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P490. Evolution of the first-line biologic treatment and cost derived from biologic therapy from year 2000: Results of the Biologic Therapies Unit (BTU) at Hospital Universitario de La Princesa

J.P. Gisbert1, M. Arredondo2, M. Chaparro1, I. Cañamares2, E. Daudén3, G. Fernández-Jiménez4, V. Meca5, A. Morell2, L. Carmona6, J.M. Alvaro-Gracia7, 1Hospital Universitario de La Princesa, IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 2Hospital Universitario de La Princesa and IP, Farmacy Unit, Madrid, Spain, 3Hospital Universitario de La Princesa and IP, Dermatology Unit, Madrid, Spain, 4Hospital Universitario de La Princesa and IP, Documentation Unit, Madrid, Spain, 5Hospital Universitario de La Princesa and IP, Neurology Unit, Madrid, Spain, 6Institute for Musculoskeletal Health, Madrid, Spain, 7Hospital Universitario de La Princesa and IP, Rheumatology Unit, Madrid, Spain

Background

The BTU was created with the aim of optimizing the use of biological therapies. It is a multidisciplinary unit, integrated by the Services of Rheumatology, Dermatology, Neurology, Digestive Diseases, and Pharmacy.

Aims: (1) to analyze the most frequently prescribed first-line biological agents for the most prevalent immune-mediated diseases, and (2) to describe the economical impact of biological therapy from 2000 up to now at our hospital.

Methods

Patients starting biological treatment for the first time during the periods 2000–2005, 2006–2010 and 2011–2012 were included. The following variables were recorded: biological drug, date of starting the drug, indication, Service (Rheumatology, Dermatology, Digestive Diseases, and Neurology), and acquisition cost of drugs. The following diseases were considered: rheumatoid arthritis, psoriatic arthritis, Crohn's disease, ulcerative colitis, multiple sclerosis, ankylosing spondylitis, and psoriasis. Source of information: database of the BTU, and Pharmacy management program (Farmatools®).

Results

From year 2000, 1,462 patients (61% females) started biological treatment: 414 in 2000–2005, 617 in 2006–2010, and 254 patients in 2011–2012. The most frequently used first-line drugs, in each of the aforementioned periods, are summarized in the Table. The cost derived from the biological drug prescription in each period was: 8,494,538 € (1,698,908 €/year) in 2000–2005 (n = 475), 33,609,418 € (6,721,884 €//year) in 2006–2010 (n = 1,095), and 17,657,677 € (8,828,838 €/year) in 2011–2012 (n = 1,107).

Disease (n)2000–20052006–20102011–2012
Rheumatoid arthritis (461)Etanercept (39%)
Infliximab (32%)
Adalimumab (40%)
Etanercept (29%)
Etanercept (26%)
Adalimumab (26%)
Certolizumab (23%)
Psoriatic arthritis (128)Etanercept (56%)
Infliximab (42%)
Adalimumab (48%)
Etanercept (45%)
Adalimumab (54%)
Etanercept (27%)
Crohn's disease (132)Infliximab (100%)Adalimumab (63%)
Infliximab (37%)
Adalimumab (74%)
Infliximab (26%)
Ulcerative colitis (29)Infliximab (100%)Infliximab (95%)
Adalimumab (5%)
Infliximab (100%)
Multiple sclerosis (212)Interferon β-1a (77%)
Interferon β-1b (15%)
Interferon β-1a (77%)
Glatiramer acetate (34%)
Interferon β-1a (77%)
Glatiramer acetate (41%)
Ankylosing spondylitis (135)Etanercept (50%)
Infliximab (48%)
Etanercept (44%)
Adalimumab (38%)
Etanercept (44%)
Adalimumab (39%)
Psoriasis (188)Etanercept (68%)Etanercept (41%)Ustekinumab (54%)
Adalimumab (33%)

Conclusion

Biologic therapy is an area in constant innovation, and the pattern of first line treatment varies considerably with time. The cost associated with the prescription of biological treatment is very relevant.