Background Since the development of biological therapy (BT), the patients refractory to other therapy responds favorably and a number of them with a state of remission or very low activity. These patients are initially treated with the recommended dose according to the results of clinical trials, but there is no current consensus on what attitude to take following remission. There are data in the literature showing that the suspension of BT occurs in most cases a clinical relapse of the disease. Some observational studies suggest of the possibility of reducing the dose to the minimum effective, with the idea that some patients could get the same benefit. This practice of dose reduction is being implemented empirically in rheumatology practice in the last years to achieve a cost reduction.
Objectives To evaluate the survival of treatment with low-dose BT in a group of patients in clinical remission
Methods A retrospective longitudinal observational study that included rheumatic patients receiving reduced doses of BT in our center. Dose reduction was applied to patients in clinical remission for at least 3 previous reviews before reduction doses. Infliximab was reduced from 5 to 3 mg/kg and/or elongation spacing to every 9-10 weeks. Adalimumab, etanercept, golimumab, tocilizumab, rituximab and abatacept was held elongation in dose spacing. Clinical remission of the disease were measure according to DAS28 for RA and Apso and BASDAI for SpA and axial Apso. Time dose reduction. Group comparisons between disease activity before and after dose reduction were performed with ANOVA-t.
Results 399 patients were receiving BT in our center. A dose reduction was started in 116 (29%) of them. Table 1 we describe the distribution of patients according to the disease and BT optimized. The survival time of treatment until the optimization was 62 month (±29.6) for RA, 54.3 month (±29.7) for SpA and 42.8 month (±27.2) in Apso, no differences. Of total 35 (26.7%) did not tolerate the optimization with a median time to relapse of 6.8 month (±4.6). There was no statistically significant difference regarding type of TB, with 6.7 m for infliximab, 7.5 m for adalimumab and 6.7 m for etanercept. Although patients with RA had a more early relavases. Regarding clinical activity data of patients at the time of the optimization, RA patients had a mean DAS28 3.1 (±1.2), in the case of SpA BASDAI 2.5 (±2) and 1.8 (±0.7) in Apso. After we comparing the clinical characteristics of the patients who remained optimized versus those who did not tolerate we not find statistically significant differences, it shown in Table 2
Conclusions According to our results we can conclude that the optimization can be a cost effective performance in patients with prolonged remission or low activity. However well-designed studies are needed to demonstrate the optimization guidelines to follow and determine what type of patients would be candidates for the same.
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Disclosure of Interest None declared