Escudero-Vilaplana Vicente, Ramírez-Herráiz Esther, Alañón-Plaza Estefanía, Trovato-López Nicolás, García-Vicuña Rosario, Carreño-Pérez Luis, Morell-Baladrón Alberto, Sanjurjo-Sáez María
Pharmacy Department, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007, Madrid, Spain.
Pharmacy Department, La Princesa University Hospital, Madrid, Spain.
Int J Clin Pharm. 2015 Oct;37(5):808-14. doi: 10.1007/s11096-015-0124-1. Epub 2015 Apr 25.
Information on the use of ankylosing spondylitis (AS) therapies in clinical practice is a key factor in decision making, as more efficient treatments may involve substantial savings while maintaining the clinical benefits for the patient.
To assess the mean annual doses and associated costs of the three main anti-tumour necrosis factor agents used in Spanish daily clinical practice in ankylosing spondylitis patients and to correlate these costs with disease activity.
This retrospective, observational study included adult ankylosing spondylitis patients over a 4-year period that had been treated for at least 6 months with adalimumab, etanercept or infliximab at two University Hospitals in Spain.
Disease activity was estimated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores at the start of anti-tumour necrosis factor (anti-TNF) therapy and in the last visit or whenever the drug was switched. Mean costs were estimated for a 52-week horizon from the delivered doses registered by pharmacy records. Outcomes were the doses and costs of anti TNFs administered to each patient, and the BASDAI score.
A total of 119 patients (137 cases) were included (28 cases treated with adalimumab, 48 cases with etanercept and 61 with infliximab). Mean doses of adalimumab and etanercept were 92.8 and 88.8% of the initially prescribed doses, respectively, while the mean dose of infliximab administered was 102%. There were no statistical differences among treatments in terms of clinical effectiveness. Associated mean patient-year costs were significantly higher in the infliximab group (€14,235), compared to the other treatments [adalimumab €11,934; etanercept €10,516; (P < 0.05)].
In certain ankylosing spondylitis patients, doses and associated costs of biological therapies can be reduced while controlling disease activity. Mean doses used in our clinical practice vary from the recommended doses and are significantly lower for adalimumab and etanercept than for infliximab. These differences impact directly on associated patient-year costs, and, thus, on treatment efficiency.
强直性脊柱炎（AS）治疗方法在临床实践中的应用信息是决策的关键因素，因为更有效的治疗方法可能在为患者维持临床益处的同时大幅节省费用。
评估西班牙日常临床实践中用于强直性脊柱炎患者的三种主要抗肿瘤坏死因子药物的年均剂量及相关成本，并将这些成本与疾病活动度相关联。
这项回顾性观察研究纳入了西班牙两家大学医院中4年内接受阿达木单抗、依那西普或英夫利昔单抗治疗至少6个月的成年强直性脊柱炎患者。
在抗肿瘤坏死因子（抗TNF）治疗开始时以及最后一次就诊或换药时，用巴斯强直性脊柱炎疾病活动指数（BASDAI）评分评估疾病活动度。根据药房记录登记的给药剂量估算52周的平均成本。结果包括每位患者接受抗TNF治疗的剂量和成本以及BASDAI评分。
共纳入119例患者（137例次）（28例次接受阿达木单抗治疗，48例次接受依那西普治疗，61例次接受英夫利昔单抗治疗）。阿达木单抗和依那西普的平均剂量分别为初始处方剂量的92.8%和88.8%，而英夫利昔单抗的平均给药剂量为102%。各治疗组在临床疗效方面无统计学差异。与其他治疗组相比，英夫利昔单抗组的平均患者年成本显著更高（14,235欧元）[阿达木单抗组11,934欧元；依那西普组10,516欧元；（P<0.05）]。
在某些强直性脊柱炎患者中，在控制疾病活动度的同时可降低生物治疗的剂量及相关成本。我们临床实践中使用的平均剂量与推荐剂量不同，阿达木单抗和依那西普的平均剂量显著低于英夫利昔单抗。这些差异直接影响相关的患者年成本，进而影响治疗效率。
