Introduction Switching from an established biologic to a biosimilar to save costs was considered likely to be ‘inappropriate and ineffective’ by ECCO.1
Methods With Area Prescribing Committee approval, all Crohns disease (CD) patients established on Remicade were provided with written and verbal information regarding the proposed switch, and all patients infused after April 2015 received Inflectra. Baseline calprotectin and Infliximab antibody and trough levels were undertaken. Harvey Bradshaw Indices (HBI) were assessed at every 8 week infusion.
Results 21 CD patients were already established on Remicade treatment. 1 patient did not receive Inflectra as he was relapsing with high antibody and low trough levels. 4 other patients with high antibody levels (>10iU/L) did receive Inflectra, but increasing symptoms led to alternative immunosuppression in 3 of these patients (2 with Adalumimab, 1 with Allopurinol/Azathioprine). A decision was made just to stop infliximab in the 4’th pt as they were in full clinical remission. The results of the remaining 16 patients are illustrated below.
Conclusion Although this is a small dataset, early results are encouraging. Patients understood the rationale behind the switch. There were no significant adverse events as a consequence of the switch. The majority of patients either remained in clinical remission or improved during the follow up period. The annual confirmed cost savings of £220,000 permitted investment in further IBD nurse monitoring (0.5 WTE) and allowed the introduction of infliximab trough and antibody testing which has certainly optimised and rationalised treatment decisions in these complex patients.
Reference 1 Danese S, et al. ECCO position statement: the use of biosimilar medicines in the treatment of IBD. J Crohns Colitis 2013;7(7): 586–9.
Disclosure of Interest None Declared