P14 Using NHS resources wisely: A Snapshot of biologic and small molecule agent prescribing at the Peter Maddison Rheumatology Centre

Abstract

Abstract Background Pharmacological management of rheumatological conditions has transformed in the past two decades. A range of targeted therapies are available to manage conditions such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Careful governance and management is required to ensure patients receive the most appropriate drug and dose for their condition. Methods Patients diagnosed with RA, PsA and SpA/AS treated with a biologic or small molecule agent during the period of April 2018 - March 2019 for >6 months duration were eligible for inclusion. Patients were identified using biologic patient registers maintained by the Rheumatology department. Results One hundred and eighty-one patients were eligible for inclusion. Ninety-two patients (51%) were female, age range: 21 - 85 years, median = 54 years. The most prescribed biologic was etanercept (n = 71, 39.2%) followed by rituximab (n = 31, 17.1%) and adalimumab (n = 23, 12.7%) of which 98.4% were prescribed a biosimilar formulation. A breakdown of prescribing is illustrated below. Over a third of patients were maintained on a reduced dose of biologic, resulting in significant cost efficiencies (£20,000 cost avoidance with etanercept dose reduction). Twenty-eight patients in the RA cohort were not on a DMARD; of these 25 patients (89.2%) had achieved remission/ low disease activity. Average annual drug cost per patient was higher for psoriatic arthritis (£6,719.33 vs. £4731.00 for RA and £3,417.27 for SpA). Patients treated with rituximab had a dosing interval of 12 months or longer between cycles, as dosing was influenced by clinical symptoms. As a result, the percentage of patients in low disease activity is lower. Conclusion This study has shown marked variance in cost per head (range= £1,769- £9,303) depending on the disease, type of targeted therapy and disease response rate. The PMRC multidisciplinary team approach to introducing biosimilar medicine prescribing and actively maintaining patients in remission/low disease activity on reduced biologic therapy, has enabled patients to access medicines and deliver value-based healthcare with positive patient outcomes in line with NICE guidelines and clinical reasoning. Disclosures A.R. Jones None. A. Batty None. L.A. Lloyd None. A. Breslin None. C. Owen None. Y. Ahmad: None.