OBJECTIVES: Since 2015 a subcutaneous (SC) formulation of tocilizumab is avalaible. Common reimbursed indications with intravenous (IV) formulation are the treatment of rheumatoid arthritis in adults, in monotherapy or associated to methotrexate. This study assesses the impact of SC’s arrival on practices in the Paris Publics Hospitals (AP-HP).

METHODS: The data collected were: I) consumptions, expenditures and common indications IV/SC from 2014 to 2017 from AP-HP prescription software; II) AP-HP prescriptions carried out in retail pharmacies (PHMEV) for SC. Consumptions were expressed in defined daily dose (DDD), setted at 20 mg by the WHO.

RESULTS: 15/37 hospitals in AP-HP consumed tocilizumab. Daily costs of treatment (DCT) were 29,2 € and 26,3 € for SC and IV respectively. In 2014 consumptions were 73204 DDD of IV only. In 2015 consumptions in AP-HP hospitals, including PHMEV were 80836 DDD including 20558 SC DDD (25,4%), proportion which increased in 2017 with 137087 DDD including 71806 SC DDD (52,4%). Most of SC were PHMEV (>99%). Expenditures in 2017 were 3983259 € with 1913096 € (48%) for IV and 2070163 € for SC with >99% of PHMEV. In 2017 3 profiles were observed : 4/15 hospitals without rheumatology department which only use IV representing <0,1% of DDD; 8/15 hospitals with rheumatology departments which kept IV for hospital but also started PHMEV representing 74,9% of DDD ; and 3/15 hospitals with rheumatology department which use both IV and SC at hospital also with PHMEV representing 25% of DDD.

CONCLUSIONS: SC consumptions are increasing but IV still accounts for a main part. As SC and IV have close DCT and are both reimbursed in indications studied, price would not explain these differences. Different factors should be considered such as hospital policies encouraging ambulatory cares regarding day hospital capacities in every hospital and the imminent arrival of IV biosimilars.