Subcutaneous infliximab CT-P13 without intravenous induction in psoriatic arthritis: A case report and pharmacokinetic considerations.

INTRODUCTION: The biosimilar CT-P13, the first and only subcutaneous (SC) infliximab formulation, is recommended for patients with psoriatic arthritis (PsA) and can be administered as a maintenance treatment, to be started 4 weeks after the induction treatment with 2 intravenous (IV) infliximab infusions. OBJECTIVE: To evaluate treatment with SC infliximab without prior IV infusion induction to meet patient needs. MATERIALS AND METHODS: After approval by the ethics review board and based on the schedule approved for rheumatoid arthritis, SC induction was performed with infliximab CT-P13 120 mg weekly for 4 weeks, followed by an injection of 120 mg every 2 weeks. RESULTS: After 4 months of therapy, joint symptoms were resolved, inflammation parameters were normalized (erythrocyte sedimentation rate) reduced from 42 to 16 mm/h, and C-reactive protein from 1.74 to 0.43 mg/dL), and clinical assessment parameters were improved. After 9 months of therapy, the clinical data remained stable, with no adverse events or local side effects. CONCLUSION: SC infliximab was successfully used without previous IV infusion induction. Although, to date, the induction of PsA treatment via the SC route is not foreseen, the known pharmacokinetic properties and the outcome improvements observed in our patient show that subcutaneous treatment induction, as is already done in the treatment of rheumatoid arthritis, is also possible.

Medicine recovery and reuse in a hospital setting: a lesson from Italy.

OBJECTIVES: In 2017, a new programme was created for recovering and reusing (i) unexpired Class A medicines (i.e. dispensed either by community pharmacies or by hospitals) in hospital settings and (ii) medicines for hospital use only (Class H). The aim of this study was to describe a three-year reuse programme and assess its impact on medicines cost savings. METHODS: The setting was AOU Città della salute e della Scienza-in Turin (Italy). All the collected data referred to packages of medicines collected by/assigned to AOU for reuse over the 1 December 2017/1 December 2020 period. Retail prices were used to calculate the financial value of the medication. Costs for the time required for the reuse programme (a working group comprising a pharmacist, an administrative and a warehouse worker) were estimated. KEY FINDINGS: A total of 10 450 boxes were recovered for reuse (corresponding to 52% of donated boxes). The total value was €1 300 000. Class H accounted for 73% (€952 000) of the total value of the recovered medicines, while they represented only 9% of the packages collected by/assigned to AOU. Estimated cost for the reuse programme was €75 806. CONCLUSIONS: Medicine recycling programmes with appropriate checks can be implemented to facilitate reuse of medications in hospital settings. This study provides evidence that a reuse programme reduced drug expenditures, especially regarding the Class H medications. These results contribute to the debate regarding opportunity for recycling and sustainability in medicines management.