Research into cost-savings by reducing the dose of biologics

Two research grants of ZonMw of around 1.5 million euro

Sanquin will contribute to two national studies on the more economical use of th biologics adalimumab and tocilizumab. Two research grants of ZonMw of around 1.5 million euro allow Sanquin to measure the blood levels of both biologics. Rheumatologists will subsequently optimise the dosage. The research will be led by Reade Rheumatology and be run in collaboration with the Sint Maartenskliniek in Nijmegen.

In the Netherlands we spend a lot of money on biologics, very effective but also expensive drugs that are often used to treat rheumatoid arthritis (RA) and other inflammatory diseases such as Crohn's disease. In 2015 this amounted to 638 million euros. Adalimumab is the most prescribed biologic. We spend more than 200 million euros per year. The registered dose of this medication is the same for all patients. Interestingly, this one-dose-fits-all leads to varying blood levels in patients.


Gertjan Wolbink and Merel l'Ami"As a result, many patients are over-treated," says Gertjan Wolbink, rheumatologist and working at Reade and Sanquin. "We showed previously that a concentration of adalimumab of 5 μg/ml in the blood is sufficient to suppress the disease in patients starting on adalimumab. A higher concentration does not alter the response. Now we want to investigate whether the dose can be reduced to drug level of 2 μg/ml in patients who are stable on adalimumab ".

Also in patients starting on adalimumab, levels will be measured to see whether these can help reduce costs. Finally, we will use drug levels in RA patients who do not respond adequately to hopefully optimise follow-up treatment.  (Photo: Gertjan Wolbink (Reade/Sanquin, Merel l'Ami, Reade)

Halving the dose

Similar questions will be answered regarding tocilizumab. Blood levels of this biologic also vary among patients. In RA patients who have been using tocilizumab for at least half a year, the researchers will measure the drug concentration. When levels are high, the dose will be halved in 50% of the patients, the other 50% continues with the standard dose. The expectation is that even with a lower dose, patients remain in remission, at significant reduced cost.

Annick de VriesAnnick de Vries, manager Bioanalysis at Sanquin Diagnostics: Excellent news to learn ZonMW also thinks this cost saving strategies should be studied. With the outcomes we can optimally advice the clinicians. This research is necessary to find an optimal concentration, especially as the pharmaceutical industry does not provide reference values for biologics''. From Sanquin Research the projects are further supported by the group of Theo Rispens

Biologics have transformed the treatment of RA and other inflammatory diseases, but prices are steep. With the two research grants from medical research funding body ZonMw, Sanquin will contribute to a more cost-effective use of biologics.