Il-17 Or Tnf Inhibitors - Real World Impact of Shared Decision Making in a Nurse Led Biologics Service

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Issue Date
2023
Authors
Begum, Julie
Nisar, Muhammad
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Research Projects
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Background Since the availability of anti TNF biosimilars and the push from reimbursement panels to use them first line, real world data regarding therapeutic choice in biologic naive population is sparse. Objectives Evaluate the reasons for nurse led service choosing IL17 antagonists in biologic naïve SpA patients, in a shared decision making model, despite the availability of cheaper anti TNF biosimilar. Methods We conducted a retrospective analysis of our electronic register for people with PsA and AS from 1994 up to and including April 2022 at our university teaching hospital. We had access to full patient records including details on co-morbidities, drugs and disease management. All patients were evaluated in biologics service led by clinical specialist nurses. Results PsA. 90 patients were prescribed Secukinumab since its availability in the UK. Mean age was 51 yrs (24-80) and 56 (62%) were women. All were prescribed since the adoption of Adalimumab biosimilar. Median duration of therapy was 551 days (62-1284). Mean TJC and SJC were 8.14 (1-64) and 3.15 (1-57) at initiation which improved at six months to 6.28 (1-46) and 2.77 (1-18) respectively. 24 (27%) were biologic naïve; 18 had it for better efficacy (six had axial disease, four with enthesitis and eight with concomitant moderate to severe psoriasis) and six for relative anti TNF contraindications including three with treated solid organ neoplasms, one with BMI>35 and two for concurrent chronic infections including HIV. AS. 47 patients were prescribed Secukinumab. Mean age was 54 (27-79) and half were women. Median duration of therapy was 679 days (51-1154). Mean BASDAI was 3.3 (0-9.2) at initiation which improved to 2.1 (0-7.5). 11 (23%) were biologic naïve; five had it for better efficacy and six for relative anti TNF contraindications including three with treated cancers, two with latent TB and one for MS. Conclusion To our knowledge this is the first dedicated retrospective review of a large real world spondyloarthritis cohort evaluating reasons for biologic choice. Nearly a quarter of patients were prescribed Secukinumab prior to cheaper adalimumab biosimilar despite it being commissioned first choice agent in the region. Clinicians including nurse specialists chose it for better efficacy in various SpA domains. Relative contraindication to anti TNF drugs, which would not have been considered significant in the past, was the second reason. Efficacy and safety outcomes were comparable to other biologics. This confirms that shared decision making process demands flexibility and limiting choice goes against clinical acumen and patient preference. Opting only for lower drug acquisition tariff is unlikely to be cost effective as the disease progresses whilst patients struggle with inappropriate prescription and thus delay biologics which are more likely to be efficacious and retained longer. Hence there is an urgent need to review prescribing guidelines to allow earlier employment of appropriate advanced therapies in the treatment paradigm with significant benefits to both patients and the health economy.
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Begum J, Nisar MPOS1200-HPR IL-17 OR TNF INHIBITORS - REAL WORLD IMPACT OF SHARED DECISION MAKING IN A NURSE LED BIOLOGICS SERVICEAnnals of the Rheumatic Diseases 2023;82:932-933.