Dose Modification of Subcutaneous Tocilizumab in Patients with Rheumatoid Arthritis

TO THE EDITOR,

In their study published in American Health & Drug Benefits in December 2019, Punekar and colleagues analyzed US claims and electronic health record data and reported that more than 33% of patients with rheumatoid arthritis who initiated treatment with subcutaneous (SC) tocilizumab administered every other week, increased the dose to every-week dosing.1

As the authors noted, according to the prescribing information approved by the US Food and Drug Administration, SC tocilizumab is administered every 2 weeks or every week, based on the patient's weight and clinical response.1,2 The authors conclude that this dose optimization of tocilizumab from every 2 weeks to every week “could result in increased economic burden.”1

We acknowledge the authors' efforts to analyze treatment patterns of patients receiving tocilizumab; however, the authors do not provide any data to support this conclusion. There are many factors that drive the direct and indirect costs related to biologic therapy use in patients with rheumatoid arthritis; the frequency of drug administration is only one component of direct costs. Other factors include concomitant treatment for rheumatoid arthritis, the number of previous treatments, adverse events, and inadequate or suboptimal response to treatment.3–5 Indirect costs, such as low productivity, lost wages, and caregiver burden, also contribute to the increased economic burden.6

In their study, Punekar and colleagues did not evaluate the economic burden associated with tocilizumab alone or in comparison with other biologic drugs. Inadequate response to rheumatoid arthritis treatment has been shown to be associated with increased costs in patients with rheumatoid arthritis.3 Multiple studies have demonstrated greater persistence with tocilizumab compared with other biologics.7–11

The ability to optimize biologic drug dosing to achieve treatment targets provides patients and physicians with more flexibility and therapy options, which can potentially reduce the costs of care. In addition, dose optimization allows physicians to adapt to the clinical needs of the patient. Accordingly, we believe that the authors' conclusion that an increased dose frequency of tocilizumab may increase economic burden is not supported by the data.

Sincerely,

Jennie H. Best, PhD

Ibrahim Abbass, RPh, PhD

Lenore Tominna, PharmD

William Reiss, PharmD

Genentech, Inc., South San Francisco, CA

All the authors are employees and shareholders of Genentech.

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