Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Dermatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands.
J Dermatolog Treat. 2023 Dec;34(1):2186728. doi: 10.1080/09546634.2023.2186728.
Dose reduction (DR) of adalimumab, etanercept and ustekinumab has proven to be (cost-)effective in psoriasis patients with low disease activity. Further implementation is needed to establish application of DR for eligible patients.
To evaluate the implementation of protocolized biologic DR in daily practice.
A pilot implementation study was performed in 3 hospitals during 6 months. By combining education and protocol development, involved healthcare providers (HCPs) were directed toward the adoption of protocolized DR. DR of adalimumab, etanercept, and ustekinumab was achieved by stepwise injection interval prolongation. Implementation outcomes (fidelity, feasibility) were assessed. Factors for optimizing implementation were explored in interviews with HCPs. Uptake was measured in patients by chart review.
The implementation strategy was executed as planned. Implementation fidelity was less than 100% as not all provided tools were used across study sites. HCPs indicated the feasibility of implementing protocolized DR, although time investment was needed. Identified additional factors for successful implementation included support for patients, uptake of DR into guidelines, and supportive electronic health record systems. During the 6 months intervention period, 52 patients were eligible for DR of whom 26 (50%) started DR. The proposed DR protocol was followed in 22/26 patients (85%) on DR.
Additional staff for support, extra time during consultations, education on DR for HCPs and patients, and effective tools such as a feasible protocol can lead to more patients on biologic DR.
在疾病活动度低的银屑病患者中，减少阿达木单抗、依那西普和乌司奴单抗的剂量已被证明具有成本效益。需要进一步实施，以确定适合的患者应用剂量减少。
评估方案化生物制剂剂量减少在日常实践中的实施情况。
在 3 家医院进行了一项试点实施研究，为期 6 个月。通过结合教育和方案制定，使参与的医疗保健提供者（HCP）采用方案化的剂量减少。通过逐步延长注射间隔来实现阿达木单抗、依那西普和乌司奴单抗的剂量减少。评估了实施的结果（忠实度、可行性）。通过与 HCP 的访谈探讨了优化实施的因素。通过病历回顾来衡量患者的接受程度。
实施策略按计划执行。实施忠实度低于 100%，因为并非所有提供的工具都在研究地点使用。HCP 表示实施方案化剂量减少具有可行性，尽管需要投入时间。确定的其他成功实施的因素包括对患者的支持、将剂量减少纳入指南，以及支持性的电子健康记录系统。在 6 个月的干预期间，有 52 名患者符合剂量减少的条件，其中 26 名（50%）开始了剂量减少。26 名接受剂量减少的患者中有 22 名（85%）遵循了提出的剂量减少方案。
增加支持人员、在咨询期间增加额外时间、对 HCP 和患者进行剂量减少教育，以及使用可行的方案等有效的工具，可以使更多的患者接受生物制剂的剂量减少。
