title: Efficiency of adalimumab, etanercept and infliximab in rheumatoid arthritis patients: dosing patterns and effectiveness in daily clinical practice.
abstract: OBJECTIVE
  This retrospective, multicentre, observational study aimed to assess the mean annual doses and associated costs of three anti-tumour necrosis factor agents in daily clinical practice in rheumatoid arthritis patients, correlating these costs with disease activity.
  
  
  METHODS
  Adult rheumatoid arthritis patients were treated and followed at the Rheumatology departments of two Spanish hospitals for at least 6 months, with adalimumab, etanercept or infliximab over a 4-year period. ANOVA and multivariate statistical analyses of dosing patterns, disease activity and annualised costs were carried out.
  
  
  RESULTS
  A total of 198 patients, comprising 215 cases, met the inclusion criteria (73 on adalimumab, 81 etanercept and 61 infliximab). Compared to recommended doses, mean doses of adalimumab and etanercept decreased by 7% and 19%, respectively, while the mean dose of infliximab increased by 36%. There were no statistical differences between treatments in terms of clinical effectiveness. The hazard of dose escalation was significantly higher for either adalimumab (4.4-fold) or infliximab (11.8-fold) compared to etanercept (p<0.05). Clinical control was achieved and maintained in more than half of the patients treated with reduced doses of etanercept. Associated mean patient-year costs were significantly higher in adalimumab patients (€11.962.58) (etanercept €9.594.73; infliximab €10.094.53; [p<0.05]).
  
  
  CONCLUSIONS
  In rheumatoid arthritis patients, it is possible to reduce doses and associated costs of biological therapies while controlling disease activity. Mean doses used in our clinical practice were significantly lower with etanercept than with the anti-TNF monoclonal antibodies, adalimumab and infliximab. Dose differences impact directly on associated patient-year costs, and thus on treatment efficiency.
authors.affiliation: Department of Pharmacy, La Princesa University Hospital, Madrid, Spain. eramirez.hlpr@salud.madrid.org
authors.forename: Esther
authors.initials: E
authors.lastname: Ramírez-Herráiz
authors.forename: Vicente
authors.initials: V
authors.lastname: Escudero-Vilaplana
authors.forename: Estefanía
authors.initials: E
authors.lastname: Alañón-Plaza
authors.forename: Nicolás
authors.initials: N
authors.lastname: Trovato-López
authors.forename: Ana
authors.initials: A
authors.lastname: Herranz-Alonso
authors.forename: Alberto
authors.initials: A
authors.lastname: Morell-Baladrón
authors.forename: María
authors.initials: M
authors.lastname: Sanjurjo-Sáez
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000191:economics; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000191:economics; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000191:economics; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D000068800:Etanercept; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000191:economics; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept