P026 Dose optimisation in rheumatology high-cost drug patients

Abstract Background/Aims Emerging evidence indicates patients with inflammatory arthritis who are stable on biologic therapies can reduce the doses or, occasionally, even come off the drug altogether without any worsening of their symptoms. Guidelines including the BSR psoriatic arthritis (PsA) treatment guidelines suggest that dose reduction can be considered for stable patients. We report the experience of a dose optimising quality improvement project at the Royal United Hospitals Bath. Methods Patients on biologic therapies and in remission (DAS 2.6, PsA no swollen, BASDAI 3) for twelve months would speak to a clinician and extend the intervals between their injections by ≈ 30% every three months. Every 30% increase would constitute a “Step” (for example, 30% is Step 1, 60% is Step 2) and would increase to a maximum of four steps. Patients had their progress reviewed every three months. Patients had full control and could return to their previous dosing frequency if they noticed a return of their symptoms. After six months we would change their prescription to reflect the change in their dosing interval. We calculated the projected savings based on the decrease of drug use. Results Out of the 2,414 on biologics in total, we have 1,987 patients on drugs that were appropriate for dose optimising. Out of these 1,987 patients, 544 patients have PsA, 742 patients have RA and 701 patients have AS. 422 patients were eligible for dose optimising. 159 patients with RA, 125 patients with PsA, and 138 patients with AS. We currently have 48 patients at Step 1, 81 patients at Step 2, 44 patients at Step 3 and 24 patients at Step 4. 174 patients declined and 123 patients failed and returned to their original dose. Calculated Savings from the Dose Optimising Programme April 2023 - September 2025: Timeframe Accumulative Calculated Savings Based on the Reduction of Medicines Used (£) April 2023 - September 2023 £119,541.25; October 2023 - March 2024 £272,757.80; April 2024 - September 2024 £430,573.28; October 2024 - March 2025 £592,117.91; April 2025 - September 2025 £746,005.98. Conclusion We report a single-centre experience of dose optimising biologic treatment. 47% of our eligible cohort have been successfully dose optimised over 2 years resulting in a cost saving of £746,005.98. These data may be useful for developing projected saving for similar dose optimising quality improvement projects in other hospitals. Disclosure R. Macmillan: None. J. Ball: None. A. Vincent: None.