spondylitis Activity (BASDAI) scores.

There are no universally accepted standard measures of remission or flare in AS. In this study, low disease activity was defined a BASDAI of under 4. There were also no differences in other measures of disease activity, including C-reactive protein, the Health Assessment Questionnaire Disability Index (HAQ-DI), Bath AS functional index (BASFI), and in the quality-adjusted life-year (QALY) area.

The treating physicians devised their own dose-tapering strategies. In the study, a 25% reduced dose might be 25 mg of etanercept (Enbrel) every 14 days instead of the standard 50 mg weekly. The median dose of a TNF inhibitor used corresponded to 67% and 0.5% of the standard dosing regimen initially and at 12 months respectively.

Among the patients, 21% needed to return to standard dosing. Equal numbers of the standard and reduced-dose patients relapsed to BASDAI scores over 4. There were more adverse events in the standard-dose group.

Czech patients are reimbursed for biologics (around €12000 or $15,333 a year) after non-steroidal antirheumatic drugs (NSAIDs) fail. But since 2009, the number of patients who can be treated with biologics is limited by preset budgets at the 20-30 centers allowed to administer the drugs.

The researchers found they were able to treat more patients within the budget of their single center, saving one third of costs over a year.

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