Background Optimization of Biological Therapy (BT) in patients with Rheumatoid Arthritis (RA) in remission, is a strategy employed in rheumatology practice in recent years consisting in dose reduction or enlargement dose interval (1,2) Some published studies (3-6) and recommendations of RA (7) management guidelines suggest that patients in sustained remission, could get the same benefit with a lower dose (8) Recently, there has been a consensus document from the Spanish Society of Rheumatology and hospital pharmacy about the unification of criteria for dose optimization with BT in order to minimizing the variability among professionals, striving for the minimum effective dose for each patient, limiting the occurrence of adverse effects and promoting economic savings.
Objectives To compare the clinical and laboratory characteristics that define the activity of RA patients in remission treated with BT at baseline and at one year after its optimization.
Methods Observational prospective study of 40 patients followed during 12 months, from a cohort of patients with RA (ACR 1987 criteria) in BT treatment (Anti TNF, Abatacept or Tocilizumab).
After reaching sustained clinical remission according DAS28 (ESR) the patients were optimized using the following treatment regimen:etanercept: 50 mg/10 days (10%), 50 mg/14 days (17.5%), infliximab: 3 mg/9 weeks (10%),3 mg/10 weeks (5%), adalimumab: 40 mg/21 days (7.5%), 40 mg /30 days (7.5%),golimumab: 50 mg/ 5 weeks (5%), tocilizumab: 8 mg/kg/5 weeks (10%), 8 mg/kg/6 weeks (15%), abatacept: 750 mg/5 weeks (7.5%) and 750 mg /6 weeks (5%)
We compared the clinical and laboratory features at the beginning of optimization and at 12 month of follow-up.
Results Of the 40 patients with RA who were optimized, 80% were women with a mean age of 55.25±14.05 years, a DAS28 at baseline optimization 2.1±0.91 and a mean duration of disease of 16.3±15.3 years. The most widely used drug with spacing pattern was etanercept (27.5%), followed by tocilizumab (25%), both infliximab and adalimumab with 15%, abatacept 12.5% and golimumab 5%. No statistically significant differences were found when contrasting clinical and laboratory parameters of activity at baseline and at 12 months, maintaining remission rates close to 100% at one year of follow-up (DAS28 medium at 12 months 2.30±0.77)
Conclusions The optimization of BT is a routine clinical practice in our hospital, employing more frequently enlargement dose interval rather than reducing it, managing to maintain remission status one year after the optimization. The adequacy to the published consensus recommendations regarding therapeutic target compliance and the rate of dose reduction was excellent, so we can conclude that optimization can be a useful performance in patients who are in sustained remission.
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Disclosure of Interest None declared