Steps towards implementation of protocolized dose reduction of adalimumab, etanercept and ustekinumab for psoriasis in daily practice

Abstract

Background

Dose reduction (DR) of adalimumab, etanercept and ustekinumab has proven to be (cost-)effective in psoriasis patients with low disease activity. Further implementation is needed to establish application of DR for eligible patients.

Objectives

To evaluate the implementation of protocolized biologic DR in daily practice.

Methods

A pilot implementation study was performed in 3 hospitals during 6 months. By combining education and protocol development, involved healthcare providers (HCPs) were directed toward the adoption of protocolized DR. DR of adalimumab, etanercept, and ustekinumab was achieved by stepwise injection interval prolongation. Implementation outcomes (fidelity, feasibility) were assessed. Factors for optimizing implementation were explored in interviews with HCPs. Uptake was measured in patients by chart review.

Results

The implementation strategy was executed as planned. Implementation fidelity was less than 100% as not all provided tools were used across study sites. HCPs indicated the feasibility of implementing protocolized DR, although time investment was needed. Identified additional factors for successful implementation included support for patients, uptake of DR into guidelines, and supportive electronic health record systems. During the 6 months intervention period, 52 patients were eligible for DR of whom 26 (50%) started DR. The proposed DR protocol was followed in 22/26 patients (85%) on DR.

Conclusion

Additional staff for support, extra time during consultations, education on DR for HCPs and patients, and effective tools such as a feasible protocol can lead to more patients on biologic DR.

Keywords:

• Psoriasis
• biologics
• dose reduction
• implementation

Acknowledgements

The authors would like to thank all participating healthcare providers. They also want to acknowledge the collaboration with patient representatives from the Dutch psoriasis patients’ association (Psoriasispatiënten Nederland) and with the Dutch Association for Dermatology and Venereology in the overarching project team involved in different projects on implementation of biological dose reduction in the Netherlands.

Disclosure statement

L.S. van der Schoot carries out clinical trials for Janssen and Novartis and received speaking fees from Janssen and Eli Lilly. All funding is not personal but goes to the independent Research Fund of the Department of Dermatology of the Radboud University Medical Center Nijmegen, The Netherlands.

D.N.H. Enomoto has attended advisory boards from UCB Pharma. R.A. Tupker has attended advisory boards from Leo Pharma, UCB Pharma, Novartis Pharma and Eli Lilly Netherlands. M.M.B. Seyger received grants from/was involved in clinical trials from Abbvie, Amgen, Celgene, Eli Lilly, Janssen, Leo Pharma and Pfizer. She served as a consultant for Abbvie, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer an UCB; fees were paid directly to the institution. J.M.P.A. van den Reek carried out clinical trials for AbbVie, Celgene and Janssen and has received speaking fees/attended advisory boards from AbbVie, Janssen, BMS, Almirall, LEO Pharma, Novartis, UCB and Eli Lilly and reimbursement for attending a symposium from Janssen, Pfizer, Celgene and AbbVie. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboudumc Nijmegen, the Netherlands. E.M.G.J. de Jong has received research grants for the independent research fund of the department of dermatology of the Radboud university medical center Nijmegen, the Netherlands from AbbVie, BMS, Janssen Pharmaceuticals, Leo Pharma, Novartis, and UCB for research on psoriasis, has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis or eczema including AbbVie, Amgen, Almirall, Celgene, Galapagos, Janssen Pharmaceuticals, Lilly, Novartis, Leo Pharma, Sanofi and UCB. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboud University medical center Nijmegen, the Netherlands. The other authors declare no conflict of interests.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

ZonMw, the Hague, The Netherlands (8360410031).