The introduction of biologics for rheumatoid arthritis has been associated with considerable improvements in its management, Robert Moots, professor of rheumatology at the University of Liverpool, told a recent EAHP satellite symposium sponsored by Pfizer.

Citing the COMET study, he said that 25 per cent of patients treated with methotrexate alone (the previous gold standard treatment) had given up work after one year, compared with fewer than 10 per cent in the group treated with combined etanercept and methotrexate. It appears, he said, that early use of biologics can prevent disease progression and improve productivity.

Dose escalation is a phenomenon that has been observed in RA patients treated with biologics. The formation of anti-drug antibodies means that an increasing dose is required to maintain efficacy. The effect is particularly marked with infliximab but occurs infrequently with etanercept.

Dose escalation is also associated with increased costs, not only for the biologic itself but also for other diseaserelated costs. In Italy research has shown dose escalation patterns similar to those seen elsewhere, the greatest being with infliximab and least with etanercept. Up to 18 per cent of patients switch from one biologic to another in the first year of treatment and persistence with treatment diminishes over a four-year period for all biologics.

By the end of the fourth year of followup only 29 and 32 per cent of patients on adlimumab and infliximab respectively are continuing to take the drugs, compared with 45 per cent of those taking etanercept. Treatment cost evaluations should therefore take into account the complex real-world patterns of usage, including dose escalation and tapering, treatment switches and persistence, rather than be based on acquisition cost alone, Dr Degli Esposti (ceo of CliCon, Italy) commented.

See also CPD module