Off-label drug use in dermatology

• Published in: European journal of hospital pharmacy. Science and practice Vol. 19; no. 2; p. 218
• Main Authors: Martin, A., Sala, F., Vilavella, M., Borràs, R., Bosch, M., Bonafont, X.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.04.2012
• Subjects: Dermatology; Drug use; Psoriasis
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2012-000074.350

Background In 2010, 1% of our pharmaceutical expenditure corresponded to off-label use, except for cytostatics. The dermatology department has increased drug costs due to the off-label use. Purpose To assess the applications and costs of off-label drug use in dermatology. To check the therapeutic results obtained and the number of available reports. Materials and methods The authors reviewed off-label requests from Dermatology during 2009 and 2010. The authors reviewed the reports compiled in Medline from 1997 to 2010 and classified according to reported cases number in N < 10, N between 10 and 50, N between 51 and 100, and N>100. The results were classified as effective if dermatologists achieved the therapeutic objective, partially effective if they reached the initial objective at least in 50% and ineffective when they didn't achieved the therapeutic purpose. Results In 2009, 95 drugs were requested for an off-label use representing 404,909 €; 7 were requests from Dermatology at a cost of 49,218 €. In 2010, 134 drugs were requested for off-label use representing 410,716 €; 5 were requests from Dermatology represented 117,565 €. Conclusions During 2010 there was an increase in the cost of off-label use in dermatology due to lenalidomide. Half of the treatments were effective, 25% partially effective and 25% ineffective. One third of the requests were supported by fewer than 10 reported cases. Table 1 European standards to test and use disinfectants, as applied in our hospital Year Drug – Indication Results Number of case reports 2009 8-methoxypsoralen – scleromyxedema Effective N < 10 Ustekinumab – psoriasis (3 cases) One case effective; one partially effective; one ineffective. N > 100 Propranolol – haemangioma Effective N > 100 Etanercept – hidradenitis suppurativa (HI) Ineffective N between 51 – 100 Etanercept – pyoderma gangrenosum (PG) Ineffective N between 10 – 50 2010 Infliximab – PG Effective N > 100 Lenalidomide – lupus erythematosus (2 cases) Effective N < 10 Alitretinoin – psoriasis Partially effective N < 10 Infliximab – HI. Partially effective N between 51 – 100