Biologic dose reduction in rheumatoid arthritis: What stops us?

Abstract

Background: Biologic dose reduction (BDR) in patients with stable rheumatoid arthritis involves using smaller doses, extending the interval between doses or a mixture of both. For patients there is less exposure to long-term effects from biologics and fewer injections. For rheumatology departments and clinical commissioning groups (CCGs) there are significant cost savings to be had and this in turn may offer the opportunity to fund further service development. Success depends on CCGs and rheumatology units working together to resolve complex local clinical and practical issues. This exploratory study aimed to build greater understanding of organizational factors affecting implementation of BDR.

Methods: Consultant rheumatologists (2), specialist pharmacists (2), specialist nurses (2) and commissioning medicines optimization leads (2) from two rheumatology units/CCGs were interviewed to explore their experiences with the local implementation process of BDR. The organizations selected had each successfully implemented a BDR pathway. The aim was to identify factors that facilitated BDR and any barriers to implementation.