Dosing Patterns of Anti-TNF Therapy in Patients with Rheumatoid Arthritis in a Managed Care Setting
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 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 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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