Abstract
Objective: To characterize the dose administration patterns of tumor necrosis factor (TNF) inhibitors for the treatment of rheumatoid arthritis (RA) within a managed care organization (MCO).
Methods: Patients with RA who received either infliximab or etanercept between 1 January 2001 and 31 May 2002 were identified using MCO pharmacy and medical claims. Prescribers were asked to send copies of the identified patients’ charts. TNF inhibitor dose administration information was abstracted from the charts.
Results: 1869 patients were potentially eligible and 936 of these could be linked to prescribers. A total of 457 of 936 (49%) requested charts were obtained. Of the 369 eligible patients, 164 received infliximab (44%) and 205 received etanercept (56%). The mean first doses ordered of infliximab and etanercept were 3.5 ± 0.6 mg/kg and 27.9 ± 24.2mg, respectively. Subsequent doses ordered were 4.2 ± 1.4 mg/kg and 25.7 ± 13.9mg, respectively. Overall, 67% of infliximab infusions used less than or equal to the expected number of vials if administered at 3 mg/kg. The estimated mean annual medication cost per patient (2004 values) was determined to be $US13 936-$US 15 734 for infliximab and $US17 105 for etanercept; however, these costs do not consider the need for methotrexate administration with infliximab and costs associated with the route of administration (intravenous for infliximab and subcutaneous for etanercept).
Conclusion: The majority of TNF inhibitor doses were within recommended ranges. Although infliximab can be administered at doses up to 10 mg/kg, the majority of infliximab infusions were administered at less than or equal to the number of vials expected for a 3 mg/kg dose (the minimum recommended dose). While these results indicate that a large-scale initiative to improve prescribing of TNF inhibitors may not be needed, a further understanding of the factors that lead to prescribing of high doses of TNF inhibitors might be warranted.
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Acknowledgments
This study was supported by a grant from Centocor, Inc. Neeta Tandon is an employee of Centocor, Inc. Karen Stockl and Manal Jarrar disclose that this study was sponsored by Centocor, Inc.
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Stockl, K., Jarrar, M. & Tandon, N. Dosing Patterns of Anti-TNF Therapy in Patients with Rheumatoid Arthritis in a Managed Care Setting. Dis-Manage-Health-Outcomes 12, 189–196 (2004). https://doi.org/10.2165/00115677-200412030-00005
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DOI: https://doi.org/10.2165/00115677-200412030-00005