Background Down-titration of biological therapy (BT) in rheumatoid arthritis (RA) patients with a good clinical response is frequently applied in daily clinical practice. An important factor in order to know if this can be safely applied is the response to retreatment in flaring patients. We present an analysis of relapses and responses to retreatment in RA patients who had previously undergone down-titration of BT.
Objectives To evaluate the effectiveness (in daily clinical practice) of retreatment in RA patients receiving BT who had been previously down-titrated and relapsed.
Methods Retrospective observational study in a single center. RA patients receiving BT (infliximab, adalimumab, etanercept, certolizumab pegol, abatacept and tocilizumab) previously down-titrated (quarterly dose of BT less than or equal to 83% of the approved dose) were included. Retreatment consisted of increasing the dose to previous or standard (EMA approved) dose, at the discretion of the attending physician. Relapse was defined as an increase greater than or equal to 0.6 points from baseline DAS28 or according to the attending physician criteria. Response to retreatment was defined according to EULAR response criteria. Numerical data are expressed as mean and standard deviation for continuous variables and percentages for qualitative variables.
Results Two hundred and fifty-six RA patients were under BT and 91 patients were down-titrated of whom 52% were in remission, 24% with low disease activity and 24% with moderate disease activity according to DAS28. Most patients (78.6%) were receiving first line BT. Twenty eight patients relapsed and received retreatment at full dose (61%) or previous dose (39%). The average time between down-titration and retreatment was 17.2±13.7 months. Mean DAS28 at the time of retreatment was 4.01±0.99. Most patients (75%) achieved EULAR good or moderate response before 6 months of retreatment, regardless of standard or previous dose. Mean DAS28 in these patients was 2.87±0.78. There was no significant difference in the response achieved at 6 months depending upon baseline disease activity status or BT line.
Conclusions Although down-titration carries a risk of relapse in RA, most patients achieve a good response after retreatment.
Disclosure of Interest None declared
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