Background: Infliximab dose is based on the patient’s body weight (3–5 mg/kg) and requires the use of multiple 100 mg vials to reconstitute the individualised dose. As the product is expensive, there is a significant cost associated with unused and wasted infliximab in any part-used vials. “Dose banding” is one solution so that patients receive a pre-prepared dose produced in advance in batches where wastage from part vials is minimised. There is some encouraging data that reconstituted infliximab is stable for long enough to allow batch production of pre-prepared doses. The theoretical risk of course is over or under treatment while respectively rounding up or down the administered dose.

Objectives: We undertook a retrospective analysis of our experience of dose banding in rheumatology unit.

Methods: All patients prescribed infliximab for rheumatic indication at our centre were included in the analysis. Case notes were retrospectively reviewed to look at dose variance following implementation of this initiative, resultant disease control and the consequent cost savings.

Results: 10 patients prescribed infliximab biosimilar and two bio-originator were identified for the analysis. Median age was 55.5 years (range 25–80 years). Nine had the drug for RA, two for AS and one for myositis.

Three had no change in dose as a result of implementing dose banding program. Three had dose increased by 3%–5%. Remaining six had dose reduced by range of 4%–6%. Their disease scores before and after dose banding remained largely unchanged (table 1). This equated to £1,184.58 annual savings in addition to the economic benefit of successfully switching the ten patients to biosimilar. No patient suffered loss of efficacy or adverse events in any of the three groups.

Conclusions: Our data confirms the utility of dose banding program for infliximab in rheumatology practice with no concerns about efficacy or safety of the initiative. There are potential opportunities to achieve considerable reductions in medicines discarded and improving finances by adopting dose banding for infliximab. It also helped curb over £10 000 expense to our Trust in infliximab waste cost alone. There are some important caveats to consider as well. True savings will depend on list price of each product and varies with originator versus biosimilar. The variance increases as the width of the dose bands increases i.e. the variance is greater at lower body weights. Consequently, depending on patient population both clinical and cost considerations could alter. Finally, assurance of the product integrity and stability is reliant on efficient pharmacy processes necessary to accommodate the use of new formulations for dose banding.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2018-eular.1300