Background Biological therapies optimization in joint inflammatory diseases is indicated in patients who have more than six months in clinical remission. The main objective is to limit the occurrence of adverse effects, which are dosage-dependent. In addition, the cost savings suppose a better access of new patients to these treatments. Given the increasing importance of this topic in recent years, we present the optimization experience in our center at the last 4 years
Objectives 1.To analyze the clinical evolution evaluated by DAS28 in patients with rheumatoid arthritis (RA) and polyarticular psoriatic arthritis (PPSA) in biological therapy (BT) followed in a university hospital in the south of Spain which are performed in optimization of BT. 2.To analyze the optimization strategies used with the different BT
Methods Observational, longitudinal, retrospective and descriptive study by the review of clinical records, between January 2013 and January 2017, of patients with RA and PPSA who underwent BT optimization for more than 6 months at follow-up (DAS28 <2.6) or minimal activity (DAS28 2.6–3.2). We analyze demographic data, time of evolution of illness before the use of BT, time of TB until optimization, clinical evaluation by DAS28 and therapeutic strategies. Statistical analysis was performed with the IBM SPSS Statistics program
Results From 294 patients in BT (174 RA and 120 PPsA), 95 (32.3%) were submitted to optimization treatment: 58 in RA group and 37 in PPSA group. 57 were women and 38 men, with 56±12 years mean age. The mean treatment time at optimized doses was 32±17 months. At the optimization time, 85 (89.5%) patients presented DAS28 remission and 10 (10.5%) had low activity; at the study cut time, 67 (70.5%) of them continue at clinical remission,14 (14.7%) low activity, 11 (11.6%) moderate and 3 (3.2%)high activity according to DAS28. A 69.5% (66) of the patients continued with optimized doses at the end of the study. From the 58 patients included in the RA group, 14 (5 with adalimumab 40 mg/21 days, 8 with etanercept 25 mg/7–10 days or 50 mg/10 days and 1 with certolizumab 200 mg/month) need the standard dose of the drug for disease control; a patient receiving etanercept discontinued the treatment after the diagnosis of breast cancer, as well as three other patients treated with adalimumab who were diagnosed of pancreatic cancer, septic arthritis and cognitive impairment respectively. On the other hand, 9 patients from of the PPSA group needed to restart the treatment at standard doses, either for articular (4) or cutaneous (5) worsening, 3 of them being treated with adalimumab and 6 with etanercept. In addition, a patient had to be discontinued due to the diagnosis of decompensated liver cirrhosis; another patient suspended it voluntarily
Conclusions After 4 years, we can conclude that in our cohort of patients with inflammatory joint disease in BT that have been submitted to dose optimization because they were in remission or low disease activity, a high percentage (69.5%) remain in the same clinical situation for an average of 32 months. The response rate obtained for optimization in the RA group and in the PPSA group are comparable. The most frequent optimization strategies employed were adalimumab 40mg/21 days, etanercept 25mg/7 days and etanercept 50mg/10 days.
Disclosure of Interest None declared