Background RA is the most common chronic inflammatory arthritis. About 30% of patients are treated with biological therapy (BT). Deintensification of BT for patients in clinical remission, is a strategy used in clinical practice to reduce side effects and burden.
Objectives The primary endpoint was evaluate clinical and radiological behavior of the RA in patients receiving BT at reduced doses.
The secondary endpoint was to analyze the characteristics of patients who remain for a longer period of time in an optimized dose regimen.
Methods In our Rheumatology Unit we are treating 271 RA patients with BT, the dose was deintensificated for 62 (23%) patients in remission or low disease activity for at least 6 months. We have selected 32 patients with BT reduced for at least 6 years in an observational, descriptive, longitudinal and retrospective study.
Disease activity was measured by the DAS 28 index. Structural damage was evaluated by SENS method.
Results We analyze 32, 20 female, 12 male, mean age at diagnosis 42.6 years old; BT was started after RA evolution of 98.63 months. Drug reduction was performed after full BT for 62 months, mean DAS 28 was 2,47.
Patients were 75% FR positive and 56.7% ACPA positive. Etanercept was the BT more commonly reduced 59.4%, followed by adalimumab 21.9%, infliximab 12.5% and certolizumab 6.3%.
BT dose returned to normal for 11 patients because of disease activity worsening after an average time of 15.90 months.
For 21 patients remaining on reduced doses, the mean DAS28 at time for analysis was 2.67.
BT reduction as different drugs: none infliximab reduced dose patients required return to normal dose. All certolizumab reduced (2 patients) patients needed to back to normal dose. Etanercept in 36,8% and adalimumab 28,6%.
The mean of SENS score before the optimization was 8.78 and at time for analysis 10.67 for both kind of patients, who continued reduced and those who needed to increase BT dose.
For the secondary endpoint 10 out of 12 male continue with deintensificated BT (83%) in the other hand only 11 out of 20 female (55%) maintained reduced dose.More negative for FR (69,2%) and ACPA (75%) patients keep on reduced dose regimen.
Conclusions We have deintensificated 62 out of 271 RA patients on BT (23%). All patients were in clinical remission at the beginning of BT dose reduction for more than 6 months.
Most patients (65%) analyzed remain long time with reduced BT in clinical remission.
We have not observed significant X-ray progression for reduced patients, even if they increase disease activity and need to back to the original BT dose.
The increase in disease activity was the main reason to interrupt the optimization regime.
Infliximab was the drug that remained more time optimized.
According to the results of our study, male patients negative for ACPA and FR remain longer with reduced doses
Disclosure of Interest None declared