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Abstract
Background The development of biological therapies (BT) represented an important advancement in the treatment of patients with inflammatory arthritis. These treatments have proven to be effective in controlling disease activity, leading to clinical remission and avoiding disease progression, allowing a better prognosis of these patients.
Objectives To describe the reasons of intra-venous BT interruption in a Rheumatology Day-Care Hospital. To evaluate whether this interruption of BT leads to an increased disease activity.
Methods This is an observational, retrospective study performed in the Rheumatologic Day-Care Hospital of a UniversityHospital between June 2014 and December 2015. We included all patients treated with intra-venous BT [i.e. infliximab (IFX), tocilizumab (TCZ) and abatacept (ABA)] with a treatment interruption longer than 15 days. Demographics (i.e. gender, age), RA features (i.e. treatment, disease duration), clinical evaluation (i.e. tender joint count, swollen joint count, patient global pain intensity VAS) and laboratory tests (i.e. ESR, CRP) were recorded. Composite scores and indices (i.e. DAS28, CDAI, SDAI, ASAS, HAQ, BASDAI and BASFI) were calculated before and at BT re-starting.
Results Out of 272 patients treated with BT, 55 (20.2%) had a temporary interruption of the treatment ≥15 days. Out of these patients, 56% were females, the mean (SD) age was 50 (32) years with a mean (SD) disease duration of 18.5 (18) years and a mean (SD) treatment duration of 8.1 (7.8) years. The diagnoses of these patients were as follows; 25 (45.4%) had rheumatoid arthritis (RA), 17 (30.9%) had spondyloarthritis (Sp), 8 (14.5%) had psoriatic arthritis (PsA), and 5 (9%) had other autoimmune disease. The BT received was as follows; 43 (78.1%) IFX, 8 (14.5%) TCZ and 4 (7.3%) ABA. Twenty two (40%) patients received also treatment with synthetic disease modifying drugs (sDMARDs) and 21 (38.1%) received also corticoid therapy with a mean dosage of 6.2 mg/day. The most frequent reasons for BT interruption were infections in 27 (49%) patients of which 11 required hospitalization (i.e. 8 pneumonias, 1 cholelithiasis, 1 lower urinary tract infection and 1 herpes zoster infection) and 16 didn't required hospitalization (i.e. 6 respiratory tract infections, 3 lower urinary tract infections, 1 herpes zoster infection, 1 cellulitis and 5 oral infections). The second reason for BT interruption was the performance of surgical procedures in 16 (29%) patients and the third reason was related to other situations such as the performance of diagnostic procedures for ruling out other diseases, work reasons or forgetfulness 12 (21.8%). In 3 patients the BT was interrupted because of a neoplasia (colon, lung and bladder adenocarcinoma) and 3 patients were pending to restart the treatment after ruling out cancer or infection. The mean (range) interruption duration was 72 (16–365) days. The disease activity before and after BT interruption is displayed in table 1.
Conclusions The most frequent reasons for BT interruption were infections, in particular respiratory tract infections and surgical procedures. BT interruption occurred in a wide age range. After BT reintroduction, we detected an increase in pain and disease activity as well as a decrease in the functional status.
Disclosure of Interest None declared