Cost Per Responder Associated with Biologic Therapies for Crohn’s Disease, Psoriasis, and Rheumatoid Arthritis

Liu, Yifei; Wu, Eric Q.; Bensimon, Arielle G.; Fan, Chun‐Po Steve; Bao, Yanjun; Ganguli, Arijit; Yang, Mei; Cifaldi, M.; Mulani, Parvez

doi:10.1007/s12325-012-0035-7

Cited by 55 publications

(52 citation statements)

References 36 publications

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“…Despite the success of biologics to treat RA, they remain expensive to produce and may only be administered intravenously or subcutaneously (Liu et al, 2012). To address this, small molecular inhibitors (SMIs) have been investigated due to their lower manufacturing costs and oral availability (Stanczyk et al, 2008).…”

Section: (B) Small Moleculesmentioning

confidence: 99%

Animal models of rheumatoid arthritis: How informative are they?

McNamee

Williams

Seed

2015

European Journal of Pharmacology

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Animal models of arthritis are widely used to de-convolute disease pathways and to identify novel drug targets and therapeutic approaches. However, the high attrition rates of drugs in Phase II/III rates means that a relatively small number of drugs reach the market, despite showing efficacy in pre-clinical models. There is also increasing awareness of the ethical issues surrounding the use of animal models of disease and it is timely, therefore, to review the relevance and translatability of animal models of arthritis. In this paper we review the most commonly used animal models in terms of their pathological similarities to human rheumatoid arthritis as well as their response to drug therapy. In general, the ability of animal models to predict efficacy of biologics in man has been good. However, the predictive power of animal models for small molecules has been variable, probably because of differences in the levels of target knockdown achievable in vivo.3

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Section: (B) Small Moleculesmentioning

confidence: 99%

Animal models of rheumatoid arthritis: How informative are they?

McNamee

Williams

Seed

2015

European Journal of Pharmacology

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“…Another option to consider is TNF inhibitors, which inhibit the potent pro-inflammatory TNF-a, often a predominant problem in patients with refractory sarcoidosis, and these have shown promising results [11][12][13][14]. However, a drawback of TNF inhibitors is considerable treatment costs [15]. Therefore, the ideal situation would involve identification of patients likely to respond to TNF inhibitors before starting treatment.…”

Section: Introductionmentioning

confidence: 99%

Association of the TNF- G-308A polymorphism with TNF-inhibitor response in sarcoidosis

Wijnen

Cremers

Nelemans

et al. 2014

European Respiratory Journal

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Responsiveness to tumour necrosis factor (TNF) inhibitors has been associated with the TNF-a G-308A polymorphism in rheumatoid arthritis. The aim of this study was to examine the association between the presence of this polymorphism and the response to TNF inhibitors in patients with refractory sarcoidosis.Patients (n5111) who started TNF-inhibitor treatment (76 infliximab, 35 adalimumab) were followed for at least 1 year. The main symptoms in these patients were fatigue (n5100, 90.1%), small fibre neuropathy (n591, 82.0%), pulmonary involvement (n569, 62.2%), and/or uveitis (n531, 27.9%). Patients were additionally genotyped for the presence of the TNF-a G-308A polymorphism. Treatment response was assessed using clinical outcome measures and questionnaires.Three-quarters (n583, 74.8%) of the patients responded well. Of the patients without the variant A-allele 93.6% (73 out of 78, p,0.001) improved, while 30.3% (10 out of 33) of variant A-allele carriers responded favourably to TNF inhibitors. For patients with the GG-genotype, the probability of improving compared with remaining stable or deteriorating was three times higher (risk ratio 3.09, 95% CI 1. 84-5.20).Sarcoidosis patients without the TNF-a -308A variant allele (GG-genotype) had a three-fold higher response to TNF inhibitors (adalimumab or infliximab). Further research is needed to evaluate the value of genotyping for the TNF-a G-308A polymorphism in order to tailor TNF-inhibitor treatment. @ERSpublications TNF-a G-308A polymorphism predicts TNF-inhibitor response in refractory sarcoidosis: a step to personalised medicine?

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“…Según un metaanálisis publicado por Liu et al 15 , el coste por respuesta adicional ACR50 sería mayor con TCZ (31.363 $) que con ADA (27.853 $). Otro tanto ocurriría en ACR70 (48.320 $ y 47.533 $ respectivamente).…”

Section: Discussionunclassified

“…Sin embargo, este estudio no incluyó el ensayo clínico ADACTA (por no estar disponible en el momento de su realización) que es el primero que ha comparado directamente la eficacia de TCZ y ADA en la AR. Por el contrario, el estudio de Liu et al 15 realizó comparaciones indirectas utilizando únicamente un ensayo clínico de TCZ controlado con placebo 16 . A este respecto, debe considerarse que las comparaciones de eficacia (y las consiguientes evaluaciones económicas) tienen mayor validez cuando proceden de ensayos clínicos de comparaciones directas 17 .…”

Section: Discussionunclassified

Evaluación económica de la monoterapia con tocilizumab frente a adalimumab en artritis reumatoide

Sarabia

Blanco

Gracia

et al. 2013

Rev. Esp. Salud Publica

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RESUMENFundamento: Tocilizumab (TCZ) fue superior a adalimumab (ADA) en monoterapia en la reducción de los signos y síntomas de la artritis reumatoide del adulto (AR) en pacientes intolerantes o con respuesta inadecuada a metotrexato (MTX). El objetivo del estudio fue analizar el costeefectividad de TCZ vs ADA en estos pacientes. Métodos:Evaluación económica del coste por respuesta o remisión con TCZ vs ADA a partir del estudio ADACTA (horizonte temporal: 24 semanas). Criterios de respuesta clínica ACR o de remisión de la enfermedad, índice DAS28. Ámbito: Sistema Nacional de Salud. Los costes incluidos (adquisición, administración y monitorización de los medicamentos en € de 2012) se obtuvieron de fuentes españolas. Se efectuaron análisis de sensibilidad simples univariantes.Resultados: Las tasas de respuesta ACR20, ACR50 y ACR70 con TCZ y ADA se obtuvieron en el 65% y 49,4% (p <0,01); 47,2% y 27,8% (p <0,01); y en el 32,5% y 17,9% (p <0,01) de los pacientes, respectivamente. La remisión DAS28 se produjo en el 39,9% y 10,5%, respectivamente (p <0,0001). El coste por respuesta fue menor con TCZ que con ADA (ACR20: 8.105 y 11.553 €; ACR50: 11.162 y 20.529 €; ACR70: 16.211 y 31.882 €) respectivamente. El coste de la remisión DAS28 fue de 13.204 € y 54.352 € respectivamente. En todos los escenarios el tratamiento con TCZ tuvo mayor eficacia y menores costes que con ADA .Conclusiones: Según este análisis, en España la monoterapia con TCZ es una estrategia eficiente frente a ADA para el tratamiento de los pacientes con AR intolerantes o con respuesta inadecuada a MTX. Background: Tocilizumab (TCZ) was superior to adalimumab (ADA), as monotherapy, in reducing signs and symptoms of adult rheumatoid arthritis (RA) when methotrexate (MTX) treatment is poorly tolerated or inappropriate. The aim of the study was to analyze the cost-effectiveness of TCZ vs ADA in these patients.Methods: Economic evaluation of the cost per response or remission of TCZ vs ADA from ADACTA (time horizon: 24 weeks). Clinical response criteria ACR or disease remission criteria, DAS28. Perspective: National Health System. The costs included (acquisition, administration and monitoring of medicines; € 2012) were obtained from Spanish sources. Simple univariate sensitivity analyzes were performed.Results: ACR20, ACR50 and ACR70 response rates with TCZ and ADA were obtained in 65% and 49.4% (p <0.01), 47.2% and 27.8% (p <0.01); and 32.5% and 17.9% (p <0.01) of patients, respectively. DAS28 remission occurred in 39.9% and 10.5%, respectively (p <0.0001). The cost per response was lower with TCZ than with ADA (ACR20: € 8, 105 and € 11,553; ACR50: € 11,162 and € 20,529; ACR70: € 16,211 and € 31,882) respectively. The cost of DAS28 remission was € 13,204 and € 54,352, respectively. Treatment with TCZ was dominant (more effective, with lower costs vs ADA) in all scenarios analyzed. Conclusions:According to this analysis, in Spain TCZ monotherapy is an efficient strategy vs ADA for treating RA patients intolerant to MTX or in which there is inappropriate ...

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Cost Per Responder Associated with Biologic Therapies for Crohn’s Disease, Psoriasis, and Rheumatoid Arthritis

Abstract: Meta-analyses of clinical trials found considerable variation in cost-effectiveness of biologic therapies for CD, Ps, and RA. These results may help determine biologic utilization in these chronic diseases.

Cited by 55 publications

References 36 publications

Animal models of rheumatoid arthritis: How informative are they?

Animal models of rheumatoid arthritis: How informative are they?

Association of the TNF- G-308A polymorphism with TNF-inhibitor response in sarcoidosis

Evaluación económica de la monoterapia con tocilizumab frente a adalimumab en artritis reumatoide

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