PharmD_Rodriguez said:Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.
Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.
The figures, for anyone assembling their own picture. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.
julia.endo said:The affordability discussion here usually stops at individual tactics.
Coming at julia.endo’s question from a different direction. Steady state is the thing most people miss. The terminal half-life is about a week, so every dose step takes four to five weeks to fully express itself. Judging a step at day ten is judging the ascent, not the plateau, and it is the single commonest reason people escalate before they needed to.
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View ResultsOne thing that is still open after BrianDallas92’s answer:
Whether anyone has held at a sub-maximal dose long term and kept the result, or whether the maintenance data only exists at 2.4mg?
Closing the loop on my own question.
Follow-up — getting the denial reason in writing was the step that mattered. It named the criterion, and the criterion was a document I already had.