Dose De-Escalation of Humira and Stelara Generates Significant Savings

A dose de-escalation program targeting Humira (adalimumab) and Stelara (ustekinumab) saved more than $86,000 per successful intervention, according to research findings presented today at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting in New Orleans.

Samantha LaBeau, Pharm.D., and her colleagues, reported that one-third of the 446 dose de-escalations interventions were successful, with success defined by implementation of the recommended de-escalated by the provider. The total savings was $13.2 million, and theaverage length of time that patients stayed on the lower dose was just under a year (11.8 months).

Drugmakers are now marketing lower-priced biosimilars to Humira and Stelara, but the pair of biologics remain expensive, top-selling agents. They are prescribed to treat inflammatory bowel disease (Crohn’s disease and ulcerative colitis), psoriasis and several other conditions,

Dose de-escalation is a tactic for lowering their cost for payers and sometimes for patients.

This study included de-escalations implemented by PA Logic Solutions, a prior authorization and utilization management vendor headquartered in Auburn, Alabama. The de-escalations occurred over an approximately three-year period from July 8, 2020, through Sept. 30, 2023. According to the findings in the poster presented by LaBeau and colleagues, candidates for dose-escalation had to meet two criteria. First, their disease had to be in remission. Second, their dosing regimen exceeded FDA recommendations for at least 12 months. The end points were average duration of sustained dose de-escalation and average total savings

The written poster does not include information about the size of the dose reduction. It also doesn’t include information about the patients for whom dose de-escalation was apparently unsuccessful, a group that comprises two-thirds of the patients.

Even so, the poster concludes that “successful dose de-escalation intervention resulted in significant cost savings while maintaining disease remission and reducing the risk of adverse events."