Background Treat to Target (T2T)is an international initiative to define Rheumatoid Arthritis (RA) treatment targets and recommendations to measure disease severity and encourage earlier diagnosis and optimize treatment. The primary target for treatment of RA should be a state of clinical remission.After reaching remission there are different therapeutic approaches to consider. In recent years, optimization of Biological Therapy (BT)is a strategy employed in patients with RA in remission, consists in a dose reduction or an extended dose interval, searching a minimum effective dose for each patient, which limits the occurrence of adverse effects and promotes economic saving
Methods RA patients (ACR criteria 1987)of CREATE registry that November 1, 2013 had clinical remission (DAS28 value <2.6)of at least 6 months constituted the cohort of patients who were optimized. According to the consensus of the Spanish Society of Rheumatology and Hospital Pharmacy, dose optimization involved the reduction of between 20 and 50% of it.Decisions about treatment and dose reduction was performed by a multidisciplinary team of clinical rheumatologists and pharmacists in a tertiary hospital,which involved the application of protocols and patients revision at least every 2 months
Results We performed a prospective observational cohort study in 70 RA optimized patients. (81.4% were women with a mean age at onset optimization of 56.9 ± 13.7 years. 68.8% were RF positive and 66.7% ACPA positive). Optimization occurred in 41.4% of patients in the first year and 58.8% in the second year (p=0.001).64 patients completed 24 month of follow-up, suffering 36 of these patients (56.3%) clinical relapse (mean DAS28 2.81 (0.88) at 1 year, reason why it was decided to return to the usual dose again reaching clinical remission in all patients after 2 years (DAS 28 2.59 (0.58).43.8% patients maintained optimization after 2 years of follow-up without suffering relapse (mean DAS28 2.19 (0.84)). Statistically significant differences were found when comparing the mean baseline DAS 28 between both groups, being lower in the subgroup of patients who maintains remission compared to the relapsing group (1.97 (0.85) vs 2.44 (0.66) (p=0.012)
Conclusions -The use of an extended dose interval maintained remission status in patients with established RA who are in sustained clinical remission it is possible in 41.2% patients after 2 years of follow-up in clinical practice (CREATE registry)-This strategy is possible in patients with controlled disease persistently and in view of our results, we might consider that those patients who have a lower level of activity at onset optimization, are less likely to relapse and therefore maintain this strategy-After 2 years of follow up all patients maintained clinical remission (DAS28 <2.6),even the patients who relapsed at 12 months and returned to their usual dose
Rodríguez-Valverde et al Clin. 2006;2:S52-S59.
Smolen JS et al 2013 update. Ann Rheum Dis 2014; 73:492–509.
Hetland ML et al. Arthritis Rheum 62(1):22–32.
Leffers HC et al Ann Rheum Dis 70(7):1216–1222.
Maneiro JR et al. Rheumatol Int 2014;1059–1063
Disclosure of Interest None declared